Category Archives: Counseling and Psychotherapy Theory and Practice

Counseling and Psychotherapy Theory and Practice

CBT and Spirituality

2 Comments

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).

 

Counseling and Psychotherapy Theory and Practice

Behavior Therapy and Spirituality

3 Comments

1974 Football Cropped II

The whole idea of integrating behavior therapy with religion and spirituality might seem odd or off or impossible. But here in Theories Land, we don’t believe in the impossible. In fact, many religious folks do just fine with behavior therapy and many behavior therapists do just fine with religious folks. If you think about it, for behaviorists, the focus is purely on problematic behaviors. In some ways, this naturally leads to an acceptance of all people . . . .

Put another way, for behaviorists, there’s no room or need for discrimination based on race, sexuality, or religion. Behaviorists work with all people to help them with their problem behaviors.

Rather than digressing into the political, let’s refocus on behavior therapy and spirituality. Here’s the short section from the 3rd edition of Counseling and Psychotherapy Theories in Context and Practice. If you feel moved (by the spirit, or anything else), please let me know what you think.

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

Strict behaviorists don’t believe in the utility of cognition. The clients’ problems are behaviors. Behavioral treatments involve new learning to facilitate behavior change. If you stick with the perspective that cognition is irrelevant—which is the perspective we’re sticking with in this chapter—then client religious or spiritual beliefs are also not relevant.

Considering religious and spiritual beliefs as irrelevant doesn’t imply disrespect for religious and spiritual beliefs. Behaviorists are respectful of beliefs, but the focus of therapy would be on behaviors—these behaviors could include religious or spiritual behaviors. If you’re following the logic here, then you can see that behavior therapy is 100% compatible with religion and spirituality.

The focus of behavior therapy with religious and spiritual clients would be on behaviors that are related to religion and spirituality. From a behavioral model, the question is, “Are your religious/spiritual behaviors causing you distress or contributing to your well-being?” The good news about this is that behavior therapy is an evidence-based approach for modifying behavior, including the development of positive and healthy habits (and behaviors commonly thought of as representing self-control and self-discipline). The focus on enhancing self-control and self-discipline is a good fit for clients with religious or spiritual orientations (Shapiro, 1978).

Researchers have explored the relationship between behavioral activation and client values. In one study, it was found that when individuals with high intrinsic religious values engaged in a greater frequency of religious behaviors, they reported reduced depressive symptoms (Agishtein et al., 2013). Conversely, for individuals with low intrinsic religious values, increasing religious behaviors were associated with more depressive symptoms. In conclusion, despite disregard for religious/spiritual beliefs, a strict behavioral approach can be used to increase or decrease specific religious and spiritual behaviors. . . and increasing or decreasing specific religious and spiritual behaviors may be therapeutic—depending on the individual client and his/her/their situation.

 

Counseling and Psychotherapy Theory and Practice

Person-Centered Spirituality

2 Comments

Rogerian Spirituality

Most of the distinct figures who developed major theories of psychotherapy also had distinct views about religion and spirituality. As you may recall, Freud was antagonistic toward religion. One of the interesting parts of exploring how each theoretical orientation deals with spirituality has involved learning a bit more about the religious and spiritual perspectives of people like Freud, Adler, and others.

In chapter 5 of Counseling and Psychotherapy Theories in Context and Practice, the focus is on Carl Rogers. Other than knowing that he was raised in a conservative Christian family, I didn’t know much about Rogers and his personal spirituality. Here’s a sampling of what I discovered.

Person-Centered Spirituality

On his journey to developing person-centered theory and therapy, Carl Rogers renounced traditional Christianity. Given that all religions, including Christianity, can be viewed as directly imposing judgmental conditions of worth, Rogers’s renouncing Christianity as antithetical to his beliefs is not surprising. In particular, Rogers may have been especially reactive to religious dogma because of his childhood experiences in an extremely conservative Christian family. Thorne (1990) proposed that Rogers broke from Christianity, at least in part, over the doctrine of original sin.

Although he died an agnostic, toward the end of his life, Rogers began speaking about transcendental or mystical experiences (Thorne, 1992). These spiritual statements were mostly made in the context of interpersonal mutuality and human connection, derived from person-centered or I-Thou experiences. Within the person-centered world, his statements about spirituality have been viewed as controversial (Fruehwirth, 2013). In an interview with Elizabeth Sheerer, one of Rogers’s early colleagues at the University of Chicago Counseling Center, Sheerer was asked about why Rogers never formally addressed spirituality. Her response included:

That’s Carl. This was an area of difficulty for Carl. We learned early in the game not to talk about religion with Carl … it was uncomfortable for him …. But, of course, his work is so profoundly influenced by his background in Christianity. I don’t think he could have developed without that background. (Barrineau, 1990, pp. 423–424)

There have been contemporary efforts to build a bridge between spirituality and PCT. One example is Fruehwirth’s (2013) work connecting PCT and Christian contemplation. He proposed that if wordless contemplation can be regarded as “the heart of the Christian spiritual tradition” (p. 370), then parallels can be drawn to wordless contemplation and the PCT experience. Similarly, a case can be made connecting the acceptance doctrine of Christian, Buddhist, and other religious viewpoints with the PCT process.

Overall, it seems reasonable that, for some therapists and clients, the deep interpersonal acceptance inherent in the PCT experience might have religious, spiritual, or mystical components. Spiritual-based acceptance is probably the main place where an integration of PCT and religion/spirituality can occur. In contrast, wherever and whenever judgment flows from religious doctrine, religion and PCT are incompatible.

 

Counseling and Psychotherapy Theory and Practice, Writing

Existential Spirituality

7 Comments

Bikes Snow 2

An impromtu word search of the existential theory chapter for the 3rd edition of Counseling and Psychotherapy Theories in Context and Practice revealed 17 appearances of the word “spirituality.” That’s nice. Seventeen is a prime number. Seventeen is also one of my favorite spiritual numbers. Back in 2nd grade in Sunday school in a synagogue in Portland, my teacher asked us to guess a number from 1 to 20. The winner had the honor of taking a special Bible story book home for the week. My guess was a perfect 17. I got the book for the week. Obviously, the number 17 is a spiritual force in my life.

More important is the sublime integration of spirituality into existential theory. Or not. It seems to go one way or another. Either existential theorists are deeply spiritual/religious or they’re atheist/agnostic. There is no middle ground. Or maybe there is? [More on this conundrum below]

What follows are several short excerpts from the Existential Theory chapter. These excerpts culminate with the short section on Existential Spirituality.

Soren Kierkegaard

The Danish philosopher Soren Kierkegaard (1813–1855) lived nearly his entire life in Copenhagen. Kierkegaard was devoutly religious. He was shaken when he discovered, at age 22, that his father had not only cursed God, but also seduced his mother prior to marriage. Subsequently, Kierkegaard’s writings focused primarily on religious faith and the meaning of Christianity. Eventually he concluded that religious faith was irrational and attainable only via a subjective experiential “leap of faith.” For Kierkegaard, virtuous traits such as responsibility, honesty, and commitment are subjective choices—often in response to a subjective religious conversion. Kierkegaard did not describe himself as an existentialist, but his work is a precursor to the existential philosophical movement, which formally began some 70 years following his death.

Friedrich Nietzsche

In contrast to Kierkegaard who began from a position of religious faith, the German philosopher Friedrich Nietzsche (1844–1900) had negative feelings about Christianity. It was he who, in his book Thus Spake Zarathustra, wrote, “God is dead.” Although he may have been referring to societal emptiness, he also claimed that religion used fear and resentment to pressure individuals into moral behavior. Instead of following a religion, he believed, individuals should channel their passions into creative, joyful activities. Irvin Yalom offers a fascinating view of Nietzsche’s psychological suffering in a historical fiction piece titled When Nietzsche Wept. In this novel, Yalom (1992) weaves existential principles into a fictional therapeutic encounter between Breuer, Freud, and Nietzsche.

Kierkegaard and Nietzsche represent an interesting paradox or dialectic in existential thinking. A dialectic is a process where learning is stimulated from the integration of opposites. On the one hand, some existentialists embrace deep religious faith, whereas others are staunchly atheistic. Still others claim an agnostic middle ground. These differences in fundamental beliefs represent a wide sweep of human intellectual diversity and provide for fascinating philosophical exploration. You will glimpse existential dialectics intermittently in this chapter.

Four Existential Ways of Being

There are four primary existential ways of being-in-the-world. They include:

  1. Umwelt: Being-with-nature or the physical world.
  2. Mitwelt: Being-with-others or the social world.
  3. Eigenwelt: Being-with-oneself or the world of the self.
  4. Uberwelt: Being-with-the-spiritual or over world.

Boss (1963), Binswanger (1963), and May et al. (1958) described the first three of these existential ways of being. van Deurzen (1988) added the fourth.

These dimensions of existence are ubiquitous and simultaneous. Some people focus more on one dimension than others or shift from one to another depending on particular intentions or situations. For example, while on a hike up the Stillwater gorge in Montana, it’s easy to experience being-with-nature as water powerfully cascades around you. However, depending on other factors, this experience can take people inward toward eigenwelt, toward an uberwelt spiritual experience, or stimulate a deep mitwelt (albeit a nonverbal one). In most cases, the direction your being-ness moves within a given situation is likely a combination of several factors, such as: awareness, anxiety, previous experiences, intention, and/or your spiritual predisposition.

The Daimonic

According to Rollo May, “The daimonic is any natural function which has the power to take over the whole person” (1969, p. 123). Historically, Daimon possession was used to explain psychotic episodes and is popularly referred to as demonic possession. However, May repeatedly emphasized that daimonic and demonic are not the same concept: “I never use the word demonic, except to say that this is not what I mean” (May, 1982, p. 11).

The daimonic is an elemental force, energy, or urge residing within all persons that functions as the source of constructive and destructive impulses. May wrote, “The daimonic is the urge in every being to affirm itself, assert itself, perpetuate and increase itself .… [The reverse side] of the same affirmation is what empowers our creativity” (May, 1969, p. 123).

Similar to C. G. Jung, May considered harnessing and integrating the daimonic as a central psychotherapy task. He viewed psychotherapy as an activity that plumbs the depths of an individual’s most basic impulses … the purpose of which is to acknowledge, embrace, and integrate every bit of being and energy into the whole person. May commented specifically about the danger of leaving the daimonic unintegrated:

If the daimonic urge is integrated into the personality (which is, to my mind, the purpose of psychotherapy) it results in creativity, that is, it is constructive. If the daimonic is not integrated, it can take over the total personality, as it does in violent rage or collective paranoia in time of war or compulsive sex or oppressive behavior. Destructive activity is then the result. (May, 1982, p. 11)

The goal is to integrate natural daimonic urges and energies in ways that maximize constructive and creative behavior.

Existential Spirituality

A spiritual-oriented client was engaging in guided imagery with an existential therapist. The client “discovered” a locked door in the basement of his “self.”

“What’s behind the door?” the therapist asked.

“It’s darkness,” he said. With shivers of fear, he added, “There’s dread. It’s the dread of being unacceptable. . . of being unacceptable to God. Even worse, it’s my dread of being unforgiveable.”

“Shall we go in?” asked the therapist.

Silence followed.

The therapist noticed his client’s reluctance and said, “Let’s wait a moment and breathe. I’m wondering if you can even get in the door. I’m wondering if you want to get in. There’s no rush. We know where the door is. We can wait. Or we can create a key and try to get in. Or we can leave the door shut. But first let’s wait here and breathe before deciding anything.”

For two minutes, client and therapist sat breathing together. The paralyzing fear diminished and the client said, “I have a key. Let’s look inside.”

“Yes. Let’s look inside.”

The key opened the lock. The door creaked open. In the dreaded darkness, there was light. A dialogue with the dread and unforgiveable ensued and the client found a broad sense of love and acceptance. There were tears of relief. His spiritual load was lightened. His basement demons were exorcised.

In this chapter we’ve discussed the deep and profound quality of existential psychotherapy. Schneider (2010) called it the “Rediscovery of Awe.” Frankl and Wong referred to it as the pursuit of meaning. In existential therapy, meaning and awe are individualized, as is spirituality. There’s great potential in combining the existential and the spiritual in psychotherapy, but clients should be forewarned and informed: combining the spiritual and existential isn’t about formulaic or surface explanations; it requires a commitment to go deep and explore doubts, uncertainties, and core vulnerabilities.

Here’s a link to the new Theories 3rd edition cover: https://www.amazon.com/Counseling-Psychotherapy-Theories-Context-Practice/dp/1119279127/ref=dp_ob_title_bk

 

 

Counseling and Psychotherapy Theory and Practice

Adlerian Spirituality

5 Comments

John and Jon on M

In these uncertain times, I know you’ve been wondering about the future. You’re probably asking, “Who will prevail in the 2018 midterm elections?” “Will the evil New England Patriots win the Super Bowl again?” and “When will the coveted 3rd edition of Counseling and Psychotherapy Theories in Context and Practice finally be available?”

Predicting the future is complicated. My psychic powers tell me that the answers to those first two questions remain uncertain and are dependent upon various intervening events such as Hillary’s emails, the battle between fake and real news, economic inflation (as well as inflation of various footballs), and the health and well-being of several very old quarterbacks. However, based on the fact that Saturn has entered my 4th House and is dropping a psychological anchor, I can say with confidence that the 3rd edition of our theories textbook is coming soon . . . probably in April, 2018.

In the run-up (as the Brits like to say) to the publication of T3 (Theories, 3rd edition), I’ll be intermittently posting a few exciting T3 previews.

One new feature is a short section on how each primary counseling and psychotherapy theory intersects with spirituality. We’re including this feature because of the core role that spirituality plays for many clients (and many counselors and psychotherapists). In addition, spirituality is often a key component of multicultural sensitivity.

Way back in June of last year, I posted the spirituality section for psychoanalytic theory (chapter 3). You can read that here: https://wordpress.com/post/johnsommersflanagan.com/2571

Today’s post includes a look at spirituality from the Adlerian perspective (chapter 3). Keep in mind that these spirituality sections are very short samplings, designed only to help readers understand how spirituality can be viewed from specific theoretical perspectives. If you’re interested in additional (and deeper) information, we recommend you track down the citations from each chapter.

Here’s the spirituality taste or peek or snippet from the Adlerian chapter.

Adlerian Theory and Spirituality

Over the years, Adlerian theory has been open to client spirituality and has attracted practitioners and writers with strong religious convictions (Cashwell & Watts, 2010; Johnson, 2013; Sweeney, 2009). This is probably because of Adler’s emphasis on social equality and justice, but also because, as Carlson and colleagues (2006) wrote:

The cardinal tenet of Adlerian theory is social interest, something Adler equated with the mandate to “Love one’s neighbor as oneself” and the Golden Rule. (pp. 33–34)

Although the Golden Rule is a Christian concept, Adlerian writers and practitioners are consistently open to other religious and spiritual perspectives. In particular, Johansen (2010) provided guidelines for integrating individual psychology (IP) concepts into Christianity, Judaism, Buddhism, Hinduism, and Islam. Overall, as described in the theoretical principles section of this chapter, Adlerians view spirituality as a life task that can contribute encouragement and meaning into clients’ lives (Bluvshtein, Belangee, & Haugen, 2015).

Consistent with what is known about Adler, the specifics of client spirituality and religious belief is of minimal importance. Recall that the Adlerian position is that all behavior is purposeful. Consequently, what’s important is for what purpose religion is used, and not the particulars of a client’s theology. A couple Adlerian questions about spirituality might include: “Does the client use religion (or spirituality) to promote separation and violence? Or is religion (spirituality) used to bring people together as a working and compassionate community?

Given Adler’s valuing of social interest and interdependence, the latter of these alternatives is clearly the Adlerian way.

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

Eight Core Conditions that Often Contribute to Suicide

14 Comments

Rainbow 2017Many professionals and media sources have proclaimed that suicide is a 100% preventable problem. Although I completely disagree with that message—and find it terribly offensive—I also believe that we should do what we can to prevent suicide.

Recently I was asked to write a journal article summarizing the conditions or dimensions that commonly contribute to suicide. To give you a flavor of these dimensions, below I’ve included brief descriptions of each one. However, I also want to emphasize that suicidologists and suicide researchers agree that death by suicide is nearly always unpredictable. Suicide is unpredictable despite the fact that, afterwards, many people and professionals will feel as though they should have “seen the signs” and done something more to prevent the death.

Knowing the following eight dimensions is useful when they’re used to enhance your compassion and capacity to collaborate with individual clients and persons. They’re not designed to be used as suicide risk factors or predictors.

Here are the eight dimensions.

Unbearable Psychological/Emotional Distress (Shneidman’s Psychache)

Shneidman (1985) originally identified “psychache” as the central psychological force leading to suicide. He defined psychache as negative emotions and psychological pain, referring to it as “the dark heart of suicide; no psychache, no suicide” (p. 200). In more modern patient-oriented language, psychache is aptly described as unbearable emotional distress. Unbearable distress can involve many factors, or center around one main trauma, loss, or other psychologically activating experiences; it may be accompanied by distinct cognitive, emotional, or physical symptoms.

Problem-Solving Impairment (Shneidman’s Mental Constriction)

Depression or low mood is commonly associated with problem-solving impairments. Originally, Shneidman called these impairments mental constriction, and defined them as “a pathological narrowing of the mind’s focus . . . which takes the form of seeing only two choices: either something painfully unsatisfactory or cessation” (1984, pp. 320–321). Researchers have reported support for Shneidman’s original ideas about mental constriction (Ghahramanlou-Holloway et al., 2012; Lau, Haigh, Christensen, Segal, & Taube-Schiff, 2012).

Agitation or Arousal (Shneidman’s Perturbation)

Agitation or arousal is consistently associated with death by suicide (Ribeiro, Silva, & Joiner, 2014). Shneidman (1985) originally used the term perturbation to refer to internal agitation that moves patients toward suicidal acts. When combined with high psychological distress and impaired problem-solving, agitation or arousal seems to push patients toward acting on suicide as a solution to their distress. Trauma, insomnia, drug use (including starting on a trial of serotonin-reuptake inhibitors), and many other factors can elevate agitation (Healy, 2009).

Thwarted Belongingness and Perceived Burdensomeness

Joiner (2005) developed an interpersonal theory of suicide. Part of his theory includes thwarted belongingness and perceived burdensomeness as contextual interpersonal factors linked to suicide. Thwarted belongingness involves unmet wishes for social connection. Perceived burdensomeness occurs when patients see themselves as flawed in ways that make them a burden to others.

Hopelessness

Hopelessness is a broad cognitive variable related to problem-solving impairment and linked to elevated suicide risk (Hagan, Podlogar, Chu, & Joiner, 2015; Strosahl, Chiles, & Linehan, 1992). Hopelessness is the belief that whatever distressing life conditions might be present will never improve. In many cases, patients hold a hopeless view—even when a rational justification for hope exists.

Suicide Desensitization

Joiner (2005) and Klonsky and May (2015) have described how fear of death or aversion to physical pain is a natural suicide deterrent present in most individuals. However, at least two situations or patterns can desensitize patients to suicide and reduce natural suicide deterrence. First, some patients may be predisposed to high pain tolerance. This predisposition is likely biogenetic, as in blood-injury phobias (Klonsky & May, 2015). Second, patients may acquire, through desensitization, a numbness that reduces natural fears of pain and suicide. Chronic pain, self-mutilation, and other experiences can be desensitizing.

Suicide Plan or Intent

In and of itself, suicide ideation is a poor predictor of suicide. Nevertheless, ideation is an important marker to explore with patients; exploring ideation can lead to asking directly about whether patients have a suicide plan. Suicide plans may or may not be associated with suicide intent. Some patients will keep a potential suicide plan on reserve, just in case their psychological pain grows unbearable. These patients do not intend to die by suicide, but they want the option and sometimes they have thought through the method(s) they might employ.

Lethal Means

Access to a lethal means is a situational dimension that substantially contributes to suicide risk. Firearms are far and away the most lethal suicide method. Specifically, Swanson, Bonnie, and Appelbaum (2015) reported that firearms result in an 84% case fatality rate. Although firearms can quickly become a politicized issue in the U.S., researchers have repeatedly found that access to firearms greatly magnifies suicide risk (Anestis & Houtsma, 2017).

 

Cool Counseling, Counseling and Psychotherapy Theory and Practice, Writing

Building Better Counselors

Leave a comment

JSF Dance Party

This is a link to a hot off the presses article in Counseling Today. The focus is all about how professional counselors (and all psychotherapists) can be BOTH evidence-based AND relationally oriented. My co-author, Kindle Lewis, is one of our fantastic doctoral students in the Department of Counselor Education at the University of Montana. And . . . by the way. . . the University of Montana is NOW the NEW best college destination on the planet. Ask me why:).

Here’s the link: http://ct.counseling.org/2017/11/building-better-counselors/

Counseling and Psychotherapy Theory and Practice

Evidence-Based Relationship Factors in Counseling and Psychotherapy

Leave a comment

The medical model of psychotherapy . . . has led us to accept a view of clients as inert and passive objects on whom we operate and whom we medicate. Gene V. Glass, in The Great Psychotherapy Debate, 2001, p. ix

John and Max Seattle

In a 1957 publication in the Journal of Consulting Psychology, Carl Rogers boldly declared:

  1. No psychotherapy techniques or methods are needed to achieve psychotherapeutic change.
  2. Diagnostic knowledge is “for the most part, a colossal waste of time” (1957, p. 102).

Let’s pause for a moment and reflect on what Rogers was saying.

**PAUSE HERE FOR SERIOUS REFLECTION**

If diagnosis is a waste of time and therapy techniques are unnecessary, then what can counselors or therapists do to produce positive outcomes? Here’s what Rogers said:

All that is necessary and sufficient for change to occur in psychotherapy is a certain type of relationship between psychotherapist and client.

Rogers’s revolutionary statements refocused counseling and psychotherapy. Until Rogers, therapy was primarily about theoretically based methods, techniques, and interventions. After Rogers, writers and practitioners began debating whether the relationship between client and therapist—not the methods and techniques employed—might be producing positive therapy outcomes.

This debate continues today. Wampold (2001) has called it “the great psychotherapy debate.” This debate has been boiled down to a dichotomy captured by the question: “Do treatments cure disorders or do relationships heal people?” (Norcross & Lambert, p. 3).

Keep in mind that like lots of things on planet Earth, the techniques vs. relationship debate promotes a false dichotomy. IMHO, most “rational” professionals understand that therapy relationships and techniques are BOTH important to positive outcomes. Seriously, how could it be otherwise?

But there is a positive outcome from this debate. Various researchers around the world started focusing on how to define specific relationship factors that contribute to counseling outcomes. Previously, these relationship factors were lumped into a category called “common factors.” Common factors were viewed as the main reason why all therapy approaches tend to produce approximately equal positive outcomes.

Flowing from research on common factors, one of the most fascinating and important movements in counseling and psychotherapy is now called, “Evidence-based relationships” (Norcross, 2011). As it turns out, there’s a large body of existing and accumulating research to help us clearly identify what’s relationally therapeutic.

In the attached link, you’ll find the powerpoint slides that Kim Parrow and I developed for a supervisor training yesterday, at the University of Montana. Our goal was to describe, demonstrate, and discuss 10 specific and observable relationship factors that contribute to positive counseling outcomes. We call them Evidence-Based Relationship Factors (EBRFs). They include:

  1. Congruence
  2. Unconditional positive regard
  3. Empathic understanding
  4. WA1: Emotional bond
  5. WA2: Goal consensus – Focus on strengths
  6. WA3: Task collaboration
  7. Rupture and repair
  8. Countertransference (management)
  9. Progress monitoring (feedback)
  10. Culture and Cultural Humility

The link at the bottom of this post will take you to our powerpoint slides. Also, for more information, you can always check out various theories textbooks, including Counseling and Psychotherapy Theories in Context and Practice (from which this blog was adapted). https://www.amazon.com/Counseling-Psychotherapy-Theories-Practice-Resource/dp/1119084202/ref=sr_1_1?ie=UTF8&qid=1504292029&sr=8-1&keywords=counseling+and+psychotherapy+theories+in+context+and+practice

EBRFs for Supervisors 2017 FIN

Counseling and Psychotherapy Theory and Practice, Uncategorized

Counseling Theories Lab Activities

Leave a comment

With Wubbolding

Hi All.

Below I’m pasting links to a variety of lab activities that I’ve used in teaching Counseling and Psychotherapy Theories. Although I’ve got a textbook that I’d love you to use: http://www.wiley.com/WileyCDA/WileyTitle/productCd-1119084202.html, this post is about free stuff that I’m happy to share to help make your theories teaching experiences more practical and more fun.

Here are the activities:

This is a short guide to conducting an Adlerian Family Constellation Interview: Chapter 3 Family Constellation Interview and Earliest Memories

This is a short guide for doing and debriefing a person-centered interview: Chapter 5 Person Centered Activity

Dreamwork can be enlightening. This guide helps students explore each other’s dreams: Chapter 6 Jungian and Gestalt Dream Work

This handout helps your students practice conducting a behavioral or cognitively oriented symptom interview. Chapter 7 Analyzing Symptoms Interview

This isn’t really an activity, just a sample Ellis ABCDE form. Chapter 8 Ellis ABCDE

These two handouts provide tips for doing a CBT Six Column intervention, as well as a sample Six Column form, filled out using an angry teen example. Chapter 8 Six Column CBT Tips  and Chapter 8 Six Columns Youth Anger Example

Here’s a video clip (just a snippet) of me doing a CBT example:https://www.youtube.com/watch?v=LQ8hNDHoyDU

This is an interview activity to give students and role-play clients a taste of solution-focused interviewing: Chapter 11 Solution-Focused Activity

I hope these materials are helpful for you. As always, if you have feedback to share, you can share it on this blogsite or via email: johnsf@mso.umt.edu

 

 

 

 

 

 

 

 

Counseling and Psychotherapy Theory and Practice, Personal Reflections, Politics

The Benefits and Limitations of Rhyming and Alliteration

1 Comment

Smoky Sunrise Aug 2017

Don’t get me wrong. I’m not anti-rhyming and I’m not anti-rap.

Truth is, I think rhyming slogans are pretty darn cool. Ask my students, I use them all the time. Here are a few that have been known to slip out my mouth and into a class lecture from time to time:

  • A pill is not a skill.
  • Get curious, not furious.
  • Your goal should be within your personal control
  • To function to the best of your ability, you should embrace your multicultural humility
  • An alcoholic drink, will not help you think (better)

The benefits of rhyming (and I daresay, alliteration) is that messages emerge with might and mass, which makes them more memorable. What I meant to say here before my alliterative self took over is that rhyming produces a powerful and memorable message. That’s the good news.

The “less good” news (as us therapist types like to say) is that rhyming and alliteration, although clever and appealing, usually don’t capture ALL OF THE TRUTH, and, are often misleading.

All this initial commentary is my way of leading up to my recent critique of the liberal use of a couple of F-words (nope, I’m not talking about “Fire and fury” although that could be an alliterative example of something that’s simply not soothing the simmering psyches of people who need to settle down). Instead, the target of my critique today is the all-too-common utterance, “Fight or flight.”

What follows is an excerpt of a slight rambling rant that was included in my keynote speech at the Montana Prevent Child Abuse Conference this past April.

The context: I had just shown a video of a Harvard professor who happened to mention (without checking with me first) the clever and popular phrase, “fight or flight.” Here’s what came next:

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

You may not be aware of this, but I’m an official, self-appointed member of the counseling and psychotherapy theories police. I don’t have a badge, but I’ve got a book. What this book means is that I’ve done a little background reading on lots of theoretical concepts, like “Fight or Flight.” “Fight or Flight” – We hear that a lot, even from, as my older daughter would say, that fancy Harvard guy on the video.

The problem with most rhyming concepts is that they tend to oversimplify whatever it is we’re talking about. Take for example, “No pain, no gain.” There’s some truth to that, but that statement probably doesn’t hold for everyone, everywhere.

Well, the troubling truth is that fight or flight isn’t really all that accurate. Stress doesn’t just trigger two behavioral options. There are other behaviors activated by stress, some of which also start with an F, but don’t rhyme so neatly.

There’s Faint. And there’s Freeze. Chronic stress can also increase Feeding; some of us know that first-hand. My favorite stress food comes from places that rhyme with Fakery, so I guess that’s another F word. But, then again, stress can also dull your appetite, so the feeding thing isn’t a universal response.

Then there are the “P” words, like poop and pee. High stress can affect those, sometimes rather dramatically.

But what most people—even fancy Harvard guys—don’t tell you or don’t know, is that much of the Fight or Flight research was conducted on White Males.

And as if that wasn’t bad enough, the research was actually conducted on White, Male, Rats.

After re-analyzing old data and new studies focusing on female rats and female humans, years ago, Shelly Taylor and her research colleagues at UCLA discovered that for females of the species, there was a tendency toward a different set of rhyming words. The females coped with stressors using a strategy referred to as “Tend and Befriend.” And to further complexify the situation, sometimes males do the tend and befriend thing too. . . although not quite so frequently as the white, male, rats.

The point . . . I know I’ve strayed from it, is that financial and workplace interventions are very good for decreasing child abuse, but IMHO. . . interventions that increase social support and connection (the tending and befriending as methods for helping highly stressed families cope) are equally important . . . and that brings us right back to you and what you can do to prevent child abuse.

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

Today’s blog is just a reminder that although powerful and memorable communication is remarkably powerful and memorable, it’s usually incomplete, not always accurate, and a function of the speaker’s need or desire to be powerful and memorable. This is just as true when I say “a pill is not a skill” or when other people say other things that make use of rambling and reckless rhetoric of the alliterative or rhyming ilk.

To finish, I’ll leave you with what Shelly Taylor said back in the year 2000, as excerpted from our forthcoming textbook, Counseling and Psychotherapy in Context and Practice (John Wiley and Sons, 2018). This particular excerpt ends with brief comments from us that also, in case you are wondering, might be relevant to the recent Google manifesto brouhaha.

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

Stress researcher and social psychologist Shelly Taylor made a similar contribution when researching the well-known fight or flight phenomenon (Taylor et al., 2000). She and her colleagues wrote:

A little-known fact about the fight-or-flight response is that the preponderance of research exploring its parameters has been conducted on males, especially on male rats. Until recently, the gender distribution in the human literature was inequitable as well. Prior to 1995, women constituted about 17% of participants in laboratory studies of physiological and neuroendocrine responses to stress. (2000, p. 412)

Reanalysis of existing data and new research revealed significant differences in the ways in which females and males respond to stressful situations. Taylor and colleagues (2000) concluded:

We propose a theory of female responses to stress characterized by a pattern termed “tend-and-befriend.” Specifically, we propose that women’s responses to stress are characterized by patterns that involve caring for offspring under stressful circumstances, joining social groups to reduce vulnerability, and contributing to the development of social groupings, especially those involving female networks, for the exchange of resources and responsibilities. We maintain that aspects of these responses, both maternal and affiliative, may have built on the biobehavioral attachment caregiving system that depends, in part, on oxytocin, estrogen, and endogenous opioid mechanisms, among other neuroendocrine underpinnings. (p. 422)

The preponderance of the research suggests that in fact, that White male ways of being aren’t always normative for females, or even for all males. There are physical and psychological similarities between females and males, but there are also differences. In this case, it would be inappropriate to make the case that a typical male fight-or-flight response is superior to a typical female tend-and-befriend response. There is likely an evolutionary benefit to both stress-related behavior patterns (Master et al., 2009; Taylor & Gonzaga, 2007; Taylor & Master, 2011). Sometimes differences are just differences and there’s no need to advocate for one sex-related pattern as superior over another (although if they feel threatened by this information, white male rats are highly likely to fight for their position…or run and hide in little holes in our cupboards). In this case it seems clear: Neither behavior pattern represents psychopathology…and neither will always be the superior response to threat.