Category Archives: Counseling and Psychotherapy Theory and Practice

Counseling and Psychotherapy Theory and Practice, Personal Reflections, Writing

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

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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.

Counseling and Psychotherapy Theory and Practice, Personal Reflections

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

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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.

Counseling and Psychotherapy Theory and Practice

Building Therapeutic Relationships: The Essence of Evidence-Based Counseling

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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

 

Cool Counseling, Counseling and Psychotherapy Theory and Practice, Parenting

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

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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.

Counseling and Psychotherapy Theory and Practice

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

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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.

*******

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.”

 

Counseling and Psychotherapy Theory and Practice

How about Spirituality and the Constructive Perspective?

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The second most popular blog post in the history of time is about the distinction between social constructionism and constructivism. Since I’m sure you want to do what’s popular, here it is: https://johnsommersflanagan.com/2015/12/05/constructivism-vs-social-constructionism-whats-the-difference/

Wait. I constructed that reality. It would be more accurate to make it clear that my bold claim only pertains to my little tiny blog. The constructivism vs. social constructionism averages about 21 hits a day. Whether that makes it popular or not depends on our agreed-upon definition of popular.

We currently live on a planet where people get away with labeling anything they personally disagree with as “fake news.” For many of us, this may have shaken our trust in all things real. Of course, that doesn’t justify me lying. about my so-called popular blog post. In fact, it may  be all he more important for me (and everyone) to be more diligent about the truth.

But this week I’m posting about spirituality and constructive counseling and psychotherapy theory. That means we question reality; it doesn’t necessarily mean we should lie.

Here’s the section from Counseling and Psychotherapy Theories in Context and Practice.

Constructive Theory and Spirituality

For constructive theorists and therapists (aka narrative and solution-focused practitioners), spirituality and religion are either (a) individual or (b) social constructions. That doesn’t mean faith is unimportant or irrelevant. In fact, narrative and solution-focused approaches can attract highly religious and spiritual individuals. However, within the scientific literature, there aren’t many publications focusing on the integration of spirituality and constructive therapies.

A PsycInfo title search identified only a handful of publications combining solution-focused or narrative and religious or spiritual. These included an article on solution-focused counseling with clients who have spiritual or religious concerns (Guterman & Leite, 2006) and a meta-analysis of spiritual/narrative interventions on quality of life among cancer patients (Kruizinga et al., 2016).

Guterman and Leite (2006) proposed implementing a standard solution-focused approach with clients who have religious or spiritual problems. They reasoned that because problems are socially constructed and can be addressed via solution-focused strategies, then religious or spiritual problems could be addressed in the same manner. In particular, they advised that the change process involve helping clients to identify and amplify exceptions until the problem is resolved (p. 45). Further, they recommended that a thorough understanding of client worldview was needed to facilitate generation of appropriate and effective solutions.

In the meta-analysis of spiritual/narrative approaches with cancer patients, 12 trials with 1,878 clients were included. Results indicated a moderate immediate effect on overall quality of life (d = 0.50). However, at 3–6 months, the quality of life was no longer significantly improved. The researchers recommend additional studies to understand better how spiritual/narrative interventions might come to have a longer-term effect.

Overall, the crossroad of spirituality and constructive counseling and psychotherapy doesn’t have much traffic. This leaves open great possibilities for further explorations, including the chance to drive brand new thesis and dissertation projects down (or up) this wide-open road.

This photo constructs a reality wherein my long-time friend Neil and I are still only 18-years-old.

Neil and John

 

Counseling and Psychotherapy Theory and Practice, Personal Reflections, Writing

Feminist Theory and Spirituality

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Woman Statue

Continuing on our stroll through counseling and psychotherapy theories and spirituality, we come now to complicated crossroad; this is where feminism and spirituality intersect. Our focus is on how feminist theorists and feminist therapists deal with spirituality.

This intersection is complex primarily because the manner in which many religions characterize women’s roles and women’s potential is, shall we say, limiting. In contrast, feminist theory views the limiting of women as inappropriate, inaccurate, unacceptable, oppressive, and pathology-creating. All this is to say that when religion and women’s rights converge, there’s ample room for conflict.

The following excerpt from Counseling and Psychotherapy Theories in Context and Practice is a lazy stroll. It’s lazy because we don’t go very deep. Instead, because adherents of both perspectives may have strong beliefs (and emotions), we leave the going deep to you. As you contemplate going deeper, it’s nice to keep in mind the theological, philosophical, and practical idea of “Both-And.” There may be paths for becoming both profoundly spiritual and profoundly feminist. And, at least from the surface, the spiritual-feminist path has the look of something quite different from a lazy stroll.

Here’s the short excerpt:

Feminist Theory and Spirituality

Most dominant world religions have rules or practices that restrict women’s freedoms. In some cases, feminists view religion as abusive, coercive, and dangerous toward women. In most cases, feminists view dominant religions as laden with conservative, patriarchal values (Hagen, Arczynski, Morrow, & Hawxhurst, 2011; Jiménez, Almansa, & Alcón, 2017).

The naturally activist orientation of feminism can create tension between feminist therapists and specific religious practices. For example, female genital mutilation is considered a male-perpetuated human rights violation that sanctions systemic violence toward girls and women. Despite the feminist general philosophy of openness to diverse ways of being, feminists view systematic oppression of females in the name of religion to be intolerable (Jiménez et al., 2017).

Feminists see potential for affirmation and liberation in spiritual alternatives. Specifically, feminist writers have discussed ways in which sexually diverse women can use spirituality to enhance their resilience within oppressive sociocultural contexts (Hagen et al., 2011). Integrating affirming spirituality into feminist therapy is an acceptable and, for many clients and therapists, preferred practice (Funderburk & Fukuyama, 2001; Hagen et al., 2011)

Adherents to male-oriented religious or cultural norms are unlikely to welcome feminist critique of their values. This is where the potential for conflict is highest and where feminists could be viewed as imposing their values on other cultural or religious groups. Feminists view the systematic oppression of women as unacceptable, regardless of political, religious, or cultural justifications that might be used to support oppression.

 

 

Clinical Interviewing, Cool Counseling, Counseling and Psychotherapy Theory and Practice, Parenting, Therapy with Adolescents, Tough Kids, Tough Kids Cool Counseling

Upcoming Workshops!

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John II

Coming up in March and April, I’ve got two, two-day professional workshops scheduled at the University of Montana. Together, these workshops can earn you 2-credits through the U of M . . . or you can enroll for continuing education credit (one workshop = 2 days = 13 CE hours). Whatever you decide, coming to Missoula in early March and early April is pretty fabulous. We’ve scheduled these workshops for the first Friday and Saturday in Missoula to coincide with the First Friday Art Walk. That way you can workshop during the day and walk around downtown Missoula and check out fantastic Montana art Friday evening.

The workshops and their descriptions are below:

March 2 and 3, 8:30am to 4:30pm: Working with Challenging Youth and Parents . . .  and Loving It

Counseling difficult youth and challenging parents can be immensely frustrating or splendidly gratifying. The truth of this statement is so obvious that the supportive reference, at least according to many teenagers is, “Duh!” Using storytelling, video clips, live demonstrations, group discussion, and skill-building break-out sessions, John will present essential evidence-based principles and over 20 specific techniques for influencing “tough” clients or students. Techniques for working with youth will include, but are not limited to: (a) the affect bridge, (b) what’s good about you?, (c) empowered storytelling, (d) generating behavioral alternatives, (e) the three-step emotional change technique, and many more. Dr. Sara Polanchek will join John for the parenting portion of the workshop. They will describe essential principles for working effectively with parents, how to conduct brief parenting consultations using a positive, solution-focused model, and strategies for providing parents with specific suggestions and advice to parents. Issues related to ethics and culture will be highlighted and discussed throughout this two-day workshop.

Here’s a link to the registration form for both workshops. Registration Form for JSF Workshops 2018

If you want to call for more information: Call 406-243-5252 and leave a message if our administrative person is away. Or you can always email me: john.sf@mso.umt.edu

April 6 and 7, 8:30am to 4:30pm: Variations on the Clinical Interview: Collaborative Approaches to Mental Status Examinations, Suicide Assessment, and Suicide Interventions

The clinical interview is the headwaters from which all mental health assessment and interventions flow. In this workshop, following an overview of clinical interviewing principles and practice, skills training for conducting the mental status examination (MSE) and suicide assessment interviews will be provided. Participants will learn MSE terminology, common symptom clusters and presentations, and strategies through which the MSE can be more collaborative and user-friendly. Additionally, participants will learn a flexible model for conducting suicide assessments. This model features eight core suicide dimensions and techniques for directly and collaboratively questioning clients about suicide ideations, previous attempts, hopelessness, and more. Five suicide interventions will be featured: alternatives to suicide; separating suicide intent from the self; interpersonal re-connection; neodissociation; and safety-planning.

One last note: On Wednesday, February 14, I’ll be doing my annual 1/2 day workshop on Tough Kids, Cool Counseling in the Schools at the annual meeting of the National Association of School Psychologists (NASP). We’re in Chicago this year. So if you happen to be in Chicago, check out the NASP conference. https://www.nasponline.org/professional-development/nasp-2018-annual-convention

 

 

 

Counseling and Psychotherapy Theory and Practice

Choice Theory/Reality Therapy and Spirituality

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John and Bob Wubbolding 2017 B

Counseling and psychotherapy theories are wildly variable and surprisingly convergent. What do I mean by this? Well, despite the fact that Sigmund Freud and Francine Shapiro and Steven Hayes and Marsha Linehan have very different ideas about what helps people change for the better, there’s also a boatload of commonality.

Based on my narrow range of experience and knowledge, nowhere is there more commonality than the theoretical outposts of Adlerian theory (i.e., Individual Psychology) and Choice Theory/Reality Therapy. Both of these approaches include a broad theoretical concept related to an individual’s personal and cultural construction of how they view themselves, others, and the world (i.e., Adlerians say “Lifestyle” while Reality Therapists say “Quality World”); both perspectives view individuals as pulled forward by internal values (and not driven by Freudian conflicts); both perspectives view behavior as purposeful, and perhaps not coincidently, they also view psychopathology as purposeful.

All this theory-speak is way for me to introduce this post as a continuation of my spirituality and counseling/psychotherapy theories series. What’s especially interesting about this post (IMHO) is that I’m writing about spirituality and Reality Therapy. I mean, how can a form of therapy that explicitly emphasizes “reality,” accommodate “spirituality?” We’ll see about that . . . maybe.

Chapter 9 of Counseling and Psychotherapy Theories in Context and Practice focuses on choice theory and reality therapy. Many people may not perfectly understand the definitions of choice theory and reality therapy. As a quick refresher, here’s an excerpt from the beginning of Chapter 9, followed by the brief spirituality section.

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

Reality therapy is often oversimplified and confused with confrontational therapeutic approaches. In this chapter we describe and explain the nuances and clarify the confusion.

What is Choice Theory and Reality Therapy?

Glasser developed reality therapy in the 1960s. Later, recognizing that he needed a theoretical foundation for his therapeutic approach, he began exploring cybernetics and control system theory (Powers, 1973; Wiener, 1948). Initially, Glasser used control theory to explain reality therapy. Later, he adapted the theoretical model and shifted to using choice theory (Glasser, 1998).

Choice theory is based on the idea that conscious behaviors are chosen in an effort to satisfy one of five internal basic human needs (Wubbolding & Brickel, 2017). The human mind or brain acts as a “negative input control system,” providing feedback to individuals so that they can correct behaviors and continue getting what they need and want (Wubbolding, 2012, p. 13).

Reality therapy is a present-focused, directive therapeutic approach designed to help individuals identify and satisfy their needs and wants more consistently and adaptively. As Wubbolding (2012) has written, “If choice theory is the track, reality therapy is the train that delivers the product” (p. 5).

Choice Theory, Reality Therapy, and Spirituality

In the 1989 Spring issue of the Journal of Reality Therapy, Brent Dennis, a certified reality therapist, wrote an article titled, “Faith: The fifth psychological need.” Glasser (1989) responded later that year. Glasser noted that he found the discussion interesting, but that there is “no possible way to resolve an argument about belief” (p. 29). He concluded with a statement embracing inclusiveness toward whatever anyone might place in their quality world. Consistent with this perspective, contemporary reality therapists have published book chapters on how to help interfaith and multicultural couples succeed in their partnerships and marriages (Minatrea & Duba, 2012; Olver, 2012). It’s interesting however, that Glasser described faith as residing in an individual’s quality world; he did not embrace it as a new psychological human need.

In an article on integrating reality therapy into Malaysian Islamic culture, Jusoh and Ahmad (2009) described many ways in which choice theory is consistent with Islam and can be practiced in Asian cultures. Specifically, they focused on the WDEP and SAMI2C3 systems and emphasized their compatibility with Islamic concepts. They concluded that “choice theory and reality therapy have universal attributes, and these can be interpreted in any religion or culture” (2009, p. 7). This statement seems consistent with Glasser’s (1989) inclusive statement on spirituality as a potential human need.

Overall, aside from the content briefly summarized here, little information exists on the integration of spirituality into reality therapy. However, given the growing international flavor of CT/RT, progress in this area seems inevitable.

 

Counseling and Psychotherapy Theory and Practice

CBT and Spirituality

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Evening Snow Absarokee

We have a friend who is the pastor of a church in Absarokee, Montana. My impression is that she frequently talks about theories of counseling and psychotherapy . . . even though I’m sure she hasn’t planned to integrate psychological theory into her sermons. The fact that I hear psychological theories as she talks theology is just another way in which the lens of the listener frames what is heard, seen, and experienced.

Today she was preaching about feelings of inferiority. She made the case, as Adler would, that inferiority feelings are natural and normal. Then she shifted to God’s acceptance or grace. Surprisingly (to me) her focus on acceptance reminded me of Albert Ellis’s REBT and his concept of universal self-acceptance. Although my friend was speaking about God’s acceptance of all humans, regardless of our warts and behaviors, I found myself thinking of times when I’ve heard parents express deep acceptance of their children and of when clients have strived to experience greater self-acceptance.

All this brought me to a place where I started thinking about how Ellis and his REBT model might actually have a spiritual dimension. “That was pleasantly unexpected” I thought to myself . . . which prompted me to write this Sunday evening spirituality post.

The following is an excerpt (preview) from the cognitive behavior chapter of the forthcoming 3rd edition of Counseling and Psychotherapy Theories in Context and Practice. Please let me know what you think.

CBT and Spirituality

Like all therapists, cognitive behavior therapists work with religious or spiritual clients. Given that cognitively oriented therapists routinely identify and challenge (either through disputation or collaborative empiricism) client beliefs, there’s a risk that clients’ deeply held religious or spiritual beliefs might also be challenged. Additionally, practiced as a radical modernist scientific paradigm, CBT has been critiqued for overlooking transcendence, grace, and evil (Stewart-Sicking, 2015).

Looking at the situation logically (which cognitive theorists would appreciate), CBT practitioners have three options:

  1. Ignore client religion and spirituality.
  2. Freely challenge religious beliefs, whenever they cause emotional distress.
  3. Integrate religious/spiritual knowledge into practice in a way that supports nuanced discussions of religion and spirituality. Unhelpful or irrational thoughts might be questioned, as needed, but not central religious values (Johnson, 2013).

Historically, cognitive therapists have followed these first two options, mostly ignoring religion, or questioning its rational foundations (Andersson & Asmundson, 2006; Nielsen & Ellis, 1994). However, in the past decade or two, interest in integrating religion/spirituality into counseling and psychotherapy has increased (Stewart-Sicking, 2015).

It can help to think about client religion/spirituality as a multicultural/diversity issue. If so, the general guide is for therapists to (a) seek awareness of their own spiritual and religious attitudes and how they might affect counseling process and specific clients, (b) obtain relevant knowledge about religion/spirituality, (c) learn religion/spirituality specific skills, and (d) advocate for individuals who are oppressed on the basis of religion/spirituality as needed and as appropriate. Each of these cultural competence components can be stimulating for individual practitioners.

For practitioners interested in religion/spirituality integration with cognitive approaches, the following two areas can provide focus for further training and development.

Gain and Apply Scriptural Knowledge with Clients

Gaining knowledge regarding how to use specific religious scriptures to dispute irrational or maladaptive cognitions may seem daunting. However, from an REBT perspective, Nielsen (2001) wrote:

Since clients usually upset themselves through their awfulizing, demanding, frustration intolerance, and human rating, REBTers need only search Scriptures that decatastrophize life, suggest forbearance in the face of uncontrollable people and situations, tolerance of life’s frustrations, and that affirm basic human equality. The prominent religious writings of most major world religions emphasize such rational values. (p. 38)

Using scriptural knowledge would be most appropriate when working with clients who have similar religious beliefs. Nielsen (2001) is advocating general knowledge, but general knowledge could prove problematic. For example, if a Jewish therapist quoted the Koran to a Muslim client, the discussion might quickly shift away from being therapeutic. On the other hand, having general knowledge, if used sensitively, could represent appreciation of religious diversity and enhance the working alliance.

Use Spiritual Principles of Acceptance for Managing Disturbing Cognitions.

Contemporary CBT approaches (covered in Chapter 14) offer an alternative way of viewing and handling so-called irrational or maladaptive cognitions. These approaches include acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and mindfulness-based cognitive therapy (MBCT). ACT, DBT, and MBCT integrate religious/spiritual philosophy (e.g., Buddhism, contemplative Christian, etc.) and generally view cognitions as disturbing, but not necessarily pathological. Acceptance of all cognitions is advocated; encouraging clients to dispute or restructure their thoughts, memories, and experiences can increase suffering (Hayes, 2016).