Category Archives: Counseling and Psychotherapy Theory and Practice

Counseling and Psychotherapy Theory and Practice

Reflections on Listening to Irvin Yalom at the ACA Conference

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After a few hectic and overstimulating days at the ACA World Conference in San Francisco, I’ve now secured the back table at a Starbucks in Vancouver, WA for brief written reflection. This reflection weaves quotations (and paraphrases) from the great Irvin Yalom into my own personal conference experiences.

My formal conference highlight was watching and listening as NPR’s Craig Windham interviewed Yalom onstage for the keynote. After listening to Yalom’s keynote six years ago, I think the interview format was an ingenious method for capturing a more personal glimpse into Yalom and his writing than a stand and deliver keynote speech.

I especially enjoyed listening to Yalom reflect on his early years. Two statements stand out:

On his career decision-making as a child of Russian immigrants: “We had two choices: We could become a doctor or a failure.”

On his unparalleled greatness within the field of group psychotherapy: “My wife thinks it’s rather ironic that I became an expert in group psychotherapy, because I’m really quite uncomfortable in groups.”

Early in his “speech” Yalom emphasized the importance of counselors to the field of psychotherapy. In several ways he made curiously stimulating statements emphasizing (I’m paraphrasing now) that counselors are the future of psychotherapy. As a hybrid counselor and psychologist, I wonder if he would have made the same statements had he been keynoting at the annual American Psychological Association meeting.

My reactions to Yalom’s claim about counselors being the future of psychotherapy are free-ranging like the chickens in our backyard, but here are two:

Yes, I think counselors will be the future of psychotherapy, but only if we’re able to stop getting in our own way . . . And psychologists will undoubtedly be the future of measuring psychotherapy efficacy . . . if they (or we) can manage to focus on issues more meaningful than pharmacology and neuroscience.

For those curious about where Yalom finds his writing inspiration, in response to Windham’s questioning, he disclosed that as a Californian he has mastered the evening hot tub experience. Subsequently, he’s able to write most productively in the morning about “what I’ve learned in the hot tub.” I suspect there’s a bit more to it than that . . . but for those of us aspiring toward more writing greatness it makes for a solid rationale for nightly inspirational hot-tubbing.

On the popularity of his Group Psychotherapy text, Yalom stated: “I suspect it’s because of the stories in the book that I smuggled in . . .”

On his personal experience of fame (keep in mind that about 4K of us had to line up like rock concert fans to see him), he shared his own sort of dissociated imposter feelings:

“There’s a part of this that is very unreal. I don’t have any foundation. My parents were uneducated. They had very little schooling. I don’t have any foundation behind me. It’s a little shaky for me. I compare it to a lily growing in a swamp. There’s no foundation underneath. No matter how successful I am, I question . . . is this really me. Am I really successful?”

As an existential psychotherapist, it’s not surprising that Yalom believes deeply in helping clients pursue meaning. This is where it gets personal for all of us. He said, “Cancer cures psychoneurosis” and that “Life cannot be postponed.” Over the years he has helped many clients focus on their regrets—which often translate into moments when they weren’t able to face life and life fully in the moment. But we shouldn’t mistake Yalom’s live-in-the-moment philosophy for old-fashioned California hot-tub hedonism.  Yalom’s version of living in the moment is at once emotional AND intellectual; it is inspirational AND intentional.

Yalom also said that “Storytelling . . . may be the very best way I can teach.” Lucky for me I’ve gathered a few teaching stories over the years. Sometimes a combination of reality and my own constructive fiction, at this ACA I had a chance to share many stories. First, in a six hour pre-conference Learning Institute on Wednesday attended by 32 fabulous counselors, and later in an ACA-sponsored Friday session on Connecting and Working Effectively with Challenging Youth attended by about 200. In terms of reaping my own share of attention and praise, this was perhaps my best ACA conference ever.

But then Sunday morning comes. And when I awaken, what grand thoughts trickle into my consciousness? Do I think of the 25 people who lined up to have me sign copies of “Tough Kids, Cool Counseling?” Do I lie on the floor of my high-school educated parents home—where I’ve stopped for a short visit—feeling smug satisfaction about the glory I felt when Craig Windham of NPR fame also stood in line to have me sign a book FOR HIM. Do I reflect on the sweet and ego-boosting comments he shared with me about my work?

Nope. Nothing so grand knocks on the door of my early morning awareness. Instead, I’m transported back to a moment when, immediately after speaking to 200 conference attendees and spontaneously signing a couple books and receiving repeated praise from participants, a bold young woman approached me. She had attended BOTH my six hour workshop AND my 90 minute talk . . . and so forgive me my anticipation of praise as I looked into her eyes. But instead, she tells me that she’s not sure she learned anything from the six hour workshop. My well-practiced response is to welcome the criticism, while fending off disappointment and defensiveness. I feel precariously situated on my own lily pad. She goes on to explain that she’d “accidentally” gotten stuck in the 90 minute presentation and that based on what I’d talked about in there she thought I’d want the constructive feedback. “Of course I do,” I say . . . “Of course I do . . . and thank you very much for that.”

This is the stinging mantra to which I awaken this lovely and cloudy Sunday morning. A mantra of self-doubt . . . of possible regret . . . of wondering what I did wrong . . . of how I might improve myself.

Which brings me back to one of my favorite Yalom quotations (from his Group Psychotherapy text) about universality:

“During my own 600-hour analysis I had a striking personal encounter with the therapeutic factor of universality . . . I was very much troubled by the fact that, despite my strong positive sentiments, I was beset with death wishes for [my mother], as I stood to inherit part of her estate. My analyst responded simply, “That seems to be the way we’re built.” That artless statement offered not only offered considerable relief but enabled me to explore my ambivalence in great depth.” (p. 7)

Thank you Dr. Yalom for helping me and many others more deeply understand ambivalence, regret, self-doubt, personal meaning, death, and many of the other interesting ways the human psyche is built. And thank you, bold young woman, for providing me with hot-tub-free grist for my morning therapeutic writing mill.

Counseling and Psychotherapy Theory and Practice

On My Way to ACA . . . and Thoughts on Drunken Sexual Consent

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Hey. I’m on my way to the American Counseling Association conference in San Francisco. Tomorrow (Wednesday) I’ll be doing a full-day workshop on working effectively with challenging teenagers. If you’re reading this and will be at the conference, I’ll be hanging out at the John Wiley & Sons booth in the Exhibition Hall off and on (especially Thursday evening about 5pm) and will be doing an author signing for ACA on Friday from 4-5pm at the ACA booth. Please stop by and introduce yourself or catch me at the conference somewhere and say hello.

On my way to SF I had a chance to read an exceptionally courageous article in the University of Montana Kaimin (the student newspaper). It was written by a young woman who is coming out about two rape experiences on campus. Both involved her being far too drunk and she was brave enough to acknowledge that. However, as she notes, being drunk and dressing provocatively is not a message to all stimulated males that she WANTS sex.

This is a tough situation. It’s about consent and risky behavior and the many different channels of human communication. What I like about her article is that by disclosing her experiences she is contributing to consciousness-raising and it is ONLY through consciousness-raising that we can hope to shift the social norms away from the acceptability of presumed (drunken) consent on college campuses and elsewhere.

There’s an important message here for college males who might interpret a college woman’s behavior as “asking for it.” We need to resist our natural male urges and think about this. Okay, she is exposing herself to a risky situation and maybe she should know better . . . but think of her as your sister or your daughter or your future wife and make the right decision to control your sexual impulses in favor of a better situation where you can be ABSOLUTELY certain that you’re getting clear and unequivocal sober consent.

Drunken sexual encounters are all-too-common on college campuses. We are all responsible. Neither drunk males or females can really give consent. There is diminished capacity. For everyone I hope the Kaimin article can raise awareness. We all can do better than obtaining sexual gratification under the cloud of a drunken haze.

Counseling and Psychotherapy Theory and Practice, Personal Reflections, Therapy with Adolescents

Flaws in the Satanic Golden Rule

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summer-13-long-shadow

Nearly always I learn tons of good stuff from my adolescent clients. A few years ago I learned what “Macking” meant. When I asked my 16-year-old Latino client if it meant having sex (I gently employed a slang word while posing my question), his head shot up and he made eye contact with me for the first time ever and quickly corrected me with a look of shock and disgust. “Macking means . . . like flirting,” he said. And as he continued shaking his head, he said, “Geeze. You’re crazy man.”

The next half hour of counseling was our best half hour ever.

I’m not advocating using the F-word or being an obtuse adult . . . just pointing out how much there is to learn from teenagers.

More recently I learned about the Satanic Golden Rule. A 17-year-old girl told me that it goes like this: “Do unto others as they did unto you.”

Now that’s pretty darn interesting.

Ever since learning about the Satanic Golden Rule I’ve been able to use it productively when counseling teenagers. The Satanic Golden Rule is all about the immensely tempting revenge impulse we all sometimes feel and experience. It’s easy (and often gratifying) to give in to the powerful temptation to strike back at others whom you think have offended you. Whether it’s a gloomy and nasty grocery cashier or someone who’s consistently arrogant and self-righteous, it’s harder to take the high road and to treat others in ways we would like to be treated than it is to stoop to their level to give them a taste of their own medicine.

There are many flaws with the Satanic Golden Rule . . . but my favorite and the most useful for making a good point in counseling is the fact that, by definition, if you practice the Satanic Golden Rule, you’re giving your personal control over to other people. It’s like letting someone else steer your emotional ship. And to most my teenage clients this is a very aversive idea.

After talking about the Satanic Golden Rule many teenage clients are more interested in talking about how they can become leaders. . . leaders who are in control of their own emotions and who proactively treat others with respect.

An excellent side effect of all this is that it also inspires me to try harder to be proactively respectful, which helps me be and become a better captain of my own emotional ship.

Counseling and Psychotherapy Theory and Practice

A New Book in the Mail

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Even though it’s only a textbook, it’s still pretty darn exciting when a new book arrives in the mail with our names on it. It will never be a NYT best-seller, but it’s far and away the funniest book there is out there on Counseling and Psychotherapy Theories. . . which is sort of a funny claim to be making anyway.

And so a small glimpse of this pure excitement, here’s a sneak peek at the . . . yessss . . . the Preface!

Preface

(from Counseling and Psychotherapy Theories in Context and Practice, 2nd edition, John Wiley & Sons, 2012)

One morning, long ago, John woke up in the midst of a dream about having written a theories book. Over breakfast, John shared his dream with Rita. Rita said, “John go sit down, relax, and I’ll sit behind you as you free associate to the dream” (see Chapter 2, Psychoanalytic Approaches).

As John was free-associating, Rita tried to gently share her perspective using a two-person, relational psychotherapy model. She noted that it had been her lived experience that, in fact, they had already written a theories text together and that he must have been dreaming of a second edition. John jumped out of his seat and shouted, “You’re right! I am dreaming about a second edition.”

This profound insight led to further therapeutic exploration. Rita had John look at the purpose of his dream (see Chapter 3, Individual Psychology); then he acted out the dream, playing the role of each object and character (see Chapter 6; Gestalt Therapy). When he acted out the role of Rita, he became exceedingly enthusiastic about the second edition. She, of course, accused him of projection while he suggested that perhaps he had absorbed her thoughts in a psychic process related to Jung’s idea of the collective unconscious. Rita noted that was a possibility, but then suggested we leave Jung and the collective unconscious online where it belongs (see the Jungian chapter in the big contemporary collective unconscious of the Internet).

For the next week, Rita listened to and resonated with John as he talked about the second edition. She provided an environment characterized by congruence, unconditional positive regard, and empathic understanding (see Chapter 5, Person-Centered Theory and Therapy). John flourished in that environment, but sneakily decided to play a little behavioral trick on Rita. Every time she mentioned the word theories he would say “Yesss!,” pat her affectionately on the shoulder and offer her a piece of dark chocolate (see Chapter 7, Behavioral Theory and Therapy). Later he took a big risk and allowed a little cognition into the scenario, asking her: “Hey, what are you thinking?” (see Chapter 8, Cognitive-Behavioral Theory and Therapy).

Rita was still thinking it was too much work and not enough play. John responded by offering to update his feminist views and involvement if she would only reconsider (see Chapter 10, Feminist Theory and Therapy); he also emphasized to Rita that writing a second edition would help them discover more meaning in life and perhaps they would experience the splendor of awe (see Chapter 4, Existential Theory and Therapy). Rita still seemed ambivalent and so John asked himself the four questions of choice theory (see Chapter 9, Choice Theory and Reality Therapy):

  1. What do you want?
  2. What are you doing?
  3. Is it working?
  4. Should you make a new plan?

It was time for a new plan, which led John to develop a new narrative (see Chapter 11, Constructive Theory and Therapy). He had a sparkling moment where he brought in and articulated many different minority voices whose discourse had been neglected (see Chapter 13, Developing Your Multicultural Orientation and Skills). He also got his daughters to support him and conducted a short family intervention (see Chapter 12, Family Systems Theory and Therapy).

Something in the mix seemed to work: Rita came to him and said, “I’ve got the solution, we need to do something different while we’re doing something the same and approach this whole thing with a new attitude of mindful acceptance” (see Chapter 11, Constructive Theory and Therapy and Chapter 14, Integrative and Evidence-Based New Generation Therapies). To this John responded with his own version of radical acceptance saying: “That’s a perfect idea and you know, I think it will get even better over a nice dinner.” It was at that nice dinner that they began articulating their main goals for the second edition of Counseling and Psychotherapy Theories in Context and Practice.

 

Counseling and Psychotherapy Theory and Practice, Group therapy

My Favorite Imaginary Group Therapy Session

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This is an excerpt from our soon-to-be-published Counseling and Psychotherapy Theories in Context and Practice (second edition, 2012, John Wiley & Sons). It is, of course, like most theories textbooks, packed with subtle and less subtle humor. We even recently had a senior in college tell us that it was the first textbook he actually read cover-to-cover. Now if that’s not an endorsement of just how riveting a textbook can be . . .

The following excerpt is from the last chapter (Chapter 14).

A Concluding Image: Group Therapy with Some Amazing Clients

After reading and writing about so many great therapy minds, one of us (you can guess which one) had the following daydream: Imagine many of the historical and contemporary therapy masters gathered together in one location. They form a circle and begin a discussion. Old friends and rivals are reunited. Freud appears and shakes hands with Jean Baker, Miller who has brought quite a number of impressive-looking women with her. Fritz Perls tries to kiss some of their hands. Adler brings his wife. Carl Rogers signs a book for Prochaska. New friends are made, old rivalries rejuvenated. Insoo Kim Berg smiles quietly off to one side. Jung notes to himself that she must be an introvert. What might happen in this circumstance? What might happen in An Encounter Group for the Major Players?

After some initial mingling, the group process begins:

Rogers: I wonder where we might want to start.

Raissa Adler: Here’s where I’m starting. I’m not taking the minutes for this meeting. I did that back in 1912 for the Free Psychoanalytic Society, so I’ve put in my time. It’s someone else’s turn, and I nominate a male, any male. Women have been taking notes in meetings for so long it’s ridiculous. The problem with women’s psyches has more to do with oppression than repression.

Feminists: [Including Jean Baker Miller, Judith Jordan, Espin, Lillian Comas-Diaz, and Laura Brown—all of whom subversively snuck into the group] You go woman! We’re with you.

Freud: That’s it. Say whatever comes to mind.

Ellis: If you want to think that taking notes is oppression, that’s up to you, but as far as I can tell, you’re oppressing yourself with a bunch of damn crazy, irrational thinking.

Beck: You know Al, we’ve been through this before, but what I think you mean is that Raissa’s thinking that taking notes is oppression could be maladaptive, but not irrational.

Glasser: Raissa can choose to take notes or choose not to take notes. She can also choose to think she’s oppressed or choose not to think she’s oppressed. Personally, Raissa, I recommend that you read my book, Choice Theory. I want you to read it, and I think it will help you, but of course, whether you read it or not, that’s completely your choice.

F. Perls: Be here now, Raissa. Act out those feelings. Be the pen. Talk to the paper.

L. Perls: Fritz, she can be the pen without your assistance. If by chance she finds herself, that’s beautiful.

Ellis: She won’t find a goddamn thing in this group of love-slobs without a flashlight.

Skinner: Uh. Albert. I’ve been wanting to mention to you that if you could just keep quiet when people in here say inappropriate things, we might have a chance at extinguishing that particular behavior.

Ellis: Well, Burris, did you have an irrational thought that someone might actually care about your opinion before you engaged in that speaking behavior, or was it just a function of its consequences?

V. Satir: Albert, if you could just get up on that chair and talk down to Burris, I think you could get in touch with your placating style.

Skinner (Whispering to Ellis): Seriously man. Just ignore her. I’m talking about a complete extinction schedule. Just like I’m ignoring you – except for when you sit quietly and listen to me like you’re doing now.

Rollo May: Freedom and dignity are the essence of being. There’s far too much freedom, with very little dignity in this room.

I. K. Berg: If a miracle happened and we all got out of this group without anyone getting murdered, what would that look like?

A. Adler: My God, I just remembered an earlier memory. No wonder I felt so inferior.

Freud: I hate that word. I just want to be recognized for my contributions. It would make my mother proud.

Rogers: It’s like if only I can make my mother happy. And getting recognized, being remembered, that’s one big way you can have that experience.

Ellis: Siggy, my man. Let me just say this. That crap about being recognized and making your mother proud is the most f—ing ridiculous thing I’ve ever heard in my life. What’s the big deal if everybody forgets you? What’s the terrible, awful, very bad thing that will happen? I mean, think logically about this. You’ll be dead and it won’t make a white rat’s ass difference if people remember you or not.

Feminists: That’s right. I can’t believe we’re agreeing with Albert Ellis. White males can afford to play with such big ideas. Immortality. Do you have a clue about the legacy you’ve actually left? There have been decades of girls and women with destroyed self-esteems. Do you recognize that they litter your road to “greatness”?

Mahoney: I can see Freud as great and I can see feminism as great. Even this lived moment in our genetic epistemology exudes the potential for greatness. We are not a passive repository of sensory experience, but instead, we’re co-constructing this reality right now.

Prochaska: This entire group seems to me to be in precontemplation.

D. W. Sue: Yeah, well, I might consider change if we could construct in a minority voice or two? Most of what I’ve heard thus far is the construction of a very narrow, White reality. Culture is primary, and we need to include color if we’re to meet the needs of everyone, including Raissa, who happens to have a strong Russian ethnocultural identity.

Raissa Adler: [Slowly stands and walks over and embraces D. W. Sue.]

Rogers: What I’m seeing and what I’m hearing, if I’m getting this right, is affection and appreciation. Two people who have, now and again, felt marginalized are able to connect more deeply with each other right now in this moment than with anyone else.

M. White: Actually, Carl, I think I’d just call this a sparkling moment.

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

Good Ideas about Multicultural Counseling and Psychotherapy – Part II

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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.

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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 . . .

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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

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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

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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.