Category Archives: Counseling and Psychotherapy Theory and Practice

The Secret Self-Regulation Cure (Seriously this time)

The Road“I’m in suspense,” Sara said. “I’ve been in suspense since the last time we recorded, because John said he had this big secret and I don’t know what it is.”

Partly Sara was lying. She wasn’t in much suspense, mostly because the “last time we recorded” had been only five minutes earlier. But, as I’m sure you realize, capturing and magnifying in-the-moment excitement is the sort of behavior toward which we Hollywood podcasting stars are inclined.

Sara stayed enthusiastic. When I told her that I thought every self-regulation and anxiety reduction technique on the planet all boiled down to a single method that Mary Cover Jones developed in 1924, she said things like, “That’s exciting!” and “I love Mary Cover Jones.”

[Side note] If you end up needing a podcasting co-host, be sure to find someone like Sara who will express enthusiasm even when you’re talking about boring intellectual stuff. [End of side note.]

Mary Cover Jones was the first researcher to employ counterconditioning with humans (although she rarely gets the credit she deserves—but that’s another story). Counterconditioning involves the pairing a desirable (pleasant or comforting) stimulus with a stimulus that usually causes anxiety or dysregulation. Over time, with repeated pairing, the pleasant feelings linked with the desirable stimulus are substituted for the anxiety response. Eventually, the person who has experienced counterconditioning can more comfortably face the undesirable and previously anxiety-provoking stimulus.

My belief is that counterconditioning is the first, best, and only approach to self-regulation and anxiety reduction. Put another way, I’d say, “If it works for self-regulation, then what you’re doing is counterconditioning—even if you call it something else.”

I know that’s a radical statement. Rather than defend my belief and philosophy, let me move on and describe how you can begin using counterconditioning to make your life better.

Let’s say your goal is for you to experience more calmness and relaxation and less agitation and anxiety. That’s reasonable. According to Herbert Benson of Harvard University, you need four things to elicit the relaxation response.

  1. A quiet place
  2. A comfortable position
  3. A mental device
  4. A passive attitude

Benson was studying meditation way back in the early 1970s. Okay. I know I’m digging up lots of old moldy stuff from the past. But take a deep breath and stay with me.

Let’s say you’re able to find a quiet place and a comfortable position. If you’re a parent, that might be tough. However, even if you find it for 12 minutes as you lie in bed, waiting for sleep, that’s a start. And really, all you need is a start, because once you get going, you don’t really even need the quiet place and comfortable position. On airplanes, I use this all the time and it’s not quiet and I’m not physically comfortable.

The next question that most people ask is: “What’s a mental device?” or, “Is that something I have to strap on my head?”

A mental device is a mental point of focus. In Benson’s time and in transcendental meditation, the popular word for it was “Mantra,” but Benson’s research showed that it can be almost anything. One mental device (that’s actually physical) is deep breathing. Another one is to sit comfortably and to think (or chant) the word OM. Benson also found that simple words, like the numbers “one” or “nine” also were effective. But, as I mentioned on the podcast, you can use other words, as long as they are—or can become—comforting. For example, I know people who use the following words:

  1. I am here
  2. Here I am
  3. Peace
  4. Shalom
  5. Banana

For those of you with religious leanings, you might want to use a specific prayer as your mental device. For those of you who are more visually inclined, you could use a mental image as your mental device. For those of you who are physically-oriented, you could use progressive muscle relaxation or body scanning.

The point is that all you need is a point . . . of focus.

Now comes the hard part. Because we’re all human and therefore, imperfect, no matter how compelling or comforting or soothing your mental device might be, you won’t be able to focus on it perfectly. You will become distracted. At some point (and for me it’s usually very early in the process), you’ll find your mind wandering. Instead of focusing on your prayer, you’ll suddenly realize that you’re thinking about a recent movie you saw or a painful social interaction you had earlier in the day or your mind will drift toward a future social situation that you’re dreading.

What’s the solution to the wandering mind?

Well, one thing that’s not the solution is to try harder.

Instead, what Benson meant by a “passive attitude” is that we need to gently accept our mental wanderings and distractions. More commonly, the words we use for Benson’s passive attitude are “Mindful acceptance.” In other words, we accept in the moment of distraction and every moment of distraction, that we are humans who naturally become distracted. And then, after the noticing and after the acceptance, we bring ourselves back to the moment and to our chosen mental device.

On the podcast, Sara asked, “What if, as I try to focus on my mental device, I notice that all the while I have an inner voice talking to me in the background?”

What an excellent question! The first answer is, of course, mindful acceptance. For example, when you notice the inner voice, you might say to yourself, I notice my mind is chattering at me in the background as I focus on my mental device. Then, without judging yourself, you return to your mental device. A second option is for you to find a more engaging or more soothing mental device. Perhaps, you need two mental devices at once? For example, that might include a soft, silky blanket to touch, along with your “I am here” mantra.

As Mary Cover Jones illustrated over 90 years ago, the counterconditioning process is a powerful tool for anxiety reduction and self-regulation. I happen to think that it’s the only tool for anxiety reduction and self-regulation. Whether you agree with me or not isn’t important; either way, don’t let anything I’ve written here get in the way of you identifying and using your own cherished mental (or physical) device. At first, it might not work. It will never work perfectly. But, like Charles Shulz was thinking when he created Linus’s special blanket, life is way better when you live it with a comforting counterconditioning stimulus.

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For more information about Mary Cover Jones, you can go here: https://johnsommersflanagan.com/2011/11/25/a-black-friday-tribute-to-mary-cover-jones-and-her-evidence-based-cookies/

Or here: https://johnsommersflanagan.com/2017/07/17/brain-science-may-be-shiny-but-exposure-therapy-is-pure-gold/

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As I write this (6/4/18), the podcast isn’t quite up yet . . . but will be soon!

To listen to The Secret Self-Regulation Cure on iTunes, go here: https://itunes.apple.com/us/podcast/practically-perfect-parenting-podcast/id1170841304?mt=2

To listen to The Secret Self-Regulation Cure on Libsyn, go here: http://practicallyperfectparenting.libsyn.com/

To check out our podcast Facebook page, go here: https://www.facebook.com/PracticallyPerfectParenting/

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News Flash: The 3rd Edition of Counseling and Psychotherapy Theories in Context and Practice is Now Available!

Theories III Photo

Hello Theories Fans.

I have exciting and good news! The third edition of Counseling and Psychotherapy Theories in Context and Practice is NOW AVAILABLE. Here’s the publisher’s link: https://www.wiley.com/en-us/Counseling+and+Psychotherapy+Theories+in+Context+and+Practice%3A+Skills%2C+Strategies%2C+and+Techniques%2C+3rd+Edition-p-9781119473312

The “less good” news (as the MI folks like to say) is that I wrote up a promotional piece for our publisher to distribute, but they thought it was TOO POSITIVE:) . . . so I’ll do what I can to temper my enthusiasm here.

What’s new in the Third edition?

Other than a massive reference overhaul, empirical updating, and re-writing and editing in response to reviewer feedback, the biggest news is that we added sections Sexuality, Neuroscience, and Spirituality.

The other good news is that our book (2nd edition) already had the highest average Amazon customer rating of all Counseling and Psychotherapy Theories texts, a whopping 4.6 out of 5.0 stars! [for comparison, 4.6 is the same rating as John Grisham’s “The Firm” and higher than Mary Pipher’s “Reviving Ophelia” . . . although, not surprisingly, Grisham’s and Pipher’s works tend to get a few more reviews]

It’s also important to note that our textbook is still relatively inexpensive (compared to other Theories textbooks).

This text also has excellent ancillaries. There is an accompanying video, test bank, online instructor’s resource manual, and a student study guide. The video clips are imperfect and spontaneous demonstrations of specific counseling skills that include counselors and clients with various cultural backgrounds.

Rita and I are humbled and happy to have the opportunity to publish the third edition of our Theories text with John Wiley & Sons. As in previous editions, our primary goal has been to translate complex theoretical material into prose that is engaging, reader friendly, easy to understand, and has a practical/skill-building emphasis. Most, but not all, of the reader reviews on Amazon are affirming and give us hope that we’ve accomplished this goal. To capture some of the positive responses, I’m sharing several Amazon reviews below:

  • The best text book I’ve ever read! Thoroughly enjoy the humor. Each chapter is written slightly different to capture the feel of the theory it describes. Laughed out loud at the final fantasy writing.
  • I love the writers of this book, it is like a conversation and sometimes humorous. Got the book right away.
  • Absolutely amazing read! Every line has important information and I actually enjoy when chapters are assigned for my theories class in this book!
  • While this was purchased for a class, I am really enjoying the information and case studies the author’s present. I do not mind reading this material and think this is one textbook I will not sell back to the bookstore, instead using it for reference throughout my new career.
  • This book was incredibly helpful to me as a counseling student. This is my first semester in the counseling program and this book was full of useful information, very easy to read and understand, and provided a vast overview of the different theories. I will definitely be keeping this book to use as a resource on future papers.

To see all 43 reviews, you have to go to the 2nd edition: https://www.amazon.com/Counseling-Psychotherapy-Theories-Practice-Resource/dp/1119084202/ref=sr_1_1?ie=UTF8&qid=1527631412&sr=8-1&keywords=John+Sommers-Flanagan

And here’s the 3rd edition on Amazon: https://www.amazon.com/Counseling-Psychotherapy-Theories-Context-Practice/dp/1119473314/ref=pd_cp_14_2?_encoding=UTF8&pd_rd_i=1119473314&pd_rd_r=229a780b-638c-11e8-890c-a735446468c0&pd_rd_w=A4Hos&pd_rd_wg=zISf0&pf_rd_i=desktop-dp-sims&pf_rd_m=ATVPDKIKX0DER&pf_rd_p=80460301815383741&pf_rd_r=SY3RS8RHYZYD8HPR7W7Y&pf_rd_s=desktop-dp-sims&pf_rd_t=40701&psc=1&refRID=SY3RS8RHYZYD8HPR7W7Y

As always, let me know if you have questions or comments on this post or on our third edition of Counseling and Psychotherapy Theories in Context and Practice.

Sincerely,

John SF

 

Memories of Memorial Day: How to Use Memory Re-consolidation to Cope with Pain from the Past

Green Shadow II

Back in the 1970s, I remember singing the lyrics to, The Way We Were, along with Barbra Streisand. Using my best falsetto, Barbra and I crooned, “Memories, light the corners of my mind.”

These lyrics aren’t technically correct. But then Barbra and the song’s lyricists, Alan and Marilyn Bergman, didn’t have access to modern brain scans. Based on neuroscience research, it would have been more accurate for Barbra and I to sing, “Memories, light the center of my mind.”

Memories live deep within the brain. If you could magically poke your index finger down through the top center of your skull, you still couldn’t quite reach your brain’s memory structures, the hippocampus and amygdala.

Memories are a fascinating electrical, molecular, cellular, and inter-structural phenomenon. I won’t be providing scientific details about memory, because then I’d have to write something about how the interaction of glucocorticoids and noradrenaline in the basolateral region of the amygdala can modulate the strength of memories in the hippocampus and other brain areas . . . and by then our fascination with memory would doubtless give way to boredom and sleepiness.

Speaking of sleepiness, it’s metaphorically accurate to say that most of our memories typically just lay around dozing in their hippocampal bed until awakened. Not surprisingly, some memories are lighter sleepers than others; they can be easily awakened. Sometimes, when sleeping memories are rudely awakened (triggered) they tend to be rather grumpy and unpleasant.

Here are three examples:

Say you’re creeping around on Facebook. You see an old high school photo from 25 years ago. The visual stimulus of the photo is a memory trigger; several related images and narratives pop into your mind. These images and narratives aren’t grumpy or unpleasant. Instead, you feel warmly nostalgic. This is an example of a visual trigger that activates a mildly pleasant set of associated memories.

In contrast, if you’re a veteran who has experienced war trauma and you hear firecrackers on the 4th of July, your consciousness may flood with vivid, multisensory memories. These memories could link to deep emotional pain. This is an example of an auditory trigger that awakens or activates disturbing memories—memories that you might prefer to put back to sleep.

Now, think of the smell of coffee in the morning. For me, the scent of coffee is neutral. No clear memories are activated. But, when coffee smells are combined with the aroma of bacon on the griddle, I have instant flashbacks to my Grandma Lucy making breakfast. This is an olfactory stimulus triggering a pleasant memory. I see my grandma’s grey hair, pulled back with bobby pins. I can see my own small hands touching and feeling the textured floral pattern on her white milk glass china as I wait for breakfast, watching her. I hear the pop of bacon sizzling. I can imagine the pain I might feel if I get too close to grandma’s griddle. I instantly know the past and future of this memory. First, Grandma Lucy peeled the bacon apart, dangling each piece before laying them on the griddle. Later, she’ll save the bacon grease, for another purpose. She was like that. Another emotion emerges. I feel sad. I miss her.

In honor of memory science, it’s important to note that each of the preceding memories may be more or less historically accurate. Even more important is the likelihood that these memories, like all memories, have changed, shifted, and evolved over time.

How can memories change? Isn’t it true that humans have an experience and then store a record of it in their brain, ready for later retrieval? Not exactly.

As it turns out, new memories are more fluid than solid. Following a memorable experience, memories stay unstable for somewhere between a few minutes and a few hours. New memories are in flux and shaped or degraded by additional new experiences that immediately follow. More remarkable is the fact that, even after storage, every time memories are pulled out (or retrieved) they return to an unstable or vulnerable state, until they re-stabilize or reconsolidate. And when they reconsolidate (a process that involves cellular protein synthesis), they can include new, different, or less information. This is how and why memories change over time.

For many Americans, Memorial Day is an intentional memory day. For example, yesterday there were flowers, speeches, and flag waving. Yesterday, you were probably in the company of family, possibly kneeling at a gravesite, perhaps celebrating the life of someone whom you loved and lost.

Memorial Day is a memory trigger. It’s a time set aside to honor the lives of men and women who died in service of our country. It’s natural and good to engage in this honoring ritual. People also honor non-military family members with flowers and graveside visits. But, amidst the celebrations, as is often the case, the emotional side of life gets short shrift. Typically, we celebrate and move on, despite the fact that it’s equally natural and good to honor the grief that we feel in response to Memorial Day celebratory rituals.

It might have been the 21 gun salute or the color of the flowers or the taste of the potato salad or the smell of your uncle’s cologne. Whatever the case, yesterday you probably had old memories awaken and stroll past you in an internal memory parade. Some of these memories may have been neutral. Others may have been pleasant. Still others, felt angry, sad, guilty, or lonely.

But memories are open to change, and that fact begs for intentionality. What I mean is that we should all have a plan for Memorial Day (and then a plan for Memorial Night). Not only do we need plans for how to celebrate, we need plans for dealing with the raw emotions that Memorial Day can trigger.

I wish I could offer up a simple method for helping you to deal effectively with Memorial Day memory activation and reconsolidation. But you (and everyone) are a unique entity with layers of fantastic idiosyncrasy. Nevertheless, here’s a quick glimpse into the emerging science of memory reconsolidation.

In one research study, participants were exposed to negative emotional memories from watching a trauma film. The next day, these memories were re-activated using a trauma-photo from the film. Then, after a 10 minute-break some participants played a game of Tetris, while others didn’t. The results: Over the next seven days, the participants who played Tetris after having traumatic memories re-activated, experienced significantly fewer intrusive trauma-related memories. The implications? Maybe the Memorial Night solution is to establish a Tetris-playing ritual.

But painful memories are complex and unique. What works for one person, might not work for another. As Drexler and Wolf (authors of a 2018 scholarly review) were inspired to write, “Indeed, when the activation of selective L-type voltage-gated calcium channels or GluN2B-containing NMDA receptors in the hippocampus was prevented before retrieval, thus blocking memory destabilization . . . the interfering air puff had no effect” (p. 15). Reading this led me to conclude that reading more of Drexler and Wolf’s article might serve as another possible memory disrupting intervention to employ during the reconsolidation period. I’m guessing, if you’ve made it to this point in this blog, that you’re inclined to agree.

From a practical perspective, it’s good to know that, generally, memory reconsolidation can take up to six hours. And so, in addition to Tetris and reading intellectual research papers, there are other reasonable strategies you can use to facilitate healthy memory reconsolidation, not just on Memorial Day (or Night), but any time of the year—as long as you’re within the six hour memory consolidation window.

  • Talk with a trusted friend or counselor about the emotions you’re experiencing. Even better, don’t just talk about your emotional pain, but also talk about and focus on the strengths you have for coping with your challenging emotions.
  • Engage in a physically strenuous activity. This could involve some sort of strenuous physical activity like cycling, running, yoga, or weight-lifting.
  • Ritual is good. This could involve a culturally appropriate spiritual activity like going to a sweat lodge or attending a religious service.
  • Writing is a common and effective method for expressing emotions. In particular, writing about your loss in ways that are meaningful to you can be therapeutic.
  • There may be no better way to deal with problematic emotions than engaging in positive helping behavior. Alfred Adler called this social interest. When you’re triggered, consider ways in which you can shift the spotlight away from yourself and toward fostering wellness in others.

Memorial Day is an intentional memory day. We created it and we celebrate it. But you can have other, self-created memory days. And what we know about memory and the disturbing emotions that can accompany memories, is that they present us with an opportunity. Some researchers call this an opportunity for “updating.” Recognizing this opportunity and intentionally engaging in healthy and soothing behaviors when difficult memories are activated is good guidance. This might be Tetris. It might even involve singing along with Barbra Streisand in your best falsetto. The point is that we have power, albeit limited, to update our activated memories . . . and so I wish you the best in finding intentional and healthy ways to soften your painful memories. It’s the honorable thing to do.

The Graduation Speech They Didn’t Let Me Give (again)

Roni Aubrey John Grad 18 Better

This year, like all other years in the history of planet Earth, no one asked me to do a college or university commencement speech. I thought I had a shot at the University of Montana, but they settled on a Nike executive instead.

I puzzled over my lack of commencement speech invites, but only briefly. After all, at my most recent keynote (the Montana School Counseling Association), I spontaneously told my “Just Shut Up” story. It just so happens that my “Just Shut Up” story references a body part that typically isn’t mentioned in keynote speeches.

In my own defense, the “Just Shut Up” story is about adolescent development, and, because the entire experience of adolescent development is inappropriate, it’s impossible to say anything inappropriate when talking about adolescent development. This is so obvious that if you saw a Jeopardy answer saying, “A topic about which it’s impossible to say anything inappropriate” the correct question would, of course, be, “What is adolescent development?” I think I’m on solid ground here.

My point is that I’ve come to accept not getting asked to do commencement speeches. After all, they’re rigorous speaking gigs where you have to be ready to offer sage and complex advice like, “Be yourself” and “Don’t forget to give back.” That sort of sage advice might be somewhat outside my wheelhouse.

But then, the week before last Saturday’s University of Montana commencement, I found out that our graduating M.A. students in Counselor Education had requested a microphone for their post-commencement reception. I didn’t realize it immediately, but upon embarking on my one-mile walk to line up for the commencement ceremony, it hit me. My students were sending me a special indirect message. The microphone was for me. Knowing my penchant for speech-giving, they leaked the microphone intel, so I’d have time to prepare a fancy commencement speech, just for them.

When it comes to graduation speeches, preparation is key, so I spent the 15 minutes of my walk in a state of profound inspiration. I prepared a formal opening and closing, and then wrote two special graduation songs, practicing them along the way. The passerby seemed appreciative, even though they probably couldn’t understand why I was singing “Move your eyes” to the tune of “Shake it Off” or what inspired me to include the main refrain of “A date with Sigmund Freud” instead of “A partridge in a pear tree” when singing “The Twelve Weeks of Theories.”

Being uncertain as to whether I should focus exclusively on songs, I outlined an additional speech. This extra speech was all about the Gestalt of be-here-now and self-awareness, as I integrated the rising (and flooding) spring waters of the Clark Fork River as a metaphor for how over-activity contributes to the opaqueness of the self. To be sure that my commencement message would get through, I also included warnings about Narcissus and his fatal projection of the self. That’s the sort of mythical anecdote that can bring down the house.

Sadly, that afternoon, I discovered that the leaking of the microphone rental was nothing more than the flirtation of a ruse. During the WHOLE Counselor Education reception, the students completely hogged the microphone. All they did was go On and On and On and On (like Jack Johnson) saying nice things about each other and the faculty and the doc students, not leaving me a minute with the mic to get up there with my Poker Face (like Lady Gaga) to perform my freshly written songs.

Grad 18 Awards

In the end, truth be told, the Nike guy was pretty darn good, and likely a better choice than me. But, more importantly, our students were like they usually are . . . AWESOME. These graduates will be heading out to schools, mental health agencies, and intercultural destinations, where they’ll connect with and counsel youth and adults and make the world a healthier place.

Other than my amazing vocal performance, there’s one thing I wish I’d had a chance to say. It might have been something like this:

Take a moment to look around the room. See your classmates, your supportive families, and your faculty. Don’t just see them, SEE them as the multi-layered and profound beings that they are. In this irretrievable sparkling moment of the now, let’s remember a few things together. Remember your decision. You walked in this building to become a counselor. You dedicated yourself to learning how to help others. How cool is that? Feel the power of that memory. Remember our first times together. Remember when your professors kept having you awkwardly introduce yourselves to your new classmates. Feel that awkwardness and anxiety. Let it be with you, remembering that you OWN your future awkwardness and anxiety, because you worked through it, conquering it for now and later. Remember the painful viewing of video recordings of yourself doing counseling. Remember the painful feedback. Remember the tears and joys you experienced together. Remember getting to know the people in this room in ways you never could have imagined, until it happened. Remember growing in respect for yourself, growing your counseling skills, and deepening your respect for your classmates. Remember the late nights, the early mornings, the six straight hours of class, and that assignment (or two) that you pretty much hated. And most of all, remember this moment, right now, surrounded by friends and family. Remember the joy of right now. Remember why you chose this path and why you’re here today. Remember it all, and put it in your heart. Then, in the future, which might be now and might be later, commit yourself to combine your counseling skills, your empathic heart, and your thirst for continued learning. Let the joy of now flow back to the memories of then and the future of what will be. Recognize your new power; it’s like the Force; it’s in your hands, it’s in your heart, it’s in your brain. You take it from here, remembering also, that we are honored to have had time with you and to send you out to shape a healthier and happier society.

Oh. Yeah. I almost forgot. Remember this too, and be grateful: Never again will you have to date Sigmund Freud.

Building Therapeutic Relationships: The Essence of Evidence-Based Counseling

Hey. I’m sitting in an ACA session right now and inappropriately typing on my computer. There’s so much I could type right now . . . but self-censoring is nearly always a good thing.

Attached you’ll find the ppts for my presentation today. I hope you’re all well, and self-censoring in ways that are adaptive and prosocial. I’d write more, but self-control is advisable.

Evidence Based #174 ACA 18

 

What’s Happening at the 2018 American Counseling Association Conference in Atlanta?

20150313_141701

The American Counseling Association annual world conference is coming to Atlanta next week (4/25-29) . . . and so am I.

This year, the ACA conference includes inspiring keynotes, 500+ unique sessions and up to 33.5 hours of CEs. I’m honored to be a part of this exciting learning and networking event. Here’s a link to general conference information: https://www.counseling.org/conference/atlanta-2018

As a part of the 500+ sessions, I’m involved in several events and would love to see you there. Here’s where you can catch me.

On Wednesday, April 25, I’m doing a full-day (6 hour) workshop titled, Tough Teens, Cool Counseling. There are plenty of seats left and you can get registration and other information at the ACA conference website: https://www.counseling.org/conference/atlanta-2018/sessions-events/pre-conference-learning-institutes

On Friday, April 27, from 2 to 3:30pm in Room A313, Kindle Lewis, Kim Parrow, and I will present: Building Therapeutic Relationships: The Heart of Evidence-Based Counseling

On Saturday, April 28, from 10:30 to Noon in Room A410, Sara Polanchek, Maegan Rides At The Door, Salena Beaumont Hill, and I will present: Using (Magic) Words to Influence Challenging Parents . . . With Cultural Commentary

Also on Saturday, April 28, from 1pm to 2pm, John Wiley and Sons is having an event in the Exhibit Hall to launch the publication of 3rd edition of Counseling and Psychotherapy Theories in Context and Practice. There will be coffee and cookies. Although I was tempted to select excerpts of this exciting new textbook and offer dramatic readings, instead, Rita and I will just be low key at the Wiley booth, meeting and greeting people, and answering any questions that might come up about the book or about life. Please come have a cookie with us so that we’re not standing there awkward and alone.

Last, but far more than least, on Saturday night I have the honor of receiving the Don Dinkmeyer Social Interest Award. The ACA National Awards event is from 6-7pm at the Omni Hotel at CNN Center, in the International Ballroom E & F.

Whether you attend ACA or not, I hope you’ll join the 55,000 members (and me) in working to facilitate greater mental and emotional health around the world.

Can Male Therapists Do Feminist Therapy with Male Clients? You Decide — A Feminist Case Example

Fishing Big Davis

The 3rd edition of Counseling and Psychotherapy Theories in Context and Practice will be available very soon. Just in case you’re longing to see the cover as much as I am, there’s a link to the new edition on Amazon. Although I’m betting your longing is much smaller than my longing, here’s the link anyway: https://www.amazon.com/Counseling-Psychotherapy-Theories-Context-Practice/dp/1119279127/ref=dp_ob_title_bk

To celebrate this forthcoming epic publication (it’s not really epic, but some days it felt like a long poem), I’m posting a case presentation from the feminist chapter. Honestly, I don’t know who gets to decide what’s epic or what’s feminist therapy. That being the case, you can decide on both points. Or you can decide you’ve had enough of JSF for today.

Here we go.

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In an interesting twist, we’re featuring a case with a male therapist and male client in the feminist chapter to illustrate how working within a feminist model can work for boys and men. This case focuses on a 16-year-old male’s struggle with emotional expression. John SF is the therapist.

Josh was a White, 16-year-old heterosexual sophomore in high school. He had never met his biological father and lived in a middle-class neighborhood with his mother and three younger sisters. His mother was diagnosed with bipolar disorder. Josh’s main loves were consistent with his gender identity. They included basketball, cars, girls, and sarcasm. He very much disliked school.

Josh and I met for therapy for several years. At the beginning of one of our sessions Josh handed me a packet of photos.

“Hey, what’s this about?” I asked.

He responded with a half-mumble about a recent awards ceremony. I thought I discerned pride in that mumble. I looked through the pictures while he told me about each one. There was one in particular that he gently lifted from my hands. It was a picture of him in a line-up with five other people. He carefully pointed out that he was standing next to the Lieutenant Governor of Oregon. I teased him because there were no pictures of him and the actual governor.

“What’s the deal?” I asked. “Wouldn’t the Guv pose with you?” Josh rolled his eyes and signaled for me to move on to the next photo.

The Problem List and Problem Formulation

Unlike CBT, feminist therapy doesn’t involve collaboratively generating a concrete problem list and formulating problems as if the problems resided in the client. Instead, because problems and problem-formulation are inseparable, we can’t talk about the problems without also talking about cultural factors creating and contributing to the problems.

If client issues are discussed as problems, they’re likely discussed as situational challenges. In Josh’s case, his mother initially had brought him to therapy for anger management. Anger was consistently a regular focus in Josh’s therapy. Like many 16-year-old boys immersed in the dominant U.S. culture, Josh’s emotional life was highly constricted. He was living by Pollack’s boy code (2000) and unable or unwilling to risk feeling anything other than anger and irritation. From the feminist worldview, this wasn’t Josh’s problem; his issues around anger stemmed from him living in a culture that kept him in an emotional straitjacket.

Josh’s issues (and case formulation from a feminist perspective) looked like this:

  1. Learning to deal more effectively with sadness, grief, and anger within the context of a repressive emotional environment.
  2. Coming to an understanding that his beliefs and views of emotional expression were not in his best interest, but instead, foisted upon him by toxic cultural attitudes about how boys and men should experience and express emotion.
  3. Developing trust and confidence in himself—despite not having a father figure or a mother who could provide him and his sisters with a consistently safe and stable home environment.
  4. Learning to talk about what he really feels inside and pursue his life passions whatever they might be instead of reflexively pursuing culturally “manly” activities.
  5. Expanding Josh’s limited emotional vocabulary through consciousness-raising.

Interventions

Feminist therapists are technically eclectic; they use a wide range of interventions imbedded in an egalitarian and mutually empathic relationship:

  1. Encouraging Josh to speak freely and openly about his life experiences.
  2. Empathic listening with intermittent focusing on more tender emotions, depending on how much of this Josh was willing or able to tolerate.
  3. Therapist self-disclosure and modeling.

As Josh and I looked at photos together, I responded with interest and enthusiasm. Because interpersonal connection is a core part of therapy, I didn’t rush him to move on to our therapy agenda. Instead, I shifted back and forth between saying, “Cool” or “What’s going on there?” to making sarcastic wisecracks like “Why exactly did the government let you into the capital building?” Sarcasm was used to express interest and affection indirectly, mirroring Josh’s humor and style. After seeing most of the photos I asked, “Who’s the person standing next to you?” I could tell from his response that I had asked a good question.

“Oh, yeah, her. Her name is Sharice; her mentor was getting the same award as my mentor. I danced with her. She’s a good dancer.”

We talked about dancing and what it was like for him to feel attracted to her. We were ten minutes into therapy and both of us had completely ignored the fact that we hadn’t been able to see each other for five weeks. Finally, I decided to break the avoidance pattern. I asked “So…how are you doing with all that’s been going on?”

He looked toward me, glancing downward.

“I’m doing okay, I guess.”

Because this was a young man who had been socialized to keep his emotions tightly wrapped, I probed, but gently.

“I understand it’s been pretty wild times?”

He looked up, eyes fixed on some invisible spot on the ceiling. I recognized this strategy—a surefire way avoid crying in public. An upward gaze constricts the tear ducts; tears cannot flow.

He looked back down and said, “I’ve been busy. My mom’s been in the hospital for about a month.”

“I heard she had a pretty hard time.”

He grunted and then, in a quiet growly voice, the words, “Let-me-tell-you-about-it” seeped out from behind his teeth. Silence followed. I cautiously probed a bit more by sharing more of what I knew.

“I talked with your mom yesterday. She told me that she got pretty caught up in some housing project.” This statement lit a fire in Josh and he plunged into the story.

“You won’t believe what she did. It was so f*ing stupid. Some punk developer is gonna build three houses. Three houses at the end of our street. This is no big deal. She just f*ing freaked out. She chained herself up to a tractor to stop them from building a house. Then she called the f*ing senator and road department and I don’t know who in hell else she called. She was totally nuts. So I told her she had a choice. I told her that she could go back home or I’d call the police and have her committed. She wasn’t taking care of my sisters. She was being a shit for a mom. So I just gave her a choice.”

I nodded and said, “You must be practicing to be a parent. That’s the kind of choice parents give their kids.”

His voice grew louder: “I gave her the choice five times. Five f*ing times! She tried to buy a Mercedes and a Volvo over the phone. So I called the cops. And the woman asked ME what to do. I’m f***ing 16 years old and they f *ing ask me what to do. I didn’t know what to say. I told ‘em to come get her. They finally sent some really big cops over to take her away.”

“Then what happened?”

“My mom was still acting nuts and my sisters were crying. So I just picked them up and held them and they took her away. We sat and they cried and we snuggled a while. And then I drove us home. I don’t have my license, but I can drive. My mom is still pissed at me about that, but I don’t give a shit!”

While listening to Josh, I formed an image of him in my mind. I saw an awkward 16-year-old boy “snuggling” his sobbing sisters, as the cops take their mother away. The girls were 9 and 6 and 4 years old—the same sisters he had complained about in previous therapy sessions.

Talking with teenage boys about emotional issues is tricky. Too much empathy and they retreat. No empathy and you’re teaching the wrong lesson. Throughout Josh’s storytelling, I used sarcasm, empathy, and emotional exploration, like, “What was that like for you to gather up your sisters and take care of them?” I suspected that if I asked too much about feelings or forced him to go too deep too fast, I would lose my “coolness rating” and there would be a relationship rupture.

Much of the session focused on empathy for Josh’s anger. Josh ranted and I listened. He was immensely angry and disappointed and hurt about his mother’s behavior. But I wanted to find a way to let Josh know that it’s okay, even a positive thing, for boys and men to feel and express more tender feelings.

About halfway through our session, I asked:

“So Josh,” I said, “When was the last time you cried?”

After a short pause he spoke with extreme deliberation, “I… don’t… cry… I… just… get… pissed.”

Josh expressed this masculine emotional principle very efficiently and then offered more about his socially coerced, but internalized emotional philosophy.

“Crying doesn’t do any good. It doesn’t change anything. It’s just stupid.”

“I know, I know” I said. “The whole idea of crying sounds pretty stupid to you. It’s not like crying will change your mom and make her better.”

“Nothing will ever change her.”

I renewed my pursuit of when he last cried. He insisted that was so long ago that he couldn’t recall, but we both knew that several years ago, after an especially hard week with his mother, he had sat on my couch and sobbed himself to sleep. Instead of bringing that up, I asked him what might make him cry now. Would he cry if his girlfriend broke up with him… if he lost his cell phone… if one of his sisters got cancer… if he didn’t graduate high school? Josh fended off my questions about tears by repeating his resolve to get “pissed” about everything that might make him feel sad. But the question about one of his sister’s getting cancer stumped him. He admitted, “Yeah, I might cry about that…” while quickly adding, “…but I’d do it alone!”

I responded, “Right. Absolutely. Some things might be worth crying about… even though it wouldn’t change things… but you’d want to do the crying alone.”

We talked indirectly and intellectually about sadness and tears, trying to model that we can talk about it—once removed—and if he cried someday, it would be perfectly okay, there would be no need to feel ashamed.

Toward the end of the session, I decided to lighten things up by teasing Josh about his social insensitivity. I said, “I can’t believe that we’ve talked this whole hour and you never asked a single thing about me.”

Josh grinned. He knew therapy was all about him and not about me. He probably thought I was playing some sort of therapy game with him. He was a good sport and played along.

“Okay. So what am I supposed to ask?”

I acted offended, saying, “After all those questions I asked you, at least you should ask me when I last cried.”

“God you don’t know when to drop things. Okay. So when did you cry?”

I said, “I think it was yesterday.”

Our eyes met. He looked surprised. I continued, “Yeah. I feel sad sometimes. It can be about really hard stories I hear in here or it can be about my own life. Even though it doesn’t change anything, it can feel better to let my sadness out.”

It was time for the session to end. We both stood and I said, “We have to stop for today, but we can talk more about this or whatever you want to talk about next time.”