Category Archives: Counseling and Psychotherapy Theory and Practice

Counseling and Psychotherapy Theory and Practice

Readers Needed for our Counseling and Psychotherapy Textbook

July 22, 2016 johnsommersflanagan 16 Comments

Hello All.

We’ve just started working on the 3^rd edition revision of our textbook, “Theories of Counseling and Psychotherapy in Context and Practice.”

For each edition of this and our Clinical Interviewing textbooks, we ask interested students, professionals, and academics to provide feedback. This is usually a positive process for us and for reader-volunteers because we usually end up learning from each other.

This time around, to make things manageable on my end, I’ll be accepting the first two volunteers for each chapter. If you’re interested, take a look at the list of chapters below.

What do you get out of the deal? Well, you get that nice warm feeling . . . AND a complimentary copy of the text (when it comes out) and your name and affiliation listed in the acknowledgements section of the text, and a BIG THANKS from Rita and me for your insights and assistance.

Thanks for your potential interest and have a great weekend.

Below there’s an outline listing the existing textbook chapters. If you’re interested in reading and commenting on one of these or need more information, send me an email: john.sf@mso.umt.edu

Thanks again for your interest and support!

John

Chapter 1: Psychotherapy and Counseling Essentials: An Introduction

Chapter 2: Psychoanalytic Approaches** [Each of the subsequent theories chapters follows the same outline as this one]**

Biographical Information: Sigmund Freud

Historical Context

Psychoanalytic Theoretical Principles

Evolution and Development in Psychoanalytic Theory and Practice

The Practice of Psychoanalytic Therapy

Case Analysis and Treatment Planning

Evidence-Based Status

Concluding Comments

Chapter Summary

Psychoanalytic Key Terms

Theories Highlights II: The Story of Freud’s Seduction Hypothesis

July 15, 2016 johnsommersflanagan Leave a comment

Let’s put it this way: When it comes to the history of counseling and psychotherapy, there’s plenty of conflict and drama. In the following excerpt from Chapter 2 of Counseling and Psychotherapy Theories in Context and Practice, you’ll get to read about Freud and his formulation and then recanting of the seduction hypothesis. Is it all true and factual? Probably not. Is it fascinating? As Freud would have likely said, “Hell yes!”

Historical Context

As suggested toward the end of Chapter 1, psychological theories are partly a product of the prevailing Zeitgeist and Ortgeist. Bankart (1997) stated:

To fathom Freud’s near-obsession with the sexual foundations of emotional distress is also to come to a fuller awareness of the sexual repression and hypocrisy in the lives of the Austrian middle class at the turn of the…[nineteenth] century and the effect of this repression on the mental health of adolescents and young adults during the time when Freud derived his theories. (p. 8)

A good illustration of psychoanalytic historical context and of Freud’s dominant persuasive powers is the dramatic story of Freud’s development and subsequent recanting of the seduction hypothesis. This story captures his psychoanalytic thinking along with the social dynamics of his time. Interestingly, there’s conflict over the truth of this story—which further illustrates the divisive nature of Freud and his legacy. As you read through the drama of the seduction hypothesis, keep in mind that certain points have been contested…but the unfolding of a spectacular drama around sexuality, sexual fantasy, and sexual abuse in a sexually repressed society is likely accurate.

The Seduction Hypothesis

In 1885, Freud went to France to study under the famous neurologist Jean Charcot. According to Jeffrey Masson, former projects director of the Freud Archives, it’s likely that Freud visited the Paris Morgue, observing autopsies of young children who had been brutally physically and sexually abused (Masson, 1984). Masson speculated that Freud’s exposure to the grisly reality of child abuse combined with stories of abuse he heard from his patients, led him to believe that hysteria was caused by child sexual abuse.

Later, Freud presented a paper titled “The Aetiology of Hysteria” at the Society for Psychiatry and Neurology in Vienna (Freud, 1896). In this paper, he outlined a controversial hypothesis:

I therefore put forward the thesis that at the bottom of every case of hysteria there are one or more occurrences of premature sexual experience, occurrences which belong to the earliest years of childhood, but which can be reproduced through the work of psychoanalysis in spite of the intervening decades. (Freud, 1896, cited in Masson, 1984, p. 263)

Note that Freud stated, “. . . at the bottom of every case of hysteria.” He was emphasizing a clear causal connection between childhood sexual abuse and hysteria. This presentation was based on 18 cases (12 women and 6 men), all of which included childhood sexual abuse. At least three key points are important in this presentation:

Freud’s idea about the connection between childhood sexual abuse and subsequent psychopathology may represent an early formulation of the contemporary diagnosis of Posttraumatic Stress Disorder and/or Dissociative Identity Disorder.
Critics contend that in Freud’s paper, “the ‘facts’ of specific case histories are never provided” (Wilcocks, 1994).
Freud may have been constructing sexual memories both through a direct pressure technique and by distorting what he heard to fit with his pre-existing ideas (Esterson, 2001).

Despite a lack of supporting detail in his presentation and the possibility that he was building evidence to support his theory, Freud goes on to suggest that hysterical symptoms don’t arise immediately, but instead develop later:

Our view then is that infantile sexual experiences…create the hysterical symptoms, but…they do not do so immediately, but . . . only exercise a pathogenic action later, when they have been aroused after puberty in the form of unconscious memories. (Freud, 1896, cited in Masson, 1984, p. 272)

It appears that Freud continued to believe his clients’ sexual abuse stories (or perhaps he believed his own constructed version of his client’s sexual abuse stories) until the late 1800s or early 1900s.

Recanting the Seduction Hypothesis

Imagine yourself alone with a great and horrible insight. In Masson’s version of the seduction hypothesis story, this was Freud’s situation. Masson (1984) describes the reception Freud received after presenting his hypothesis (and this part of the seduction hypothesis story is not disputed):

The paper…met with total silence. Afterwards, he was urged never to publish it, lest his reputation be damaged beyond repair. The silence around him deepened, as did the loneliness. But he defied his colleagues and published “The Aietology of Hysteria.” (pp. xviii–xix)

Five days after presenting his paper, Freud wrote about the experience to his friend and otolaryngologist (ear, nose and throat physician) Wilhelm Fliess. Freud’s anger is obvious:

[My] lecture on the aetiology of hysteria at the Psychiatric Society met with an icy reception from the asses, and from Kraft-Ebing [the distinguished professor and head of the Department of Psychiatry at the University of Vienna] the strange comment: “It sounds like a scientific fairy tale.” And this after one has demonstrated to them a solution to a more than thousand-year-old problem, a “source of the Nile!” They can all go to hell. (Schur, 1972, p. 104)

Although it’s clear that Freud’s lecture received “an icy reception” it’s less clear why the audience was unimpressed. According to Masson, the reception is icy because Freud is bringing up sex and sexual abuse and that psychiatry (and most professionals and citizens at the time) were uncomfortable with facts linked to high sexual abuse rates. Alternatively, others have suggested that Freud’s style, perhaps a combination of arrogance along with an absence of scientific rigor or detail, moved the audience to rebuke him. For example, Wilcocks (1994) wrote:

The inferential support offered—without detail, of course—is that in eighteen cases out of eighteen, Freud has “discovered” the same etiological factors. But since neither we nor his audience are/were privy to the circumstances of any of his cases, this claim—whatever it’s other inferential mistakes—is simply useless. (p. 129)

It may never be clear whether Freud’s motives in presenting the seduction hypothesis were noble or manipulative. However, regardless of motive, the ensuing years following his “Aetiology of Hysteria” lecture were difficult. Reportedly, his private practice was in decline and his professional life in shambles. It was at this time that Freud began what has been described as “his lonely and painful self-analysis” (Prochaska & Norcross, 2003, p. 29). His 2-year self-analysis included uncovering memories of yearning for his mother and equally powerful feelings of resentment toward his father (Bankart, 1997).

Eventually, Freud discarded his seduction hypothesis in favor of the Oedipus complex (where the child holds unconscious wishes to have sexual relations with the parent of the opposite sex). Some suggest this was because he began noticing seductive patterns in so many parent-child interactions that it was unrealistic to assume that child sexual abuse occurred at such a ubiquitous rate. Others believe Freud was ahead of his time in discovering child sexual abuse, but buckled under the social and psychological pressure, abandoning the truths his patients shared with him. Still others contend that while Freud was constructing his theoretical principles, he was projecting and mixing his own fantasies into his clients’ stories. The following statement illustrates the highly personalized nature of some of Freud’s theorizing:

I found in myself a constant love for my mother, and jealousy of my father. I now consider this to be a universal event in childhood. (R. A. Paul, 1991)

Eventually, in 1925, long after he recanted the seduction hypothesis, he reflected on his struggle:

I believed these stories, and consequently supposed that I had discovered the roots of the subsequent neurosis in these experiences of sexual seduction in childhood.… If the reader feels inclined to shake his head at my credulity, I cannot altogether blame him.… I was at last obliged to recognize that these scenes of seduction had never taken place, and that they were only fantasies which my patients had made up. (Freud, 1925, cited in Masson, 1984, p. 11)

In the creation and recanting of the seduction hypothesis, it’s difficult to sort out fact from fantasy. Perhaps this is as it should be, as it illustrates at least one formidable lesson about psychology. That is, when diving headlong into the deep psychological processes of humans, it’s possible to elicit confused and confusing storylines and to knowingly or unknowingly (unconsciously) mix (or project) our own personal issues into the plot. In the end, it may be that we create Kraft-Ebing’s “Scientific fairy tale” or, alternatively, something with lasting and meaningful significance. More likely, we create a combination of the two. (See Table 2.1 for three possible conclusions about Freud and the seduction hypothesis.)

Table 2.1: Freud’s Seduction Hypothesis: Three Conclusions

The official Freudian storyline goes something like this: Sigmund Freud was an astute observer who had to discard his earlier views about child seduction and sexual abuse to discover the more basic truth of the power of internal fantasy and of spontaneous childhood sexuality.

Although he initially believed his clients’ sexual abuse reports, he later discovered that it was not actual abuse, but imagined sexualized relationships (fantasies) between children and caretakers—aka: the Oedipus complex—that caused psychopathology.

Masson’s (1984) version, subsequently labeled “a new fable based on old myths” (Esterson, 1998), suggests that Freud was ahead of his time in recognizing child sexual abuse. These abuses were real and it was correct of Freud to identify them and to develop his seduction hypothesis. However—and unfortunately—Freud abandoned his sexually abused clients by recanting the seduction theory. He abandoned them because of pressure from medical and scientific colleagues and because society was not ready to face the reality of rampant child sexual abuse.

Freudian critics suggest that Freud was an exceptionally bright, persuasive, and powerful speaker and writer, but he was practicing bad science. He was more interested in building his theory than psychological reality. Consequently, he twisted his clients’ stories, mixing them with his own issues and fantasies, and created an elaborate theory initially around sexual abuse and later around sexual fantasy. His theories, although fascinating and capturing much about the projective potential in human thinking, are more about Freud than they are about his clients.

Counseling and Psychotherapy Theory and Practice

Theories Highlights I: What’s the difference between counseling and psychotherapy?

July 14, 2016 johnsommersflanagan 4 Comments

My younger daughter has graduated, our video shoots for the Clinical Interviewing text are “in the can,” my time with the grandkids has passed, and the family reunion is over. Now, as the summer sun blazes, I’ve retreated to my standing desk and dived head-first into revising the 3rd edition of our Counseling and Psychotherapy Theories textbook. Later today, I’ll refresh myself with a different sort of dive into the beautiful and frigid Stillwater River.

As I work on revising this textbook I’ll be posting a series of “Theories Highlights.” They will be short excerpts from the forthcoming 3rd edition. Here’s the first one. As always, I’d love feedback if you feel like sharing.

From Chapter 1:

Definitions of Counseling and Psychotherapy

Over the years, many students have asked: “Should I get a PhD in psychology, a master’s degree in counseling, or a master’s in social work?”

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

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

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

What Is Psychotherapy?

Anna O., an early psychoanalytic patient of Josef Breuer (a mentor of Sigmund Freud), referred to the treatment she received as “the talking cure.” This is an elegant, albeit vague description of psychotherapy. Technically, it tells us very little, but at the intuitive level, it explains psychotherapy very well. Anna was saying something most people readily admit: Talking, expressing, verbalizing, or sharing one’s pain and life story is potentially healing. This definition isn’t satisfactory as a research definition, but it provides an elegant historic and foundational frame.

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

We have four favorite (and different) psychotherapy definitions we’d like to share:

A conversation with a therapeutic purpose (Korchin, 1976).
The purchase of friendship (Schofield, 1964).
[A] situation in which two people interact and try to come to an understanding of one another, with the specific goal of accomplishing something beneficial for the complaining person (Bruch, 1981).
When one person with an emotional disorder gets help from another person who has a little less of an emotional disorder (J. Watkins, personal communication, October 13, 1983).

What Is Counseling?

In some settings, an evaluative or judgmental distinction is made between counseling and psychotherapy. Alfred Adler, whom we’ll get to know more intimately in Chapter 3, might say that counseling has an inferiority complex with respect to its older sibling, psychotherapy (Adler, 1958). Or, perhaps it could be that psychotherapy has a superiority complex toward its younger rival, counseling. Either way, at some point you may notice or experience people passing judgment on the relative merits of psychotherapy and counseling.

Counselors have struggled to define their craft in ways similar to psychotherapists. Consider, Kottler and Brown’s (2008) perspective:

Counseling is indeed an ambiguous enterprise. It is done by persons who can’t agree on what to call themselves, what credentials are necessary to practice, or even what the best way is to practice—whether to deal with feelings, thoughts, or behaviors; whether to be primarily supportive or confrontational; whether to focus on the past or the present. Further, the consumers of counseling services can’t exactly articulate what their concerns are, what counseling can and can’t do for them, or what they want when it’s over. (pp. 16–17)

As with the term psychotherapy, a good definition of counseling is hard to find. Here’s a sampling:

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

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

What Are the Differences Between Psychotherapy and Counseling?

Years ago, Patterson (1973) answered this question directly: “There are no essential differences between counseling and psychotherapy” (p. xiv). On this issue, we agree with Patterson and Corsini and Wedding (2000), who wrote:

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

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

For the most part, the professional literature implies that psychotherapists are less directive, go a little deeper, work a little longer, and charge a higher fee. In contrast, counselors are slightly more directive, work more on developmentally normal—but troubling—issues, work more overtly on practical client problems, work more briefly, and charge a bit less. In the case of individual counselors and psychotherapists, each of these tendencies may be reversed. For example, some counselors work longer with clients and charge more, whereas some psychotherapists work more briefly with clients and charge less. Additionally, although it used to be that counselors worked with clients who displayed less severe problems and psychotherapists worked with patients who display more severe problems, now, perhaps because obtaining services from master’s-level counselors or social workers is less expensive, counselors often work with lower income clients whose financial stress interacts with and complicates their personal and family problems.

A Working Definition of Counseling and Psychotherapy

At the very least, there are strong similarities between counseling and psychotherapy. Because the similarities vastly outweigh the differences we use the words counseling and psychotherapy interchangeably. And sometimes we use the word therapy as an alternative.

For the purposes of this text and to keep things simple, we offer a 12-part general definition of counseling and psychotherapy (in case you weren’t sure, this reference to keeping things “simple” is an example of sarcasm). Counseling or psychotherapy is:

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

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

Counseling and Psychotherapy Theory and Practice, Personal Reflections

Why Xavier University Students in Cincinnati Sent Me a Petition . . .

April 29, 2016 johnsommersflanagan 12 Comments

Yesterday I had the honor of receiving my first-ever petition from a group of “disgruntled” graduate students. Actually, the petition arrived in my email in-box, but was addressed to my publisher, John Wiley and Sons.

I read it anyway. Here it is:

Petition for Wiley Publishing – 4/27/16

We, the undersigned and overworked graduate counseling students in Dr. Brent Richardson’s Counseling Theories and Techniques course at Xavier University strongly object to the inference on page 480 of “Counseling and Psychotherapy Theories” that Dr. Brent Richardson only “thinks he is funny.” All of us have chuckled at least one time over the past 14 weeks. We declare that he is actually funny and demand that this phrase be amended to reflect this fact in future editions.

Sincerely,

The names and signatures of 14 students followed, along with an electronic copy of page 480.

I have the following response to offer the “petitioners.”

Dear Petitioners.

Your note to Wiley raises a number of concerns.

First and foremost, it makes me worry about the level of academic discourse that may or may not be happening in your class with Dr. Richardson. Here’s the passage toward which you are alleging offense:

As one of our colleagues who thinks he’s funny says, “Sometimes counselors mix up the words eclectic and electric—they think they can just do whatever turns them on” (Richardson, personal communication, November 2002).

I think a close reading of this passage makes it obvious that we’re just maintaining truth and objectivity. In no way are we claiming or implying that Dr. Richardson is NOT funny. We’re only staying within the safe harbor of direct observation. It seems indisputable that Dr. Richardson THINKS HE’S FUNNY. But is he objectively funny? We admit (a) we’ve laughed at him, (b) we’ve seen him laugh at himself, and (c) we’ve witnessed other people laughing at him during professional presentations . . . but how can we be sure that people (including Dr. Richardson) weren’t laughing out of their discomfort because he sometimes uses words like “piss” when he tells counseling stories. We just didn’t feel right privileging the text with our assumptive biases. Let that be a lesson to you in your future petition-writing.

Second, inasmuch as we respect your lived experience and it appears you signed your petition in solidarity, how can we be certain that each of you really think Dr. Richardson is funny? He obviously still has an evaluative relationship with you and, given that relational component, some or all of you may have felt compelled to sign said petition. This is of especial concern because the petition was delivered to me via email from the man who, quite obviously, thinks he’s funny.

Third, and I’m taking an educated guess here, but it shouldn’t be left unsaid that many alternative interpretations exist for you forwarding this petition to me through Dr. Richardson. One prominent alternative interpretation is that vicarious learning/imitation/modeling might have occurred.

In your case, because Dr. Richardson thinks he’s funny and you’ve been exposed to him for the past 14 weeks, you’ve probably started thinking you’re funny too. It’s natural. My evidence? The phrasing, “We, the undersigned and overworked graduate counseling students . . .” This phrase appears to be an effort at humor. Am I correct? And so I am loathe, but forced to conclude, that you have absorbed Dr. Richardson’s way of being and consequently, are at risk for future incidents where you end up thinking you’re pretty darn funny.

And so finally, to the question of whether I’ll forward this to John Wiley and Sons and make corrections for the forthcoming 3^rd edition? The answer: It depends on whether 14 students who may well have been coerced and who most certainly are under the impression that they’re funny, can provide me with more concrete and substantial evidence that either you or Dr. Richardson are objectively funny. . . because I’m really on the fence about that right now.

Sincerely yours,

John SF

Here’s a photo of Dr. Brent Richardson. Does he look funny? Just curious.

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice

Five Recommendations for Developing a Positive Working Alliance

April 6, 2016 johnsommersflanagan 2 Comments

The working alliance is one of the most robust predictors of positive counseling and psychotherapy outcomes. This excerpt, from the forthcoming 6th edition of Clinical Interviewing, describes five recommendations. You can always email me directly if you have questions about these resources I post. Have an excellent Wednesday evening.

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Therapists who want to develop a positive working alliance (and that should include everyone) will employ alliance-building strategies beginning with first contact. Using Bordin’s (1979) model, alliance-building strategies focus on (a) collaborative goal setting; (b) engaging clients in mutual therapy-related tasks; and (c) development of a positive emotional bond. Progress monitoring is also recommended. The following list includes alliance-building concepts and illustrations:

Initial interviews and early sessions are especially important to alliance-building. Many clients will be naïve about psychotherapy. This makes role inductions essential. Here’s a cognitive-behavioral therapy (CBT) example:

For the rest of today’s session, we are going to be doing a structured clinical interview. This interview assesses a range of different psychological difficulties. It is a way to make sure that we “cover all of our bases.” We want to see if social anxiety is the best explanation for your problems and also whether you are having any other difficulties that we should be aware of. (Ledley, Marx, & Heimberg, 2010, p. 36)

Asking clients direct questions about what they want from counseling and then integrating that information into your treatment plan helps build the alliance. In CBT this includes making a problem list (J. Beck, 2011).

Clinician: What brings you to counseling and how can I be of help?

Client: I’ve just been super down lately. You know. Tough to get up in the morning and face the world. Just feeling pretty crappy.

Clinician: Then we definitely want to put that on our list of goals. Can I write that down? [Client nods assent] How about for now we say, “Find ways to help you start feeling more up?”

Client: Sounds good to me.

Engaging in collaborative goal-setting to achieve goal consensus is central to alliance-building. In CBT this involves transforming the “problem list” into a set of mutual treatment goals.

Clinician: So far I’ve got three goals written down: (1) Find ways to help you start feeling more up, (2) Help you deal with the stress of having your sister living with you and your family, and (3) Improving your attitude about exercising. Does that sound about right?

Client: Totally. It would be amazing to tackle those successfully.

Problem lists and goals are a good start, but clients engage with clinicians better when they know the treatment plan (TP) for moving from problems to goals. The TP includes specific tasks that will happen in therapy and may begin in the first clinical interview. Here’s an example of a “Devil’s Advocacy” technique where the clinician takes on the client’s negative thoughts and then has the client respond (Newman, 2013). You’ll notice that collaboratively engaging in mutual tasks offers spontaneous opportunities for deeper connection and clinician-client bonding:

Clinician: You said you want a romantic relationship, but then you start thinking it’s too painful and pointless. Let’s try a technique where I take on your negative thinking and you respond with a reasonable counter argument. Would you try this with me?

Client: Sure. I can try.

Clinician: Excellent. Here we go: “It’s pointless to pursue a romantic relationship because they always come to a painful end.”

Client: That’s possible, but it’s also possible to have some good times along the way toward the painful end.

Clinician: [Smiles, breaks from role, and says] . . . That’s the best come-back ever.

Soliciting feedback from clients from the first session on to monitor the quality and direction of the working alliance contributes to the alliance. Although you can use an instrument for this, you can also ask directly:

We’ve been talking for 20 minutes and so I want to check in with you on how you’re feeling about our time together so far. How are you doing with this process?

Making sure you’re able to respond to client anger without becoming defensive or counterattacking is essential to positive working relationships. We usually apply radical acceptance (Linehan, 1993). Here’s an excerpt from an initial session with an 18-year-old male where the clinician accepted the client’s aggressive message and transformed it into a relational issue:

Clinician: I want to welcome you to therapy with me and I hope we can work together in ways you find helpful.

Client: You talk just like a shrink. I punched my last therapist in the nose (client glares at therapist and awaits a response) (J. Sommers-Flanagan & Bequette, 2013, p. 15).

Clinician: Thanks for telling me that. I’d never want to have the kind of relationship with you where you felt like hitting me. And so if I ever say anything that offensive, I hope you’ll just tell me, and I’ll stop.

Clinical Interviewing, Cool Counseling, Counseling and Psychotherapy Theory and Practice, Tough Kids Cool Counseling

Using an Invitation for Collaboration in Counseling and Psychotherapy

March 27, 2016 johnsommersflanagan Leave a comment

As I’m sure you know, I believe (rather strongly) that counselors and psychotherapists should work hard to collaborate with clients. Being an authoritarian therapist is passe.

Sometimes collaboration sounds easy in theory, but it can be difficult in practice. It’s especially difficult if clients come into your office not “believing in therapy” and not trusting you. In the following excerpt from the forthcoming 6th edition of Clinical Interviewing, you can see how a skilled therapist deals with some initial client hostility.

Case Example 3.1: An Early Invitation for Collaboration

Sophia, a 26-year-old mother of two was referred for counseling by her children’s pediatrician. When she sat down with her counselor, she stated:

I don’t believe in this counseling thing. I’m stressed, that’s true, but I’m a private person and I believe very strongly that I should take care of myself and not have anyone take care of my problems for me. Besides, you look like you might be 18 years old and I doubt that you’re married or have children. So I don’t see how this is supposed to help.

It’s easy to be shaken when clients like Sophia pour out their doubts about therapy and about you at the beginning of the first session. Our best advice: (a) be ready for it; (b) don’t take it personally, Sophia is speaking of her doubts, don’t let them become yours; (c) be ready to respond directly to the client’s core message; and (d) end your response with an invitation for collaboration. An invitation for collaboration is a clinician statement that explicitly offers your client an opportunity to work together. In some cases, an invitation for collaboration is a time-limited “let’s try this out” offer.

Here’s a sample counselor response to Sophia:

Counselor: I hear you loud and clear. You don’t believe in counseling, you’re a private person, and you’re concerned that I don’t have the experiences needed to understand or help you.

Sophia: That’s right. [Sometimes when the counselor explicitly reflects the client’s core message (i.e., “. . . you’re concerned I don’t have the experience needed to understand or help you”) the client will retreat from this concern and say something like, “Well, it’s not that big of a deal.” But that’s not what Sophia does.]

Counselor: Well then, I can see why you wouldn’t want to be here. And you’re right, I don’t have a lot of the life experiences you’ve had. . But I do have knowledge and experience working with people who are stressed and concerned about parenting and I’d very much like to have a chance to be of help to you. How about since you’re here, we try out working together today and then toward the end of our time together I’ll check back in with you and you can be the judge of whether this might be helpful or not?

Sophia: Okay. That sounds reasonable.

In this case the counselor responded directly and with empathy to Sophia and then offered an invitation for collaboration. As the session ends, Sophia may or may not accept the counselor’s invitation. But either way, the counselor’s skillful response provides an opportunity for a collaborative relationship to develop.

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice, Personal Reflections

Parallel Process in Clinical Supervision

January 25, 2016 johnsommersflanagan 4 Comments

This short case example from the forthcoming 6th edition of Clinical Interviewing is a small tribute to all the great supervisors I had over the years.

Case Example 7.2:

Intermittent Unconditional Positive Regard and Parallel Process

Abby is a 26-year-old graduate student. She identifies as a White Heterosexual female. After an initial clinical interview with Jorge, a 35-year-old who identifies as a male heterosexual Latino, she meets with her supervisor. During the meeting she expresses frustration about her judgmental feelings toward Jorge. She tells her supervisor that Jorge sees everyone as against him. He’s extremely angry at his ex-wife and he’s returning to college following his divorce and believes his poor grades are due to racial discrimination. Abby tells her supervisor that she just doesn’t get Jorge. She thinks she should refer him instead of having a second session.

Abby’s supervisor listens empathically and is accepting of Abby’s concerns and frustrations. The supervisor shares a brief story of a case where she had difficulty experiencing positive regard toward a client who had a disability. Then, she asks Abby to put herself in Jorge’s shoes and imagine what it would be like to return to college as a 35-year-old Latino man. She has Abby imagine what might be “under” Jorge’s palpable anger toward his ex-wife. The supervisor also tells Abby, “When you have a client who views everyone as against him, it’s all the more important for you to make an authentic effort to be with him.” At the end of supervision Abby agrees to meet with Jorge for a second session and to try to explore and understand his perspectives on a deeper level. During their next supervision session, Abby reports great progress at experiencing intermittent unconditional positive regard for Jorge and is enthused about working with him in the future.

One way to enhance your ability to experience unconditional positive regard is to have a supervisor who accepts your frustrations and intermittent judgmental-ness. If the issues that arise in therapy are similar (or parallel) to the issues that arise in supervision, it’s referred to as parallel process (Searles, 1955). This is one reason why when you get a dose of unconditional positive regard in supervision, it may help you pass it on to your client.

Counseling and Psychotherapy Theory and Practice, Personal Reflections, Writing

Neuroscience New Year’s Resolutions for 2016

January 15, 2016 johnsommersflanagan 4 Comments

In case you forgot or never knew, 1990 to 2000 was championed as the decade of the brain. You would think one decade would be enough, but judging by how much of a darling neuroscience is in the media, it looks like the brain will be hogging the whole 21st century too. And so in celebration of our perpetually “New Brain Science,” I’m offering six neuroscience-based New Year’s resolutions for 2016

1. For years, the Dali Lama has been advising everyone to develop a “Loving Kindness” meditation practice. Even if his advice doesn’t change the world, having a consistent loving kindness meditation practice can change your brain. Mindfulness meditation strengthens a region in the brain called the insular cortex, an area broadly linked to self-control and good judgment. This makes 2016 a good time to start meditating. We could all use a little more self-control and good judgment.

2. You should sit down for this one. Or stand up. And then sit down again. This is because scientific research supports brain-body connections. Exercise facilitates everything from sleep to sex. If you want a sharper brain for 2016, then stand-up and get walking or stretching or running or lifting or dancing your way to clearer thinking.

3. Last year might have been the year of the gut. There’s been plenty of talk about the “gut” being our second brain. Of course, this isn’t about growing your gut or striving for a dad-bod. It’s all about digestive health. The best way to get your second brain to support your mental health is to feed it whole, fresh foods, probiotics, and fermented foods (like kombucha, sauerkraut, and kimchee), while avoiding the evils of eating highly processed white sugar/white flour.

4. Exercise is great and good sex may be better, but loving and gentle touch is the bomb. Make 2016 the year—not only for consensual hugs and kisses—but also for shoulder and neck and foot massages. You can even put brushing each other’s hair on your “this-just-might-improve-my-mental-health” to-do list.

5. In 2015 sleep research was hot. It’s more obvious than ever that sleep deprivation is generally bad for your brain; it contributes to clinical depression, suicide, accidents, and illness. Finding a way to sleep well in 2016 means turning off your screens at least 30 minutes before bedtime, cutting out the caffeine after 2pm, and establishing a steady personal and family sleep routine. Sleep is the new black.

6. For those of us in the helping professions, the biggest neuroscience news is all about what psychotherapists call empathic listening. Turns out, listening in an effort to understand others grows the brain in ways similar to mindfulness meditation. That means the more you practice listening with empathy, the more you’ll grow that all-important insular cortex . . . and the more you grow your insular cortex, the less likely you are to engage in violent behaviors that threaten the planet. So if you want a more peaceful planet, put empathic listening on your New Year’s resolution list.

There’s one big principle that underlies all of the new brain science: Whatever behaviors you rehearse, practice, or repeat, are likely to strengthen your skills and grow your brain in those particular regions. What this means is that if your goal is to be a couch potato for 2016, you should spend lots of time couch potatoing so you can develop mad skills in that area, with a neurological net to match. On the other hand, if you want a healthy brain and body and awesome friendships and romance in your life, you should engage in the activities listed above—especially the mindfulness meditation and empathic listening—and you’ll grow a brain and skills that just might bring health, love, and peace in 2016.

Note: I submitted this awesome resolution list to a couple newspapers just before the New Year, but only got rejections. And so I decided to submit it to myself and, voila!, it got published right here on my very own blog (smiley face). Please share and pass it on so that all the newspaper editors who keep rejecting my work start feeling the deep regret they deserve.

Counseling and Psychotherapy Theory and Practice

Constructivism vs. Social Constructionism: What’s the Difference?

December 5, 2015 johnsommersflanagan 31 Comments

This is an excerpt from the beginning of Chapter 11 of Counseling and Psychotherapy Theories in Context and Practice (3rd ed., John Wiley & Sons, 2018). Despite the heavily intellectual content and use of the traditional sex binary, I hope you’ll find this way of defining these two different post-modern perspectives helpful, and I hope you get the joke at the end.

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

The best way to begin a chapter on constructive theory and therapy is with a story.

Once upon a time a man and a woman met in the forest. Both being academic philosophers well-steeped in epistemology, they approached each another warily. The woman spoke first, asking, “Can you see me?”

The man responded quickly: “I don’t know,” he said. “I have a plethora of neurons firing in my occipital lobe and, yes, I perceive an image of a another person and I can see your mouth was moving precisely as I was experiencing auditory input. Therefore, although I’m not completely certain you exist out there in reality—and I’m not completely certain there even is a reality—I can say without a doubt that you exist … at least within the physiology of my mind.”

Silence followed.

Then, the man spoke again,

“Can you hear me?” he asked.

The woman responded: “I’m not completely certain about the nature of hearing and the auditory process, but I can say that in this lived moment of my experience I’m in a conversation with you and because my knowledge and my reality is based on interactive discourse, whether you really exist or not is less important than the fact that I find myself, in this moment, discovering more about myself, the nature of the world, and my knowledge of all things.”

There are two main branches of constructive theory. These branches are similar in that both perspectives hold firmly to the postmodern idea that knowledge and reality are subjective.

What is Constructivism and What is Social Constructionism?

Constructivism, as represented by the man in the forest, includes people who believe knowledge and reality are constructed within individuals. In contrast, social constructionism, as represented by the woman in the forest, includes people who believe knowledge and reality are constructed through discourse or conversation. Constructivists focus on what’s happening within the minds or brains of individuals; social constructionists focus on what’s happening between people as they join together to create realities. Guterman (2006) described these two perspectives:

Although both constructivism and social constructionism endorse a subjective view of knowledge, the former emphasizes individuals’ biological and cognitive processes, whereas the latter places knowledge in the domain of social interchange. (p. 13)

In this chapter, just as you might avoid traditional “constructed” gender binaries, we de-emphasize distinctions between constructivist and social constructionist perspectives. Mostly, we lump them together as constructive theories and therapies and emphasize the intriguing intervention strategies developed within these paradigms. This may upset staunch constructivists or radical social constructionists, but we take this risk with full confidence in our personal safety—because most constructive types are nonviolent, strongly preferring to think, write, and engage in intellectual discussion. Therefore, within our own socially or individually constructed realities, we’ve concluded that we’re in no danger of bodily harm from angry constructive theorists or therapists.

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice, Parenting

Doing an Internet Interview on IHeart Radio

November 23, 2015 johnsommersflanagan 2 Comments

Today I did an internet interview with Dr. Carlos Vazquez on his “Circle of Insight” show on IHeart Radio. A few minutes after we finished, I got an email from Dr. Carlos indicating it was posted and ready to hear. Wow. Technology is amazing and it’s especially amazing when it works.

Here’s the link to the interview. Check it out if you like. Or ignore it if you prefer.

https://www.spreaker.com/episode/7224462

The show is titled: A discussion about Psychological Theories and how to talk to parents so they Listen with Dr. Sommers-Flanagan

This is what I look like when I do radio interviews.

	ifydtest on Good Morning, Good Solstice…
	johnsommersflanagan on Who Are You? A Request
	johnsommersflanagan on A Glimpse and Quote from Laura…
	Suvendrini on Who Are You? A Request

John Sommers-Flanagan

Category Archives: Counseling and Psychotherapy Theory and Practice

Readers Needed for our Counseling and Psychotherapy Textbook

Theories Highlights II: The Story of Freud’s Seduction Hypothesis

Theories Highlights I: What’s the difference between counseling and psychotherapy?

Why Xavier University Students in Cincinnati Sent Me a Petition . . .

Five Recommendations for Developing a Positive Working Alliance

Using an Invitation for Collaboration in Counseling and Psychotherapy

Parallel Process in Clinical Supervision

Neuroscience New Year’s Resolutions for 2016

Doing an Internet Interview on IHeart Radio

Today I did an internet interview with Dr. Carlos Vazquez on his “Circle of Insight” show on IHeart Radio. A few minutes after we finished, I got an email from Dr. Carlos indicating it was posted and ready to hear. Wow. Technology is amazing and it’s especially amazing when it works.

The place to click if you want to learn about psychotherapy, counseling, or whatever John SF is thinking about.