Category Archives: Counseling and Psychotherapy Theory and Practice

Counseling and Psychotherapy Theory and Practice, Personal Reflections, Uncategorized

Happy New Year (or Not) from Me and my Buddy Sigmund

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On November 10, 2016, I decided to read Sigmund Freud’s Civilization and Its Discontents. I was suddenly interested in how and why individuals and society develop an urge toward the death instinct. It’s light reading. I mean, the book is light, and it’s short. So there’s that.

Some people are unhappy that I’ve chosen to read something by Freud. He wasn’t known for his progressive feminist views. He didn’t even make it into the first wave. Maybe I should have read Adler or Dietrich Bonhoeffer. But Freud was on my bookshelf. Besides, the person who doesn’t think I should be reading Freud is the very same person who gave me this particular copy of Civilization and Its Discontents.

Having an impulse to read about the death instinct is ironic. Or maybe it’s funny. But if there’s one thing that’s not especially funny, it’s Freud. I know he has a book on Jokes and Their Relation to the Unconscious, but I’m betting right now—without even looking at it—that it doesn’t make people laugh.  If Civilization and Its Discontents is any indication, Freud may have written about jokes, but he was no joker.

Here’s a little glimpse of his optimistic discourse.

Thus our possibilities of happiness are already restricted by our constitution. Unhappiness is much less difficult to experience. We are threatened with suffering from three directions: from our own body, which is doomed to decay and dissolution and which cannot even do without pain and anxiety as warning signals; from the external world, which may rage against us with overwhelming and merciless forces of destruction; and finally from our relations to [others]. The suffering which comes from this last source is perhaps more painful to us than any other. (1930/1961, pp. 23-24)

Okay. So maybe when Freud wrote this he was a little short on serotonin at his pre-synaptic cleft [as if I believe that neurochemical imbalance nonsense]. Seriously, what Freud needed was some regular aerobic exercise . . . and maybe yoga combined with mindfulness-based cognitive therapy so he could embrace nonjudgmental acceptance. I think Freud would have gotten into mindfulness because it would have allowed him to bask in nonjudgmental acceptance of all things except for people who didn’t practice mindfulness. Or maybe he would have been better served using individual emotion focused therapy with Leslie Greenberg; that way he could talk to a chair and emote. And if you read Freud, it’s easy to conclude he needed to do some emoting because his self-analysis was sort of like late 19th century self-injurious behavior. . . VERY PAINFUL.

In Civilization and Its Discontents, Freud starts by confessing that he feels troubled over his apparent inability to have religious experiences. He seems to long for an “oceanic” experience of being one with the universe that might be attributable to God or religion. Although he seems rather reluctant to openly admit that. Later, he trudges through an analysis of “Love thy neighbor.” Unfortunately (at least for his neighbor), Freud ends up making more of a case for hating the neighbor. His logic is flawless, at least from his perspective. In the end, Freud embraces the likelihood of a death instinct which, in his time, was probably related to Hitler’s rise to power.

But what was Freud’s solution to the death instinct and Hitler’s ascension?

He had no solution. Or at least he had no solution in which he had much confidence. His last two sentences mark the battle lines. He admits to an incontrovertible aggressive and destructive impulse in individuals and in society. That’s much less fun than riding in a convertible. But more to the point, will hate, aggression, and destruction dominate? Freud seems to say—paraphrasing here, “Maybe so, maybe not.” The future, according to Freud, is in the hands of Eros.

With regard to the final outcome, Freud implies, “We shall see.”

This is like when your television show ends with the phrase, “To be continued.” Only now with internet streaming, rarely do we have to wait a whole week for the stunning conclusion. Sadly, Freud died before he reached the stunning conclusion.

But here’s where things get interesting.

Freud died on 23 September 1939 and John Lennon was born on 9 October 1940.

According to Buddhist philosophy, the soul can be reincarnated somewhere between 49 days to 2 years following death.

This leaves open the possibility—or even likelihood—that Freud was reincarnated as John Lennon and eventually, in 1967, wrote and sang, along with his Beatle friends, “All You Need is Love.” The point that Freud, reincarnated as John Lennon, was trying to make is that we all need to be liberally spreading Eros around as a Death Instinct antagonist.

There’s much more to say about this, but for now, I think the obvious take-home message is for us to all practice loving our neighbors even though we might be able to make a better intellectual case for hating them. We should probably love our enemies too. And I’m adding a twist to this for 2017: sometimes this isn’t going to be fluffy gooey love. It’s going to be some bad-ass, in-your-face tough love.

This is my New Year’s resolution—to be a practitioner of good-old Freudian in-your-face tough Eros.

Although I’m ending this with a wish for you all to have a Happy New Year, I’m also recognizing that the pursuit of happiness is aptly phrased because just when you think you’ve got it, it goes and flits off to somewhere else and you have to keep chasing it.

Good luck with the chase and good luck with that Eros thing.

Cool Counseling, Counseling and Psychotherapy Theory and Practice, Personal Reflections, Uncategorized

The Sweet Spot of Self-Control

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The Sweet Spot of Self Control (and Anger Management)

The speedometer reads 82 miles per hour. The numbers 8 and 2, represent, to me, a reasonable speed on I-90 in the middle of Montana. Our new (and unnecessary) speed limit signs read eight-zero. So technically, I’m breaking the law by two miles per hour. But the nearest car is a quarter mile away. The road is straight. Having ingested an optimal dose of caffeine, my attention is focused.

Slowly, a car creeps up from behind. He has his cruise control set at 83 mph. He lingers beside me and edges ahead. Then, with only three car lengths between us, he puts on his blinker and pulls in front of me. Now, with no other cars in sight, there’s just me and Mr. 83 mph on I-90, three car lengths apart.

An emotion rises into awareness. It’s almost anger. But nope, it’s not anger, it’s anger’s close cousin, annoyance. I feel it in my psyche and immediately know it can go in one of three directions: It could sit there and remain itself, until I tire of it; if I feed it, it could rise up and blossom into full-blown anger; or, I can send it away, leaving room for other thoughts and actions.

This is fabulous. This is the Sweet Spot of Self-Control.

Anger is lurking there, I know. I see it peeking over the shoulder of its cousin. “Hello anger,” I say.

In this sweet spot, I experience expanding awareness, a pinch of energy, along with an unfolding of possibilities. I love this place. I love the feelings of strength and power. I also recognize anger’s best buddy, the behavioral impulse. This particular impulse (they vary of course), is itching for me to reset my cruise control to 84 mph.  It’s coming to me in the shape of a desire—a desire to send the driver in front of me a clear message.

“You should cut him off,” the impulse says, “and let him know he should get a clue and give you some space.”

The sweet spot is sweet because it includes the empowered choice to say “No thanks” to the impulse and “See you later” to anger.

Now I’m listening to a different voice in my head. It’s smaller, softer, steadier. “It doesn’t matter” the voice whispers. “Let him creep ahead. Revenge only satisfies briefly.”

I feel a smile on my face as I remember an anger management workshop. With confidence, I had said to the young men in attendance, “No other emotion shifts as quickly as anger. You can go from feeling completely justified and vindicated, but as soon as you act, you can feel overwhelmed with shame and regret.”

A man raised his hand, “Lust” he said. “Lust is just like anger. One second you want it more than anything, but the next second you wish you hadn’t.”

“Maybe so,” I said. “Maybe so.”

There are many rational reasons why acting on aggressive behavioral impulses is ill-advised. Maybe the biggest is that the man in the car wouldn’t understand my effort to communicate with him. This gap of understanding is common across many efforts to communicate. But it’s especially linked to retaliatory or revenge-filled impulses. When angry, I can’t provide nuance in my communication and make it constructive.

The quiet voice in my brain murmurs: “You’re no victim to your impulses. You drive the car; the car doesn’t drive you.” That doesn’t make much sense. Sometimes the voice in my head speaks in analogy and metaphor. It’s a common problem. I want straight talk, but instead I get some silly metaphor from my elitist and intellectual conscience.

But I do get it and here’s what I get. I get that my conscience is telling me that this sweet spot is sweet because I get to see and feel my self-control. Not only do I get to see my behavioral options, I get to see into the future and evaluate their likely outcomes. I get to reject poor choices and avoid negative outcomes linked to aggressive actions. I’m not a victim of annoyance, anger, or aggressive impulses. I get to make the plan. I get to drive the car.

Now that other driver is far ahead.

Being on a Montana freeway, it’s hard to not think of deer. It’s clear now, but at dusk, deer will be everywhere. They have an odd instinct. Freud and my elitist conscience are inclined to call it a death instinct. Here’s how it works:

When I drive up alongside a deer on the side of the road, it dashes ahead, running alongside me; then it tries to cut across in front of me. This is the coup de gras of bad judgment. I’m in a big metal machine. The deer isn’t. So the deer dies. Not a good choice for the deer.

Yesterday, my phone alerted me to a Youtube speech by an unnamed alt right big-man. I watched and listened. So much smugness I was sick. In the end he shouted out “Hail Trump” and a few others jumped up and gave the “Heil Hitler!” salute.

Like a crazed deer, I felt an instinct. I wanted to drive to D.C. or Whitefish, Montana and find unnamed alt-right man and cut him off with some uncivil discourse. Instead, because I have a frontal lobe, I walked to the gym. Upon arriving, I discovered I’d stepped in dog poop. I’m sure this was an annoying but meaningful metaphor for something. At least that’s what my metaphor-loving conscience suggested. I didn’t buy it. Instead, I muttered “WTF” to myself. Okay, so maybe I muttered “WTF” several times. Then I walked outside in my socks and started cleaning the poop off my shoe. Not an easy task, especially if you’re wearing brand new trail-runners. I had to find a restroom near my office, an old toothbrush, lots of foamy soap, and mindfully scrub away the poop.

I was reminded of something my daughter Rylee once said at age three. She was being carried down a hill and there were many small piles of deer scat. She noticed, commenting: “I didn’t know the poop was so deep.”

Neither did I.

But the good news is that I (like you) own a functional frontal lobe that gifts me with the Sweet Spot of Self-Control. Many of us will be mindfully removing the metaphorical shit from our shoes for some time into the future. So let’s make some plans. Not revenge-laced plans; they don’t last. Yes. Let’s pause in the special sweet spot, evaluate our alternatives, and make some excellent plans.

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Cool Counseling, Counseling and Psychotherapy Theory and Practice, Personal Reflections, Uncategorized

Emotional Dysregulation: Finding the Way Out

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Sometimes we call it affect dysregulation. It creeps around like a metaphorical tarantula, sometimes popping up—big and frightening—and always best viewed from a distance. Just like shit, emotional dysregulation happens.

In counseling and psychotherapy, we throw around jargon. It can be more or less helpful. When it’s helpful, it facilitates important communication; when it’s not, it distances us from the experiences of our clients, students, and other mental health consumers.

So what is emotional dysregulation? Here’s what Wikipedia says:

Emotional dysregulation (ED) is a term used in the mental health community to refer to an emotional response that is poorly modulated, and does not fall within the conventionally accepted range of emotive response. ED may be referred to as labile mood (marked fluctuation of mood) or mood swings.

I hereby declare that definition not very helpful.

I have a better definition. Emotional dysregulation (ED) is the term of the month. Why? Because I’ve been intermittently emotionally dysregulated since November 9 and I see emotional dysregulation nearly everywhere I look.

I’ve seen many clients for whom the term emotionally dysregulated is an apt description. These clients report being frequently triggered or activated (more jargon) by specific incidents or experiences. Many of these incidents are interpersonal, but as many of us know from the recent election, they can also be political and, for many, reading about or directly experiencing social injustice is a big trigger. After being emotionally triggered, the person (you, me, or a client) is left feeling emotionally uneasy, uncomfortable, and it can be hard to regain emotional equilibrium, calm, or inner peacefulness.

What are common emotional dysregulators? These include, but are certainly not limited to: Being misunderstood, experiencing social rejection or social injustice, harassment, or bullying, or being emotionally invalidated. Consider these (sometimes well-meaning) comments: “Smile.” “What’s wrong with you?” “You’re overreacting.” “Chill.” “Cheer up.”). One time I overheard a father tell his son, “Do you think I give a shit about what you’re feeling?” Yep. If someone says that to you or you overhear someone saying it to a 10-year-old, that might trigger emotional dysregulation.

Emotional dysregulation passes. That’s the good news. But sometimes it doesn’t pass soon enough. And other times, like when I see he-who-will-not-be-named on the television screen or hear his voice on the radio, repeated re-activation or re-triggering can occur. It becomes the Ground Hog’s Day version of emotional dysregulation.

In the clinical world, emotional dysregulation is linked to post-traumatic stress disorder, borderline personality disorder, clinical depression, and a range of other anxiety disorders. Suicidal crises often have emotional triggers. The point: emotional dysregulation is a human universal; it occurs along a continuum.

The Fantastic Four

Emotional dysregulation usually involves one of the fantastic four “negative” emotions. These include:

  • Anger
  • Sadness
  • Fear
  • Guilt

To be fair, these emotions aren’t really negative. They have both negative and positive characteristics. In every case, they can be useful, sooner or later, to the person experiencing them. For example, anger is both light and energy. It can clarify values and provide motivation or inspiration. Unfortunately, the light and energy of anger is also confusing and destabilizing. It’s easy for anger to cloud cognition; it’s easy for anger to send people out on misguided behavioral missions. Funny thing, these misguided, anger-fueled missions often feel extremely self-righteous, right up until the point they don’t. Less funny thing, immediately after the punch, the flip-off, the profanity, the broken window or door or relationship or whatever—regret often follows. Ironically then, the emotional dysregulation (anger) leads to behavioral dysregulation (aggression), which leads right back to emotional dysregulation (guilt and remorse).

Dysregulation can be experienced via any of a number of dimensions. You can experience behavioral, mental, social, and spiritual dysregulation. What fun! Who designed this system where we can get so dysregulated in so many different ways? Never mind. It was probably he-who-will-not-be-named.

One of the most perplexing things about emotional dysregulation is that so very often, we do it to ourselves. We do it repeatedly. And more or less, we usually know we’re doing it. We seem to want to embrace our anger, sadness, fear, and guilt. What’s wrong with that? Nothing, that is, until we want out.

For most people, the fantastic four feel bad. They stay too long. They adversely affect relationships. They’re bad company.

There’s one best way out of emotional dysregulation. I’ll say it in a word that I’m borrowing from Alfred Adler. Gemeinschaftsgefühl. I’ll say it in another word: Empathy. Empathy for yourself and others. The kind of empathy that moves you to being interested in other people and motivated to help make our communities and the world better, safer, and more filled with justice.

Okay then. Let’s get out there and start Gemeinschaftsgefühling around. We’ve got at least four years of work ahead.

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For another, less profound way out of the Fantastic Four negative emotions, check out the Three-Step Emotional Change Trick: https://johnsommersflanagan.com/2012/09/23/the-three-step-emotional-change-trick/

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Counseling and Psychotherapy Theory and Practice

My Journey to Neuroscience

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For the revision of our Counseling and Psychotherapy text, Rita and I are contemplating how to integrate some neuroscience information in a balanced way. Each chapter would include a short section discussing neuroscience as it pertains to each theoretical perspective. This essay is one effort for beginning or framing the discussion.  Check it out (if you like this sort of thing) and let me know your thoughts (if you do that sort of thing).

From Biological Psychiatry to Interpersonal Neurobiology

In 1980, I (John) began my career in mental health services as a recreation therapist in a 22-bed psychiatric hospital. The patients were experiencing severe depression, manic episodes, and psychotic symptoms.

There was a large and intimidating psychiatrist (Dr. M) on the unit. Dr. M was a fan of biological psychiatry. He would smile as I engaged patients in the “Newly-Friend Game” (like the Newly-Wed Game, only better), relaxation groups, bowling nights, and ice cream socials. Occasionally Dr. M cornered me, explaining how my “cute” recreational programs had absolutely no influence on our hospitalized patients’ mental health. He waxed eloquent about brain chemistry. Never mind that the Thorazine and Haldol he prescribed had nasty side effects. Eventually, he claimed, there would be designer drugs that cured mental disorders from the inside out. Everything else was irrelevant.

I had a fresh, new bachelor’s degree in psychology. Dr. M had his M.D. He knew more than I did. Class dismissed. But it’s funny how encountering a condescending attitude can be motivating. I figured there must be a brain chemistry explanation for that too.

The chemical imbalance theory of mental disorders continued its dominance through the 1980s and 90s. Explanations for psychopathology focused on too much dopamine (causing schizophrenia) and not enough norepinephrine or serotonin (causing depression). No one really knew what caused these so-called imbalances, but biogenetic factors were the prime suspects. Although I kept silent with Dr. M, I held tight to my beliefs that social, psychological, and physical experience could be therapeutic.

Evidence slowly rolled in. While teaching a class on developmental counseling, I found a study showing that testosterone levels vary as a function of winning or losing tennis matches (Booth, Shelley, Mazur, Tharp, & Kittok, 1989). My brain (and the chemicals therein) loved this idea. If our testosterone levels could change based on competitive experiences, what other ways might human behavior influence the brain?

In 1998, while perusing research on serotonin and depression, I discovered that treadmill running increased brain serotonin in rats. The researcher described the complexity of the phenomenon:

Lipolysis-elicited release of free fatty acids displaces the binding of tryptophan to albumin and because exercise increases the ratio of circulating free tryptophan to the sum of the concentrations of the amino acids that compete with tryptophan for uptake at the blood-brain barrier level, tryptophan enters markedly in the brain compartment. (Chaoeloff, 1997, p. 58)

But my take-home message was simple: physical exercise might increase serotonin in human brains and also help alleviate depression.

Then neurogenesis came along. Neurogenesis is the creation of new brain cells. It has been long known that during fetal development, cells are created and migrate to specific places in the brain and body where they engage in their specific role and function. Cells that become rods and cones end up in the eyes, while other cells become bone, and still others end up in the cerebral cortex. In the 1980s and 1990s, everyone agreed that that neurogenesis continued during infancy, but most neuroscientists also believed that after early childhood the brain locked down and neurogenesis stopped. In other words, as adults, we only had neuronal pruning (cell death) in our future.

In the late 1980s, neuroscientists began conducting research that shook long-held assumptions about neurogenesis. For example, Jenkins and colleagues housed adult monkeys in cages where the monkeys had to use their middle finger to rotate a disc to get banana pellets. Even after a short time period (1 week) upon autopsy the monkeys had an enlarged region in their motor cortex. The conclusion: Even in adult monkeys, repeated physical behaviors stimulate neurogenesis in the motor cortex. This seemed like common sense. Not only do our brains shape our experiences, but our experiences shape the brain (literally).

As it turns out, neurogenesis slows with age, but it doesn’t stop. It continues throughout the lifespan. New learning stimulates cell birth and growth in the hippocampus (and other areas involving memory processing and storage). The “new brain research” left open the possibility that counseling and psychotherapy has the potential to stimulate neurochemical changes and cell birth in the human brain.

The evidence is no longer slowly rolling in—it’s popping like popcorn. Neuroscience research is as popular as Beyoncé. Whenever more evidence arrives showing how counseling and psychotherapy might be affecting brain functioning, non-medical mental health professionals get giddy. As you might suspect (or already know) occasionally we’re so excited that our statements about the implications and applications of neuroscience are way ahead of the actual scientific evidence. Counseling and psychotherapy practitioners have created new marketing terminology like “brain-based therapy” and “neurocounseling” and “interpersonal neurobiology” despite the lack of clear scientific evidence to support these terms. In some cases the birthing of this new terminology has caused lament within the neuroscience community (Satel & Lillienfeld, 2015).

Where does all this take us? As Dr. M would say, the brain is central to mood and behavior change. But now we know the reverse is also true: mood and behavior are central to brain development and change. If Dr. M were still alive, I might say, “touche” or “voila” or some other fancy and clever retort to show him that he had the directionality wrong—all these years.

But my retort would be incorrect too. The influence goes both directions at once. Even more importantly, we need to acknowledge that the relationships between and among brain structures, neurotransmitters, hormones, other chemicals, and human behaviors are still complex and mysterious. Even though journalists sometimes write with flourish about our ability to peer directly into the brain and see exactly what’s happening, that’s just not true. And to the extent we can “see” what’s happening, it appears that the brain is simultaneously functioning as a whole, as regions, as inter- and intra-cellular processes, and doing all these activities in particular sequences and all at once. Sure, as many mental health professionals will enthusiastically claim, we now know that meditation and interpersonal empathic experiences appear to stimulate the anterior insular cortex (AIC)! But it’s more complicated than that. The following excerpt from the neuroscience literature helps communicate this complexity (Mutschler, Reinbold, Wankerl, Seifritz, & Ball, 2013).

In summary, we argue that the dorsal AIC plays a pivotal role in empathy (similarly as during emotion processing and pain) by integrating sensory stimuli with its salience, possibly via connections to the cingulate cortex. This assumption is also supported by the fact that ALE-findings related to emotion and empathy for pain and also the DGR—which has been associated with cognition—overlap in the dorsal anterior insula, suggesting that these functions share a common neural substrate . . . . As mentioned above we assume that the overall role of the morphometrically identified area in the dorsal AIC related to individual differences in empathy which overlaps the DGR might be involved in integrating information which is relevant for socio-emotional and cognitive processing. Thus, we assume that empathy is not (only) related to a specific “socio-emotional” interaction area, but to a superordinate “domain-general” area, in line with concepts of empathy that include not only social and emotional, but also cognitive aspects . . . . Whether our findings in the dorsal AIC have also a relation to the “von Economo neurons” [VENs, . . .] remains to be determined. VENs have been hypothesized to play are role in social-emotional processing including empathy . . . .

This excerpt should inspire us all to pause with respect for the density and specificity of neuroscience. It should also inspire us to ramp down our expectations. If we just focus on empathy and the insula, we can see many sources of potential error: (a) much of the empathy research focuses on empathy for pain; (b) empathy is hard to measure; (c) it’s possible for a human brain to “light up” with empathy, but for the human to not express or show empathy toward someone else; (d) while empathy is generally considered a positive quality, some people use empathy to manipulate and hurt others; (e) there is brain structural and functional overlap; (f) the role of the VENs is unknown; and on and on. To use an inappropriate metaphor, it’s likely that the particular blend and balance of neurotransmitters (there may be up to 100) and hormones (there are about 50) and other cellular substances in each individual—along with structural variability—is more unique than a fingerprint on a snowflake.

In every chapter of this text Charles Luke (of Tennessee Tech) and I will share a highlight or update on neuroscience research. These highlights and updates will focus not only on the promise and potential of neuroscience to counseling and psychotherapy, but also on its limitations. A focus on limitations is needed because our ability to imagine what’s happening in the brain greatly outpaces neuroscience research. Although it’s tempting (and terribly fun), we shouldn’t let our imagination get too far in front of the science. As Dr. M might have said, “the brain offers us the greatest opportunity and potential to understand, explain, predict, and manage human behavior.” Of course it does; and it always will.

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Counseling and Psychotherapy Theory and Practice

Check Out These Blogs about Counseling Theories

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John and Jon on M

Over the past five years I’ve written over 50 blog posts linked to teaching and learning the theory and practice of counseling and psychotherapy. While procrastinating on another project, I decided to organize these blog posts by topic. If you follow the links below, they’ll take you to blog posts relevant to specific theories. Included in some of these are a few links to short (and free) theories-based video examples. If you teach a theories course, you could select some of these links to assign students outside readings or you could peruse them yourself to stimulate a few lecture ideas.

Please note that if you use our Counseling and Psychotherapy Theories in Context and Practice textbook, there’s a bit of redundancy with the textbook’s content. However, if you don’t use the text, the material will be new to you and your students.

Chapter 1 – Opening and Overview

A Plan for Maximizing Positive Counseling and Psychotherapy Outcomes: https://johnsommersflanagan.com/2014/09/07/a-plan-for-maximizing-positive-counseling-and-psychotherapy-outcomes/

Teaching Counseling and Psychotherapy Theories: Reflections on Week 1: https://johnsommersflanagan.com/2012/08/29/teaching-counseling-and-psychotherapy-theories-reflections-on-week-1/

Reformulating Clinical Depression: The Social-Psycho-Bio Model: https://johnsommersflanagan.com/2013/09/03/reformulating-clinical-depression-the-social-psycho-bio-model/

What’s the Difference between Counseling and Psychotherapy? https://johnsommersflanagan.com/2016/07/14/theories-highlights-i-whats-the-difference-between-counseling-and-psychotherapy/

Neuroscience New Year’s Resolutions: https://johnsommersflanagan.com/2016/01/15/neuroscience-new-years-resolutions-for-2016/

Evidence-Based Relationships in Counseling and Psychotherapy: https://johnsommersflanagan.com/2015/09/29/evidence-based-relationships-three-new-case-examples/

Chapter 2 – Psychoanalytic Approaches

Attachment-Informed Psychotherapy: https://johnsommersflanagan.com/2015/08/12/attachment-informed-psychotherapy/

The Story of Freud’s Seduction Hypothesis: https://johnsommersflanagan.com/2016/07/15/theories-highlights-ii-the-story-of-freuds-seduction-hypothesis/

The Working Alliance in Counseling and Psychotherapy: https://johnsommersflanagan.com/2016/04/06/five-recommendations-for-developing-a-positive-working-alliance/

Chapter 3 – Adlerian Approaches: Individual Psychology

The Three-Step Emotional Change Trick: https://johnsommersflanagan.com/2012/09/23/the-three-step-emotional-change-trick/

A Parenting Homework Assignment on Natural and Logical Consequences: https://johnsommersflanagan.com/2011/11/30/a-parenting-homework-assignment-on-natural-and-logical-consequences/

More Than Praise — Other Ways Parents Can Be Positive With Their Children: https://johnsommersflanagan.com/2012/08/16/more-than-praise-other-ways-parents-can-be-positive-with-their-children/

Chapter 4 – Existential Approaches

Reflections on Listening to Irvin Yalom at the ACA Conference: https://johnsommersflanagan.com/2012/03/25/reflections-on-listening-to-irvin-yalom-at-the-aca-conference/

A Short Existential Case Example from Counseling and Psychotherapy Theories . . .: https://johnsommersflanagan.com/2015/08/25/a-short-existential-case-example-from-counseling-and-psychotherapy-theories/

Fun with Existential Theory: https://johnsommersflanagan.com/2016/08/01/fun-with-existential-theory/

Chapter 5 – Person-Centered Approaches

Reflections on Magic: https://johnsommersflanagan.com/2011/11/28/reflections-on-magic/

Listening as Meditation on Psychotherapy.net: https://johnsommersflanagan.com/2014/02/25/listening-as-meditation-on-psychotherapy-net/

An Interview with Natalie Rogers (Daughter of Carl Rogers) about Person-Centered Therapy: https://johnsommersflanagan.com/2015/08/04/an-interview-with-natalie-rogers-daughter-of-carl-rogers-about-person-centered-therapy/

Why Therapists Should Never Say, “I know how you feel”: https://johnsommersflanagan.com/2013/05/30/why-therapists-should-never-say-i-know-how-you-feel/

Carl Rogers and Brain-Science do an Empathy Smackdown in Chapter 3: https://johnsommersflanagan.com/2015/07/09/carl-rogers-and-brain-science-do-an-empathy-smackdown-in-chapter-3/

An Invitation for Collaboration: https://johnsommersflanagan.com/2016/03/27/using-an-invitation-for-collaboration-in-counseling-and-psychotherapy/

Chapter 6 – Gestalt Approaches

Go Go Gestalt: The Theories Video Shoot, Part I: https://johnsommersflanagan.com/2012/04/24/go-go-gestalt-the-theories-video-shoot-part-i-2/

Chapter 7 – Behavioral Approaches

A Black Friday Tribute to Mary Cover Jones and her Evidence-Based Cookies: https://johnsommersflanagan.com/2011/11/25/a-black-friday-tribute-to-mary-cover-jones-and-her-evidence-based-cookies/

Behavioral Activation Therapy: Let’s Just Skip the Cognitions: https://johnsommersflanagan.com/2014/06/30/behavioral-activation-therapy-lets-just-skip-the-cognitions/

Imaginal or In Vivo Exposure and Desensitization: https://johnsommersflanagan.com/2012/05/19/imaginal-or-in-vivo-exposure-and-desensitization-2/

A New Look at Time-Out for Kids and Parents: https://johnsommersflanagan.com/2012/08/04/a-new-look-at-time-out-for-kids-and-parents/

Information on Using Time-Out — Part II: https://johnsommersflanagan.com/2012/08/05/information-on-using-time-out-part-ii/

Talking with Parents about Positive Reinforcement: https://johnsommersflanagan.com/2014/09/06/talking-with-parents-about-positive-reinforcement/

Backward Behavior Modification: https://johnsommersflanagan.com/2012/12/02/backward-behavior-modification/

Behaviorism for Everyone: https://johnsommersflanagan.com/2015/10/06/dont-let-your-philosophical-beliefs-make-you-less-professionally-competent/

Chapter 8 – Cognitive-Behavioral Approaches

Positive Thinking is Not (Necessarily) Rational Thinking: https://johnsommersflanagan.com/2011/12/06/positive-thinking-is-not-necessarily-rational-thinking/

How to Use the Six Column CBT Technique: https://johnsommersflanagan.com/2014/02/18/how-to-use-the-six-column-cbt-technique/

A Quick Look at the Collaborative Cognitive Therapy Process: https://johnsommersflanagan.com/2012/09/30/a-quick-look-at-the-collaborative-cognitive-therapy-process/

Tomorrow’s Election and Confirmation Bias: https://johnsommersflanagan.com/2012/11/05/tomorrows-election-and-confirmation-bias/

Confirmation Bias on My Way to Spearfish, South Dakota: https://johnsommersflanagan.com/2014/04/30/confirmation-bias-on-my-way-to-spearfish-south-dakota/

Chapter 9 – Choice Theory and Reality Therapy

The Seven Magic Words for Parents: https://johnsommersflanagan.com/2012/12/23/the-seven-magic-words-for-parents/

Give Information and then Back-Off: A Choice Theory Parenting Assignment: https://johnsommersflanagan.com/2012/07/09/give-information-and-then-back-off-a-choice-theory-parenting-assignment/

How Parents Can Use Problem-Solving Power: https://johnsommersflanagan.com/2012/10/23/how-parents-can-use-problem-solving-power/

Chapter 10 – Feminist Approaches

Opening Thoughts on Feminism: https://johnsommersflanagan.com/2012/04/03/opening-thoughts-on-feminism-3/

The Girl Code by Ashley Marallo: https://johnsommersflanagan.com/2012/12/03/the-girl-code-by-ashley-marallo/

A Guest Essay on the Girl Code and Feminism: https://johnsommersflanagan.com/2014/12/07/a-guest-essay-on-the-girl-code-and-feminism/

Feminist Culture in Music: https://johnsommersflanagan.com/2013/11/18/feminist-culture-in-music/

Chapter 11 – Constructive (Solution-Based and Narrative) Approaches

Is Solution-Focused Therapy as Powerfully Effective as Solution-Focused Therapists Would Have Us Believe?: https://johnsommersflanagan.com/2012/07/01/is-solution-focused-therapy-as-powerfully-effective-as-solution-focused-therapists-would-have-us-believe-2/

Secrets of the Miracle Question: https://johnsommersflanagan.com/2015/03/04/secrets-of-the-miracle-question/

The Love Reframe: https://johnsommersflanagan.com/2013/04/07/the-love-reframe/

Constructivism vs. Social Constructionism: What’s the Difference? https://johnsommersflanagan.com/2015/12/05/constructivism-vs-social-constructionism-whats-the-difference/

Chapter 12 – Family Systems Approaches

None posted on this topic. Obviously, I need help here.

Chapter 13 – Multicultural Approaches

Four Good Ideas about Multicultural Counseling and Psychotherapy—In Honor of Martin Luther King, Jr.: https://johnsommersflanagan.com/2012/01/16/four-good-ideas-about-multicultural-counseling-and-psychotherapy-in-honor-of-martin-luther-king-jr/

Good Ideas about Multicultural Counseling and Psychotherapy – Part II: https://johnsommersflanagan.com/2012/01/22/good-ideas-about-multicultural-counseling-and-psychotherapy-part-ii/

Cultural Adaptations in the DSM-5: Insert Foot in Mouth Here: https://johnsommersflanagan.com/2014/07/08/cultural-adaptations-in-the-dsm-5-insert-foot-in-mouth-here/

Psychic Communications . . . and Cultural Differences in Mental Status: https://johnsommersflanagan.com/2013/01/02/psychic-communications-and-cultural-differences-in-mental-status/

A White Male Psychologist Reflects on White Privilege: https://johnsommersflanagan.com/2012/09/14/a-white-male-psychologist-reflects-on-white-privilege/

Tips for Counseling Culturally Diverse Youth: https://johnsommersflanagan.com/2015/11/19/counseling-culturally-diverse-youth-research-based-and-common-sense-tips/

Chapter 14 – Integrative Approaches

Making Memories in L.A.: An Interview with Matt Englar-Carlson: https://johnsommersflanagan.com/2016/05/20/making-memories-in-l-a/

My Response to a Petition from a Theories Class at Xavier University: https://johnsommersflanagan.com/2016/04/29/why-xavier-university-students-in-cincinnati-sent-me-a-petition/

With Wubbolding

Counseling and Psychotherapy Theory and Practice

Fun with Existential Theory

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I think existentialists have gotten a bad rap over the years. They don’t deserve their depressive reputation. If you’re not sure about this claim, invite a bunch of existentialists over for a party. They know how to have a good time. Just think of Jean Paul Sartre and Simone de Beauvoir. I’m sure they did some table-dancing (among other things) in their time.

Why are they so much fun? Well, in addition to their tendency to go on and on about death and meaninglessness, existentialists were some of the original embracers of carpe diem. They believe in seizing the day (or moment)–regardless of whether they’re playing Pokemon Go or working with you in counseling or psychotherapy.

Below I’ve included a short excerpt from the upcoming 3rd edition of Counseling and Psychotherapy Theories in Context and Practice. One of the reasons I’m posting this is because one of the reviewers of the 2nd edition noted that we were trying too hard to to be “cute” . . . so I thought I’d see if any of you blog-readers think that’s the case. This particular excerpt is as cute as we get in this chapter. What do you think?? Overboard? Just right? Or should we try to be more like Stephen Colbert. You be the judge in this moment in time.

Theoretical Principles

As noted previously, there’s no single theorist or theory of existential psychotherapy. Consequently, although we focus on key existential philosophical and phenomenological principles, other existential writers and theorists may emphasize principles slightly different from the following.

The I-Am Experience

The I-am experience is the experience of being, of existing (R. May et al., 1958). The experience of being is often referred to as ontological experience (ontos means “to be” and logical means “the science of”). Literally, then, a major focus of existential therapy consists of exploring immediate human experience. You might think of it as suddenly waking up and being completely tuned into what it’s like to exist and be here and now in this particular moment in time.

Existentialists like to use hyphens to capture the interconnectedness of phenomenological experience. For example, in contrast to May’s I-am experience, Boss (1963) and Binswanger (1933) used Dasein (which is translated to being-in-the-world) to describe the sense-of-existence. Also, the phrase, “Dasein choosing,” which is translated to the-person-who-is-responsible-for-his-existence choosing is used. We should note that this practice is in no way related to our own hyphenated last names, although it has inspired John to consider adding a hyphenated middle name so he can refer to himself in the third person as, “John-who-is-responsible-for-his-existence-Sommers-Flanagan,” which he thinks sort of rolls right off the tongue.

It follows, as-if-anything-really-follows-from-the-preceding, that existential therapy is almost always in the service of self-awareness or self-discovery. However, unlike psychoanalysts, existentialists seek to expand client self-awareness rather than interpreting client unconscious processes. This is because existentialists believe the entirety of an individual’s human experience is accessible to consciousness. It’s not so much a matter of uncovering an elusive unconscious as it is a matter of elucidating the conscious and deepening the relational.

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.

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

These four 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 mountain hike up the Stillwater gorge in Montana, it’s difficult not to become profoundly into being-with-nature as water powerfully cascades around you, making all conversation (being-with-others) impossible. 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 that your being moves in a given situation is likely a combination of several factors, including, but not limited to: anxiety, previous experiences, intention, as well as your spiritual predisposition.

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Counseling and Psychotherapy Theory and Practice

Readers Needed for our Counseling and Psychotherapy Textbook

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Hello All.

We’ve just started working on the 3rd 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

Recommended Readings and Resources

Chapter 3: Individual Psychology and Adlerian Therapy

Chapter 4: Existential Theory and Therapy           

Chapter 5: Person-Centered Theory and Therapy             

Chapter 6: Gestalt Theory and Therapy 

Chapter 7: Behavioral Theory and Therapy          

Chapter 8: Cognitive-Behavioral Theory and Therapy     

Chapter 9: Choice Theory and Reality Therapy   

Chapter 10: Feminist Theory and Therapy            

Chapter 11: Constructive Theory and Therapy    

Chapter 12: Family Systems Theory and Therapy              

Chapter 13: Developing Your Multicultural Orientation and Skills              

Chapter 14: Integrative and Evidence-Based New Generation Therapies 

One Theory or Many?

Psychotherapy Integration: Historical and Theoretical Trends

The Practice of Eclectic and New Generation Integrative Therapies

Concluding Comments

Chapter Summary

Integrative Key Terms

Recommended Readings and Resources

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Counseling and Psychotherapy Theory and Practice

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

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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:

  1. 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.
  2. Critics contend that in Freud’s paper, “the ‘facts’ of specific case histories are never provided” (Wilcocks, 1994).
  3. 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?

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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 . . .

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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 3rd 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.

Brent Richardson