Category Archives: Cool Counseling

How to Listen so Parents will Talk: Strategies for Influencing Parents — DVD filming with Alexander Street Press

This past week I was in Chicago to be filmed doing three 15 minute TED Talk like speeches for Alexander Street Press. The experience was both exciting and anxiety-provoking. . . as it’s rather challenging to deliver a 15 minute piece in a darkish studio to a camera on one take. Shannon Dermer of Governor’s State University was the smooth as silk facilitator who conducted 15 minute interviews after each speech. I was lucky enough to be filming on the same day as Paul Peluso of Florida Atlantic University. Although it was comforting to see that Paul was just as nervous as I was, it was not comforting watching him absolutely nail a perfect 10 of a presentation on Humor in Psychotherapy just a couple hours before it was my turn in front of the camera.

In the end, the filming went well, but of course during the live filming my imperfect memory led me to miss a few “lines” and so I’m posting here, a text version of the How to Listen so Parents will Talk THERAPY talk.Although my goal was to post an audio version, WordPress has thwarted that particular plan for now. . . sorry about that.

How to Talk so Parents will Listen: Strategies for Influencing Parents

When I talk with large groups about parenting, I like to begin with a survey. I ask: “How many of you ARE parents?” Of course, nearly everyone raises his or her hand. Then I ask a follow up: “How many of you WERE children.” At this question some participants laugh and a few raise their hands and others joke that they’re still immature.

“This reason I start with this survey is because if you’re a parent, you know that being a parent is an amazing and gratifying challenge. You also know that it’s 24-7; and you know it doesn’t end when your child turns 18. You’re a parent for life. And if you WERE a child, and all of you were, then you know how important it is to have a parent or caretaker who makes it perfectly clear that YOU ARE LOVED. But there’s more. If you were a child, then you also know how important it is to have a parent who not only loves you, but who is skillful . . . a parent who is dedicated to being the best parent possible.

Plain and simple: PARENTS NEED SKILLS FOR DEALING WITH THEIR CHILDREN IN THE 21ST CENTURY. And learning to be a better parent never stops.

Once upon a time I had a mom come consult with me about her five year old son. She said: “I have a strong-willed son.” My response was to acknowledge that lots of parents have strong-willed children. She said, “No, no, you don’t get it. I have a very strong-willed son, let me tell you about it. Just the other night, I asked him to go upstairs and clean his room and he put his hands on his hips and said, “NO.” So I said in response, “Yeah, yeah. He sounds very strong willed.” And she said, “Wait. There’s more. I asked him to clean his room a second time and he glared and me, and said “NO. YOU WANT A PIECE OF ME?” Then she told me the real problem. The problem was that, in fact, she did want a piece of him at that particular point in time and so she grabbed him and hauled him up the stairs in a way that was inconsistent with the kind of parent she wanted to be.

This is one of the mysteries of parenting. How can you get so angry at a small child whom you love more than anything else in the world?

Parents are a unique population and deserve an approach to counseling that’s designed to address their particular needs. In this talk I’ll mostly be using stories to talk about
a. what parents want for their children
b. what parents need in counseling
c. and how professionals can be effective helpers.

Most parents want some version of the same thing: To raise healthy and happy children who are relatively well-adjusted. But what do parents need in counseling. WHAT WILL HELP THEM GET WHAT THEY WANT?

First, parents need empathic listening. They need this big time. Our American culture puts lots of social pressure on parents . . . It’s implied that parenting should be easy and all parents should want to spend 24-7 with their child in an altered state of parental bliss. But this isn’t reality and so we need empathy for the general scrutiny parents feel in the grocery store, at church, on the playground, and everywhere else.

But they also need listening and specific empathy: like in the situation where the mom wanted to tell me about her 5-year-old son. She had specific information to share and it was really important for me to take time to listen to her unique story about her son who, unfortunately, may have been watching too many Clint Eastwood movies.

Parents come to counseling or parent education feeling simultaneously insecure and indignant. They feel insecure because of the scrutiny they feel from their parents and in-laws and society, but they also feel indignant over the possibility that anyone might have the audacity to tell them how to parent their children. As professionals, we need to be ready to handle both sides of this complex equation.

Another thing parents have taught me over the years is to never start a parenting session by sharing educational information. You should always wait to offer educational advice, even when parents ask you directly for it. When they do ask, let them know that your ideas will be more helpful later once you get to know what’s happening in their family.

This leads us to the second crucial part of what parents need in counseling. They need collaboration. We can’t be experts who tell parents what to do, instead we have to recognize that parents are the experts in the room. They’re the experts on their children, on their family dynamics, and on themselves. If we don’t engage and collaborate with parents, very little of what we offer has any chance of being helpful.

Parents also need validation to counter their possible insecurity. We call this radical acceptance or validation and it involves explicitly and specifically giving parents positive feedback. We do this by affirming, “You sure seem to know your daughter well.” And by saying, “When I listen to how committed you are to helping your son be successful in life, I can’t help but think that he’s lucky to have you as a parent.”

And so we begin with empathic listening and we move to collaboration and we make sure that we offer radical acceptance or validation and we do all this so we can get to the main point: providing parents with specific parenting tips or guidance.

And there are literally TONS of specific parenting tips that professionals can offer parents. Most of the good ones include four basic principles:

First, getting a new attitude – because developing parenting skills requires a courageous attitude to try things out.

The second one involves making a new and improved plan. Because a courageous attitude combined with a poor plan won’t get you much.

Third is to get support when you need it. Parenting in isolation is almost always a bad idea.

Fourth, underlying all tips there should be the foundation of being consistently loving.

I’d like to tell two parenting stories to illustrate all of the preceding ideas.

This first story is about a parenting struggle I had. I share it for two reasons: One is that it’s a great example of the need for parents to make a new plan to handle an old problem. And two, often it’s good to self-disclose—but not too much—when working with parents.

When my youngest child was 5-years-old, she ALSO was a strong-willed child. I vividly recall one particular ugly scene on the porch. It was time for us to leave the house. But we lived in Montana and there was snow and my daughter needed to put her boots on. Funny thing, she was on a different schedule than I was. This created tension and anger in me. And so I got down into her face and I yelled GET YOUR BOOTS ON! And her eyes got big and she did. Later that evening I was talking with my wife and she saw the scene and she said to me, “I know John, that’s not the kind of parent you want to be.” And even though it’s not easy to take feedback from our romantic partners, she was right and so obviously so, that I had no argument” which led me to tell her, “I’m not going to yell at our daughter any more. I am, instead going to whisper, because I learned in a parenting book, that sometimes when you’re angry it’s more effective to whisper than it is to yell. That was my new plan. Of course, like new plans everywhere, it needed tweaking. But it didn’t take long for me to have an opportunity to test it because if there’s anything on the planet that’s predictable, it’s that we’ll all soon have another chance to manage our anger toward our children more constructively.

It was the next day or week and my daughter did not get her boots on and she was not on the same schedule as me and I got down in her face, once again, but I remembered the plan to whisper and I did my best to transform my anger from the historical yell to the contemporary whisper and what happened was that what came out was sort of like the exorcist and I said to my daughter: “GET YOUR BOOTS ON!”

Now. I wasn’t especially proud of that, but she got her boots on.

It was the beginning of a big change for me because I learned I could play the exorcist instead of yelling; then I learned to growl and then I learned to count to three and then I learned a cool technique called Grandma’s rule where you use the formula, WHEN YOU, THEN YOU to set a limit and build in a positive outcome. Like . . . “Honey, when you get your boots on, then you can have your cell phone back.” Very cool.

What I learned from this experience is that I could be more than a one-trick parenting pony. I became the kind of parent who, although far from perfect, was able to set limits that were in my daughter’s best interest.

And what I like the best about this particular story is that daughter is now 26 years-old and she still says the same thing she used to say to me when she was 15 . . . that is, “Dad, one thing I really love about you is you never yell.” What’s cool is that I did yell, but I worked on it, I made a new plan, and now she doesn’t even remember the yelling.

I’d like to finish with one last story about how much parents need people like you to have empathy, collaborate, validate, and offer concrete parenting ideas.

I was working with a 15-year-old boy. His mom was bringing him to counseling because he and his dad weren’t speaking anymore. I hadn’t met the dad, but one day, when I went to the boy’s IEP meeting at school the dad was there. I saw this as a chance to make a connection and get him to come to counseling.

I did a little chit-chatting and sat next to him in the group meeting. Then, at one point, I asked the boy a question: “If you got an A on a test, who would you show first?” He answered, “I’d show my dad, my mom, and my special ed teacher.” This inspired me to turn to his dad and say, “It’s obvious that you’re very important to your son and so I’d like to invite you to come join him and me in counseling.” Dad gave me a glare and pushed my shoulder and began a 2-minute rant about how the school had failed his son. Everyone was stunned and then he turned back to me and said, “I’ll come to counseling. I been to counseling before and I can do it again.”

At that point I wondered if I could take back my offer.

The day the dad drove to counseling he and his son weren’t speaking, so I met with them separately. The son was clear that he would never speak to the dad again, but the dad was open. When I asked if I could offer him some ideas, he said, “Well I tried MY best and that dog don’t hunt, so I can try something else.” I was wishing for subtitles.
I told the dad I wanted him to keep his high standards for his son, but to add three things. First, I asked, do you love your son? The dad said “Yes” and so I told him, “Okay then. I want you to tell him ‘I love you’ every day.” He said, “Usually I leave that to the wife, but I can do that.” Second, I said, “Everyday, I want you to touch your son in a kind and loving way.” He asked, “You mean like give him a hug?” I said, “that would be great” and he responded, “Usually I leave that to the wife too, but I’ll give it a shot.” Third, I said, “Once a week, you should do something fun with your son, but it has to be something that he thinks is fun.” He said back: “That’s no problem. We both like to go four-wheeling, so we’ll do that.”

And they left my office for an hour-long of what I imagine was a silent trip home.

The next afternoon, I got a call from the mom. She was ecstatic. She said, “I don’t know what you did or what you said, but they’re talking again.” And then she added, “This morning, when they were in the kitchen, I was in the other room and I thought I heard them hug and when I saw my son walking down the driveway to head to school, there were tears running down his cheeks.”

This was obviously a mom who was listening and watching very closely.

Things got much better for the 15-year-old after that. He didn’t get straight As, but he stopped getting straight Fs. And I learned two things: First, I learned just how much that boy needed to get reconnected with his father. And second, I learned that sometimes, no matter how gruff parents may seem, what they need is some clear and straightforward advice about how to reconnect with their son or daughter.

My final thoughts about this topic are very simple. I hope you’re inspired enough to acquire the knowledge and skills it takes to work effectively with parents. I know their children will deeply appreciate it.

Thanks for listening.

The book upon which the talk is based is available here on Amazon: http://www.amazon.com/How-Listen-Parents-Will-Talk/dp/1118012968/ref=la_B0030LK6NM_1_9?s=books&ie=UTF8&qid=1402106002&sr=1-9 . . . and here on Wiley: http://www.wiley.com/WileyCDA/WileyTitle/productCd-1118012968.html

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Tough Kids, Cool Counseling PowerPoints from SDMHCA May 1 Workshop

Attached to this post are the handouts from the May 1 “Tough Kids, Cool Counseling” workshop in Spearfish, South Dakota.

It was a great day with about 85 wonderful, amazing, and exceptionally nice school and mental health counselors from throughout South Dakota.

This is the powerpoint:

SDMHCA Workshop 14 Part No Cartoons

And this is the supplementary handout:

SDMHCA TKCC Part II Supplement

I hope this information is helpful!

John SF

 

What You Missed in Cincinnati: Part II

While in Cincinnati, I ran short on time and we missed a chance to watch a video clip on “Generating Behavioral Alternatives.” And so as a substitute, I’m posting the verbatim script of the clip we were supposed to watch, and although we’ll miss out on discussing, the clip is fun on its own. Here it’s an excerpt from our Counseling and Psychotherapy Theories book and placed in the context of “Problem-Solving Therapy.”

Generating Behavioral Alternatives With an Aggressive Adolescent

As noted previously, problem-solving therapy (PST) focuses on teaching clients steps for rational problem solving. In this case vignette, the therapist (John) is trying to engage a 15-year-old White male client in stage 2 (generating solutions) of the problem-solving model. At the beginning of the session, he client had reported that the night before, a male schoolmate had tried to rape his girlfriend. The client was angry and planning to “beat the s*** out” of his fellow student. During the session, John worked on helping the boy identify behavioral alternatives to retributive violence.

The transcript below begins 10 minutes into the session.

Boy: He’s gotta learn sometime.

JSF: I mean. I don’t know for sure what the absolute best thing to do to this guy is . . . but I think before you act, it’s important to think of all the different options you have.

Boy: I’ve been thinking a lot.

JSF: Well, tell me the other ones you’ve thought of and let’s write them down so we can look at the options together.

Boy: Kick the shit out of him.

JSF: Okay, I know 2 things, actually maybe 3, that you said. One is kick the [crap] out of him, the other one is to do nothing . . .

Boy: The other is to shove something up his a**.

JSF: And, okay—shove—which is kinda like kicking the s*** out of him. I mean to be violent toward him. [Notice John is using the client’s language.]

Boy: Yeah, Yeah.

JSF: So, what else?

Boy: I could nark on him.

JSF: Oh.

Boy: Tell the cops or something.

JSF: And I’m not saying that’s the right thing to do either. [Although John thinks this is a better option, he’s trying to remain neutral, which is important to the brainstorming process; if the client thinks John is trying to “reinforce” him for nonviolent or prosocial behaviors, he may resist brainstorming.]

Boy: That’s just stupid. [This response shows why it’s important to stay neutral.]

JSF: I’m not saying that’s the right thing to do . . . all I’m saying is that we should figure out, cause I know I think I have the same kind of impulse in your situation. Either, I wanna beat him up or kinda do the high and righteous thing, which is to ignore him. And I’m not sure. Maybe one of those is the right thing, but I don’t know. Now, we got three things—so you could nark on him. [John tries to show empathy and then encourages continuation of brainstorming.]

Boy: It’s not gonna happen though.

JSF: Yeah, but I don’t care if that’s gonna happen. So there’s nark, there’s ignore, there’s beat the s**. What else?

Boy: Um. Just talk to him, would be okay. Just go up to him and yeah . . . I think we need to have a little chit-chat. [The client is able to generate another potentially prosocial idea.]

JSF: Okay. Talk to him.

Boy: But that’s not gonna happen either. I don’t think I could talk to him without, like, him pissing me off and me kicking the s*** . . . [Again, the client is making it clear that he’s not interested in nonviolent options.]

JSF: So, it might be so tempting when you talk to him that you just end up beating the s*** out of him. [John goes back to reflective listening.]

Boy: Yeah. Yeah.

JSF: But all we’re doing is making a list. Okay. And you’re doing great. [This is positive reinforcement for the brainstorming process—not outcome.]

Boy: I could get someone to beat the s*** out of him.

JSF: Get somebody to beat him up. So, kind of indirect violence—you get him back physically—through physical pain. That’s kind of the approach.

Boy: [This section is censored.]

JSF: So you could [do another thing]. Okay.

Boy: Someone like . . .

JSF: Okay. We’re up to six options. [John is showing neutrality or using an extinction process by not showing any affective response to the client’s provocative maladaptive alternative that was censored for this book.]

Boy: That’s about it. . . .

JSF: So. So we got nark, we got ignore, we got beat the s*** out of him, we got talk to him, we got get somebody else to beat the shit out of him, and get some. . . . [Reading back the alternatives allows the client to hear what he has said.]

Boy: Um . . . couple of those are pretty unrealistic, but. [The client acknowledges he’s being unrealistic, but we don’t know which items he views as unrealistic and why. Exploring his evaluation of the options might be useful, but John is still working on brainstorming and relationship-building.]

JSF: We don’t have to be realistic. I’ve got another unrealistic one. I got another one . . . Kinda to start some shameful rumor about him, you know. [This is a verbally aggressive option which can be risky, but illustrates a new domain of behavioral alternatives.]

Boy: That’s a good idea.

JSF: I mean, it’s a nonviolent way to get some revenge.

Boy: Like he has a little dick or something.

JSF: Yeah, good, exactly. [John inadvertently provides positive reinforcement for an insulting idea rather than remaining neutral.]

Boy: Maybe I’ll do all these things.

JSF: Combination.

Boy: Yeah.

JSF: So we’ve got the shameful rumor option to add to our list.

Boy: That’s a good one. (Excerpted and adapted from J. Sommers-Flanagan & R. Sommers-Flanagan, 1999)

This case illustrates what can occur when therapists conduct PST and generate behavioral solutions with angry adolescents. Initially, the client appears to be blowing off steam and generating a spate of aggressive alternatives. This process, although not producing constructive alternatives, is important because the boy may be testing the therapist to see if he will react with judgment (during this brainstorming process it’s very important for therapists to remain positive and welcoming of all options, no matter how violent or absurd; using judgment can be perceived and experienced as a punishment, which can adversely affect the therapy relationship). As the boy produced various aggressive ideas, he appeared to calm down somewhat. Also, the behavioral alternatives are repeatedly read back to the client. This allows the boy to hear his ideas from a different perspective. Finally, toward the end, the therapist joins the boy in brainstorming and adds a marginally delinquent response. The therapist is modeling a less violent approach to revenge and hoping to get the boy to consider nonphysical alternatives. This approach is sometimes referred to as harm reduction because it helps clients consider less risky behaviors (Marlatt & Witkiewitz, 2010). Next steps in this problem-solving process include:

  • Decision making
  • Solution implementation and verification

As the counseling session proceeds, John employs a range of different techniques, including “reverse advocacy role playing” where John plays the client and the client plays the counselor and provides “reasons or arguments for [particular attitudes] being incorrect, maladaptive, or dysfunctional” (A. M. Nezu & C. M. Nezu, 2013).

What You Missed in Cincinnati

For me, the hardest thing about presenting professional workshops is time management. I want participants to comment, but how can I plan in advance for exactly how long their comments will be? Even worse, how can I accurately estimate the length of my own impromptu moments? It seems obvious that there’s a need for spontaneity. I don’t want to cut off potentially valuable comments from participants . . . and I don’t want to cut off my own creative musings either. Clearly, the clock is my workshop enemy.

For example, how could I know in advance that I would suddenly feel compelled to share a personal dream of mine with 85 of my new Cincinnati counselor friends? Never before had I shared with a workshop audience that 45 years-ago I dreamt I was Felix-the-Cat and then while crossing the road (as Felix), I got hit by a car . . . and died.

But then I woke up and have kept on living.

I like to think that particular disclosure is a perfectly normal thing to do when you’ve got a group of professional counselors to listen to you.

The point was to bust the myth that some teenage client have (and will talk about in counseling) that if they dream they die, it is prophetic and means they’ll die soon in real life also.

And beyond my personal dream disclosure, how would I know that one of the participants would have such passion that he would accept an invitation to come up to the microphone and share a physical relaxation technique that he uses with elementary school students.

These are just two samples of the sort of thing you missed because you weren’t in Cincinnati at the Schiff Center on the Xavier University campus yesterday.

But you also missed the start of the workshop where I decided on the spot that it was just the right time and place for me to open the workshop with a story of the most embarrassing moment in my life. It struck me as an awesome idea at the time . . . and it really was the most embarrassing moment of my life . . . until a few hours later when I shared my Felix-the-Cat dream.

There are always bigger mountains to climb.

You also missed meeting my incredibly gracious hosts from the Greater Cincinnati Counseling Association including, Butch Losey (who’s the most humble and understated guy who should be famous I’ve ever met), Kay Russ (who’s right up there with the most responsible person I’ve ever met), and Brent Richardson (who is as irreverent and insightful as ever), and Robert Wubbolding (who may be on his way to Casablanca to do a week long choice theory/reality therapy workshop by the time I post this and yet took eight hours out of his life to attend the workshop anyway).

So that’s just a little taste of what you missed in Cincinnati.

I’ll bet you wish you were there. I know I’m glad I was.

January is an Excellent Month to Attend Workshops in Cincinnati

Just in case you’re planning to be in or around the Cincinnati area this weekend, the Greater Cincinnati Counseling Association (GCCA) is offering a day and a half of workshops starting on Friday afternoon, January 10 and two workshops with one of my favorite workshop presenters on Saturday, January 11. Here’s the info:

On Friday, January 10, there are two Ethics workshops to choose from:

2:00-5:15

School Counselor Ethics: Case

Discussions and Current Trends

Tanya Ficklin

Or

2:00-5:15

Ethical and Professional Issues:

Therapeutic Alliance Building and

Ethical Considerations When

Working with Children and

Families

Barbara Mahaffey

On Saturday, January 11, I’m doing two separate ½ day workshops:

Tough Kids, Cool Counseling

John Sommers-Flanagan

Saturday 8:45-12:00

Therapy with adolescents can be immensely frustrating or splendidly gratifying. The truth of this statement is so obvious that the supportive reference, at least according to many adolescents is, “Duh!” In this workshop participants will sharpen their therapy skills by viewing and discussing video clips from actual sessions and participating in live demonstrations. Over 20 specific cognitive, emotional, and constructive therapy techniques will be illustrated and/or demonstrated. Examples include acknowledging reality, informal assessment, the affect bridge, therapist spontaneity, early interpretations, asset flooding, externalizing language, and more. Countertransference and multicultural issues will be highlighted.

Suicide Assessment Interviewing

Saturday 1:00-4:15

John Sommers-Flanagan

Freud once said, “By words one person can make another blissfully happy or drive him to despair.” Ironically, traditional adolescent suicide assessment and intervention procedures overemphasize a pathology-based biomedical model that orients adolescents toward despair. In this workshop suicidal crises are reformulated as normal expressions of human suffering and a specific, positive, and practical approach to adolescent suicide assessment interviewing is described. This contemporary adolescent suicide assessment model has a constructive focus, addresses diversity issues, and integrates differential activation theory and Jobes’s approach to Collaborative Assessment and Management of Suicidality. Specific suicide intervention procedures will be described and reformulated.

You can register for these workshops by phone by calling: 513-688-0092

 

The “Extra” Tough Kids, Cool Counseling Workshop Handout

This is the supplementary handout for the Tough Kids, Cool Counseling workshop. It includes more detailed information about all of the techniques covered in the workshop (as well as a few extra). Of course, those interested in EVEN MORE details, should somehow get a hold of a copy of the Tough Kids, Cool Counseling book:  http://www.amazon.com/Tough-Kids-Cool-Counseling-User-Friendly/dp/1556202741/ref=cm_cr_pr_product_top

Tough Kids, Cool Counseling

Supplementary Handout

John Sommers-Flanagan, Ph.D.

University of Montana

John.sf@mso.umt.edu

Johnsommersflanagan.com

“I have lived some thirty years on this planet, and I have yet to hear the first syllable of valuable or even earnest advice from my seniors”   — Henry David Thoreau

The following techniques and strategies are discussed in the workshop. More extensive information is included in the Tough Kids, Cool Counseling (2007) book published by ACA publications and other resources listed in the reference section.

  1.  Acknowledging Reality: Teenagers and some pre-teens are likely to be initially suspicious and mistrustful of adults – especially sneaky, manipulative, authority figures like mental health or school counselorsJ. To decrease distrust, it is important to simply acknowledge reality about the reasons for meeting, about the fact that you’re strangers, and to notice obvious differences between the therapist and teen.
  2. Sharing Referral Information: To gracefully talk about referral information with teens, therapists need to educate referral sources about how this practice will be used. Specifically, referral sources should be trained to give therapists information about clients that is both accurate and positive. If referral information from teachers, parents, or probation officers is especially negative, the therapist should screen and interpret the information so it is not overwhelming or off-putting to young clients.  Simblett (1997), writing from a constructive perspective, suggested that if therapists are planning to share referral information with clients, they should warn and prepare referral sources about such a practice. If not, the referral sources may feel betrayed. Also, when sharing negative information about the client, it’s important for the counselor to have empathy and side with the client’s feelings, while at the same time, not endorsing the negative behaviors. For example, “I can see you’re really mad about your mom telling me all this stuff about you. I don’t blame you for being mad. I think I’d be upset too. It’s hard to have people talking about you, even if they might have good intentions.”
  3. The Affect Bridge and Early Memories: The affect bridge is designed to link current emotions with past emotions. Originally described as a hypnoanalytic technique by John Watkins (1971), the procedure can be used without a trance state to deepen your understanding of the origin and power of your client’s problematic affective states. The technique is simple and direct. For example, you might say: “You’re doing a great job telling me about some recent things that really make you mad. Now, tell me about an earlier time, when you were younger, when you felt similar feelings.” This technique or prompt will often elicit early memories that can then be used, similar to Adler’s early recollection method, to understand the client’s schema, cognitive map, or lifestyle.
  4. Reflection of Emotions: Emotional reflections or reflection of feeling (Rogers, 1942, 1961), are very important in counseling adolescents. This is because most youth are just learning about themselves and calibrating their emotional selves. Emotional reflections serve at least a two-fold purpose: (a) they provide youth a chance to see/hear themselves in an emotional mirror, and (b) they provide youth with a chance to tell the therapist that he or she has it all wrong (a corrective function). If the therapist begins noticing that he or she is consistently getting the emotional and content reflections incorrect with a given client, an effort at emotional repair is warranted. This simply involves apologizing for being incorrect, appreciating the client’s efforts to correct the therapist and a statement of commitment to continue trying.
  5. Coping with Countertransference: Research has shown that our countertransference reactions can teach us about ourselves, our underlying conflicts, and our clients (Betan, Heim, Conklin, & Westen, 2005; Mohr, Gelso, & Hill, 2005). For example, based on a survey of 181 psychiatrists and clinical psychologists, Betan et al., reported “patients not only elicit idiosyncratic responses from particular clinicians (based on the clinician’s history and the interaction of the patient’s and the clinician’s dynamics) but also elicit what we might call average expectable countertransference responses, which likely resemble responses by other significant people in the patient’s life” (p. 895). Countertransference is now widely considered a natural phenomenon and useful source of information that can contribute to counseling process and outcome (Luborsky, 2006). In fact, clinicians from various theoretical orientations have historically acknowledged the reality of countertransference. Speaking from a behavioral perspective, Goldfried and Davison (1976), the authors of Clinical Behavior Therapy, offered the following advice: “The therapist should continually observe his own behavior and emotional reactions, and question what the client may have done to bring about such reactions” (p. 58). Similarly, Beitman (1983) suggested that even technique-oriented counselors may fall prey to countertransference. He believes that “any technique may be used in the service of avoidance of countertransference awareness” (p. 83). In other words, clinicians may repetitively apply a particular therapeutic technique to their clients (e.g., progressive muscle relaxation, mental imagery, or thought stopping) without realizing they are applying the techniques to address their own needs, rather than the needs of their clients. There are many moments to reflect on how countertransference dynamics might affect the counseling process during the workshop.
  6. Exploring Attributions and Core Beliefs and Constructing Alternative, Strength-Based Theories: It’s a funny thing that most people, not just adolescents, seem to automatically adopt and hang onto negative core beliefs about the self. In the workshop video clip, you will see Rita SF as she gently helps her client explore his own beliefs and attributions. She then, using rational explanation, nudges him toward a shift in those beliefs. Interestingly, after she makes her intervention, the client then begins speaking in a different—and perhaps more positive—way about his primary conflict. Of course, we know that it is very challenging to convince clients of new, strength-based attributions about the self. Often clients take a step or two forward and then a step or two back—because it is often tremendously difficult to begin believing in a new and better self.
  7. What’s Good About You? This procedure provides an opportunity for a rich interpersonal interaction with teenage clients. It also generates useful information regarding child/adolescent self-esteem. I like to initially, introduce it as a “game” with specific rules: “I want to play a game with you. I’m going to ask you the same question 10 times. The only rule is that you cannot answer the question with the same answer twice. In other words, I’ll ask you the same question 10 times, but you have to give me 10 different answers.” When playing this game therapists simply ask their client, “What’s good about you?” (while writing down the responses), following each response with “Thank you” and a smile. If the client responds with “I don’t know” the therapist simply writes down the response the first time, but if the client uses “I don’t know” (or any response) a second time, the therapist reminds the client, in a light and possibly humorous manner, that he or she can use answers only one time. As with all techniques, this should be used with client consent or agreement. If the client is uncomfortable and does not want to proceed, his or her reluctance should be respected. In some cases, there may be cultural reasons (i.e., a client has a collectivist cultural background) for refusing to do this activity.
  8. Interpersonal Simulations: In this procedure the counselor provides the teen with an interpersonal scenario to solve. This technique is based on the fact that it is often easier for young people to openly discuss how they feel about impersonal situations that it is for them to openly discuss their own situations. The technique can be used for either assessment or intervention purposes and can be initiated as a generic question or “survey” that you’re using with teens or as a personal story/situation that you need help with. For example, you might say, “I’ve been doing a sort of survey with other teens and I’m interested in your opinion. Let’s say your parents are going to be out of town for the weekend. As they’re leaving, they tell you they trust you to take care of yourself and they trust you not to have a big party at home while they’re gone. After they left, what would you do?” Then, depending upon the youth’s response to this situation, you can ask many follow-up questions: “Would you have a party?, How many people would you invite? What if you didn’t want to have a party, but the rumor that your parents were gone got out and people started pressuring you? If you had a party, would you have alcohol? How about drugs? If your parents ask you if you had a party when they get back into town, how would you respond? Would you lie? How would that feel?” Finally, at the end you can ask the teen if he/she is interested in hearing about how others have responded to the questions/survey.
  9. Asset Flooding: With many teens who engage in challenging behaviors, communication breaks down because of how badly they are feeling about themselves. Consequently, communication and cooperation can be enhanced when the counselor simply stops and reflects on the teen’s positive qualities. Of course, you need to have several positive attributes available in your mind before beginning this intervention. You can proceed by saying something like: “You know, I was just thinking about how I think you have all sorts of good qualities. . . like you’re always on time, you hang in there and keep attending your classes, even though I know sometimes you don’t really like them. . . that tells me you’ve got courage, courage to face unpleasant things. . . I also like your sense of humor. . . and. . .”
  10. Generating Behavioral Alternatives: Frequently teens become focused on one or two maladaptive behavioral responses to challenging situations. For example, they may either yell at their teacher or run out of class, but they seem unable or unwilling to try a more moderate response such as discussing their conflict or problem with the teacher in order to seek resolution. In the workshop, I will discuss a counseling session illustrating a modified behavioral alternatives procedure designed to reduce behavioral aggression. The transcript for this session is included at the end of this handout.
  11. Using Riddles and Games: In the Tough Kids book we describe a number of interesting activities that therapists can use with young clients. One strategy is to initiate some “mental set” activities with your client. For example, you might say, “I’d like you to say the word ‘ten’ ten times and I’ll count.” The client then says, “10, 10, 10. . .” and at the end you say, “Okay, what are aluminum cans made of?” Often the youth will say, “TIN” which of course the wrong answer, because the correct answer is aluminum. After doing this you can then discuss how our minds sometimes will misinterpret things which is why we should always think twice before reacting.
  12. Food and Mood: Using food with young clients can help put them in a better mood and if they’re in a better mood, generally counseling proceeds a bit more smoothly. Our food guidelines include: (a) we try to keep relatively healthy snacks available (e.g., sugarless gum, juice, herbal tea, granola bars, carrots, grapes); (b) we don’t always offer something to eat (that usually depends on the time of day and the client’s hunger state), but we usually offer something to drink at the beginning of each session; (c) occasionally kids will overstep boundaries and ask for more and more food and sometimes they begin to expect treats, or even to criticize their counselor for the types of treats available—but of course, such behavior simply provides the astute professional with more material for exploration and interpretation. Perhaps children who act out with respect to food lack social inhibition—or are not eating well—or are impulsive—or are hungry for attention. Whatever the case, food items provide opportunity for discussion, feedback, and behavior change. And of course, food almost always improves mood.
  13. A Multicultural Opening: In the video clip with John and Michael, John begins by noting differences between the two of them and then asking Michael to share some of his personal experiences about being an African American gang member. This opening comes dangerously close to an inappropriate request – for Michael to educate John about his culture and lifestyle. However, because John emphasizes his interest in Michael’s personal experiences, the opening may be appropriate – but you can be the judge.
  14. Noticing Process in Counseling: When there’s a clear pattern that begins to manifest itself in the counseling session, it’s best to acknowledge that pattern. This may be a pattern, as in the John-Michael clip, where the counselor is not “getting it” or having trouble accurately listening to the client. Or, it may be a situation where the counselor is trying to convince the student of something, but the student is resisting. In these situations, it’s recommended that the counselor acknowledge the process reality in the session.
  15. Four Forms of Relaxation: Young clients are often resistant to relaxation techniques. During the workshop, four approaches to helping teens relax and self-soothe will be demonstrated. Generally, we recommend using all four approaches in a single session with young clients. These approaches include: (a) deep breathing; (b) visualization; (c) autogenic training; and (d) progressive muscle relaxation. The offering of these relaxation approaches in this particular order is designed to help young clients decide which approach will work best for them and to end on a light note that facilitates a positive mood.
  16. Cognitive Storytelling: Most teens, especially elementary teens, have a natural interest in stories and storytelling. In addition to using stories as metaphors, it can be useful for counselors to incorporate storytelling procedures that illustrate cognitive and behavior principles into counseling. The road rage, monkey surgery, or cherry story will be shared with participants in this workshop.
  17. Respect, Liking, and Interest: In person-centered counseling, it’s not the counselor’s microskills of listening, etc., that facilitate change, but instead, it is the therapist’s attitude of congruence, unconditional positive regard, and empathic understanding. Similarly, spontaneity and humor with young clients should be avoided unless you, as a therapist, experience the attitudes and feelings of respect, liking, and interest for the teen. There is no substitute for this therapeutic foundation. It must be genuine because teens are especially adept at detecting phoniness in adults. You should work toward feeling deep inside that there is no other place you would rather be than sitting in the room and listening and talking with your young client.
  18. Early Interpretation: In the Adlerian counseling spirit, early interpretations with adolescents are quick observations of the teen’s cognitive style or lifestyle. These interpretations are not particularly deep, but instead designed to provide insight into the surface dynamics with which the teen is struggling. There are two examples of early interpretations given in the workshop. First, I observe with Sean that he is “perfectionistic” which then allows exploration of how his perfectionism is affecting his anger. Second, I share with Meagan the observation that she seems very sensitive to “injustice,” which we then explore together. Early interpretations provide an initial formulation upon which both client and therapist can work.
  19. Self-Rating Strategies: There are many different rating strategies that can be used to facilitate the counseling process. The scaling question from the solution-focused framework can be helpful for identifying what it would look like if small amounts of change occurred. In the session with Sean, John tries using a 0-100 scale combined with a grading system to uncover Sean’s maladaptive thoughts.
  20. Using a Role-Reversal: Role reversals with teens can be interesting and sometimes fun. In the workshop example, I ask Sean to be my “counselor.” Sean responds by taking his role seriously and I surprise myself somewhat by taking my role very seriously (which may be, to some degree, a manifestation of countertransference). The purpose of role reversals is twofold. First, it helps teens work on the crucial cognitive task of perspective taking. Second, it can help the teen have more empathy for himself or herself.
  21. Self Disclosure: Self disclosure is risky, but necessary when working with teens. Most of the time, they don’t really want to hear long, boring stories about the therapist and so those stories should be avoided. Instead, short stories that serve to deepen the connection or to make a therapeutic point are recommended.
  22. The Fool in the Ring and Satanic Golden Rule: This technique is derived from Eva Feindler’s work with aggressive youth. It involves using the “Fool in the Ring” metaphor for helping youth see that they are giving up freedom when they react (predictably) and aggressively toward individuals who provoke them. The therapist draws a picture of two stick-figures engaging in a conflict and brainstorms how the young person being provoked might respond to conflict situations without engaging in retaliation and without engaging in behaviors likely to perpetuate aggression and result in negative consequences. Additionally, the message behind this metaphor and brainstorming activity is further developed by discussing the Satanic Golden Rule. In the end, youth are encouraged to use a more thoughtful and intentional response to provocation – instead of simply responding to aggression.
  23. Reconstructing the Client’s Story About the Self (Questioning the Main Maladaptive Narrative): One of the most powerful factors influencing human behavior is the self-story. Most teens spend mental time telling themselves about themselves. This inner story or narrative usually includes a number of old, negative, and maladaptive judgments about the self. For example, many teens will make claims like, “I have a terrible temper. I just blow my top if anybody gets on my case.” It’s important for therapists to question young clients when they make definitive claims about having a negative trait. In particular, using the questions: “Have you ever performed in a play?” and “How did you remember your lines?” can be used to point out to teens that they have been practicing the same “lines” about themselves for years and that it might be time to start learning and practicing some new and different lines about themselves.
  24. Alternatives to Suicide: This technique is virtually identical to generating behavioral alternatives except it’s used with young clients who are suicidal. It involves simply but compassionately listing the client’s options in life, including suicide. Then, after a list is jointly generated, the client ranks his/her top preferences. This process provides both assessment and intervention data.
  25. Neo-Dissociation: Adolescence is a time of ambivalence. Although adolescents often express very strong feelings, they also usually have underlying feelings that may even be contradictory to the strong feelings they are expressing. This technique is designed to capitalize on the teen’s underlying, prosocial thoughts and impulses. If a teen adamantly emphasizes that s/he doesn’t care about something, after you have empathized with his/her apathy, then you can explore for underlying feelings of caring or concern. For example, if the teen says, “I don’t care about math. It sucks. The teacher sucks. Anybody who likes math is a nerd. So I don’t care if I flunk,” you can respond with empathy: “Okay. I totally hear you. You hate math and you totally don’t care if you flunk.” Then, you can explore using the neo-dissociative technique by saying: “I’m guessing that even though you really don’t care about your math grade, there might be a part of you that cares just a little bit. I’d like to talk to that part of you for a minute.”
  26. Note-Passing: This technique can be used with students who have shut down and require a new communication modality. It involves the counselor noticing the “shut down” state and then writing a kind and supportive note to the student, folding it, and handing it over. It’s often hard for students to resist reading a handwritten passed note. Sometimes they’ll speak in response, other times they’ll write a note back, and sometimes they’ll continue in their shut down state. Drawing or artwork can also function as an alternative communication modality.

 References

 Berman, A. L., Jobes, D. A., & Silverman, M. (2006). Adolescent suicide: Assessment and intervention. (2nd ed.). Washington, D.C.: American Psychological Association.

Bernstein, N. (1996). Treating the unmanageable adolescent. Northvale, NJ: Jason Aronson.

Betan, E., Heim, A.K., Conklin, C. Z., & Westen, D. (2005). Countertransference phenomena and personality pathology in clinical practice: An empirical investigation. American Journal of Psychiatry, 162 (5), 890 – 898.

Castro-Blanco, D., & Karver, M. S. (2010). Elusive alliance: Treatment engagement strategies with high-risk adolescents. Washington, DC: American Psychological Association.

Creed, T. A., & Kendall, P. C. (2005). Therapist alliance-building behavior within a cognitive– behavioral treatment for anxiety in youth. Journal of Consulting and Clinical Psychology, 73, 498-505.

de Shazer, S. (1985). Keys to solution in brief therapy. New York: Norton.

Feindler, E. (1986). Adolescent anger control. New York: Pergamon Press.

Glasser, W. (2002). Unhappy teens. New York: HarperCollins.

Hanna, F. J., Hanna, C. A., & Keys, S. G. (1999). Fifty strategies for counseling defiant, aggressive adolescents: Reaching, accepting, and relating. Journal of Counseling & Development, 77(4), 395-404.

Hawley, K. M., & Garland, A. F. (2008). Working alliance in adolescent outpatient therapy: Youth, parent and therapist reports and associations with therapy outcomes. Child & Youth Care Forum 37(2), 59-74

Juhnke, G. A., Granello, P. F., Granello, D. H. (2011). Suicide, self-injury, and violence in the schools: assessment, prevention, and intervention strategies. Hoboken, NJ: Wiley.

Kazdin, A. E. (2008). The Kazdin method for parenting the defiant child: With no pills, no therapy, no contest of wills. Boston, MA: Houghton Mifflin Company.

Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York: Guilford Press.

Mohr, J. J., Gelso, C. J., & Hill, C. E. (2005). Client and counselor trainee attachment as predictors of session evaluation and countertransference behavior in first counseling sessions. Journal of Counseling Psychology, 52 (3), 298–309.

Rogers, C. R. (1961). On becoming a person. Boston: Houghton Mifflin.

Shea, S. C. (1999). The practical art of suicide assessment. New York: Wiley.

Sommers-Flanagan, J., & Bequette, T. (2013). The initial interview with adolescents. Journal of Contemporary Psychotherapy, 43(1), 13-22.

Sommers-Flanagan, J., Richardson, B.G., & Sommers-Flanagan, R. (2011). A multi-theoretical, developmental, and evidence-based approach for understanding and managing adolescent resistance to psychotherapy. Journal of Contemporary Psychotherapy, 41, 69-80.

Sommers-Flanagan, J., & Campbell, D.G. (2009). Psychotherapy and (or) medications for depression in youth? An evidence-based review with recommendations for treatment. Journal of Contemporary Psychotherapy, 32,111-120.

Sommers-Flanagan, J., & Sommers-Flanagan, R. (2007). Tough kids, cool counseling: User-friendly approaches with challenging youth (2nd ed.). Alexandria, VA: American Counseling Association.

Sommers-Flanagan, J., & Sommers-Flanagan, R. (2014). Clinical interviewing. (5th ed.). New York: Wiley.

Sommers-Flanagan, J., & Sommers-Flanagan, R. (2012). Counseling and psychotherapy theories in context and practice: Skills, strategies, and techniques. New York: Wiley.

Sommers-Flanagan, J., & Sommers-Flanagan, R. (2004). The challenge of counseling teens: Counselor behaviors that reduce resistance and facilitate connection. [Videotape]. North Amerst, MA: Microtraining Associates.

The TADS Team. (2007). The treatment for adolescents with depression study (TADS): Long term effectiveness and safety outcomes. Archives of General Psychiatry, 64(10), 1132-1144.

The TADS Team. (2004). Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for adolescents with depression study (TADS) randomized controlled trial. JAMA: Journal of the American Medical Association, 292(7), 807-820.

Turner, E.H., Matthews, A.M., Linardatos, E., Tell, R.A., & Rosenthal, R. (2008). Selective publication of antidepressant trials and its influence on apparent efficacy. The New England Journal of Medicine, 358, 252-360.

United States Food and Drug Administration. (2007). FDA proposes new warnings about suicidal thinking, behavior in young adults who take antidepressant medications. Retrieved January 10, 2008, from http://www.fda.gov/bbs/topics/NEWS/2007/NEW01624.html

Watkins, J. G. (1971). The affect bridge: A hypnoanalytic technique. International Journal of Clinical and Experimental Hypnosis, 19, 21-27.

Weisz, J., & Kazdin, A. E. (2010). Evidence-based psychotherapies for children and adolescents (2nd ed.). New York: Guilford.

Willock, B. (1986). Narcissistic vulnerability in the hyper-aggressive child: The disregarded (unloved, uncared-for) self. Psychoanalytic Psychology, 3, 59-80.

Willock, B. (1987). The devalued (unloved, repugnant) self: A second facet of narcissistic vulnerability in the aggressive, conduct-disordered child. Psychoanalytic Psychology, 4, 219-240.

If you have questions about this handout, or are interested in having John SF conduct a workshop or keynote for your organization, please contact John at: 406-243-4263 or john.sf@mso.umt.edu. You may reproduce this handout to share with your colleagues if you like, but please provide an appropriate citation. For additional free materials related to this workshop and other topics, go to John’s Blog at: johnsommersflanagan.com

Electronic Classrooms of Tomorrow — Powerpoint slides for “How to Listen. . .”

This coming Thursday and Friday I’ll be in Columbus, OH for the Electronic Classrooms of Tomorrow (ECOT) conference. For Thursday, I’m presenting several break-out sessions on “How to Listen so Parents will Talk and Talk so Parents will Listen.” The powerpoints for that presentation are here:

How to Listen for ECOT

On Friday I doing an all-day workshop with the ECOT counselors with a little of everything (Tough Kids, Cool Counseling, Suicide Assessment/Intervention, and Working with Parents). Here are the ppts for Friday’s workshop:

ETOC TKCC No Tunes

Thanks very much to Emma Baucher who has been incredibly helpful in arranging this.