Category Archives: Counseling and Psychotherapy Theory and Practice

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice, Therapy with Adolescents

Good Ideas about Multicultural Counseling and Psychotherapy – Part II

2 Comments

Three More Ideas About Multicultural Counseling

4.  Developing your Self-Awareness is Central

Both the American Counseling Association and the American Psychological Association place self-awareness of the therapist as a central factor in developing multicultural competency. This is a great, but tricky idea. It’s tricky because of the nature of awareness is such that it’s all too easy for us to remain unaware to very significant multicultural issues. If you’re interested in exploring your multicultural awareness further, you should check out the Implicit Association Test at: https://implicit.harvard.edu/implicit/.

I have a friend who often claimed: “I’m not insensitive, I’m just oblivious!” Of course this was offered in humor, but obliviousness—especially if you’re aware of it—is no good excuse for being insensitive to diversity issues. I’m also reminded of the insensitive and oblivious response of many White Montana students to multicultural discussions. It’s not unusual for some of them to say things like, “I just haven’t had much contact with people from other cultures because we don’t have many minorities in Montana.” When I hear this I try not to gasp aloud as I, or a Native or First Nations Person points out that, in fact, 6.8% of Montana’s population is Native American and that several people IN THE ROOM are Native American.

The initial splash of multicultural awareness is often accompanied by an emotional response . . . and occasionally a bit or a bundle of defensiveness.

5.  As you Work Towards Multicultural Competence, Remember the Concept of Multicultural Humility

Although it’s standard procedure in the counseling and psychotherapy literature to refer to multicultural competence, one major problem with the term multicultural competence is that it implies that there’s an endpoint in the multicultural awareness, knowledge, and skill acquisition process. For this reason, I prefer the terms multicultural humility or multicultural sensitivity.

Similar to awareness, I think humility is central to good multicultural work. Unfortunately, within the dominant cultural media-based messages humility is typically viewed as being weak and confidence, swagger, and even arrogance is seen as more desirable. Thomas Merton (quoted in part I of this blog series) has a quotation that speaks to the tendency for entire countries to engage in self-superiority. He wrote:

“The greatest sin of the European-Russian-American complex which we call the West (and this sin has spread its own way to China) is not only greed and cruelty, not only moral dishonesty and infidelity to the truth, but above all its unmitigated arrogance toward the rest of the human race.”

It’s crucial for multicultural counselor and psychotherapists to move beyond thinking in terms of competence and tolerance (both of which speak to Merton’s ideas of arrogance). Instead, we need to embrace our fallibilities and humility and approach cultural and individual differences with what Marcia Linehan might call radical acceptance and what Carl Rogers would have referred to as unconditional positive regard.

6.  Keep Making Efforts to Understand a Collectivist Cultural Perspective.

In collectivist cultures, values and norms are shared. The self and the personality are defined in terms of group memberships, and the group needs and values are more central than those of the individual. Some people with collectivist perspectives avoid the whole idea of the concept of self or self-esteem or self-image. Instead, Collectivists tend to evaluate themselves based on attaining group goals.

For lots of us folks who have been deeply involved in American individualism, the idea of collectivism can feel odd and repeatedly difficult to grasp. This is where exposure, discussion, and real listening to others becomes so important. Rather than trample on the idea of collectivist being, we need to persistently take extra steps to maintain awareness of this concept that can be so slippery for individualists to grasp.

To close this blog, in 1975 Robert Hogan wrote,

A central theme in Western European history for about 800 years has been the decline of the medieval synthesis or, alternatively, the emergence of individualism. Two hundred years ago individualism was a moral and religious ideal capable of legitimizing revolutions and inspiriting sober and thoughtful minds. Sometimes in the last century, however, social thinkers began to regard individualism in more ambivalent terms, even in some cases as a possible indicator of social decay. (p. 533)

This is interesting stuff, even if it’s sometimes difficult to completely and consistently understand.

Counseling and Psychotherapy Theory and Practice, Multicultural, Personal Reflections

Four Good Ideas about Multicultural Counseling and Psychotherapy—In Honor of Martin Luther King, Jr.

6 Comments

1. Don’t think about multiculturalism as being about tolerance. Instead, approach other cultures with an attitude of “what can I learn?”

The Trappist monk Thomas Merton (1974) wrote about his deep regrets for the ways religious missionaries contributed to cultural genocide. He wondered:

“What would the world be like if different cultures had encountered each other with questions instead of answers? What if the questions went something like these?”

What can you tell me about yourselves?

  • What would you like to know about us?
  • What can you teach me about the Creator?

This same idea forms the foundation of affirmative therapy for GLBTQ clients. Because they’re so used to and sensitive to negative judgments, we should approach GLBTQ clients not only with openness, but with a positive and affirming attitude. When I really think about it, it doesn’t make much sense to approach clients who may be different from us with anything other than a positive and affirming attitude?

 2.  Try to Understand the Implications of White Privilege

As a White male I sometimes have difficulty stretching my neck far enough to be able to see all the White privilege I carry around in my invisible knapsack (see Peggy McIntosh’s 1998 article for more on the Invisible Knapsack). White privilege is defined as the unearned assets associated with being an upper or middle class member of a dominant culture. Although White privilege is often hard to see (because unearned assets are invisible), Prochaska and Norcross provide three darn good examples in the 2010 edition of their psychotherapy theories text. They wrote:

  • · “White privilege is when you can get pregnant at age 17 and everyone is quick to insist that your life and that of your family is a personal matter, and that no one has a right to judge you or your parents, even as Black and Latino families with similar challenges are regularly typified as irresponsible and pathological.”
  • · “White privilege is when you are a gun enthusiast and do not make people immediately scared of you.”
  • · “White privilege is when you can develop a painkiller addiction, having obtained your drug of choice illegally, go on to beat that addiction, and everyone praises you for being so strong, while being an ethnic minority who did the same thing is routinely labeled a drug addict who probably winds up in jail.” (p. 408)

3.  When Counseling, Make Cultural Adaptations

Not long ago it was reported that 50% of diverse clients dropped out of therapy after only one session (S. Sue, 1977). This suggests that it only took one therapy session to convince half of all diverse clients not to return for session number two. This is not very impressive.

To address this and other issues, counselors and psychologists now talk about making cultural adaptations so the therapy experience is more appealing to clients from diverse cultural backgrounds. Several cultural adaptations have proven at least somewhat helpful. Two of the most significant are: (a) Language Matching (Surprise! Clients tend to benefit more when they can do therapy in their native languageJ); and (b) explicit incorporation of cultural content/values into the intervention (Griner & Smith, 2006).

 4. Remember that multicultural counseling is like qualitative research; you may not generalize.

This is one of the puzzling paradoxes associated with multicultural counseling. Of course we should learn as much as we can about other cultures—but, because skin color, ethnicity, sexual orientation, disabilities, and other client characteristics all exist within unique individuals, groups, and communities it’s inappropriate to make assumptions about clients based on knowledge about any of these factors. Just as you would never generalize your findings from eight clients in a phenomenological-qualitative study, you shouldn’t use your knowledge of any “categories” to make generalizations about the person or people in your office.

Related to this, S. Sue and Zane (2009) commented on how, when it comes to multicultural knowledge, a little bit does not go a long ways (and often a large amount of knowledge won’t take you very far either). They wrote:

“. . . cultural knowledge and techniques generated by this knowledge are frequently applied in inappropriate ways. The problem is especially apparent when therapists and others act on insufficient knowledge or overgeneralize what they have learned about culturally dissimilar groups.” (p. 5)

Working cross-culturally or interculturally is both a challenge and a privilege. This is part one of a three-part blog about how we can meet this challenge and honor clients who have diverse characteristics. Thanks for being interested enough in this topic to read this and stretch your multicultural competence.

Counseling and Psychotherapy Theory and Practice, Parenting, Therapy with Adolescents

Happy New Year . . .

7 Comments

Non-Drug Options for Dealing with Depression

                               “When it comes to treating depressive symptoms, there’s no better                     medicine than healthy and loving relationships”

 The following options can be very effective for relieving depression symptoms. Although antidepressant medications are also an option, because they’re so widely marketed only non-drug alternatives are listed and described here.

  1. Psychotherapy – Going to a reputable and licensed mental health professional who offers counseling or psychotherapy for depression can be very helpful. This may include family, couple, or group counseling or therapy.
  2. Vigorous Aerobic Exercise – Consider initiating and maintaining a regular cardiovascular or aerobic exercise schedule. This could involve a referral to a personal trainer and/or local fitness center (e.g., YMCA).
  3. Herbal Remedies – Some individuals benefit from taking herbal supplements. For example, there is evidence that Omega-3 Fatty Acids (Fish oil) can reduce depressive symptoms. It’s good to consult with a health care provider if you’re pursuing this option.
  4. Light Therapy – Some people describe great benefits from light therapy. Information on light therapy boxes is available online and possibly through your physician.
  5. Massage Therapy – Research indicates that massage therapy can relieve depressive symptoms. A referral to a licensed massage therapy professional is advised.
  6. Bibliotherapy – Research indicates that some people benefit from reading and working with self-help books or workbooks. The Feeling Good Handbook (Burns, 1999) and Mind over Mood (Greenberger and Padesky, 1995) are two popular self-help books.
  7. Mild Exercise and Physical/Social Activities – Even if you’re not up to vigorous exercise, you should know that nearly any type of movement has antidepressant effects. These activities could include, but not be limited to yoga, walking, swimming, bowling, hiking, or whatever you can do!
  8. Relationship Enhancement – As suggested by the opening quotation, the most potent medicine available for addressing depressive symptoms is a healthy and loving relationship. You can work on improving relationships in many ways, especially by developing effective communication skills, engaging in mutually enjoyable activities, and making a commitment to behaving in ways that support both your own mental health and that of your partner.
  9. Other Meaningful Activities – Never underestimate the healing power of meaningful activities. Activities could include (a) church or spiritual pursuits; (b) charity work; (c) animal caretaking (adopting a pet); and (d) other activities that might be personally meaningful to you.

 For information about this tip sheet, contact John Sommers-Flanagan, Ph.D. at johnsf44@gmail.com

Counseling and Psychotherapy Theory and Practice

Positive Thinking is Not (Necessarily) Rational Thinking

6 Comments

This past Saturday I got a phone call from a former Counseling student (who will remain unnamed). He said that he and another student were heading to the University of Montana gym to play basketball at 1pm and wondered if I’d like to join them.

I should have recognized I was in trouble when I somehow decided NOT to tell my wife that my sudden reason for going to the gym was to play basketball. She would have reminded me that the odds of injuring my back while playing basketball are better than any odds you can get in Vegas. But I didn’t want her to rain on my positive thinking fantasy world. Do you know what I mean? Have you ever had a time when a part of you knew better and so you decided not to tell any other rational human being what you were planning?

I also should have recognized a few other obvious flaws in my positive thinking: (a) my age is approximately the sum of the two young men with whom I planned to play; (b) I quickly began developing a handicapping system through which I could compete with them; (c) for a few minutes I was visualizing myself leaping into the air without hurting myself.

In his book, The Elements of Counseling, Scott Meier, an old friend of mine and professor at SUNY-Buffalo, wrote that positive thinking is not rational thinking. This is a great point . . . and one that’s easy to forget. Despite the many cultural messages that we get about having “no limits” or being “able to accomplish whatever we can imagine,” it’s not really true. No matter how much visualizing (and personal training) I do, I’ll never be able to keep up with any professional . . . or college . . .  or high school . . . or middle school basketball player. I can practice “the secret” ( a visualizing strategy) all I want, but Obama will not ask me to replace Joe Biden on his 2012 campaign. These are limitations; they are SIMPLY NOT HAPPENING.

Typically, when positive thinking fails, many of us begin rationalizing away because we want to jump back on the positive thinking horse. This is a form of denial that even happens to cult members who are planning for the end of the world. When the end doesn’t come they develop a reason why . . . and often set a new date.

In my case, as I limped and slumped home in humiliation, I was already rationalizing my glorious return. And this is my second point: Rationalizing is generally irrational. What this means is that when we catch ourselves excusing our behavior or re-writing history, we’re probably fooling ourselves. In this case, I quickly began telling myself that the main reason I hurt myself was because I just wasn’t in good enough shape to play on this particular day . . . but that if I rehabbed and worked on my conditioning (for the next year!), I could return to the court and teach those young whipper-snappers a lesson they wouldn’t soon forget. Of course, I forgot to factor in (a) I’m already in pretty good shape; (b) in a year, I’ll be a year older (duh!); (c) I can’t reasonably spend all day rehabbing; and (d) there aren’t many bionic body parts for sale at the local hardware store.

Positive thinking and rationalizing are, quite naturally, at the heart of most of our temptations. For some, the temptation is alcohol, drugs, sex, or chocolate. We may tell ourselves we can have one drink, one bowl, one sexual indiscretion, or one bite and then find ourselves suffering the consequences. This doesn’t mean we shouldn’t engage in positive thinking. It’s just that we need to balance or moderate it with real rational thinking. And one way to get a dose of rational thinking — even if we don’t want to admit it — is to ask someone who really loves us and cares about us if we’re sounding reasonable or not. Another way is to engage in honest self-scrutiny.

Personally, I plan to remain a positive thinker, but in the future I will moderate it with spousal consultation and honest personal reflection. This isn’t nearly as fun as pretending I’m younger and more capable than I really am . . . but right now the pain, ibuprophen, ice, and physical therapy are inspiring me to think more rationally and live more mindfully. I share this story as a reminder to myself and others of what Norman Vincent Peale referred to as the power of positive thinking. In fact, positive thinking is so powerful that it’s actually one more good way for us to get ourselves in trouble. Really, it may seem depressing, but it’s perfectly okay to know our limits and live within them. In the spirit of reality therapy, that’s my new plan . . . and I’m sticking with it.

Counseling and Psychotherapy Theory and Practice

Reflections on Magic

6 Comments

I have a former graduate student (you know who you are) who always talks about using magic. If she wants something to work out a certain way, she simply “casts a spell” to make things right. Of course, like most of us, she expertly avoids paying attention to evidence refuting her magical abilities, while studiously attending to moments when it appears her spells have somehow affected reality.

This was all in good fun. We were driving many miles back and forth to an internship site at Trapper Creek and in some ways her spells were designed to counter my tendency to construct a firm deterministic viewpoint. Although I agree there are many mysteries in life and that there’s likely room for magic, I get quickly impatient with too many attributions about magic, miracles, past lives, and sinister ghosts in the halls of the female dorm at Trapper Creek Job Corps.

Despite my general avoidance of magical thinking, I find myself very intrigued with this old quotation of Freud’s that Steven de Shazer turned into a book title:

“Words were originally magic and to this day words have retained much of their ancient magical power. By words one person can make another blissfully happy or drive him [or her] to despair . . . . Words provoke affects and are in general the means of mutual influence among men [or women].”

I do think words have powerful influence . . . but it’s equally true that what we don’t say—the nonverbal, and listening in particular—can be just as magical. All this is a way of introducing the following excerpt soon be published in the 2nd edition of our Counseling and Psychotherapy Theories in Context and Practice textbook as food for thought this Monday morning. Here it is:

The Magic of Person-Centered Listening

Person-centered listening isn’t in vogue in the United States. It might be that most of us are too busy tweeting and expressing ourselves to dedicate time and space to person-centered listening. The unpopularity of person-centered approaches also might be related to the prominent “quick fix” attitude toward mental health problems. And so, call us old-fashioned, but we think that if you haven’t learned to do person-centered listening, you’re missing something big.

Years ago, when John was deep into the “Carl Rogers” stage of his development, he decided to create a person-centered video recording to demonstrate the approach. He recruited a volunteer from an introductory psychology course, obtained informed consent, set up a time and a place, welcomed a young woman into the room, and started listening.

Lucky for John, the woman was a talker. It’s much harder to get the magic to happen with nonverbal introductory psychology students.

It wasn’t long into the session when John attempted a short summary of what the woman had said. He felt self-conscious and inarticulate, but was genuinely trying to do the person-centered listening thing: He was paraphrasing, reflecting feelings, summarizing, walking within, and doing all he could to be present in the room and make contact or connect with the “client.” After his rambling summary, there was an awkward silence. John remained silent, trusting that the client knew where to go next. And she did. She cut through the awkwardness with a disclosure of having been sexually molested as a child. John continued listening non-directively as the woman told her story, shed a few tears, and spoke powerfully about her journey toward building inner strength.

The demonstration recording was a huge success . . . except for the fact that the audio was terrible. To hear the powerful disclosure and share in the magic of person-centered process, John had to force his class of 15 graduate students to gather within three feet of the television in perfect silence . . . which was also rather awkward.

The lesson of person-centered listening is that sometimes when you put it all together the client can take you places you never knew existed. There are many things about our clients that we’ll never know unless and until we listen empathically, communicate genuinely, and experience respect for the other person with our heart and soul. As Rogers (1961) said, “. . . the client knows what hurts. . .” and so it’s up to us—as therapists—to provide an environment where clients can articulate their pain and re-activate their actualizing tendency.

Counseling and Psychotherapy Theory and Practice

A Black Friday Tribute to Mary Cover Jones and her Evidence-Based Cookies

4 Comments

In honor of Black Friday and the opening of this blog, I’d like to sell you on why the story of Mary Cover Jones and her evidence-based cookies is one of the coolest in the history of counseling and psychotherapy.

Mary Cover Jones probably wasn’t big on shopping. That’s because she was a woman scientist in the 1920s. She was too busy working in John Watson’s lab (yes, this is the same John Watson who, at least according to historical accounts, turned out to be a bit of a turkey.)

Mary Cover Jones was amazing. She’s best known for her work with a young boy named “Little Peter.” When everyone else was focusing on how to create fear in humans (or out shopping for Black Friday bargains), Mary was discovering how children’s fears could be extinguished or eliminated.

Little Peter suffered from a specific fear. As silly as it sounds, he was deeply afraid of white bunnies. This fear had generalized to white rats, white cotton balls, and just about anything white and fluffy. Using cookies, Mary Cover Jones counter-conditioned the fear right out of Little Peter. She started by having Peter enjoy his favorite cookies in one corner of the room and gradually brought a caged white rabbit over to him until, eventually, Peter was able to eat cookies with one hand and pet the bunny with the other.

But Mary Cover Jones didn’t stop with Little Peter. Over time, she worked with 70 different institutionalized children, all of whom had big fears. Not only was she successful, but her conclusions (from 1924) still constitute the basic foundation for contemporary (and evidence-based) behavioral approaches to treating human fears and phobias. This is what she wrote toward the end of her 1924 article:

“In our study of methods for removing fear responses, we found unqualified success with only two. By the method of direct conditioning we associated the fear-object with a craving-object, and replaced the fear by a positive response. By the method of social imitation we allowed the subjects to share, under controlled conditions, the social activity of a group of children especially chosen with a view to prestige effect. [Other] methods proved sometimes effective but were not to be relied upon unless used in combination with other methods.” (M.C. Jones, 1924, p. 390)

Mary’s findings remain deeply profound. They have implications not only for how we treat children’s fears, but also for how to work effectively with resistant or reluctant teens and adults. In later blogs I’ll often be serving a batch of Mary’s evidence-based cookies in one form or another.

After her work with John Watson, Mary Cover Jones continued working in a research lab. She moved across the U.S. and 50 years after her publications on children’s fears, she reflected on her life and her work. Here’s what she said:

“[M]y last 45 years have been spent in longitudinal research in which I have watched the psychobiological development of our study members as they grew from children to adults now in their fifties… My association with this study has broadened my conception of the human experience.  Now I would be less satisfied to treat the fears of a 3-year-old, or of anyone else, without a later follow-up and in isolation from an appreciation of him as a tantalizingly complex person with unique potentials for stability and change.” (Jones, 1974, p. 186).

Just minutes before she passed away, Mary said to her sister, “I am still learning about what is important in life” (as cited in Reiss, 1990).

We should all strive to never stop learning about what’s important in life and therefore be more like Mary Cover Jones. Although the famous psychologist, Joseph Wolpe, dubbed her “the mother of behavior therapy” she was obviously much more than a behavior therapist. You can learn more about her (she would probably have liked that) from a web-based article by Alexandra Rutherford of York University at: http://www.psych.yorku.ca/femhop/Cover%20Jones.htm. Rutherford’s article was originally published in The Feminist Psychologist, Newsletter of the Society for the Psychology of Women, Division 35 of theAmerican Psychological Association, Volume 27, Number 3, Summer, 2000.

And, believe it or not, Mary Cover Jones is on Facebook. You should become her friend . . . just like I did.

Mary Cover Jones

Counseling and Psychotherapy Theory and Practice, Uncategorized

Theories Video-Shoot 1

1 Comment

Did the first of a series of video-shoots today for a counseling theory-based skills project. I had my Freud action-figure sitting on the table next to me, reminding me how to act. Nevertheless, Dr. Rita still says I was more like Carl Rogers than Sigmund . . . which, basically, I consider a good thing. Carl Rogers with a psychodynamic twist. Or an actively empathic Sigmund. That’s okay with me.