Category Archives: Counseling and Psychotherapy Theory and Practice

Counseling and Psychotherapy Theory and Practice, Happiness, Personal Reflections

Positive Psychology for the Weekend

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Rock People

Yesterday I happened to meet up with a guy in a coffee shop. We recognized each other immediately. While chatting, we got coffee, sat down, and talked about positive psychology.

The meeting was neither random nor happenstance. We planned it. I know it’s silly to say that something goes without saying, and writing that something goes without saying is sillier yet, but I’m writing it anyway: Planning and intentionality are very good things. Without intentional planning, I never would have met my coffee-buddy, and I’d be less smart today than I am now.

This guy (I’ll call him Carlton, because that’s his name) was inspired to reach out to me with an email because I’m teaching a Happiness Class at the University of Montana this spring semester. He has a Master’s degree in positive psychology. He wanted to talk. Positive psychology people are like that. After using my impaired scheduling skills to mess up our first planned meeting, we were able to get together on our second try.

Carlton was abuzz with positive energy even before he drank his Americano, but that should be no particular surprise. He told me about taking red-eye flights from Seattle to Philadelphia to complete his “commuter” M.A. in positive psych. Clearly, he’s high on life, which made for an episode of fast talking and listening that got cut short by my need to drive east to Absarokee. So, what happened during this short, speedy conversation that made me smarter?

Turns out, we’re from the same hometown. I’m sure that made me smarter. After all, that was the town where I read nearly every Norman Vincent Peale book ever written. Apparently, I learned that growing up in Vancouver, Washington creates a need for positivity. But, of greater relevance was the fact that he was (another non-surprise) a treasure of information about positive psychology.

Carlton told me of some of his favorite positive psychology ideas and activities. I took notes. I’m not going into the details. Most of the information is top-secret and you’ll have to take my Happiness class to get the down low. Instead. I’m presenting you with one highlight to take with you into your weekend.

The best part—amongst many good parts—was being re-introduced to one of the biggest positive psychology names of all time. Although I knew about Christopher Peterson in a distant sort of way, I’d never really plunged into his work. Maybe that’s because I figured if I knew about Martin Seligman, then I didn’t need to know much about Chris Peterson. Or maybe it was because sometimes I have a limited and narrow take on the world. Somehow, sometimes, I presume that if I don’t know about something, it must not be all that important, or I would have already learned it. I recognize that as a terribly self-centered perspective, but it can creep into my psyche anyway, leading me down a road where I think I already know everything I need to know. When that happens, I need to do work to get around and past or through my own narrow mental world.

Carlton not only offered to lecture in my Happiness class (yet another reason to register now!), he also helped open my mind to deeper issues in positive psychology. He told me about a video where Peterson boils everything about positive psychology down to three words. The three words, “Other people matter.”

Being a big fan and proponent of Adler and social interest or Gemeinschaftsgefühl, I experienced deep and immediate love for Peterson’s three words. They were simpler and deeper than other positive psychology words and ideas I’d experienced previously. And remember, I spent most of the late 1970’s reading Norman Vincent Peale. In addition to The Power of Positive Thinking and You Can If You Think You Can, both of which I now consider mostly a load of crock (I’m not quite sure what a crock is, but I’m using crock as a euphemism so I can claim that at least some of my blogs are profanity-free). I even read some of Peale’s less popular works, like, Sin, Sex, and Self-Control. . . the reading of which may partially explain my interest in having at least some profanity-free blogs.

This morning I looked at my notes and I looked up the Chris Peterson video. Spoiler alert, my favorite part is when Peterson says:

“Sometimes when I give a talk, I tell the audience, if you really don’t want to listen to me for the next hour, listen to me for five seconds, because I’ll tell you what positive psychology is all about. Other people matter. Period. I’m done with my talk.” (Chris Peterson, Ph.D., from an interview and shown as a part of a Positivity Project video that you can watch here:  https://www.youtube.com/watch?v=AEc2W8JVuRw).

Obviously, that’s an awesome quotation, and an amazing five-second talk, but I like this next Peterson quotation even better. The story is that one of Peterson’s research buddies, Nansook Park, asked Peterson how or why he gave so freely of himself to others. Peterson responded, “Other people matter and we are all other people to everyone else.”

I know everyone reading this won’t feel the tingle I feel, but I love the statement, “Other people matter and we are all other people to everyone else.” Peterson’s message is circular. If I want to be loved, then I love. Okay, maybe it’s just a knock off of the Golden Rule, which may be a knock off of ancient Egypt’s “Do to the doer to make him do.” Even so, I find the statement that “Other people matter and we are all other people to everyone else” an empowering way to think about how important it is to lead with love and kindness and respect. It’s important for them, and it’s important for us.

Now that I’ve quoted and re-quoted Peterson several times, I’m sensing that this blog is moving toward its natural conclusion. But, just like it’s hard to find the natural origin of the reciprocity maxim (i.e., Golden Rule), it’s also hard to find the natural conclusion. I could end with Adler (always a solid choice). In his boldly titled book (What life should mean to you) from 1931, Adler said that the meaning of life was to have “interest in others and cooperation.”

Alternatively, I might end with a quick summary of a 75-year longitudinal Harvard study. The researchers concluded: “Good relationships keep us happier and healthier.”

Instead, I’ll point you to a video written by Tiffany Shlain and Sawyer Steele, titled 30,000 Days. I discovered this video while in pursuit of information on Christopher Peterson (instead of being in the pursuit of happiness). Watching the 11 minute 30,000 Days video is one way to launch your upcoming fantastic weekend. Here’s the link: https://vimeo.com/226378903  

 

 

Counseling and Psychotherapy Theory and Practice, Personal Reflections

Two Announcements: A New Article on EBRFs and a New Milestone

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Coffee

Two things.

First, Kim Parrow, a doctoral student at the University of Montana emailed me a copy of our hot new journal article. The article explores evidence-based relationship factors as an exciting focus of research, practice, and training in Counselor Education. The article is published in the Journal of Mental Health Counseling. Here’s a link so you can read the article, if you like: EBRFs in JMHC 2019

Second, today when I logged into my WordPress blog, something seemed different. As it turns out, my official number of followers had turned from 999 to 1,000. I’m not sure what that means, other than a woman named Shaina from Thrive has won a special prize. Maybe I’ll see you on Thursday evening Shaina.

I hope you’ve all had a great day, especially all the veterans out there, who IMHO deserve deep appreciation for their service.

Counseling and Psychotherapy Theory and Practice, Happiness, Suicide Assessment and Intervention

On the Road to Billings . . . and Well-Being . . . and Happiness

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Baby Laugh

Tonight I have the honor of offering a public lecture in Billings. Situated as a part of a series of community suicide-related talks, my title is “Psychological Well-Being and the Pursuit of Happiness.” I suspect somewhere between 3 and 30 people will be in attendance. Although I’m hoping for 30, I’m realistically assuming that Rita and the program’s host will show. Counting me, that makes three!

To help get attendance over 3, someone suggested I edit this post to include the time and location. I’m on at 7pm till 8:30pm on the second floor of the MSU-B library, room 231. Hope to see you there.

Below, I’m pasting the handout for tonight. Being in the green lane, I’m trying to save paper and make these products available online. Here you go!

Psychological Well-Being and the Pursuit of Happiness

John Sommers-Flanagan, Ph.D.

Following is a summary of key points for John Sommers-Flanagan’s presentation for the Big Sky Youth Empowerment Program and Montana Social Scientists, LLC, Billings, MT – November 7, 2019

Introduction: Happiness can run very fast. So, let’s chase well-being instead

  1. The Many Roads to Well-Being. You can find well-being on emotional, mental, social, physical, spiritual/cultural, behavioral, and environmental roadways.
  2. It’s Natural, but not Helpful, to do the Opposite of What Creates Well-Being. If we want to catch well-being, we need to actively plan and pursue it.
  3. The Pennebaker Studies. Writing or talking about deeper emotions and thoughts will make you healthier (better immune functioning) and happier. Choking off our emotions is inadvisable.
  4. The Cherries Story. It’s not what happens to us . . . but what we think about what happens to us . . . that increases or decreases our misery. Focusing on your good qualities can be difficult, but doing so helps build a strong foundation.
  5. Savoring. Use the power of your mind to extend and expand positive experiences.
  6. Why Children (and Adults) Misbehave. When people feel a deep sense of belonging and socially useful, the need to misbehave and feelings of suicide diminish.
  7. Exercise is the Solution (No matter the question). Exercise reduces depression in youth and offsets the genetic predisposition toward depression in adults. You can stretch or lift or do cardio, but get moving!
  8. Holding Hands and Hugging is a Chemical Gift (or not). Consent, timing, and desirable companionship are foundational to whether touch contributes to health.
  9. If You Can’t Catch Happiness or Well-Being, Start Chasing Meaning. Regular involvement in spiritual, cultural, religious, or social justice groups will feel so good that you might experience happiness and well-being along the way.
  10. Remember gratitude. All too often we forget to notice and express gratitude. Put it on your planner; both you and the person who receives your gratitude will thank you for it.

 ****************************************************

John Sommers-Flanagan is a Professor of Counseling at the University of Montana. For more information, go to his blog at johnsommersflanagan.com. John is solely responsible for the content of this handout. Good luck in your pursuit of wellness.

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice, Suicide Assessment and Intervention

A Sneak Peek at the Suicide Assessment and Treatment Planning Workshop Coming to Billings on November 8

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IMG-1852

Anybody wondering what’s new in suicide assessment and treatment?

If so, come listen to any or all of a very nice suicide prevention/intervention line-up on November 7 and 8 on the campus of Montana State University in Billings. Here’s a news link with detailed info: https://billingsgazette.com/news/local/let-s-talk-montana-suicide-prevention-workshops-coming-to-msub/article_9a6f04ff-376f-56b8-a6a8-9a0160ba1cbb.html

For my part, I’m presenting the latest iteration of the suicide assessment and treatment model Rita and I have been working on for the past couple years. To help make suicide assessment and treatment planning easier, we’ve started using six common sense life domains to organize, understand, and apply specific assessment and intervention tools.

Another unique component of our model is an emphasis on client strengths and wellness. Obviously, in the context of suicide, it’s impossible (and wrong) to ignore clients’ emotional pain and suffering. However, we also think it’s possible (and right) to intermittently recognize, nurture, and focus on clients’ strengths, well-being, and goals.

What follows is a sneak peek at what I’ll be covering on Friday, November 8.

Suicide Interventions and Treatment Planning: Foundational Principles

Two essential principles that cut across all modern evidence-based protocols and evidence-based interventions form the foundation of all contemporary suicide assessment and treatment models:

  • Collaboration – Working in partnership with clients
  • Compassion – Emotional attunement without judgment

Collaborative practitioners work with clients, not on clients. Clients experiencing suicidal thoughts and impulses typically know their struggles from the inside out. Their self-knowledge makes them an invaluable resource. Carl Rogers (1961) put it this way,

It is the client who knows what hurts, what directions to go, what problems are crucial, what experiences have been deeply buried. It began to occur to me that unless I had a need to demonstrate my own cleverness and learning, I would do better to rely upon the client for the direction of movement in the process. (p. 11)

Compassionate practitioners resonate with client emotions and engage in respectful and gentle emotional exploration. Although compassion involves an empathic emotional response, it also includes tuning into and respecting client cognitions, beliefs, and experiences. For example, some clients who are suicidal feel spiritually or culturally bereft or disconnected. Regardless of their own beliefs and cultural values, compassionate counselors show empathy for their clients’ particular spiritual or cultural distress.

Clients who are or who become suicidal are often observant, sensitive, and intelligent. If they feel you’re judging them, they’re likely to experience a relationship rupture (Safran, Muran, & Eubanks-Carter, 2011). When ruptures occur, clients typically become less open, less engaged, and less honest about their suicidal thoughts and impulses. They also may become angry, aggressive, and critical of your efforts to be of help. In both cases, relational ruptures signal a need to work on mending the therapeutic relationship.

[For a helpful meta-analysis with recommendations on repairing ruptures, check out this article from the Safran lab: http://www.safranlab.net/uploads/7/6/4/6/7646935/repairing_alliance_ruptures._psychotherapy_2011.pdf%5D

The Six Life Domains

Working with clients who are suicidal can be overwhelming. To help organize and streamline the assessment and treatment planning process, it’s helpful to consider six distinct, but overlapping life domains. These domains provide a holistic description of human functioning. When clients experience suicidal thoughts and impulses, you can be sure the suicidal state will manifest through one or more of these six domains (i.e., emotions, cognitions, interpersonal, physical, spiritual/cultural, and behavioral; see below for a brief description of the six domains). All case examples and content in the workshop use these six domains to focus and organize client problems, goals/strengths, and interventions.

Suicidality as Manifest through Six Life Domains             

The Emotional Domain. A driving force in the suicidal state is excruciating emotional distress. Shneidman called this “psychache” and toward the end of his career concluded: “Suicide is caused by psychache” (1993, p. 53). Extreme distress is experienced subjectively. This is one reason there are so many different suicide risk factors. When a specific experience triggers excruciating distress for a given individual (e.g., unemployment, insomnia, etc.), it may increase suicide risk. Reducing emotional distress and facilitating positive emotional experiences is usually goal #1 in your treatment plan. Treatment plans often target general distress as well as specific and problematic emotions like (a) sadness, (b) shame, (c) fear/anxiety, and (d) guilt/regret.
The Cognitive Domain. Suicidal distress interferes with cognitive functioning. The resulting constricted thinking impairs problem-solving and creativity. The emotional distress and depressed mood associated with suicidality decreases the ability to think of or value alternatives to suicide. Several other cognitive variables are also linked to suicidality, including hopelessness and self-hatred. Most treatment plans will include collaborative problem-solving, and gentle challenging of maladaptive thoughts. Specific interventions may be employed to support client problem-solving, increase client hopefulness, and decrease client self-hatred.
The Interpersonal Domain. Hundreds of studies link social problems to suicidality, suicide attempts, and suicide deaths. Joiner (2005) identified two interpersonal problems that are deeply linked to suicide: thwarted belongingness and perceived burdensomeness. Many risk factors (e.g., recent romantic break-up, family rejection of sexuality, health conditions that cause people to feel like a burden) can exacerbate thwarted belongingness and cause people to perceive themselves as a social burden. Improving interpersonal relationships is often a key part of treatment planning.
The Physical/Biogenetic Domain. Physiological factors can contribute to suicide risk. In particular, researchers have recently focused on agitation or physiological arousal; these physical states tend to push individuals toward suicidal action. Additionally, chronic illness or pain, insomnia, and other disturbing health situations (including addictions) contribute to suicide, especially when accompanied by hopelessness. When present, physical conditions and biogenetic predispositions should be integrated into suicide prevention, treatment planning, and risk management.
The Spiritual/Cultural Domain. Meaningful life experiences can be a protective influence against suicide. No doubt, a wide range of cultural or religious pressures, spiritual/religious exile, or other factors can decrease an individual’s sense of meaning and can contribute to suicidal thoughts and behaviors. Including spiritual or meaning-focused components in a treatment plan can improve outcomes, especially among clients who hold deep spiritual and cultural values.
The Behavioral Domain. All of the preceding life domains can contribute to suicide, but suicide doesn’t occur unless individuals act on suicidal thoughts and impulses. The behavioral domain focuses on suicide intentions and active suicide planning. When clients actively plan or rehearse suicide, they may be doing so to overcome natural fears and aversions to physical pain and death; natural fears and aversions stop many people from suicide. Joiner (2005) and Klonsky and May (2015) have written about how desensitization to physical pain and to ideas of death move people toward suicidal action. Several factors increase risk in this domain and may be relevant to treatment planning, (a) availability of lethal means (especially firearms), (b) using substances for emotional/physical numbing, and (c) repeated suicide rehearsal (e.g., increased cutting behaviors).

*Note: These domains will always overlap, but they can prove helpful as you collaboratively identify problem areas and goals with your client.

If you’re interested in learning more about this suicide assessment and treatment planning model, I hope to see you in Billings on November 8!

 

 

 

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice, Writing

The Dialectics of Diagnosis at MFPE in Belgrade

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Waving

Today I’m in Bozeman on my way to present to the Montana School Counselors in Belgrade, MT. As my friends at the Big Sky Youth Empowerment Program like to say, “I’m stoked!” I’m stoked because there’s hardly anything much better than spending a day with Montana School Counselors. Woohoo!

My topic tomorrow is “Strategies for Supporting Students with Common Mental Health Conditions.” That means I’ll be reviewing some DSM/ICD diagnostic criteria and that brings me to reflect on the following. . . .

Not long ago (July, 2019), Allsopp, Read, Corcoran, & Kinderman published an article in Psychiatry Research, not so boldly titled, “Heterogeneity in psychiatric diagnostic classification.” Hmm, sounds fascinating (not!).

A few days later, a summary of the article appeared in the less academically and more media oriented, ScienceDaily. The ScienceDaily’s contrasting and much bolder title was, “Psychiatric diagnosis ‘scientifically meaningless.” Wow!

The ScienceDaily summary took the issue even further. They wrote: “A new study, published in Psychiatry Research, has concluded that psychiatric diagnoses are scientifically worthless as tools to identify discrete mental health disorders.”

Did you catch that? Scientifically worthless!

In an interview with ScienceDaily, Allsopp, Read, and Kinderman stoked the passion, and avoided any word-mincing.

Dr. Kate Allsopp said, “Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences.”

Professor Peter Kinderman, University of Liverpool, said: “This study provides yet more evidence that the biomedical diagnostic approach in psychiatry is not fit for purpose. Diagnoses frequently and uncritically reported as ‘real illnesses’ are in fact made on the basis of internally inconsistent, confused and contradictory patterns of largely arbitrary criteria. The diagnostic system wrongly assumes that all distress results from disorder, and relies heavily on subjective judgments about what is normal.”

Professor John Read, University of East London, said: “Perhaps it is time we stopped pretending that medical-sounding labels contribute anything to our understanding of the complex causes of human distress or of what kind of help we need when distressed.”

In contrast to the authors’ conclusions, nearly every conventional psychiatrist believes the opposite–and emphasizes that psychiatric diagnosis is of great scientific and medical importance. For example, the Midtown Psychiatry and TMS Center website says, “A correct diagnosis helps the psychiatrist formulate the most effective treatment that will result in remission.”

No doubt there.

In addition, although I literally love that Allsopp, Read, and Kinderman are so outspoken about the potential deleterious effects of diagnosis, I think maybe they take it too far. For example, “Shall we pretend that we should provide the same intervention for panic attacks as we provide for conduct disorder, autism spectrum disorder, and gender dysphoria?”

That’s me talking now . . . and as I discussed this with Rita, she amplified that, of course, if you have a student who’s intentionally engaging in violent acts that harm others, we’re not treating them the same as a student who’s suffering panic attacks. Obviously.

Psychiatric diagnosis is a great example of a dialectic. Yes, in some ways it’s meaningless and overblown. And yes, in some ways it provides crucial information that informs our treatment approaches.

This leads me to my final point, and to my handouts.

What’s our School Counseling take-away message?

Let’s keep the baby and throw out with the bathwater.

Let’s de-emphasize labels – because labelling, whether accurate or inaccurate and whether self-inflicted or other inflicted, are possibly pathology-inducing.

Instead, let’s focus on specific behavior patterns, as well as abilities, impairments, stressors, and trauma experiences that interfere with academic achievement, personal and social functioning, and career potential.

In case you’re interested in more on this. My handouts for the workshop are below.

The Powerpoints: MFPE 2019 Belgrade Final

Managing fear and anxiety:Childhood Fears Rev

Student de-escalation tips: De-escalation Handout REV

Why Kids Lie and What to Do About It

 

 

Counseling and Psychotherapy Theory and Practice, Personal Reflections

Happy Saturday Morning at ACES in Seattle

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Space_Needle_2011-07-04

The Association of Counselor Educators and Supervisors (ACES) conference is underway in Seattle. Seattle is a fabulous location. It’s great to be back in my home state.

It’s also great to be with so many fabulous people. Counselor educators are some of the nicest people on the planet. The conversations are intellectually stimulating, kind, compassionate, and positive relationship skills are on display everywhere.

Speaking of positive relationship skills, this morning, Kim Parrow (a fantastic doc student in our Counseling program at U of Montana) and I are presenting on Evidence-Based Relationship Factors (EBRFs). If you’re not sure what EBRFs are, or want to learn more, then check out the resources below.

The Powerpoints are here: ACES Seattle Kim and John Final REV

A previously published journal article from the Journal of Mental Health Counseling is here: JoMHC EB Article by John SF 2015

Counseling and Psychotherapy Theory and Practice, Suicide Assessment and Intervention

Trauma, Suicide, and Motivational Interviewing: A Handout for BYEP Mentors

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Sunset

Trauma may be the most common underlying factor contributing to mental disorders. Unfortunately, trauma is often overlooked, partly because it can manifest itself in so many different ways. That said, here are some common definitions. Trauma always involves a stressful trigger that activates a trauma response. Because, like everything, trauma responses are brain-based and involve the body, symptoms affect the whole person.

Old, informal, and useful definitions include:

  • A stressor outside the realm of normal human experience (but sadly, trauma is all-too-common)
  • A betrayal . . . (e.g., something that should not happen)
  • Occurrence of an event that’s emotionally overwhelming

Below I’ve listed the essence of the DSM-5 definition for Post-Traumatic Stress Disorder (note that the whole idea of PTSD centers on the chronic or long-lasting effects of trauma).

Exposure to a traumatic stressor that involves direct personal experience, witnessing, or learning about events involving threatened death, serious injury, or a threat to your physical integrity. The trauma response includes:

  • Intrusion symptoms (recurring unwanted memories, nightmares, flashbacks, and triggered distress)
  • Avoidance of trauma-related thoughts or external cues
  • Negative cognitive alternations (e.g., memory gaps, no joy, etc.)
  • Arousal and reactivity (e.g., irritability, risky behaviors, hypervigilance, insomnia, startle response)

Trauma and trauma responses can be big, medium, and small. Big traumas meet the DSM-5 diagnostic criteria for PTSD or acute stress disorder. Small traumas are usually disturbing and disruptive, but the body and brain adjust to them within 2-3 days. Medium size traumas have lasting effects, but don’t meet formal diagnostic criterial, and are usually referred to as subclinical.

I like to think of Trauma with an uppercase T (like in the DSM) and all other traumas that are difficult, challenging, and require adjustment as traumas with a lowercase t.

What to Say

Sometimes trauma responses or symptoms are visible and obvious. If so, it’s good to say and do some of the following:

  • Listen and show compassion
  • Reassure participants that physical/psychological responses are normal, take up energy & need soothing
  • Note that very effective treatments are available (e.g., This American Life)
  • Brainstorm on what helps
  • Remember: A pill is not a skill
  • Link and universalize (“It’s normal to have pleasant and unpleasant reactions to things we talk about”)
  • Brainstorm on more and less healthy reactions (Using substances is a quick distraction, but not a fix)
  • Share hopeful stories (what skills can be developed?)
  • Self-disclosure can help. But be careful with self-disclosure and remember that it’s not about you

Trauma is a normal and natural human response. You may experience trauma just by listening to people talk about trauma, or you may have your own direct experiences. When in the business of helping others, be sure to take good care of yourself.

Three Suicide Myths

Myth #1: Suicidal thoughts are about death and dying.

Most people assume that suicidal thoughts are about death and dying. On the surface, it seems like a no-brainer: Someone has thoughts about death, therefore, the thoughts must be about death. But the truth isn’t always how it appears from the surface. The human brain is complex. Thoughts about death may not be about death itself.

Myth #2: Suicide and suicidal thinking are signs of mental illness.

Not true. Philosophers and research scientists agree: nearly everyone on the planet thinks about suicide at one time or another—even if briefly. The philosopher Friedrich Nietzsche referred to suicidal thoughts as a coping strategy, writing, “The thought of suicide is a great consolation: by means of it one gets through many a dark night.”

Myth #3: Scientific knowledge about suicide risk factors and warning signs allows for the prediction and prevention of suicide.

Believing in this myth can make surviving family members, friends, and helping professionals experience too much guilt and responsibility. In fact, even the most famous suicidologists say that it’s impossible to consistently and accurately predict suicide.

Tips for Talking about Suicide

We need to be able to talk directly about suicide with courage and calmness. But first, we should listen. Here’s what you should listen for in general

  • Emotional pain
  • A sense of feeling trapped or ashamed
  • Not believing that anything can possibly help to reduce the pain and misery

While listening, show acceptance, empathy, and compassion. Remember: suicidal thoughts are not signs of illness or moral failing; if you judge the person, it will make it harder for the person to be open. Also remember: when people talk with you about their suicidal thoughts, that’s a good thing, because you can’t help unless they’re comfortable enough with you to speak openly about their suicidal thoughts and feelings.

Traditional warning signs in particular

Although it’s good to know these warning signs, there’s not much research supporting the idea that anything predicts suicide.

  • Active suicidal thinking that includes planning and talk about wanting to die
  • Preparation and rehearsal behaviors (stockpiling pills, giving away belongings, etc.)
  • Hopelessness related to feeling that the excruciating distress will never end
  • Recklessness, impulsivity, dramatic mood changes
  • Anger, anxiety, and agitation
  • Feeling trapped
  • No reasons for living, no purpose in life, broken relationships
  • Increased alcohol or substance abuse
  • Immense shame or self-hatred

How should I ask about suicide?

The answer to this is always, “Ask directly.” But we can do even better than that. We need to de-shame suicidal thoughts and talk. Before asking, communicate that you know suicidal thoughts are a normal and natural response to emotional pain and disturbing situations. For example, you could ask it this way, “I know that it’s not unusual for people to think about suicide. Have you had any thoughts about suicide?”

What should I say if someone admits to thinking about suicide? You can say things like,

  • Thanks for telling me.
  • It sounds like things have been terribly hard.
  • Thanks for being so honest, that takes courage.
  • I know I can’t instantly make everything better, but I want you to live and I want to help.
  • How can I best support you right now?
  • What can we do together that would help?
  • When you want to give up, tell yourself to hold off for one more day, hour, minute—whatever you can.
  • Or . . . use your good listening skills and reflect back the feelings and thoughts that the person shared.

Resources for Help

  • National Suicide Prevention Lifeline: Call 800-273-TALK (800-273-8255)
  • Crisis Text Line: Text HOME to 741741
  • Bozeman Help Center – 24-Hour Crisis Line: (406) 586-3333

What is Motivational Interviewing?

Motivational interviewing (MI) is an evidence-based approach to treating substance problems, health concerns, and other mental health issues. MI is “person-centered” and based on the foundational principle that clients should be the ones who make the case for change in their lives. MI:

  • Focuses on the common problem of ambivalence about change.
  • Relies on four central listening skills (OARS): open questions, affirming, reflecting, and summarizing.
  • Helps clients transition from less healthy to more healthy behaviors

Four overlapping components combine to create the spirit of MI:

  • Collaboration (partnership; dancing, not wrestling)
  • Acceptance (UPR, accurate empathy, autonomy, affirmation)
  • Compassion (honoring the client’s best interest)
  • Evocation (tapping the client’s well of wisdom)

MI is a specific treatment approach that requires professional training. However, operating on a few basic MI principles can improve nearly anyone’s approach to helping others. For more information, see the book: Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. New York, NY: Guilford Press.

This handout is from a mentor workshop for the Big Sky Youth Empowerment Program. These ideas are based on research and collected from professionals who have experience working with people who are feeling suicidal. These guidelines should not be considered medical advice and are no substitute for getting an appointment with a licensed health or mental health professional. See: johnsommersflanagan.com for more information.

Counseling and Psychotherapy Theory and Practice

Why Bother Studying Counseling and Psychotherapy Theories?

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rita-and-john-tippet

A photo of me and my feminist inspiration.

People are often curious about why I would bother writing (and revising) a book on Counseling and Psychotherapy Theories. I usually tell them “I do it for the money” and then laugh like the witch in The Wizard of Oz.

Okay. So it’s obviously not about the money, and I don’t really laugh like that witch, because that would just be frightening and weird and ever since I fell down and hit my head while engaging in a frightening and weird act, I’ve had a pact with myself not to do things that are frightening and weird.

Anyway, to refocus . . . in response to this “Why bother” question, and to elaborate on the post from last week about “What’s your theoretical orientation?” I’m including an excerpt from Chapter One of our Theories textbook. Enjoy.

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About a decade ago, we were flying back from a professional conference when a professor (we’ll call him Darrell) from a large Midwestern university spotted an empty seat next to us. He sat down, and initiated the sort of conversation that probably only happens among university professors.

“I think theories are passé. There has to be a better way to teach students how to actually do counseling and psychotherapy.”

When confronted like this, I (John) like to pretend I’m Carl Rogers (see Chapter 5), so I paraphrased, “You’re thinking there’s a better way.”

“Yes!” he said. “All the textbooks start with Freud and crawl their way to the present. We waste time reviewing outdated theories that were developed by old white men. What’s the point?”

“The old theories seem pointless to you.” I felt congruent with my inner Rogers.

“Worse than pointless.” He glared. “They’re destructive! We live in a diverse culture. I’m a white heterosexual male and they don’t even fit me. We need to teach our students the technical skills to implement empirically supported treatments. That’s what our clients want, and that’s what they deserve. For the next edition of your theories text, you should put traditional theories of counseling and psychotherapy in the dumpster where they belong.”

John’s Carl Rogers persona was about to go all Albert Ellis (see Chapter 8) when the plane’s intercom crackled to life. The flight attendant asked everyone to return to their seats. Our colleague reluctantly rose and bid us farewell.

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On the surface, Darrell’s argument is compelling. Counseling and psychotherapy theories must address unique issues pertaining to women and racial, ethnic, sexual, and religious minorities. Theories also need to be more practical. Students should be able to read a theories chapter and finish with a clear sense of how to apply that theory in practice.

Darrell’s argument is also off target. Although he’s advocating an evidence-based (scientific) orientation, he doesn’t appreciate the central role of theory to science. From early prehistoric writing to the present, theory has been used to guide research and practice. Why? Because theory provides direction and without theory, practitioners would be setting sail without resources for navigation. In the end, you might find your way, but the trip would be shorter with GPS.

Counseling and psychotherapy theories are well-developed systems for understanding, explaining, predicting, and controlling human behavior. When someone on Twitter writes, “I have a theory that autism is caused by biological fathers who played too many computer games when they were children” it’s not a theory. More likely, it’s a thought or a guess or a goofy statement pertaining to that person’s idiosyncratic take on reality; it might be an effort to prove a point or sound clever, but it’s not a theory (actually, that particular idea isn’t even a good dissertation hypothesis).

Theories are foundations from which we build our understanding of human development, human suffering, self-destructive behavior, and positive change. Without theory, we can’t understand why people engage in self-destructive behaviors or why they sometimes stop being self-destructive. If we can’t understand why people behave in certain ways, then our ability to identify and apply effective treatments is compromised. In fact, every evidence-based or empirically supported approach rests on the shoulders of counseling and psychotherapy theory.

In life and psychotherapy, there are repeating patterns. I recall making an argument similar to Darrell’s while in graduate school. I complained to a professor that I wanted to focus on learning the essentials of becoming a great therapist. Her feedback was direct: I could become a technician who applied specific procedures to people or I could grapple with deeper issues and become a real therapist with a more profound understanding of human problems. If I chose the latter, then I could articulate the benefits and limitations of specific psychological change strategies and modify those strategies to fit unique and diverse clients.

Just like Darrell, my professor was biased, but in the opposite direction. She valued nuance, human mystery, and existential angst. She devalued what she viewed (at the time) as the superficiality of behavior therapy.

Both viewpoints have relevance to counseling and psychotherapy. We need technical skills for implementing research-based treatments, but we also need respect and empathy for idiosyncratic individuals who come to us for compassion and insight. We need the ability to view clients and problems from many perspectives—ranging from the indigenous to the contemporary medical model. To be proficient at applying specific technical skills, we need to understand the nuances and dynamics of psychotherapy and how human change happens. In the end, that means we need to study theories.

Contemporary Theories, Not Pop Psychology

Despite Darrell’s argument that traditional theories belong in the dumpster, all the theories in this text—even the old ones—are contemporary and relevant. They’re contemporary because they (a) have research support and (b) have been updated or adapted for working with diverse clients. They’re relevant because they include specific strategies and techniques that facilitate emotional, psychological, and behavioral change. Although some of these theories are more popular than others, they shouldn’t be confused with “pop” psychology.

Another reason these theories don’t belong in the dumpster is because their development and application include drama and intrigue that rival anything Hollywood has to offer. They include literature, myth, religion, and our dominant and minority political and social systems. They address and attempt to explain big issues, including:

  • How we define mental health.
  • Whether we believe in mental illness.
  • Views on love, meaning, death, and personal responsibility.
  • What triggers anger, joy, sadness, and depression.
  • Why trauma and tragedy strengthens some people, while weakening others.

There’s no single explanation for these and other big issues; often mental health professionals are in profound disagreement. Therefore, it should be no surprise that this book—a book about the major contemporary theories and techniques of psychotherapy and counseling—will contain controversy and conflict. We do our best to bring you more than just the theoretical facts; we also bring you the thrills and disappointments linked to contemporary theories of human motivation, functioning, and change.

Counseling and Psychotherapy Theory and Practice

What’s Your Theoretical Orientation?

5 Comments

Corey Wubbolding and SF

On CESNET, several people asked about a “cheat sheet” to help students understand the distinctions between different counseling and psychotherapy theories,. Although many excellent options exist and some were offered up on CESNET, I’m adding mine here.

Here’s a Table with brief descriptions of each theory: Theoretical Orientation Summary Table

Here’s a short self-report “test” that students can take to self-identify their natural theoretical perspectives: What’s Your Theoretical Orientation – Short Questionnaire

I also have a longer self-report test that I can send you upon request. Just email me at john.sf@mso.umt.edu and I can send it along.

Thanks for your interest in counseling theories.

The files on this post are adapted from Chapter 1 (Psychotherapy and Counseling Essentials) of Counseling and Psychotherapy Theories in Context and Practice (2018, 3rd edition, John Wiley & Sons) by John and Rita Sommers-Flanagan.

You can request a free evaluation copy of the text through John Wiley & Sons: 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-9781119279136

Counseling and Psychotherapy Theory and Practice

Thinking About Counseling and Psychotherapy Theories

7 Comments

Theories III Photo

Definitions happen.

The process through which words and concepts are defined is fascinating. By definition, definitions need to be sharp and make distinctions, and yet they also sometimes be inclusive and blurry on the edges.

In the latest (3rd) edition of Counseling and Psychotherapy Theories in Context and Practice, Rita and I take aim at the definitions of counseling and psychotherapy. Read on, and if you’re inspired to do so, let me know what you think.

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Definitions of Counseling and Psychotherapy

Many students have asked us, “Should I get a PhD in psychology, a master’s degree in counseling, or a master’s in social work?”

This question usually brings forth a lengthy response, during which we not only explain the differences between these various degrees but also discuss additional career information pertaining to the PsyD degree, psychiatry, school counseling, school psychology, and psychiatric nursing. This sometimes leads to the confusing topic of the differences between counseling and psychotherapy. As time permits, we also share our thoughts about less-confusing topics, like the meaning of life.

Sorting out differences between mental health disciplines is difficult. Jay Haley (1977) was once asked: “In relation to being a successful therapist, what are the differences between psychiatrists, social workers, and psychologists?” He responded: “Except for ideology, salary, status, and power, the differences are irrelevant” (p. 165). Obviously, many different professional tracks can lead you toward becoming a successful mental health professional – despite a few ideological, salary, status, and power differences.

In this section we explore three confusing questions: What is psychotherapy? What is counseling? And what are the differences between the two?

What Is Psychotherapy?

Anna O., an early psychoanalytic patient of Josef Breuer (a mentor of Sigmund Freud), called her treatment the talking cure. This is an elegant, albeit vague, description of psychotherapy. Technically, it tells us very little but, at the intuitive level, it explains psychotherapy very well. Anna was saying something most people readily admit: talking, expressing, verbalizing, or sharing one’s pain and life story is potentially healing.

As we write today, heated arguments about how to practice psychotherapy continue (Baker & McFall, 2014; Laska, Gurman, & Wampold, 2014). This debate won’t soon end and is directly relevant to how psychotherapy is defined (Wampold & Imel, 2015). We explore dimensions of this debate in the pages to come. For now, keep in mind that although historically Anna O. viewed and experienced talking as her cure (an expressive-cathartic process), many contemporary researchers and writers emphasize that the opposite is more important – that a future Anna O. would benefit even more from listening to and learning from her therapist (a receptive-educational process). Based on this perspective, some researchers and practitioners believe therapists are more effective when they actively and expertly teach their clients cognitive and behavioral principles and skills (aka psychoeducation).

We have several favorite psychotherapy definitions:

  • A conversation with a therapeutic purpose (Korchin, 1976, p 281).
  • The purchase of friendship (Schofield, 1964, p. 1).
  • When one person with an emotional disorder gets help from another person who has a little less of an emotional disorder (J. Watkins, personal communication, October 13, 1983).

What Is Counseling?

Counselors have struggled to define their craft in ways similar to psychotherapists. Here’s a sampling:

  • Counseling is the artful application of scientifically derived psychological knowledge and techniques for the purpose of changing human behavior (Burke, 1989, p. 12).
  • Counseling consists of whatever ethical activities a counselor undertakes in an effort to help the client engage in those types of behavior that will lead to a resolution of the client’s problems (Krumboltz, 1965, p. 3).
  • [Counseling is] an activity … for working with relatively normal-functioning individuals who are experiencing developmental or adjustment problems (Kottler & Brown, 1996, p. 7).

We now turn to the question of the differences between counseling and psychotherapy.

What are the Differences Between Psychotherapy and Counseling?

Years ago, Patterson (1973) wrote: “There are no essential differences between counseling and psychotherapy” (p. xiv). We basically agree with Patterson, but we like how Corsini and Wedding (2000) framed it:

Counseling and psychotherapy are the same qualitatively; they differ only quantitatively; there is nothing that a psychotherapist does that a counselor does not do. (p. 2)

This statement implies that counselors and psychotherapists engage in the same behaviors—listening, questioning, interpreting, explaining, and advising—but may do so in different proportions.

The professional literature mostly implies that psychotherapists are less directive, go a little deeper, work a little longer, and charge a higher fee. In contrast, counselors are slightly more directive, work more on developmentally normal—but troubling—issues, work more overtly on practical client problems, work more briefly, and charge a bit less. In the case of individual counselors and psychotherapists, each of these tendencies may be reversed; some counselors work longer with clients and charge more, whereas some psychotherapists work more briefly with clients and charge less.

A Working Definition of Counseling and Psychotherapy

There are strong similarities between counseling and psychotherapy. Because the similarities vastly outweigh the differences we use the words counseling and psychotherapy interchangeably. Sometimes we use the word therapy as an alternative.

To capture the natural complexity of this thing called psychotherapy, we offer the following 12-part definition. Counseling or psychotherapy is:

(a) a process that involves (b) a trained professional who abides by (c) accepted ethical guidelines and has (d) competencies for working with (e) diverse individuals who are in distress or have life problems that led them to (f) seek help (possibly at the insistence of others) or they may be (g) seeking personal growth, but either way, these parties (h) establish an explicit agreement (informed consent) to (i) work together (more or less collaboratively) toward (j) mutually acceptable goals (k) using theoretically-based or evidence-based procedures that, in the broadest sense, have been shown to (l) facilitate human learning or human development or reduce disturbing symptoms.

Although this definition is long and multifaceted, it’s still probably insufficient. For example, it wouldn’t fit for any self-administered forms of therapy, such as self-analysis or self-hypnosis—although we’re quite certain that if you read through this definition several times, you’re likely to experience a self-induced hypnotic trance state.

*To learn more about our Counseling and Psychotherapy Theories text, all you have to do is Google it. If you’re looking for an instructor’s copy, Google the book title and then go to the Wiley website and request one. If you have troubles with that, email me . . . and I can likely help out.