Category Archives: Cool Counseling

Clinical Interviewing, Cool Counseling, Counseling and Psychotherapy Theory and Practice, Writing

Paradoxical Intention: Don’t Try This at Home (or maybe don’t try it anywhere)

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People want change.

People don’t want change.

As W. R. Miller noted in his treatise on motivational interviewing (MI), ambivalence is nearly always the order of the day. Most people, most of the time, would like to be better and healthier versions of themselves. And, most people, most of the time, resist becoming better and healthier versions of themselves.  Who knew?

Alfred Adler may have been the first modern psychotherapist to write from a non-psychoanalytic perspective about how to work with individuals not interested in changing. What follows is a complex quote from Adler. He’s writing about how to work with a patient who is depressed, but not motivated or willing to change. You may need to read this excerpt several times to track it and appreciate Adler’s method. You may see all those words below and not want to put in the effort. That’s okay. You can stop reading now if you don’t want to gather in the nuance sprinkled into Adler’s indirect suggestion.

After establishing a sympathetic relation, I give suggestions for a change of conduct in two stages. In the first stage my suggestion is “Only do what is agreeable to you.” The patient usually answers, “Nothing is agreeable.” “Then at least,” I respond, “do not exert yourself to do what is disagreeable.” The patient, who has usually been exhorted to do various uncongenial things to remedy this condition, finds a rather flattering novelty in my advice, and may improve in behavior. Later I insinuate the second rule of conduct, saying that “It is much more difficult and I do not know if you can follow it.” After saying this I am silent, and look doubtfully at the patient. In this way I excite his [her/their] curiosity and ensure his attention, and then proceed, “If you could follow this second rule you would be cured in fourteen days. It is—to consider from time to time how you can give another person pleasure. It would very soon enable you to sleep and would chase away all your sad thoughts. You would feel yourself to be useful and worthwhile.”

I receive various replies to my suggestion, but every patient thinks it is too difficult to act upon. If the answer is, “How can I give pleasure to others when I have none myself?” I relieve the prospect by saying, “Then you will need four weeks.” The more transparent response, “Who gives me pleasure?” I counter with what is probably the strongest move in the game, by saying, “Perhaps you had better train yourself a little thus: do not actually do anything to please anyone else, but just think about how you could do it!” (Adler, 1964a, pp. 25–26)

Similar to Adler, Viktor Frankl also wrote about using “anti-suggestion” or paradox. Frankl was keen on this method as a means for treating anxiety, compulsions, and physical symptoms. An excerpt from our theories textbook describing Frankl’s paradoxical intention follows.

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Paradoxical Intention

. . . In a case example, Frankl discussed using paradox with a bookkeeper who was suffering from chronic writer’s cramp. The man had seen many physicians without improvement; he was in danger of losing his job. Frankl’s approach was to instruct the man to:

Do just the opposite from what he usually had done; namely, instead of trying to write as neatly and legibly as possible, to write with the worst possible scrawl. He was advised to say to himself, “now I will show people what a good scribbler I am!” And at that moment in which he deliberately tried to scribble, he was unable to do so. “I tried to scrawl but simply could not do it,” he said the next day. Within forty-eight hours the patient was in this way freed from his writer’s cramp, and remained free for the observation period after he had been treated. He is a happy man again and fully able to work. (Frankl, 1967, p. 4)

Frankl attributed the success of paradox, in part, to humor. He claimed that paradox allows individuals to place distance between themselves and their situation. New (humorous) perspectives allow clients to let go of symptoms. Frankl considered paradoxically facilitated attitude changes to represent deep and not superficial change.

Given that Frankl emphasized humor as the therapeutic mechanism underlying paradoxical intention, it fits that he would use a joke to explain how paradoxical intention works,

The basic mechanism underlying the technique…perhaps can best be illustrated by a joke which was told to me some years ago: A boy who came to school late excused himself to the teacher on the grounds that the icy streets were so slippery that whenever he moved one step forward he slipped two steps back again. Thereupon the teacher retorted, “Now I have caught you in a lie—if this were true, how did you ever get to school?” Whereupon the boy calmly replied, “I finally turned around and went home!” (Frankl, 1967, pp. 4–5)

Frankl believed paradoxical intention was especially effective for anxiety, compulsions, and physical symptoms. He reported on numerous cases, similar to the man with writer’s cramp, in which a nearly instantaneous cure resulted from the intervention. In addition to ascribing the cure to humor and distancing from the symptom, Frankl emphasized that paradox teaches clients to intentionally exaggerate, rather than avoid, their existential realities.

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I’m writing about paradoxical intention today because of an inspiration from Rita’s blog yesterday. There’s so much ostensible hate, judgment, and certainty in contemporary discourse. That got me thinking about whether a paradoxical approach might be timely and effective. Yesterday, I tried it on myself. Stay tuned, in my next post, I’ll write about how a little paradox worked out for me, and how it might help shift some of the lamentable, polarized arguments happening all around us.  

Cool Counseling

Have You Heard about the Therapist Throw-Down?

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A friend recently alerted me to the “Therapist Throw Down.” I haven’t watched the whole competition, but I did view the promo video, and I love it, not only because there’s a brief image of me doing counseling at the beginning (which is cool), but because the deep voice and introduction to the competition is completely hilarious.

I’m very jealous of the Therapist Throw Down because I wish I’d thought of it, or somehow been a part of it. Maybe next year. Here’s the link to the promo video:  https://www.youtube.com/watch?v=6Gm9vTr1sTk

And of course, for lots of excellent educational psychotherapy videos, check out the sponsor of the Throw Down, Psychotherapy.net: https://www.psychotherapy.net/

Cool Counseling, Counseling and Psychotherapy Theory and Practice, Personal Reflections, Writing

The Feminist Lab in Counseling and Psychotherapy Theories

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Sometimes when I’m talking about feminism in my theories class, I refer to it as the F-word. I feel like I have to do more “selling” of feminist therapy than any other approach. Maybe I’m just imagining it, but I hear rumors like, “I hope we get to skip feminist therapy in the lab” and “How do you practice feminist therapy?”

The answers are: “No, you don’t get to skip feminist therapy” and “Because feminist therapy is technically eclectic, you can practice it nearly any which way you like.” Freedom is another F-word, and there’s plenty of that when you’re being afeminist.

Yesterday, while facilitating a grad lab where the practicing happens, it was fascinating to observe feminist therapy in 10 minute snippets. I heard a beautiful self-disclosure. I heard talk of clothes and bodies and of the wish to be taken seriously. No one mentioned the patriarchy . . . but everyone . . . hopefully . . . got to taste and talk about oppression and hierarchy and the wish to be a free and expansive self.

Someone even talked about farting. Someone else about dancing. Others about uninhibited delight.

Should you be interested in what prompted these interactions, I’m attaching my feminist lab instructions here:

ch-10-lab-exploring-and-practicing-feminist-therapyDownload

Clinical Interviewing, Cool Counseling, Counseling and Psychotherapy Theory and Practice

The Art of Giving Feedback–Revised

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[Note: This is an edited and updated version of a post I did a year or two ago.]

Giving and receiving feedback is a huge topic. In this blog post the focus is on giving and receiving feedback in classroom settings or in counseling/psychotherapy supervision. The following guidelines are far from perfect, but they offer ideas that instructors and students can use to structure the feedback giving and receiving process. Check them out, and feel free to improve on what’s here.

Before you do anything, remember that feedback can feel threatening. Hearing about how we sound and what we look like is pretty much a trigger for self-consciousness and vulnerability. Sometimes, when we look in the mirror, we don’t like what we see, and so obviously, when someone else holds up a mirror, the feedback we experience may be . . . uncomfortable. . . to say the least. To help everyone feel a bit safer, the following can be helpful:

  • Acknowledge that feedback is scary.
  • Emphasize that feedback is essential to counseling skill development.
  • Share the feedback process you’ll be using
  • Make recommendations and give examples of what kind of feedback is most useful.

Acknowledge that Feedback is Scary: You can talk about mirrors (see above), or about how unpleasant it is for most people to hear their own voices or see their own images, or tell a story of difficult and helpful feedback. I encourage you to find your own way to acknowledge that feedback triggers vulnerability.

Feedback is Essential: Encourage students to lean into their vulnerability and be open to feedback—but don’t pressure them. Explain: “The reason you’re in a counseling class is to improve your skills. Though hard to hear, constructive feedback is useful for skill development. Don’t think of it as criticism, but as an opportunity to learn from mistakes and improve your counseling skills.” What’s important is to norm the value of giving and getting feedback.

Share the Process You’ll be Using: Before starting a role play or in-class practice scenario, describe the guidelines you’ll be using for giving and receiving feedback (and then generate additional rules from students in the class). Here are some guidelines I’ve used:

  • Everyone who volunteers (or does a demonstration or is being observed) gets appreciation. Saying, “Thanks for volunteering” is essential. I like it when my classes establish a norm where whoever does the role-playing or volunteers gets a round of applause.
  • After being appreciated, the role-player starts the process with a self-evaluation. You might say something like, “After every role play or presentation, the first thing we’ll do is have the person or people who were role-playing share their own thoughts about what they did well and what they think they didn’t do so well.”
  • After the volunteer self-evaluates, they’re asked whether they’d like feedback from others. If they say no, then no feedback should be given. Occasionally students will feel so vulnerable about a performance that they don’t want feedback. We need to accept their preference for no feedback and also encourage them to solicit and accept feedback at some later point in time.

Giving Useful Feedback: It’s always good to start with the positive. Try to be very clear and specific about some things you especially liked. I usually take notes to help me with this; I’ll write down exactly what the role player said and put a + sign next to it so I can say something like, “I see in my notes that I put a + sign next to your very first paraphrase. You seemed to be tracking very well and you shared what you heard with your client in a way that felt nice.

Constructive or corrective feedback shouldn’t focus so much on what was done poorly, but emphasize what could be done to perform the skill even better. Constructive or corrective feedback might sound like this: “I noticed you asked several closed questions. Closed questions aren’t bad questions, but sometimes it’s easier to keep clients talking about important content if you replace your closed questions with open questions or with a paraphrase. Let’s try that. How could you change one of your closed questions to an open question or a paraphrase?” BTW: General and positive comments (e.g., “Good job!”) are pleasant and encouraging, but should be used in combination with more specific feedback; it’s important to know what was good about your job.

Constructive feedback should be specific, concrete, and focused on things that can be modified. For example, you can offer a positive or non-facilitative behavioral observation (e.g., “I noticed you leaned back and crossed your arms when the client started talking about sexuality.”). After making an observation, the feedback giver or the group can explore potential hypotheses (e.g., “Your client might interpret you leaning back and crossing your arms as judgmental”). The feedback giver can also offer an alternative (“Instead, you might want to lean forward and focus on some of your excellent nonverbal listening skills.”).

With constructive feedback you can take some of the evaluation out of the comment by just noticing or observing, rather than judging, “I noticed you said the word, ‘Gotcha’ several times.” You can also ask what else they might say instead, “To vary how you’re responding to your client, what might you say instead of ‘Gotcha’?”

General negative comments such as “That was poorly done.” should be avoided. To be constructive, provide feedback that’s specific, concrete, and holds out the potential for positive change. Feedback should never be uniformly negative. Everyone engages in counseling behaviors that are more or less facilitative. If you happen to be the type who easily sees what’s wrong and have trouble offering praise, impose the following rule on yourself: If you can’t offer positive feedback, don’t offer any at all. Another alternative is to consciously focus on using the sandwich feedback technique when appropriate (i.e., say something positive, say something constructive, then say another positive thing).

IMHO, significant constructive feedback is the responsibility of the instructor and should be given during a private, individual supervision session. The general rule: “Give positive feedback in public and constructive feedback in private” can be useful.

Finally, students should be reminded of the disappointing fact that no one performs perfectly, including the teacher or professor. Also, when you do demonstrations, be sure to model the process by doing a self-evaluation (including things you might have done better), and then asking students for observations and feedback.

Cool Counseling, Counseling and Psychotherapy Theory and Practice, Writing

Your Fall 2021 Counseling and Psychotherapy Theories Resources

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Fall semester is quickly approaching. For some of you, it may have already arrived.

This post includes my usual free offer of theories resources. Even though Rita and I have our own Theories textbook, and we would love for you use it, the resources below are free and will work for you regardless of whether you use our textbook. My general philosophy on textbooks is that I’d rather be helpful than try to coerce people to buy books.

Here we go:

  1. To help students explore their theoretical orientations, we’ve got a short https://johnsommersflanagan.com/2019/07/27/whats-your-theoretical-orientation/ and long-form of a Theoretical Orientation Test. https://johnsommersflanagan.com/2021/02/11/the-long-version-of-our-theoretical-orientation-test-which-hogwarts-hat-fits-you-best/ These tests are for exploration purposes . . . and my or may not have good psychometrics (although someone contacted me about doing a psychometric study on the long version, so we shall see about that).
  2. The Instructor’s Resource Manual is linked here. It includes a chapter-by-chapter glossary, as well as other info that might help with your teaching.
instructor-manual_john-sf-theoriesDownload
  • I’ve got a set of theories lab activities. I tried posting them here, but technology wasn’t helping. If you want them, email me and I’ll send them out as an attachment. john.sf@mso.umt.edu
  • You can access several theories-related counseling demonstration videos through my YouTube page. Also, I’ve posted a bunch of links previously, and you can access them with brief descriptions here: https://johnsommersflanagan.com/2020/03/14/free-video-links-for-online-teaching/ If you want access to the complete set of all of our theories videos, you have to use the text, but the preceding link has several potentially useful videos.

Theories is my favorite course to teach. I hope these resources will help you have a fun, engaging, skills-based, and inclusive theories teaching experience.

If you have feedback, please share here or via email: John.sf@mso.umt.edu

John SF

Cool Counseling, Counseling and Psychotherapy Theory and Practice, Writing

Volunteers Needed for This Friday, July 16

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This Friday, July 16, Rita and I are doing a professional video shoot in Billings, MT. Due to some minor scheduling changes, we suddenly have openings for two last minute volunteers, who are willing to talk about personal issues in the role of clients. Below, I’ve written a short description of what we need. If you happen to be an open-minded person interested in a little psychological discovery, read on . . . .

John and Rita Sommers-Flanagan, authors of Clinical Interviewing, Tough Kids, Cool Counseling, and other professional books, are doing a video shoot on Friday, July 16. The video content will be used for educational purposes, primarily to accompany textbooks and for training mental health professionals. John and Rita have openings for volunteers to participate in two demonstrations in the afternoon of July 16. Each demonstration will involve about 30 min of on-camera time, with additional time for prepping and debriefing. Volunteers will be paid a one-time stipend of $100. A description of the two demonstrations follow:

  1. John will engage a volunteer in a brief (single-session) nightmare treatment. The volunteer should have a real problem with nightmares. The therapeutic demonstration will focus on coping with nightmares and changing or reducing their frequency and intensity.
  2. Rita will demonstrate how current emotions are linked or related to past emotions. The volunteer should have experience with some problematic emotions in their present-life and be willing to explore past connections to current distressing emotions. Anger, sadness, and anxiety are three emotions that work well for this demonstration.

Volunteers should be open and interested in exploring psychological issues. Potential volunteers (we only need two!) should contact John Sommers-Flanagan ASAP at john.sf@mso.umt.edu

Cool Counseling, Happiness, Personal Reflections

My Six Promises to Members of the Association for Humanistic Counseling

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Rita and I have been watching way too many bad detective shows. You know the format, someone gets abducted, then the hero or detective or agent tells the frightened parent or spouse or sibling, “We’ll get her back, I promise.”

The words “I promise” are accompanied by intense eye contact and complete—albeit unfounded—confidence.

IMHO, these scenes represent a very poor use of the words, “I promise.” How can you promise something over which you don’t have complete control? For example, I can promise never to leave the toilet seat up again, but I can’t promise to rescue someone who just got abducted by aliens. What the writers/actors really mean to say is something like, “By golly, I’ll do my best to rescue your son from the jaws of that shark, but I don’t really have control over all the variables here, and so, although I wish I could guarantee a positive outcome, I can’t.”

Now you see why no one is asking me to become a screenwriter.

My point is that I’m about to make several promises to the members of the Association for Humanistic Counseling, and I want everyone reading this to know that I take promise making very seriously. I’m a careful and contemplative promise-maker. . . and I promise to do my best to fulfill the following promises during my online keynote speech this coming Friday, June 4, from 1-2pm (EDT).

Wait, one other sidetrack, before I share my list of promises.

My speech is titled, “Growth through Struggle: Embracing Sparkling Moments and Strengths, while Avoiding Avoidance and Denial.”

Now you can see why no one is asking me to come up with titles for their keynote speeches.

In the description of my speech, I included the following statement (which is sort of like a promise): “Join John Sommers-Flanagan in this keynote presentation, for a review of five positive strategies counselors can use for lightening their burdens, while simultaneously embracing deep existential challenges.” The problem here is that the five positive strategies I’ll be sharing come from the so-called “happiness” literature, and when talking about happiness with people who are fully in touch with their existential angst and nihilism, it’s advisable to offer a few caveats.

And so here come the caveats (aka promises):

  • I promise not to use reductionistic pop-psych pretend brain science terminology like the “amygdala hijack,” partly because if we really imagine an amygdala hijack, then we have to conjure up miniature D.B. Cooper character to conduct the hijacking, and those of us who embrace the humanist label tend to be rather disinclined to attribute our behavior to imaginary entities that live in our brains.
  • When talking about evidence-based happiness interventions, for obvious reasons, I promise to never use the phrase, “Happiness Hack.”
  • Throughout the keynote, I’ll never use the term “Mental illness” unless I’m explaining to everyone why I never use the term “Mental illness.”
  • Because I like to use a little Carl Rogers terminology here and there, I may spontaneously weave the term “organismic” into my speech. I’m sharing this in advance because, at that moment when I’m speaking to hundreds of people via Zoom and feeling nervous, there’s always the possibility that Sigmund Freud will pop into my brain, double-crossing Rogers, and taking over my unconscious. This could cause me to misspeak, and say “orgasmic” instead of “organismic.” Keep in mind that if you think you hear the word “orgasmic” during my keynote, I promise, what I really meant was “organismic” in the Rogerian sense of the word.
  • I promise to stretch myself, my self-awareness, and my understanding of the whole of existential humanism by refusing to boil down any part of human existence into the presence or absence of specific hormones or neurotransmitters like oxytocin, serotonin, and dopamine.
  • I won’t engage in reductionistic and sexist discourse by using rhyming words, like “fight or flight,” to describe complex, multidimensional human behavioral choices.

Overall, I promise to do my best to talk about how to use happiness interventions to help cope with the immense struggles many of us have been experiencing, without pretending that any of us can easily discover a secret, magic, or miraculous solution to human suffering.

If you’re interested in tuning into this keynote speech, during which I do not say the word “orgasmic,” yes, there’s still time. You can register and experience to whole slate of amazing, live, online presentations brought to you by the fabulous Association for Humanistic Counseling and their cool and fantastic President, Victoria Kress, by clicking here:  https://www.humanisticcounseling.org/ahc-conference Then, just scroll down until you see, “Register for the Conference.”

I hope to see you there.

Cool Counseling, Counseling and Psychotherapy Theory and Practice, Suicide Assessment and Intervention, Writing

Working in the Cognitive Dimension

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Today I’ve been putting together my powerpoints for the upcoming Nate Chute Foundation workshop. The NCF workshop is on two consecutive Tuesday evenings, starting this coming Tuesday.

While reviewing content for the ppts, I tried to pull all the intervention strategies from my brain, and failed. My excuse is that there are too many possible interventions for my small brain to memorize. As a consequence, I was forced to check out the “Practitioner Guidance and Key Points to Remember” sections at the end of all the intervention chapters. To give you a taste, here’s a photo of the “summary” page at the end of the cognitive chapter.

The Cognitive Dimension – Chapter Summary

Each of these bulleted items represents a potential method or strategy for intervening in the cognitive dimension with clients or students who are experiencing suicidality. I’m looking forward to talking about these strategies at the Nate Chute workshop, but rather than trying to commit them to memory (like Ebbinghaus would have), I’ll be using my powerpoint slides as a memory aid.

I hope you’re all having a great Sunday night.

John SF

Cool Counseling, Parenting, Writing

The Book . . . Again

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Just for fun, here’s a photo of a page from our Suicide Assessment and Treatment Planning book. This page is the lead in to a section that focuses in on how to work with clients who are suicidal, but whom also may be naturally also experiencing irritability, hostility, and hopelessness. For info, go to the publisher, ACA: https://imis.counseling.org/store/detail.aspx?id=78174