Category Archives: Counseling and Psychotherapy Theory and Practice

Two New Theories Homework Assignments and Links to Old Theories Resources

My apologies for some bad links when I posted this yesterday. I tried a different linking strategy and it seemed to work on my computer, but not so much for anyone else. Sorry for your inconvenience! And embarrassed for myself.

John Sommers-Flanagan

For the past two years I’ve been using some new theories course assignments and am sharing them here.

New Assignments

The first new homework assignment is called: Multicultural Competence, Multicultural Humility, and Me.  I use this as an early (about week 3) writing assignment for first-year, first-semester M.A. students. I like using it because it gives me a taste of their writing skills, while also introducing them to foundational multicultural content. I have been consistently impressed with the students’ sensitivity to culture and desires to be humble, lifelong learners when it comes to cultural diversity.

The second new homework assignment is for students to take the long form of my Theoretical Orientation test during week 1 and then to retake it during week 15. I have them compare their scores and declare up to three “favorite” theoretical perspectives. Like the multicultural paper, this assignment has produced very interesting…

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Two New Theories Homework Assignments and Links to Old Theories Resources

For the past two years I’ve been using some new theories course assignments and am sharing them here.

New Assignments

The first new homework assignment is called: Multicultural Competence, Multicultural Humility, and Me.  I use this as an early (about week 3) writing assignment for first-year, first-semester M.A. students. I like using it because it gives me a taste of their writing skills, while also introducing them to foundational multicultural content. I have been consistently impressed with the students’ sensitivity to culture and desires to be humble, lifelong learners when it comes to cultural diversity.

The second new homework assignment is for students to take the long form of my Theoretical Orientation test during week 1 and then to retake it during week 15. I have them compare their scores and declare up to three “favorite” theoretical perspectives. Like the multicultural paper, this assignment has produced very interesting (and relatively fun to read) reflections from our students.

Old Resources

If you’re new to teaching or haven’t caught my previous postings for Theories resources, below are some links to materials I’ve found useful. As I’ve said before, although it’s great if you use our Theories text (woohoo), you can also use all these materials in combination with whatever text you’re using. I’m aware of many other strong textbooks—although my bet is that ours is the leader in theories jokes and humor and is probably the most well-liked by students (but I might be biased!).

Theories Course Syllabus

Here’s a link to my most recent syllabus:

Videos

I have a previous blog with links to free videos on my Youtube site. That link is below:

Although we have an excellent theories-specific video series, you need to adopt our text to access them.

Lab Activities

If you want these, email me at john.sf@mso.umt.edu and I’ll email them to you at my earliest convenience.

Good luck in your teaching this semester. I know the challenges are big, but the process of witnessing and participating in student learning is a big positive reinforcement.

Paradoxical Intention, Part II: Transformative Epiphanies

Often, I have the honor of getting a personal preview of Rita S-F’s Godblogs. I sit in a cushy chair, shut my eyes, and let her words create images in my brain. It’s not unusual for her readings to stimulate unusual thoughts. But, last week, while listening, I was taken with a particular epiphany.

She was reading about how easy (and destructive) it is to be judgmental; I can’t recall the details. In response, a voice in my head spoke gently,

“I wonder if it might help if you could try, just a little, to be even more judgmental. . .” followed by an additional internal commentary “. . . said no one ever.”

The thought—of trying to be even more judgmental—made my lips curl upward into a smile. I felt an urge to laugh. Then, naturally, I thought of Viktor Frankl.

As I wrote in my last blog (https://johnsommersflanagan.com/2021/12/06/paradoxical-intention-dont-try-this-at-home-or-maybe-dont-try-it-anywhere/), Frankl was the first person I know of who explicitly discussed paradoxical intention as working like a joke to the psyche. I’ve written about that, but I’d never felt it in my gut. This time I did actually feel it. Then, and in response to the thought of intending to be “even more judgmental,” along with the urge to laugh, I also felt a small internal push back toward acceptance.  

Paradoxical intention has two parts. First, there’s the intention. I’ve tried the intention part of paradoxical intention with myself (and used it with clients) in specific situations when physical behaviors or responses feel outside of voluntary control. One example is the twitching eye syndrome. If you have an eye that’s prone to twitching, you can try to make it twitch more or try to make it twitch when it hasn’t been twitching. That’s the intention part. The other part is for the intention to be aimed toward the opposite of your goal. In the case of listening to Rita’s blog, the thought of intending to be more judgmental was received and then produced psychological push-back. What was different than any other response I’ve ever felt about paradoxical intention was my urge to smile and laugh. I’d never felt like laughing when I tried to make a bothersome eye twitch . . . twitch more.

Later—while driving I-90 west—a place where I’m prone to feeling intermittent anger toward drivers I label in my mind as “stupid,” I did another experiment.

“I wonder,” I thought to myself, “if maybe I could try to start feeling just a little angrier toward those other drivers. Being alone in the car, I tried it out with a brief litany of profanity. In response, I felt increased anger. That wasn’t good. But within seconds, my brain started the natural push-back. I took note of my greater anger and quickly judged it as unpleasant. Then, I noticed an internal psychological push-back toward the center. I suddenly wanted the anger—which usually feels so justified in the moment—to go away. And so, I let it go.

Paradoxical intention isn’t a magic trick. Nothing in the world of human psychology is magical. Paradoxical intention operates on natural psychological dynamics. Laura and Fritz Perls would have called it an internal polarity. Behaviorists like to call it a form of overcorrection. The popular press tends to reduce it to a term I can’t help but find offensive: reverse psychology.

Although you might try paradoxical intention on your children or your friends, because of one central underlying principle, that’s not a great idea. The underlying principle is best expressed by an old (and bad) joke.

“How many mental health professionals does it take to change a light bulb?”

“Only one. But the light bulb has to want to change.”

You could try a little paradoxical intention . . . on yourself . . . but only if you want to experience a new transformative epiphany.

Paradoxical Intention: Don’t Try This at Home (or maybe don’t try it anywhere)

People want change.

People don’t want change.

As W. R. Miller noted in his treatise on motivational interviewing (MI), ambivalence is nearly always the order of the day. Most people, most of the time, would like to be better and healthier versions of themselves. And, most people, most of the time, resist becoming better and healthier versions of themselves.  Who knew?

Alfred Adler may have been the first modern psychotherapist to write from a non-psychoanalytic perspective about how to work with individuals not interested in changing. What follows is a complex quote from Adler. He’s writing about how to work with a patient who is depressed, but not motivated or willing to change. You may need to read this excerpt several times to track it and appreciate Adler’s method. You may see all those words below and not want to put in the effort. That’s okay. You can stop reading now if you don’t want to gather in the nuance sprinkled into Adler’s indirect suggestion.

After establishing a sympathetic relation, I give suggestions for a change of conduct in two stages. In the first stage my suggestion is “Only do what is agreeable to you.” The patient usually answers, “Nothing is agreeable.” “Then at least,” I respond, “do not exert yourself to do what is disagreeable.” The patient, who has usually been exhorted to do various uncongenial things to remedy this condition, finds a rather flattering novelty in my advice, and may improve in behavior. Later I insinuate the second rule of conduct, saying that “It is much more difficult and I do not know if you can follow it.” After saying this I am silent, and look doubtfully at the patient. In this way I excite his [her/their] curiosity and ensure his attention, and then proceed, “If you could follow this second rule you would be cured in fourteen days. It is—to consider from time to time how you can give another person pleasure. It would very soon enable you to sleep and would chase away all your sad thoughts. You would feel yourself to be useful and worthwhile.”

I receive various replies to my suggestion, but every patient thinks it is too difficult to act upon. If the answer is, “How can I give pleasure to others when I have none myself?” I relieve the prospect by saying, “Then you will need four weeks.” The more transparent response, “Who gives me pleasure?” I counter with what is probably the strongest move in the game, by saying, “Perhaps you had better train yourself a little thus: do not actually do anything to please anyone else, but just think about how you could do it!” (Adler, 1964a, pp. 25–26)

Similar to Adler, Viktor Frankl also wrote about using “anti-suggestion” or paradox. Frankl was keen on this method as a means for treating anxiety, compulsions, and physical symptoms. An excerpt from our theories textbook describing Frankl’s paradoxical intention follows.

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Paradoxical Intention

. . . In a case example, Frankl discussed using paradox with a bookkeeper who was suffering from chronic writer’s cramp. The man had seen many physicians without improvement; he was in danger of losing his job. Frankl’s approach was to instruct the man to:

Do just the opposite from what he usually had done; namely, instead of trying to write as neatly and legibly as possible, to write with the worst possible scrawl. He was advised to say to himself, “now I will show people what a good scribbler I am!” And at that moment in which he deliberately tried to scribble, he was unable to do so. “I tried to scrawl but simply could not do it,” he said the next day. Within forty-eight hours the patient was in this way freed from his writer’s cramp, and remained free for the observation period after he had been treated. He is a happy man again and fully able to work. (Frankl, 1967, p. 4)

Frankl attributed the success of paradox, in part, to humor. He claimed that paradox allows individuals to place distance between themselves and their situation. New (humorous) perspectives allow clients to let go of symptoms. Frankl considered paradoxically facilitated attitude changes to represent deep and not superficial change.

Given that Frankl emphasized humor as the therapeutic mechanism underlying paradoxical intention, it fits that he would use a joke to explain how paradoxical intention works,

The basic mechanism underlying the technique…perhaps can best be illustrated by a joke which was told to me some years ago: A boy who came to school late excused himself to the teacher on the grounds that the icy streets were so slippery that whenever he moved one step forward he slipped two steps back again. Thereupon the teacher retorted, “Now I have caught you in a lie—if this were true, how did you ever get to school?” Whereupon the boy calmly replied, “I finally turned around and went home!” (Frankl, 1967, pp. 4–5)

Frankl believed paradoxical intention was especially effective for anxiety, compulsions, and physical symptoms. He reported on numerous cases, similar to the man with writer’s cramp, in which a nearly instantaneous cure resulted from the intervention. In addition to ascribing the cure to humor and distancing from the symptom, Frankl emphasized that paradox teaches clients to intentionally exaggerate, rather than avoid, their existential realities.

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I’m writing about paradoxical intention today because of an inspiration from Rita’s blog yesterday. There’s so much ostensible hate, judgment, and certainty in contemporary discourse. That got me thinking about whether a paradoxical approach might be timely and effective. Yesterday, I tried it on myself. Stay tuned, in my next post, I’ll write about how a little paradox worked out for me, and how it might help shift some of the lamentable, polarized arguments happening all around us.  

The Feminist Lab in Counseling and Psychotherapy Theories

Sometimes when I’m talking about feminism in my theories class, I refer to it as the F-word. I feel like I have to do more “selling” of feminist therapy than any other approach. Maybe I’m just imagining it, but I hear rumors like, “I hope we get to skip feminist therapy in the lab” and “How do you practice feminist therapy?”

The answers are: “No, you don’t get to skip feminist therapy” and “Because feminist therapy is technically eclectic, you can practice it nearly any which way you like.” Freedom is another F-word, and there’s plenty of that when you’re being afeminist.

Yesterday, while facilitating a grad lab where the practicing happens, it was fascinating to observe feminist therapy in 10 minute snippets. I heard a beautiful self-disclosure. I heard talk of clothes and bodies and of the wish to be taken seriously. No one mentioned the patriarchy . . . but everyone . . . hopefully . . . got to taste and talk about oppression and hierarchy and the wish to be a free and expansive self.

Someone even talked about farting. Someone else about dancing. Others about uninhibited delight.

Should you be interested in what prompted these interactions, I’m attaching my feminist lab instructions here:

The Efficacy of Antidepressant Medications with Youth: Part II

After posting (last Thursday) our 1996 article on the efficacy of antidepressant medications for treating depression in youth, several people have asked if I have updated information. Well, yes, but because I’m old, even my updated research review is old. However, IMHO, it’s still VERY informative.

In 2008, the editor of the Journal of Contemporary Psychotherapy, invited Rita and I to publish an updated review on medication efficacy. Rita opted out, and so I recruited Duncan Campbell, a professor of psychology at the University of Montana, to join me.

Duncan and I discovered some parallels and some differences from our 1996 article. The parallels included the tendency for researchers to do whatever they could to demonstrate medication efficacy. That’s not surprising, because much of the antidepressant medication research is funded by pharmaceutical companies. Another parallel was the tendency for researchers to overstate or misstate or twist some of their conclusions in favor of antidepressants. Here’s the abstract:

Abstract

This article reviews existing research pertaining to antidepressant medications, psychotherapy, and their combined efficacy in the treatment of clinical depression in youth. Based on this review, we recommend that youth depression and its treatment can be readily understood from a social-psycho-bio model. We maintain that this model presents an alternative conceptualization to the dominant biopsychosocial model, which implies the primacy of biological contributors. Further, our review indicates that psychotherapy should be the frontline treatment for youth with depression and that little scientific evidence suggests that combined psychotherapy and medication treatment is more effective than psychotherapy alone. Due primarily to safety issues, selective serotonin reuptake inhibitors should be initiated only in conjunction with psychotherapy and/or supportive monitoring.

The main difference from our 1996 review was that in the late 1990s and early 2000s, there were several SSRI studies where SSRIs were reported as more efficacious than placebo. Overall, we found 6 of 10 reporting efficacy. An excerpt follows:

Our PsychInfo and PubMed database searches and cross- referencing strategies identified 10 published RCTs of SSRI efficacy. In total, these studies compared 1,223 SSRI treated patients to a similar number of placebo controls. Using the researchers’ own efficacy criteria, six studies returned significant results favoring SSRIs over placebo. These included 3 of 4 fluoxetine studies (Emslie et al. 1997, 2002; Simeon et al. 1990; The TADS Team 2004), 1 of 3 paroxetine studies (Berard et al. 2006; Emslie et al. 2006; Keller 2001), 1 of 1 sertraline study (Wagner et al. 2003), and 1 of 1 citalopram study (Wagner et al. 2004).

Despite these pharmaceutical-funded positive outcomes, medication-related side-effects were startling, and the methodological chicanery discouraging. Here’s an excerpt where we take a deep dive into the medication-related side effects and adverse events (N.B., the researchers should be lauded for their honest reporting of these numbers, but not for their “safe and effective” conclusions).

SSRI-related medication safety issues for young patients, in particular, deserve special scrutiny and articulation. For example, Emslie et al. (1997) published the first RCT to claim that fluoxetine is safe and efficacious for treating youth depression. Further inspection, however, uncovers not only methodological problems (such as the fact that psychiatrist ratings provided the sole outcome variable and the possibility that intent-to-treat analyses conferred an advantage for fluoxetine due to a 46% discontinuation rate in the placebo condition), but also, three (6.25%) fluoxetine patients developed manic symptoms, a finding that, when extrapolated, suggests the possibility of 6,250 mania conversions for every 100,000 treated youth.

Similarly, in the much-heralded Treatment of Adolescents with Depression Study (TADS), self-harming and suicidal adverse events occurred among 12% of fluoxetine treated youth and only 5% of Cognitive Behavioral Therapy (CBT) patients. Additionally, psychiatric adverse events were reported for 21% of fluoxetine patients and 1% of CBT patients (March et al. 2006; The TADS Team 2004, 2007). Keller et al. (2001), authors of the only positive paroxetine study, reported similar data regarding SSRI safety. In Keller et al.’s sample, 12% of paroxetine-treated adolescents experienced at least one adverse event, and 6% manifested increased suicidal ideation or behavior. Interestingly, in the TCA and placebo comparison groups, no participants evinced increased suicidality. Nonetheless, Keller et al. claimed paroxetine was safe and effective.

When it came to combination treatment, we found only two studies, one of which made a final recommendation that was nearly the opposite of their findings:

Other than TADS, only one other RCT has evaluated combination SSRI and psychotherapy treatment for youth with depression. Specifically, Melvin et al. (2006) directly compared sertraline, CBT, and their combination. They observed partial remission among 71% of CBT patients, 33% of sertraline patients, and 47% of patients receiving combined treatment. Consistent with previously reviewed research, Sertraline patients evidenced significantly more adverse events and side effects. Surprisingly and in contradiction with their own data, Melvin et al. recommended CBT and sertraline with equal strength.

As I summarize the content from our article, I’m aware that you might conclude that I’m completely against antidepressant medication use. That’s not the case. For me, the take-home points include, (a) SSRI antidepressants appear to be effective for some young people with depression, and (b) at the same time, as a general treatment, the risk of side effects, adverse effects, and minimal treatment effects make SSRIs a bad bet for uniformly positive outcomes, but that doesn’t mean there won’t be any positive outcomes. In the end, for my money—and for the safety of children and adolescents—I’d go with counseling/psychotherapy or exercise as primary treatments for depressive symptoms in youth, both of which have comparable outcomes to SSRIs, with much less risk.

And here’s a link to the whole article:

 

Antidepressant Medications for Treating Depression in Youth: A 25-Year Flashback

About 25-years ago Rita and I published an article titled, “Efficacy of antidepressant medication with depressed youth: what psychologists should know.” Although the article targeted psychologists and was published in the journal, Professional Psychology, the content was relevant to all mental health professionals as well as anyone who works closely with children.

Yesterday, when teaching my research class to a fantastic group of Master’s students in the Department of Counseling at UM, I had a moment of reminiscence. Not surprisingly, along with the reminiscence, came a resurgence of emotion and passion. I was sharing about how it’s possible to find an area of interest that hooks so much passion, that you might end up tracking down, literally everything ever published on that topic (as long as the topic is small enough!).

The motivation behind my interest in the efficacy of antidepressants with youth came about because of a confluence of factors. First, I was working with youth every day, many of whom were prescribed antidepressant medications. Second, I was in a sort of professional limbo—working in full-time private practice—but wishing to be in academia. Third, out of virtual nowhere, in 1994, Bob Deaton, a professor of social work at the University of Montana, asked Rita and I to do an all-day presentation for the Montana Chapter of the National Association of Social Workers. Bob’s offer was not to be refused, and I’ve been in Bob Deaton’s debt ever since. If you’re out there reading this, thanks again Bob, for your confidence and the opportunity.

To prep, Rita and I split up the content. One of my tasks was to dive into all things related to antidepressant medications. Before embarking on the journey into the literature, I expected there would be modest evidence supporting the efficacy of antidepressants in treating depression in youth.

My expectations were completely wrong. Much to my shock, I discovered that not only was there not much “out there,” but the prevailing research was riddled with methodological problems and, bottom line, there had NEVER been a published study indicating that antidepressants were more effective in treating depression in youth than placebo. I was gob smacked.

Just to give you a taste, here’s the abstract:

Pharmacologic treatments for mental or emotional disorders are becoming increasingly popular, especially in managed care environments. Consequently, psychologists must remain cognizant of medication efficacy concerning specific mental disorders. This article reviews all double-blind, placebo- controlled efficacy trials of tricyclic antidepressants (TCAs) with depressed youth that were published in 1985-1994. Also, all group-treatment studies of depressed youth using fluoxetine, a serotonin-specific reuptake inhibitor (SSRI), are summarized. Results indicate that neither TCAs nor SSRIs have demonstrated greater efficacy than placebo in alleviating depressive symptoms in children and adolescents, despite the use of research strategies designed to give antidepressants an advantage over placebo. The implications of these findings for research and practice are discussed.

Early in my research class this semester, an astute young woman asked about the “rule” she had heard about that you shouldn’t cite research that’s more than 10-years-old. It was a great question. I hope I responded rationally, but my apoplectic-ness may have showed in my complexion and words. In my view, we cannot and should not ignore past research. As Samuel Clemens once wrote, “History doesn’t repeat itself, it only rhymes.” If we don’t know the old stuff, we may miss out on the contemporary rhyming pattern. In our article, 25-years-old now, we also discussed some medication research reporting shenanigans (although we used more professional language. Here’s an excerpt of our discussion about drop-out rates.

Dropout rates. Side effects and adverse events can significantly affect medication study outcomes by causing participants to discontinue medication treatment. For example, in the IMI [imipramine] study with children ( Puig-Antich et  al.,  I987), 4 out of 20 (20%) of the medication group did not complete the study, whereas in the two DMI [desipramine] studies ( Boulos et al., l99 l; Kutcher et al., 1994 ), 6 out of 18 (33%) and 9 out of 30 (30%) medication participants dropped out because of side effects. For each of these studies, participants who dropped out of the treatment groups before completing the treatment protocol were eliminated from data analyses. The elimination of dropout participants from data analyses produced inappropriately inflated treatment-response rates. For example, although Puig-Antich et al. (1987) reported a treatment-response rate of 56% (9 of 16 participants), if all participants are included within the data analyses, the adjusted or intent-to-treat response rate is 45% (9/20). For the three studies that reported the number of medication protocol participants who dropped out of the study, the average reduction in response rate was 16.5%. Overall, intent­to-treat response rates ranged from less than 8% to 45% (see Table 2 for intent-to-treat response rates for all reviewed TCA studies).

What’s the value, you might wonder, of looking back 25-years at the methodology and outcomes related to tricyclic antidepressant medication use? You may disagree, but I think the rhyming pattern within antidepressant medication research for youth (and adults) remains. If you’re interested in expanding your historical knowledge about this rhyming, I’ve linked the article here.

Research can be boring; it can be opaque; it can be riddled with stats and numbers. Nevertheless, for me, research remains exciting, both as a source of amazing knowledge, but also as something to read with a critical eye.

The Art of Giving Feedback–Revised

[Note: This is an edited and updated version of a post I did a year or two ago.]

Giving and receiving feedback is a huge topic. In this blog post the focus is on giving and receiving feedback in classroom settings or in counseling/psychotherapy supervision. The following guidelines are far from perfect, but they offer ideas that instructors and students can use to structure the feedback giving and receiving process. Check them out, and feel free to improve on what’s here.

Before you do anything, remember that feedback can feel threatening. Hearing about how we sound and what we look like is pretty much a trigger for self-consciousness and vulnerability. Sometimes, when we look in the mirror, we don’t like what we see, and so obviously, when someone else holds up a mirror, the feedback we experience may be . . . uncomfortable. . . to say the least. To help everyone feel a bit safer, the following can be helpful:

  • Acknowledge that feedback is scary.
  • Emphasize that feedback is essential to counseling skill development.
  • Share the feedback process you’ll be using
  • Make recommendations and give examples of what kind of feedback is most useful.

Acknowledge that Feedback is Scary: You can talk about mirrors (see above), or about how unpleasant it is for most people to hear their own voices or see their own images, or tell a story of difficult and helpful feedback. I encourage you to find your own way to acknowledge that feedback triggers vulnerability.

Feedback is Essential: Encourage students to lean into their vulnerability and be open to feedback—but don’t pressure them. Explain: “The reason you’re in a counseling class is to improve your skills. Though hard to hear, constructive feedback is useful for skill development. Don’t think of it as criticism, but as an opportunity to learn from mistakes and improve your counseling skills.” What’s important is to norm the value of giving and getting feedback.

Share the Process You’ll be Using: Before starting a role play or in-class practice scenario, describe the guidelines you’ll be using for giving and receiving feedback (and then generate additional rules from students in the class). Here are some guidelines I’ve used:

  • Everyone who volunteers (or does a demonstration or is being observed) gets appreciation. Saying, “Thanks for volunteering” is essential. I like it when my classes establish a norm where whoever does the role-playing or volunteers gets a round of applause.
  • After being appreciated, the role-player starts the process with a self-evaluation. You might say something like, “After every role play or presentation, the first thing we’ll do is have the person or people who were role-playing share their own thoughts about what they did well and what they think they didn’t do so well.”
  • After the volunteer self-evaluates, they’re asked whether they’d like feedback from others. If they say no, then no feedback should be given. Occasionally students will feel so vulnerable about a performance that they don’t want feedback. We need to accept their preference for no feedback and also encourage them to solicit and accept feedback at some later point in time.

Giving Useful Feedback: It’s always good to start with the positive. Try to be very clear and specific about some things you especially liked. I usually take notes to help me with this; I’ll write down exactly what the role player said and put a + sign next to it so I can say something like, “I see in my notes that I put a + sign next to your very first paraphrase. You seemed to be tracking very well and you shared what you heard with your client in a way that felt nice.

Constructive or corrective feedback shouldn’t focus so much on what was done poorly, but emphasize what could be done to perform the skill even better. Constructive or corrective feedback might sound like this: “I noticed you asked several closed questions. Closed questions aren’t bad questions, but sometimes it’s easier to keep clients talking about important content if you replace your closed questions with open questions or with a paraphrase. Let’s try that. How could you change one of your closed questions to an open question or a paraphrase?” BTW: General and positive comments (e.g., “Good job!”) are pleasant and encouraging, but should be used in combination with more specific feedback; it’s important to know what was good about your job.

Constructive feedback should be specific, concrete, and focused on things that can be modified. For example, you can offer a positive or non-facilitative behavioral observation (e.g., “I noticed you leaned back and crossed your arms when the client started talking about sexuality.”). After making an observation, the feedback giver or the group can explore potential hypotheses (e.g., “Your client might interpret you leaning back and crossing your arms as judgmental”). The feedback giver can also offer an alternative (“Instead, you might want to lean forward and focus on some of your excellent nonverbal listening skills.”).

With constructive feedback you can take some of the evaluation out of the comment by just noticing or observing, rather than judging, “I noticed you said the word, ‘Gotcha’ several times.” You can also ask what else they might say instead, “To vary how you’re responding to your client, what might you say instead of ‘Gotcha’?”

General negative comments such as “That was poorly done.” should be avoided. To be constructive, provide feedback that’s specific, concrete, and holds out the potential for positive change. Feedback should never be uniformly negative. Everyone engages in counseling behaviors that are more or less facilitative. If you happen to be the type who easily sees what’s wrong and have trouble offering praise, impose the following rule on yourself: If you can’t offer positive feedback, don’t offer any at all. Another alternative is to consciously focus on using the sandwich feedback technique when appropriate (i.e., say something positive, say something constructive, then say another positive thing).

IMHO, significant constructive feedback is the responsibility of the instructor and should be given during a private, individual supervision session. The general rule: “Give positive feedback in public and constructive feedback in private” can be useful.

Finally, students should be reminded of the disappointing fact that no one performs perfectly, including the teacher or professor. Also, when you do demonstrations, be sure to model the process by doing a self-evaluation (including things you might have done better), and then asking students for observations and feedback.

Skills and Strategies for Conducting Excellent Clinical Interviews

As seen on a Sussex Directories Inc site

Hello.

This morning I had the honor of spending two hours with counselors from the Western Tidewater Community Services Board in beautiful Virginia. Unfortunately, I wasn’t in Virginia, but the magic of Zoom made the connection and collaboration possible.

The presentation focused on how to integrate assessment and relational factors into an initial clinical interviews. The powerpoints are here:

Before signing off, I want to emphasize how much I enjoyed the short and Zoom-based interactions I had with the Western Tidewater clinicians. They were focused, interested, and engaged. Being with them (over 120 people) increased my belief that there are good people in the world. Thanks!

Emergence of Personal Theory

I think I might be uncertain about my theoretical orientation

For many counseling students, September brings with it the question, “What’s my theoretical orientation?” This is a big question . . . and its bigness is probably the reason why many of our old “theoretical orientation” blog posts suddenly get hot this time of year.

Below, I’ve excerpted a section from the end of chapter 1 of our Counseling Theories textbook. If you’re exploring your theoretical orientation, reading this section might be useful.

Here’s the excerpt

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If you want to be an excellent mental health professional, then it makes sense to closely study the thinking of some of the greatest minds and models in the field. This text covers 12 of the most comprehensive and practical theories in existence. We hope you absorb each theory as thoroughly as possible and try experiencing them from the inside out. As you proceed through each chapter, suspend doubt, and try thinking like a practitioner from each theoretical orientation.

It’s also important for you to discover which theory or theories are the best fit for you. You’ll have opportunities reflect on the content of this text and hopefully that will help you develop your own ideas about human functioning and change. Although we’re not recommending that you develop a 13th theory, we are recommending that you explore how to integrate your genuine self into these different theoretical perspectives.

Some of you reading this book may already have considerable knowledge and experience about counseling and psychotherapy theories. However, even if you have very little knowledge and experience, you undoubtedly have some preexisting ideas about what helps people change. Therefore, before reading chapters 2 through 14, we encourage you to look at your own implicit ideas about people, and how they change.

Your First Client and Your First Theory

Pretend this is the first day of your career as a mental health professional. You have all the amenities: a tastefully decorated office, two comfortable chairs, a graduate degree, and a client.

You also have everything that any scarecrow, tin man, or lion might yearn for: a brain full of knowledge about how to provide therapy, a heart with compassion for a diverse range of clients, and courage to face the challenge of providing therapy services. But do you have what it takes to help a fellow human being climb from a pit of despair? Do you have the judgment to apply your knowledge in an effective way?

You walk to the waiting room. She’s there. She’s your first client ever. You greet her. The two of you walk back to the office.

In the first 20 minutes, you learn quite a lot about your client: She’s a 21-year-old college student experiencing apathy, insomnia, no romantic interests, carbohydrate cravings, an absence of hobbies, and extremely poor grades. She’s not using drugs or alcohol. Based on this information, you tentatively diagnose her as having some variant of clinical depression and proceed with counseling. But how do you proceed? Do you focus on her automatic thoughts and the core beliefs about herself that might be contributing to her depressive symptoms? Do you help her get a tutor, thinking that improved grades might lift her depressive symptoms? Do you recommend she begin an exercise routine? Do you explore her childhood, wondering if she has a trauma experience that needs to be understood and worked through? Do you teach her mindfulness skills and have her practice meditation? Do you have her role play and rehearse solutions to her problems? Do you focus on listening, assuming that if you provide her a positive therapy environment, she’ll gain insight into herself and move toward greater psychological health? Do you help her recast herself and her life into a story with a positive ending more adaptive identity? Do you ask her to sit in different chairs—speaking from different perspectives to explore her here and now feelings of success and failure? Any or all of these strategies might help. Which ones seem best to you?

You have many choices for how to proceed, depending upon your theoretical orientation. Here’s our advice: Don’t get stuck too soon with a single theoretical orientation. It’s unlikely that all humans will respond to a single approach. As suggested in Putting it in Practice 1.3, experiment and reflect before choosing your preferred theory. (Complete the ratings in Table 1.2 and then look through Table 1.3 to see which major theoretical perspectives might fit best for you).

Note: the info from Tables 1.2 and 1.3 are linked in this previous blog post: https://johnsommersflanagan.com/2019/07/27/whats-your-theoretical-orientation/