Category Archives: Counseling and Psychotherapy Theory and Practice

Alfred Adler All Day Long

alfred adler photo small

It’s too bad, but IMHO we don’t ever seem to take enough time to celebrate the ideas and deeds of Alfred Adler. If, by chance, you’re not sure who the heck I’m talking about, then I’ll take that as validation of my point. Who was Alfred Adler? . . . sadly, that’s a question many people can’t answer.

Today, April 4, 2019, I’m doing a webinar on the similarities and distinctions between Alfred Adler’s “Individual Psychology” (aka Adlerian therapy) and cognitive-behavioral therapy. Most people who study these things, including Albert Ellis, recognize that Adler’s work was ahead of his time and much of what he wrote about can be considered foundational to cognitive therapy. Staunch Adlerians sometimes put it more dramatically when they say, “In the beginning, there was Adler.”

Today’s webinar has inspired me to renew my efforts to spread the gospel of Alfred Adler. If you read this blog regularly, you know I’ve done this before. You can read some of my previous Adler posts by clicking here: https://johnsommersflanagan.com/tag/adler/

Today, I feel like I’m taking the lazy way out. But Adler would likely correct me. He didn’t much believe in the word lazy. Instead, Adler would reformulate lazy as discouraged, or more specifically, in this, and many cases (think of your children, perhaps), what appears to be laziness is a function of having goals and aspirations that are beyond one’s reasonable skills and available time. I think that could be the case here. Although I’d like to shower you with lots of new and exciting Adlerian information, instead, I’m posting the first five pages of the Adlerian chapter of our Counseling and Psychotherapy theories textbook. Here it is . . . five pages of the start of a chapter that only begins to describe the life and work of the amazing Alfred Adler.

Chapter 3: Individual Psychology and Adlerian Therapy

We often wonder about Alfred Adler. Who was this man whose theories and approach predate and contribute substantially to ego psychology (Chapter 2), the cognitive therapies (Chapter 8), reality therapy (Chapter 9), feminist therapy (Chapter 10), and constructive perspectives (Chapter 11)? How did he develop—over 100 years ago—influential and diverse ideas that are foundational to so many different approaches to therapy, and so thoroughly infused into contemporary culture? His beliefs were so advanced that he seems an anomaly: He’s like a man from the future who landed in the middle of Freud’s inner circle in Vienna.

Introduction

Despite the ubiquity of Adler’s ideas, many contemporary mental health professionals don’t recognize, acknowledge, or appreciate his contributions to modern counseling and psychotherapy (Carlson & Englar-Carlson, 2017). Perhaps this is because Adler provided services for working class people, rather than the wealthy elite; or because he was an early feminist; or because his common sense ideas were less “sexy” than Freud’s.

What is Individual Psychology? (. . . and what is Adlerian Therapy?)

Individual psychology was the term Adler used to describe the psychotherapy approach he founded. Watts and Eckstein (2009) recounted Adler’s rationale for choosing the name Individual Psychology: “Adler chose the name individual psychology (from the Latin, individuum, meaning indivisible) for his theoretical approach because he eschewed reductionism” (p. 281).

Most people know individual psychology as Adlerian therapy, the contemporary applied term. Adlerian therapy is described as “a psychoeducational, present/future-oriented, and brief approach” (R. E. Watts & Pietrzak, 2000, p. 22). Similar to psychoanalytic psychotherapy, Adlerian therapy is also insight-oriented. However, therapists can use direct educational strategies to enhance client awareness.

Adler was a contemporary—not a disciple—of Freud. During their time, Adler’s ideas were more popular than Freud’s. Adler’s first psychology book, Understanding Human Nature, sold over 100,000 copies in six months; in comparison, Freud’s Interpretation of Dreams sold only 17,000 copies over 10 years (Carlson & Englar-Carlson, 2017). Jon Carlson (2015) referred to Adler as “the originator of positive psychology” (pp. 23-24).

Adler wove cognition into psychotherapy long before Albert Ellis and Aaron Beck officially launched cognitive therapy in the 1950s and 1960s. In the following quotation, Adler (1964; originally published in 1933) easily could be speaking about a cognitive rationale for a computerized virtual reality approach to treating fears and phobias (now growing in popularity in the 21st century):

I am convinced that a person’s behavior springs from his [or her] idea.… As a matter of fact, it has the same effect on one whether a poisonous snake is actually approaching my foot or whether I merely believe it is a poisonous snake. (pp. 19–20)

In his historical overview of the talking cure, Bankart (1997) claimed, “Adler’s influence on the developing fields of psychology and social work was incalculable” (p. 146). This chapter is an exploration of Alfred Adler’s individual psychology and his vast influence on modern counseling and psychotherapy.

Alfred Adler

Alfred Adler (1870-1937) was the second of six children born to a Jewish family outside Vienna. His older brother was brilliant, outgoing, handsome, and also happened to be named Sigmund. In contrast, Alfred was a sickly child. He suffered from rickets, was twice run over in the street, and experienced a spasm of the glottis. When he was 3 years old, his younger brother died in bed next to him (Mosak, 1972). At age 4, he came down with pneumonia. Later Adler recalled the physician telling his father, “Your boy is lost” (Orgler, 1963, p. 16). Another of Adler’s earliest memories has a sickly, dependent theme:

One of my earliest recollections is of sitting on a bench bandaged up on account of rickets, with my healthy, elder brother sitting opposite me. He could run, jump, and move about quite effortlessly, while for me movement of any sort was a strain and an effort. Everyone went to great pains to help me, and my mother and father did all that was in their power to do. At the time of this recollection, I must have been about two years old. (Bottome, 1939, p. 30)

In contrast to Freud’s childhood experience of being his mother’s favorite, Adler was more encouraged by his father. Despite his son’s clumsy, uncoordinated, and sickly condition, Adler’s father Leopold, a Hungarian Jew, firmly believed in his son’s innate worth. When young Alfred was required to repeat a grade at the same middle school Freud had attended 14 years earlier, Leopold was his strongest supporter. Mosak and Maniacci (1999) articulate Adler’s response to his father’s encouragement:

His mathematics teacher recommended to his father that Adler leave school and apprentice himself as a shoe-maker. Adler’s father objected, and Adler embarked upon bettering his academic skills. Within a relatively short time, he became the best math student in the class. (p. 2)

Adler’s love and aptitude for learning continued to grow; he studied medicine at the University of Vienna. After obtaining his medical degree in ophthalmology in 1895, he met and fell in love with Raissa Timofeyewna Epstein, and married her in 1897. She had the unusual distinction of being an early socialist and feminist. She was good friends with Leon and Natalia Trotsky and she maintained her political interests and activities throughout their marriage (Hoffman, 1994).

Historical Context

Freud and Adler met in 1902. According to Mosak and Maniacci (1999), Adler published a strong defense of Freud’s Interpretation of Dreams, and consequently Freud invited Adler over “on a Wednesday evening” for a discussion of psychological issues. “The Wednesday Night Meetings, as they became known, led to the development of the Psychoanalytic Society” (p. 3).

Adler was his own man with his own ideas before he met Freud. Prior to their meeting he’d published his first book, Healthbook for the Tailor’s Trade (Adler, 1898). In contrast to Freud, much of Adler’s medical practice was with the working poor. Early in his career, he worked extensively with tailors and circus performers.

In February 1911, Adler did the unthinkable (Bankart, 1997). As president of Vienna’s Psychoanalytic Society, he read a highly controversial paper, “The Masculine Protest,” at the group’s monthly meeting. It was at odds with Freudian theory. Instead of focusing on biological and psychological factors and their influence on excessively masculine behaviors in males and females, Adler emphasized culture and socialization (Carlson & Englar-Carlson, 2017). He claimed that women occupied a less privileged social and political position because of social coercion, not physical inferiority. Further, he noted that some women who reacted to this cultural situation by choosing to dress and act like men were suffering, not from penis envy, but from a social-psychological condition he referred to as the masculine protest. The masculine protest involved overvaluing masculinity to the point where it drove men and boys to give up and become passive or to engage in excessive aggressive behavior. In extreme cases, males who suffered from the masculine protest began dressing and acting like girls or women.

The Vienna Psychoanalytic Society members’ response to Adler was dramatic. Bankart (1997) described the scene:

After Adler’s address, the members of the society were in an uproar. There were pointed heckling and shouted abuse. Some were even threatening to come to blows. And then, almost majestically, Freud rose from his seat. He surveyed the room with his penetrating eyes. He told them there was no reason to brawl in the streets like uncivilized hooligans. The choice was simple. Either he or Dr. Adler would remain to guide the future of psychoanalysis. The choice was the members’ to make. He trusted them to do the right thing. (p. 130)

Freud likely anticipated the outcome. The group voted for Freud to lead them. Adler left the building quietly, joined by the Society’s vice president, William Stekel, and five other members. They moved their meeting to a local café and established the Society for Free Psychoanalytic Research. The Society soon changed its name to the Society for Individual Psychology. This group believed that social, familial, and cultural forces are dominant in shaping human behavior. Bankart (1997) summarized their perspective: “Their response to human problems was characteristically ethical and practical—an orientation that stood in dramatic contrast to the biological and theoretical focus of psychoanalysis” (p. 130).

Adler’s break from Freud gives an initial glimpse into his theoretical approach. Adler identified with common people. He was a feminist. These leanings reflect the influences of his upbringing and marriage. They reveal his compassion for the sick, oppressed, and downtrodden. Before examining Adlerian theoretical principles, let’s note what he had to say about gender politics well over 90 years ago:

All our institutions, our traditional attitudes, our laws, our morals, our customs, give evidence of the fact that they are determined and maintained by privileged males for the glory of male domination. (Adler, 1927, p. 123)

Raissa Epstein may have had a few discussions with her husband, exerting substantial influence on his thinking (Santiago-Valles, 2009).

Reflections

What are your reactions to Adler as a feminist? Do you suppose he became more of a feminist because he married one? Or did he marry a feminist because he already was one?

Theoretical Principles

Adler and his followers have written extensively about the IP’s theoretical principles. Much of what follows is from Adler (1958), Ansbacher and Ansbacher (1956), Mosak and Maniacci (1999), Carlson, Watts, and Maniacci (2006), Sweeney (2009), and Carlson & Englar-Carlson, 2017).

People are Whole and Purposeful

Adler emphasized holism because he believed it was impossible “. . . to understand an individual in parts” (Carlson & Johnson, 2016, p. 225). Instead of dichotomies, he emphasized unity of thinking, feeling, acting, attitudes, values, the conscious mind, the unconscious mind, and all aspects of human functioning. This holistic approach was in direct contrast to Freud’s id, ego, and superego. The idea of an id entity or instinct separately pushing for gratification from inside a person was incompatible with Adler’s holism.

A central proposition of individual psychology is that humans are purposeful or goal-oriented (Sweeney, 2009). We don’t passively act on biological traits or react to the external environment; instead, we behave with purpose. Beyond nurture or nature, there’s another force that influences and directs human behavior; Adler (1935) referred to this as “attitude toward life” (p. 5). Attitude toward life is composed of a delightful combination of human choice and purpose.

Everyday behavior is purposeful. When Adlerian therapists notice maladaptive behavior patterns, they focus on behavioral goals. They don’t aggressively interrogate clients, asking, “Why did you do that?”—but are curious about the behavior’s purpose. Mosak and Maniacci (1999) articulated how Adler’s holism combines with purposeful behavior:

For Adler, the question was neither “How does mind affect body?” nor “How does body affect mind?” but rather “How does the individual use body and mind in the pursuit of goals?” (pp. 73–74).

Rudolph Dreikurs (1948) applied the concept of purposeful striving to children when he identified “the four goals of misbehavior” (see Putting it in Practice 3.1).

Putting it in Practice 3.1

Why Children Misbehave

Adler’s followers applied his principles to everyday situations. Rudolph Dreikurs posited that children are motivated to grow and develop. They’re naturally oriented toward feeling useful and a sense of belonging. However, when children don’t feel useful and don’t feel they belong—less positive goals take over. In his book The Challenge of Parenthood, Dreikurs (1948) identified the four main psychological goals of children’s misbehavior:

  1. To get attention.
  2. To get power or control.
  3. To get revenge.
  4. To display inadequacy.

Children’s behavior isn’t random. Children want what they want. When we discuss this concept in parenting classes, parents respond with nods of insight. Suddenly they understand that their children have goals toward which they’re striving. When children misbehave in pursuit of psychological goals, parents and caregivers often have emotional reactions.

The boy who’s “bouncing off the walls” is truly experiencing, from his perspective, an attention deficit. Perhaps by running around the house at full speed he’ll get the attention he craves. At least, doing so has worked in the past. His caregiver feels annoyed and gives him attention for misbehavior.

The girl who refuses to get out of bed for school in the morning may be striving for power. She feels bossed around or like she doesn’t belong; her best alternative is to grab power whenever she can. In response, her parents might feel angry and activated—as if they’re in a power struggle with someone who’s not pulling punches.

The boy who slaps his little sister may be seeking revenge. Everybody talks about how cute his sister is, and he’s sick of being ignored, so he takes matters into his own hands. His parents feel scared and threatened; they don’t know if their baby girl is safe.

There’s also the child who has given up. Maybe she wanted attention before, or revenge, or power, but no longer. Now she’s displaying her inadequacy. This isn’t because she IS inadequate, but because she doesn’t feel able to face the Adlerian tasks of life (discussed later). This child is acting out learned helplessness (Seligman, 1975). Her parent or caregiver probably feels anxiety and despair as well. Or, as is often the case, they may pamper her, reinforcing her behavior patterns and self-image of inadequacy and dependence.

Dreikurs’s goals of misbehavior are psychological. Children who misbehave may also be acting on biological needs. Therefore, the first thing for parents to check is whether their child is hungry, tired, sick, or in physical discomfort. After checking these essentials, parents should move on to evaluating the psychological purpose of their child’s behavior.

Social Interest or Gemeinschaftsgefühl

Adler believed that establishing and maintaining healthy social relationships was an ultimate therapy goal. He developed this belief after working with shell-shocked soldiers from World War I (K. Adler, 1994; Carlson & Englar-Carlson, 2017). He became convinced that individualism and feelings of inferiority were destructive; in contrast, he viewed social interest and community feeling as constructive. Another way of thinking about this theoretical principle is to consider humans as naturally interdependent. Lydia Sicher (1991) emphasized this in the title of her classic paper “A Declaration of Interdependence.” When we accept interdependence and develop empathy and concern for others, social relationships prosper.

Adler used the German word, Gemeinschaftsgefühl, to describe what has been translated to mean social interest or community feeling. Carlson and Englar-Carlson (2017) elaborated on the meaning of this uniquely Adlerian concept.

Gemein is “a community of equals,” shafts means “to create or maintain,” and Gefühl is “social feeling.” Taken together, Gemeinschaftsgefühl means a community of equals creating and maintaining social feelings and interests; that is, people working together as equals to better themselves as individuals and as a community” (p. 43, italics in original)

Adlerians encourage clients to behave with social interest (Overholser, 2010). Watts (2000) emphasized that, “The ultimate goal for psychotherapy is the development or enhancement of the client’s social interest” (p. 323). Research has shown that social interest is positively related to spirituality, positive psychology, and health (G. K. Leak, 2006; G. K. Leak & K. C. Leak, 2006; Nikelly, 2005), and inversely related to anger, irritability, depression, and anxiety (Newbauer & Stone, 2010). Some writers consider the positive aspects of religion to be a manifestation of social interest. This was Adler’s position as well (Manaster & Corsini, 1982; Watts, 2000).

Various writers, and Adler himself, noted that Gemeinschaftsgefühl essentially boils down to the edict “love thy neighbor” (Alizadeh, 2012; Watts, 2000). Carlson and Englar-Carlson described it as being the “same as the goal of all true religions” (p. 44). Although Adler wasn’t especially religious, he had no difficulty embracing the concept of love thy neighbor as a social ideal. In contrast, Freud (1930/1961) concluded, “My love is something valuable to me which I ought not to throw away without reflection” (p. 56). This is one of several distinctions between Adler and Freud; for Adler, love is valuable, powerful, and abundant. It should be freely given; for Freud, love is also valuable, but should be conserved.

Striving for Superiority

Adler believed that the basic human motive is the striving for superiority. However, like Gemeinschaftsgefühl, this concept requires a detailed explanation.

The term superiority is an oversimplification. Heinz Ansbacher provided a more comprehensive description of Adler’s striving for superiority in a published interview:

The basic striving, according to Adler, is the striving for Vollkommenheit. The translation of Vollkommenheit is completeness, but it can also be translated as excellence. In English, only the second translation was considered; it was only the striving for excellence. The delimitation of the striving for excellence is the striving for superiority.

Basically, it all comes from the striving for completeness, and there he said that it is all a part of life in general, and that is very true. Even a flower or anything that grows, any form of life, strives to reach its completeness. And perfection is not right, because the being does not strive—one cannot say to be perfect—what is a perfect being? It is striving for completeness and that is very basic and very true. (Dubelle, 1997, p. 6)

Striving for individual superiority can take on a Western, individualistic quality. This wasn’t Adler’s perspective. He viewed excessive striving for self-interest as unhealthy; Adler once claimed he could simplify his entire theory by noting that all neurosis was linked to vanity. Striving for self-interest translates into striving for superiority rather than for social interest (Watts & Eckstein, 2009).

When it comes to basic human nature and potential, Adlerian theory is like Switzerland: Adler was neutral. He didn’t believe in the innate goodness or destructiveness of humans. He believed we are what we make ourselves; we have within us the potential for good and evil.

Striving for superiority is an Adlerian form of self-actualization. More concretely, it occurs when individuals strive for a perceived “plus” in themselves and their lives. Mosak and Maniacci (1999) applied this concept to a clinical situation:

How can self-mutilation move someone toward a plus situation? Once again, that may be a “real” minus, especially in the short-term situation. Long-term, however, that person may receive attention, others may “walk on eggshells” when near that person (so as to not “upset” him or her), and he or she may gain some sense of subjective relief from the act, including a sense of being able to tolerate pain. (p. 23)

Adler observed that people often compensate for their real or perceived inadequacies. Individual inadequacies can be in any domain (e.g., physical, psychological, social). Adler may have believed in compensation partly because he experienced it himself, while growing up. Being inadequate or deficient is motivating. “The fundamental law of life is to overcome one’s deficiencies” (Ansbacher & Ansbacher, 1956, p. 48). Compensation is the effort to improve oneself in areas perceived as weak. The existential philosopher Friedrich Nietzsche expressed the same sentiment, “What does not kill me makes me stronger.”

In an ideal situation, individuals strive to (a) overcome their deficiencies, (b) with an attitude of social interest, and (c) to complete or perfect themselves. Watts (2012) has argued that the Adlerian social interest and striving for superiority are foundational to positive psychology—despite the fact that Adler’s work remains largely unacknowledged within the positive psychology discipline.

 

Breathing New Life into Your Dead, White Counseling and Psychotherapy Theories Course

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Artwork by Rita Sommers-Flanagan**

On April 18 at 1:00p.m. EST, I’ll be doing a Wiley Webinar. This webinar is free, and especially geared toward academics who want to expand their repertoire for teaching counseling and psychotherapy theories. Because this webinar is sponsored by my publisher, John Wiley & Sons, there will be some minor marketing of my textbook, Counseling and Psychotherapy Theories in Context and Practice (3rd ed.). However, you can attend this webinar regardless of the textbook you use. My goal is to help open all of us up to how we can integrate new ideas into existing “older” theoretical perspectives.

Here’s the link to register: https://www.wileyplus.com/wiley-webinar-series/#john-sommers-flanagan

And here’s the official blurb for the webinar:

Teaching traditional counseling and psychotherapy theories courses can feel dull and boring. In this webinar session, John Sommers-Flanagan will share pedagogical strategies for integrating culture into theory, and engaging students with here-now activities that bring the dusty old theories to life. This webinar will include specific recommendations for how to integrate culture and feminist ideas into traditional theories. Learning activities will be demonstrated, including: (a) early intercultural memories; (b) sex, feminism, and psychoanalytic defense mechanisms; (c) empowered narrative storytelling; and (d) spiritual and behavioral forms of relaxation. Handouts for each activity will be available later on this blogsite.

Beyond this short description, I also want to acknowledge the obvious. As a living White person who writes about, teaches, and practices theory-based counseling and psychotherapy, I know that my ability to claim expertise in making cultural adaptations is limited. I don’t want to be the expert on this (or most things). The purpose of this webinar is NOT to “tell” anyone exactly what diversity modifications “should” be made when teaching counseling and psychotherapy theories. Instead, my purpose is to talk about and illustrate ways in which new diversity-sensitive ideas might be creatively integrated into old theoretical perspectives. From there . . . the application of these and your own ideas about how to breathe new life into old theories is up to you and your unique personal and professional worldview.

Given this big preceding caveat, the webinar’s learner objectives are to help participants:

  • Identify compatibilities of culture, spirituality, and feminist thought with traditional counseling and psychotherapy theories
  • Implement an intercultural memory activity with large or small groups
  • Implement and discuss diverse sexualities along with psychoanalytic defense mechanisms
  • Implement a multicultural empowered storytelling strategy
  • Implement and debrief spiritual and behavioral integrations to achieve relaxation

Soon (right around 4/18/19) I’ll be posting more information related to this webinar. In the meantime, let me know your thoughts on this topic. As always, I value alternative perspectives and enjoy hearing your reactions to the posts on this blog.

Transforming Therapeutic Relationships into Evidence-Based Practice

Here are the ppts for today’s Webinar: v2 TherapySites 2019 Final
The handout linked below is an in-depth supplement to a webinar I’m providing for TherapySites.com on March 13, 2019. Although it’s designed to go with the webinar, it’s also a standalone resource for learning more about how to integrate evidence-based relationship factors into counseling and psychotherapy practice.

Webinar Transforming Therapeutic Relationships into Evidence-Based Counseling

 

Suicide Assessment and Treatment Planning: Resources for Professionals

The Road

As you probably know, suicide rates are and have been on the rise. Here’s what the Centers for Disease Control said several months ago: “From 1999 through 2017, the age-adjusted suicide rate increased 33% from 10.5 to 14.0 per 100,000” (CDC, November, 2018).

Although the CDC’s report of a 33% increase in the national suicide rate is discouraging, the raw numbers are even worse. In 1999, an estimated 29,180 Americans died by suicide. As a comparison, in 2017 (the latest year for which data are available), there were 47,173 suicide deaths. This represents a 61.9% rise in the raw number of suicide deaths over the past 17 years.

Along with rising suicide rates, there’s also a palpable rise in anxiety and panic among mental health and healthcare professionals, teachers, and the public. Even though suicides still occur at a low rate (14 per 100,000), it’s beginning to feel like a public health crisis. We don’t have much evidence that current intervention and prevention efforts are working, and the continued tragic outcomes (about 129 suicide deaths each day in the U.S.) are painful and frustrating.

The purpose of this post is simply to offer resources. I’ve been working in this area for many years; my sense is that having additional resources to help professionals feel more competent can reduce anxiety and probably increases competence. Here are some resources that might be helpful.

  1. In 2018 I published an article in the Journal of Health Service Psychology. The purpose of the article was to provide clear ideas about how psychological providers can be more effective in how they work with clients or patients who are suicidal. You can click here to access a pdf of the article. Conversations About Suicide by JSF 2018
  2. I’ve been working with some of my doctoral students on alternatives to the traditional (and failed) approach of using client risk factors to categorize or estimate suicide risk. One product of this work is an evidence-based list of eight potential suicide dimensions. These suicide dimensions can be used with other models (e.g., safety planning) to guide collaborative treatment planning. To see a description of the eight dimensions and a treatment planning form based on the eight dimensions, you can click on the following links. Suicide TPlanning Handout            Suicide TPlanning Handout Blank
  3. Barbara Stanley and Gregory Brown developed the “Safety Planning Intervention.” For information about their intervention and access to their safety planning form, you can go to their website: http://suicidesafetyplan.com/Home_Page.html
  4. Along with Victor Yalom and some other contributors, this past year I helped produce a 7.5 hour professional training video titled, Assessment and Intervention with Suicidal Clients. You can buy this 3-part video series through Psychotherapy.net and can access a preview of the video series here: http://www.psychotherapy.net/video/suicidal-clients-series
  5. I’m a big fan of David Jobes’s work on the collaborative assessment and management of suicide. You can check out his book on Amazon: https://www.amazon.com/Managing-Suicidal-Risk-Second-Collaborative/dp/146252690X/ref=sr_1_1?crid=29DN6ZM2BUCV3&keywords=david+jobes+suicide&qid=1551837394&s=gateway&sprefix=david+jobes%2Caps%2C177&sr=8-1
  6. Later this spring and this fall, in collaboration with the Big Sky Youth Empowerment Program and the University of Montana, I’ll be offering several low-cost six-hour training workshops in four different Montana locations. These trainings will include research data collection, as well as an opportunity to participate in follow up booster trainings—booster sessions that will happen about three months after you attend an initial six-hour session. If you’re interested in participating in these Montana Suicide Assessment and Treatment Planning Workshops, you can email me, send me your email via a comment on this blog, or begin following this blog so you don’t miss out when I share the dates, times, and locations, and registration information in an upcoming post.

I hope this information is helpful to you in your work with clients struggling with suicide. Together, hopefully we can make a difference.

How to Make a Collaborative Plan for Terminating Counseling without Ever Using the Word Termination

Stone Smirk

Not long ago I noticed some of my excellent and well-intended supervisees talking with their clients about “termination.” They would say things like, “We need to prepare for termination” or “Let’s talk about termination today.” When this happened, I’d get nervous, squirm a bit, and eventually find a way to tell my supervisees that, although we use the word termination all the time when talking with each other ABOUT counseling, we shouldn’t use it when talking with clients DURING counseling.

Instead of saying termination, it’s preferable to talk about final sessions, or the ending of counseling, or to use normal and jargon-free words that speak to the reality that all good things—including counseling—must end. Sometimes the number of counseling sessions possible is dictated in advance by employee assistance program guidelines or insurance companies; other times, clients and counselors have more freedom to work together as long as the work is helpful or productive. Either way, ongoing conversations linking goals to progress is a part of an evidence-based approach to counseling and psychotherapy. Effective counselors connect the “ending” of counseling with the goals that were, in the beginning of counseling, collaboratively identified (and then possibly modified as needed).

Although you should use your own words, statements like some of the following can help you talk with clients or students about termination without using the word termination.

  • “Let’s talk about how our counseling is going and whether we’re making progress toward your goals”
  • “How do you feel about our counseling together?”
  • “I’d love to talk about what I can do differently to keep helping you move forward toward your goals.”

Speaking of termination—and now I’m speaking to you and not my clients—below you’ll find a Termination Checklist that you might find helpful as you talk with your students about preparing for termination. As will everything, this checklist is imperfect, but it’s a good start to help all of us address the ending of counseling, before counseling actually ends.

Termination Checklist

[Adapted from Sommers-Flanagan, J., and Sommers-Flanagan, R., (2007).
Tough Kids, Cool Counseling: User-Friendly Approaches with Challenging Youth.
Alexandria, VA: American Counseling Association]

This is a guide to help you think about termination—even though some of the details will be different for you and your client(s).

_____ 1. At the outset and throughout counseling, identify progress in the movement toward termination (e.g., “Before our meeting today, I noticed we have 4 more sessions left,” or “You are doing so well at home, at school, and with your friends. . . let’s talk about how much longer you’ll want or need to come for counseling”).

_____ 2. Reminisce about early sessions or the first time you and your client met. For example: “I remember something you said when we first met, you said: ‘there’s no way in hell I’m gonna talk with you about anything important.’ Remember that? I have it right here in my notes. You weren’t exactly excited about coming for counseling.”

_____ 3. Identify and describe positive behaviors, attitude, and/or emotional changes. This is part of the process of providing feedback regarding problem resolution and goal attainment: “I’ve noticed something about you that has changed. Do you mind if I share what I’ve noticed?” [Client gives permission]. It used to be that you wouldn’t let adults get close to you. And you wouldn’t accept compliments from adults. Now, from what you and your parents tell me and from how you act in here, it’s obvious that you give adults a chance. You don’t automatically push adults away from you. I think that’s a good thing.”

_____ 4. You should acknowledge, in advance, that the end of counseling is coming up, but there’s a possibility you’ll see each other in the future. “Our next session will be our last session. I guess there’s a chance we might see each other sometime, at the mall or somewhere. If we do see each other, I hope it’s okay for me to say hello. But I want you to know that I’ll wait for you to say hello first. And of course, if we see each other in public, I’ll never say anything about you having been in counseling.”

_____ 5. Identify a positive personal attribute that you noticed during counseling. This should be a personal characteristic separate from your client’s goals: “From the beginning of our time together, I’ve always enjoyed your sense of humor. You’re really creative and really funny, but you can be serious too. Thanks for letting me see both those sides. It took courage for you to get serious and tell me how you’ve been feeling about your mom.”

_____ 6. If there’s unfinished business (and there always will be) provide encouragement for continued work and personal growth: “Of course, your life isn’t perfect, but I have confidence that you’ll keep working on communicating well with your sister and those other things we’ve been talking about.” You may want to say that even though your client doesn’t “need” counseling, choosing to come back for counseling in the future might be helpful: “You know some people come to counseling to work on big problems; other people come because they find counseling helps them be a better person; and other people just like counseling. You might decide you want start up again for any of these reasons.”

_____ 7. Provide opportunities for feedback to you: “I’d like to hear from you. What did you think was most helpful about coming to counseling? What did you think was least helpful?” You can add to this any genuine statements about things you wish you’d done differently. For example, if your client got angry at you for misunderstanding something and this was processed earlier, you might say: “And of course I wish I had heard you correctly and understood you the first time around on that [issue], but I’m glad we were able to talk through it and keep working together.”

_____ 8. If it’s possible, let the client know that he or she may return for counseling in the future: “I hope you know you can come back for a meeting sometime in the future if you want or need to.”

_____ 9. Make a statement about your hope for the client’s positive future: “I’ll be thinking of you and hoping that things work out for the best. Of course, like I said in the beginning, I’m hoping you get what you want out of life, just as long as it’s legal and healthy.”

_____ 10. As needed, listen to and discuss how your client is feeling about ending counseling. Don’t make this into a big deal, but offer opportunities for the client to say “I can hardly wait for the end of this counseling crap” or “I wish we could keep meeting.” Whatever your client is feeling about termination warrants respectful listening.

_____ 11. Consider a parting gift. Although I don’t routinely recommend this with adults, with young clients you might give a meaningful gift at the end of counseling. It could be anything from a painted rock to a blank notebook for writing or a written card. The point is to give a gift that’s not especially expensive, but that might hold meaning for your client in the future.

For more information on termination with youth, go to: https://www.amazon.com/Tough-Kids-Cool-Counseling-User-Friendly-ebook/dp/B00QYU630Q/ref=sr_1_7?s=books&ie=UTF8&qid=1550512844&sr=1-7&keywords=sommers-flanagan

Guidelines for Using Congruence in Counseling and Psychotherapy

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Consistent with my recent preoccupation with evidence-based relationships in counseling and psychotherapy, I’m posting a short excerpt from the 6th edition of our Clinical Interviewing textbook (check it out here: https://www.amazon.com/gp/product/1119215587/ref=dbs_a_def_rwt_bibl_vppi_i0)

Here’s the excerpt, coming at you from Chapter 7: Evidence-Based Relationships.

Students often have questions about how congruence sounds and looks in a clinical interview. Common questions (and brief answers) follow:

  • Does congruence mean I say what I’m really thinking in the session? [Usually not. Your thoughts may mean something important and may warrant being shared at some point, but initial spontaneous thoughts and reactions to clients should stimulate personal reflection, not immediate disclosure.]
  • What if I dislike something a client says or does? Am I being incongruent if I don’t express my dislike? [No. If you have an aversion to something your client says or does, reflect on it, rather than reacting with judgment. As Rogers (1957) recommended, if you have a negative reaction, try to transform it to your internal experience and find a way to express it in a positive manner.]
  • If I feel sexually attracted to a client, should I be “congruent” and share my feelings? [Absolutely not. As discussed in Chapter 2, you should NEVER share feelings of sexual attraction with clients. Doing so is manipulative and unethical. Deal with your sexual issues and attractions in supervision and on your own time.]

One general guideline for determining when and how to be transparent or congruent is to ask: Would the disclosure help facilitate my client’s work?  Making this decision involves relying on your clinical judgment—which is difficult for everyone, but especially for new clinicians. Too much self-disclosure—even in the service of congruence or authenticity—can muddy the assessment or therapeutic focus. The key is to maintain balance; self-disclosure in the service of congruence should be limited, purposeful, and based on solid theoretical foundations (Ziv-Beiman, 2013)

Rogers (1958) was wary about excessive self-disclosure:

Certainly the aim is not for the therapist to express or talk about his (sic) own feelings, but primarily that he should not be deceiving the client as to himself. At times he may need to talk about some of his own feelings (either to the client, or to a colleague or superior) if they are standing in the way. (pp. 133–134)

Imagine that you’re working with a client and you feel the impulse to self-disclose in the spirit of being congruent. If you’re not confident your comment will be facilitative or will keep the focus on the client, then you shouldn’t disclose. Given the challenges inherent in deciding how to be congruent, you should discuss struggles with self-disclosure with peers or supervisors. This can deepen your understanding of how to be therapeutically congruent.

Based on recommendations from the literature (Farber, 2006; Kolden et al., 2011; Ziv-Beiman, 2013) and our own clinical experiences, we offer the following guidelines for self-disclosures:

  • Examine your motives for the self-disclosure you have in mind.Is it more about you or more about your client?
  • Ask yourself if the disclosure is likely to be facilitative.
  • Ask yourself if the comment will keep the focus on the client or will it distract from the client’s process and issues?
  • Consider the possibility of a negative reaction. Could your client respond in a negative or unpredictable manner?
  • Remember, congruence doesn’t mean you say whatever comes to mind; it means that when you do speak, you do so with honesty and integrity.

Case Example 7.1:

Congruence Across Cultures

Cultural identity has many dimensions (Collins, Arthur, & Wong-Wylie, 2010). In this example, during an initial clinical interview with an African American male teenager, the clinician uses congruence across several different cultural domains.

Client: This is stupid. What do you know about me and my life?

Clinician: I think you’re saying that we’re very different and I totally agree. As you can probably guess, I’ve never been in a gang or lived in a neighborhood like yours. And you can see that I’m not a Black teenager and so I don’t know much about you and what your life is like. But I’d like to know. And I’d like to be of help to you in some way during our time together.

This clinician is being open and congruent and speaking about obvious differences that might interfere with the clinician-client relationship. It would be nice to claim that being open like this always improves clinician-client connection, but nothing always works. However, as researchers have reported, congruence tends to facilitate improved treatment process and also contributes to positive outcomes, at least in small ways (Kolden et al., 2011; Tao, Owen, Pace, & Imel, 2015).