Category Archives: Counseling and Psychotherapy Theory and Practice

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

Talking with Kids about Trauma and Tragedy

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             All too often, very bad and traumatic things happen in the world. Many of these terrible things find their way into the news. This can be shocking and depressing not only for the people who were directly affected, but also for the general public. We are often repeatedly exposed to words and images that can trigger emotional and behavioral reactions in adults and children. Below is a short list with brief descriptions of how adults can help children deal effectively with traumatic information from the news and other media sources.

TALKING WITH CHILDREN: CONVERSATIONS ABOUT REALITY

The first step in talking with children is always the opposite of talking. LISTEN. Listen for how children have been affected. Listen for what they’ve seen and heard. Listen for their fears and fantasies. Listen for their personal coping strategies and solutions.

It’s important to listen closely, but if you listen too hard for children to talk about trauma, you run the risk of making them think they SHOULD be traumatized. If this happens, then children often will start giving you what they think you want . . . they’ll start talking about trauma. Therefore, a big challenge for adults is to listen in a balanced way.  Don’t spend too much time everyday encouraging children to talk about their deepest fears. If you do, it’s possible that everyone will get more and more scared — including you!

Perhaps the biggest deal when talking with kids about real tragic events, is being able to answer their questions. They may ask you terribly hard questions, like, “Will there be a plane crashing in our neighborhood?” or “Do you think a shooter might come to our school?” or “Will I be safe at home?” or “Teacher, are you scared?”

Children often ask very good and very hard questions. An important guideline for teachers, parents, and counselors is to stay balanced. This means you can admit to being scared — as long as you also admit to being strong. Some children can quickly pick up on false reassurance, which is one reason why I’m not in agreement with Dr. Joyce Brothers who suggested after 9/11 that it was a good time to lie to your children. Instead, I recommend acknowledgement that the world is not always a safe place, but that you’ll do everything you can to be strong and help keep the child or children safe.

With preschoolers, there are some conversational topics that are best to avoid. For example, there’s no need to go into graphic detail about specific injuries, etc.  This is similar to the fact that very young children don’t need to know all the details about sexuality. It’s better to speak generally about violence and destruction. It’s also very important to protect your children from too much exposure to media coverage of violent events.

It’s also important to never forget about focusing on children’s strengths. Listening first provides you with a foundation for giving children feedback about their strengths. Be sure to listen for children’s strengths . . . and then reflect them back. You can also encourage children to tell you about their strengths – including both ways they’ve handled hard things in the past and ways they might handle hard things in the future.

 PLAYING WITH CHILDREN: REENACTMENT, PRETEND PLAY, AND MASTERY

Younger children will typically play out or reenact their traumatic experiences. For preschoolers pretend play will be the dominant way they deal with the trauma of what they’ve seen and heard. Around 9/11 children were likely to build towers and have them knocked down. They also enacted play activities involving airplanes, police, terrorists (or other “evil/bad” people). If they’ve been exposed to images and heard about school shootings you might see some play activities involving guns and death and loss. For the most part, it’s best to just sit back and watch children as they enact these scenes. By allowing them un-directed play time and some nondirective commentary, you’ll be helping them take their first steps toward healing (more information on non-directive play is included on the “Special Time” tip sheet on this blogsite).

On the other hand, sometimes children get stuck in the same repeated play pattern. This more chronic form of play is referred to as post-traumatic play. When children seem genuinely stuck repeating pretend interactions through non-interactive play that provides no apparent gratification, you may need to interact with them in ways that help them get un-stuck. You might want to try these strategies: (a) have the child stand up and take some deep breaths before resuming play; or (b) interact with the child in a way that disrupts the pattern (for example, you might ask, “what would happen if . . . ?”).

Obviously, rigid post-traumatic play patterns indicate a need for professional assistance.

 DRAWING WITH CHILDREN:  CAPTURING THE FEAR ON PAPER

Children’s fears can seem big and intimidating. That’s true for people of any age. Maybe that’s why, for adults and older children, writing about specific fears and trauma can be so helpful. Somehow, writing things down on paper can help to put it in perspective.

Younger children aren’t able to use the written word effectively for personal journaling. That’s where drawing comes in. When children color, draw, paint, or sculpt their fears, the fears become more manageable.

 STORYTELLING STRATEGIES

Storytelling is a very powerful tradition and technique for dealing with many human problems and challenges. Stories can be designed or obtained through published materials. In response to tragedy, it can be helpful for children to hear stories of bravery under difficult or perilous conditions.

If you choose to invent your own stories, be sure to create a story with a main character and a clear beginning, middle, and ending. If you’re comfortable with it, you can even have the children help invent characters and their own stories.

There are many ways to encourage children to make up stories of their own. The advantage of this is that you get to listen for the dynamics of the children’s story and so it provides some assessment information. As a counseling technique, it’s possible to use a pretend radio or television show. You can invite children to be guests on your “show” and interview them about their experience or have them share a story.

 HELPING WITH TRANSITIONS:

Separation anxiety is a common reaction that children have to stressful news or situations. This means children may have trouble saying goodbye to their parents and being left at school or day care. In most cases, it’s best for parents, children, and staff to develop an individualized goodbye and hello routine for drop-offs and pick-ups. These routines will be less necessary as time goes by, but it’s good to have goodbye and hello rituals there when you need them. For example, having a hello and goodbye song, transitional objects, and other objects of comfort can ease the pain of separation.

 HAVING FUN: USING DISTRACTION, HUMOR, AND PLAY TO MOVE PAST TRAUMA

Don’t forget, it’s easy to pay way too much attention to the traumatic news and ignore regular daily play routines. Don’t fall into this trap. It’s good to keep kids active and keep them having fun. It’s good to be prepared with some games, songs, or activities that you can rely on to engage children and help them forget about the bad news for a while.

 LEARNING ACTIVITIES: MASTERY THROUGH EDUCATION, SAFETY, AND SERVICE

Not only does life go on after a trauma; it’s important for life to keep getting better. Ways to move forward include (a) continuing with educational, skill-building, and stress management activities, (b) promoting safety strategies and skills, and (c) involving children in basic service activities . . . possibly even service activities that include teaching other children strategies for coping with trauma or difficult situations.

 GET HELP AS NEEDED

It’s a sign of strength to get help when it’s needed. You may notice specific reactions or experiences in children or yourself that indicate it’s time to for professional assistance. Some of the primary symptoms of trauma and vicarious trauma that can develop in these situations include the following:

  • Repetitive and intrusive thoughts and images.
  • Sleep problems: Insomnia, nightmares, and night terrors.
  • Separation Anxiety and clingy-ness.
  • Specific fears/phobias.
  • Hypervigilence.
  • Regression.

 SELF CARE NOW AND INTO THE FUTURE

Remember to take good care of yourself so you can be of greater help for others. This could involve many different activities including vigorous exercise, maintaining healthy eating and sleeping routines, and scheduling time for social contact and social support.

This Tip Sheet was written by John Sommers-Flanagan, Ph.D., professor of Counselor Education at the University of Montana.

Counseling and Psychotherapy Theory and Practice, Group therapy, Personal Reflections

When Giving Gives Back

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For several years Rita has been having first year counseling students do at least five hours of “volunteer” work with our local day treatment center for clients (or consumers) who struggle with chronic mental disorders. This year Rita is on sabbatical and so the task fell to me. To be honest, I was ambivalent about the assignment, mostly because the logistics seemed challenging. I had to arrange two separate organizational visits to the mental health center for about 15 students with different schedules before the volunteering could start and I struggled to make these happen in a timely manner. I secretly wondered if arranging this experience would be worth the hassle.

On Monday, October 29, I finally met the first group at the Day Treatment program and was emotionally transported back to the early 1980s when I was worked in a Day Treatment program and then as a recreation therapist at a 23-bed private psychiatric hospital. I listened as a staff member gave us the most unstructured orientation ever. He eventually told us that he was a “client” at the center before becoming staff. He told the students they were free to just drop in and hang out whenever. I could feel the students’ anxiety rising at the thought of just hanging out and so I asked a few questions and told a couple stories to take up time and they asked questions of their own. In an odd mix of awkwardness and genuineness and anxiety, I felt the wish to just hang out with the day treatment clients myself.   

But instead of hanging out, the reality of other responsibilities started pressing forward and I left with unresolved emotions. I decided to deal with those emotions by writing a small check to support the River House Day Treatment Member Fund. I wrote the check and sent it off.

After completing their five volunteer hours, our students are required to write a short essay about their experience. Today, I’ve spent much of my day reading these essays. They are amazingly open and appreciative of the experience. Some samples:

“I am always humbled by the willingness of others to not only be open with me and to share with me their experiences but also by the ‘sameness’ of a lot of human experiences and suffering.”

“It felt good to share in the humanness of it all- bad days, favorite things, boyfriends, girlfriends, family, and trying to find meaning even when our stories are so different.”

“The clients were not only positive and loving toward the staff members, but also towards me as a volunteer. Every client I was able to talk to complimented something about me and they were constantly complimenting each other.”

“The clients I talked with accepted me in to their community and openly shared their experiences with me. This allowed me to see the world, in a small way, through their eyes.”

Every essay has emphasized the positive environment, the loving-kindness of staff and patients, and the surprise and joy of making deeply human connections. I also received an excellent formal thank-you note from the program director (for the small donation). In it she enclosed a short note from the clients or members of the Day Treatment Center. They wrote:

Thank you so much for the monetary gift. We appreciate it so much. Your students have blessed us with their presence and we have enjoyed them. I hope that we can give the students a fresh perspective on how a special place such as River House can do good and help its members. I hope you will always feel welcome here and thank you for all you do, mentoring the students and giving gifts to us.

This letter and the feelings I get when I read “Your students have blessed us with their presence . . .” was much bigger than what I gave. That’s the same message I keep getting from my students. They went with minimal expectations, a little angst, and to clock their required hours. But instead of just completing a simple assignment, they received an experience so meaningful that many of them have are extending their volunteer work far beyond the required five hours.

This is a fabulous example of how giving can give back much more than what was originally given. This is probably what Adler meant by Gemeinschaftsguful.

Thank-you to the River House staff and members for . . . BLESSING US with YOUR presence.

Counseling and Psychotherapy Theory and Practice

The Girl Code by Ashley Marallo

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In 1999, William Pollack published a book titled, Real Boys.This book, based on his interviews with adolescent boys, included a list of behaviors he referred to as the “Boy Code.” The Boy Code included boy-related norms like: (a) Stand on your own two feet, (b) never show emotion–except anger, and (c) separate from your mother and all things female ASAP.

When lecturing on feminist theory and therapy, I often include a short review of Pollack’s Boy Code and follow that with a discussion about what might be the American version of a Girl Code. Most years I offer students a few points if they’ll email me their personal rendition of a Girl Code.

The year, Ashley Marallo, M.S.W., who’s currently a doctoral student in our counselor education program sent me her amazing and poetic version of the Girl Code. With Ashley’s permission, here it is:

Be nurturing and passive and loyal. Above all else, sacrifice for others who need you to tend to them. Put your life on hold to be available at the moment they need you. Standby anxiously watching and waiting to be of use. It is why you are loved. Don’t forget you are nothing without me. But I will throw you a bone, the façade of real belonging, and you will be too scared to look for something better. Please me. Be desirable. Put on a show for me. Show me how much you care what I think. Don’t inhabit your body. Detach yourself so you see you through my eyes. Remove all your body hair. Look like a porn star. Be skinny, but still curvy. But eat! Take this and buy yourself something nice. By nice I mean Victoria’s Secret for you to parade around in later for me. Be sexual when I want you to be, anticipate my moods, take charge within the limits of the power I give you, make decisions. Make the right ones. You’re an idiot if you make the wrong one. Obviously you’re not paying attention. Be sorry. You’re so emotional. Crazy. Needy. Clingy. You need help. Need me. I’ll keep you safe. Then trust me and be vulnerable and I’ll make you feel weak and worthless. Be feminine but independent. Your ambition is so cute. So is your anger as long as it bends to mine. I’m not happy. Do something for me. Be responsible for my emotions. Feel bad about it. Come home. Read my mind. Control yourself. You’re like a child. Grow up. All you ever do is think about yourself. Prove yourself. Work harder than everyone else then I’ll approve. Be perfect. Look rested. Glow. Don’t wear too much makeup. You look like a slut. Why did you cut your hair that way? Be graceful. Be beautiful and make it look natural. Don’t cry. It makes your eyes puffy. No one wants to be around you when you are like this. Your job is to make men feel important and special. Your value depends on it. If they want you, go with them. That will give you power. You can make them lose control. Be mysterious and intriguing. Speak intellectually but not over their head. You don’t want them to feel inadequate. A specific level of smartness is sexy. Be fun. Be charming and alluring. Drink and show you can have a good time. But don’t get wasted or throw up. Maintain the precise amount of control over yourself at all times. Be sensitive. Absorb meanness. Forgive them. It’s nice of them to apologize. Don’t be too hard to handle, or too much work. They’ve had a hard day. Go be by yourself when you feel sad. Like the things I like. Look adorable in oversized football jerseys. Hang out with the guys. Let me show you off. Who’s that guy you were talking to at the bar? You probably want to fuck him. Take birth control pills so I don’t have to wear condoms. Get on top. Make out with girls. Watch the kids. If you make it to 17 without having your own, you are doing pretty good. Stay together for the kids. Let them be angry with you. It is your fault it didn’t work after all. If you had just tried harder. Everything’s fine. It’s all in your head. It’s always something. Make me a cup of tea. Avoid conflict. Smooth it over. Just say you’re sorry and it will be ok. Keep the family together. Use sexuality as a weapon. Just the right amount. Don’t talk about it. Lie about how many men you’ve slept with and the size of their penises. They don’t really want to know even when they ask. Make sure you lay down in just the right position that your belly looks flat and your hip bones protrude just enough to create a small shadow. Enjoy strip clubs. It makes you an edgy chic. Agonize over bathing suit season and buy something that costs twice as much as a shirt for a pile of strings half the size. And make sure it makes your boobs look perky. And by the way all women should be able to wear tube tops. Get a tan and pedicures. Our feet are supposed to be cute, small and smooth. Giggle at lewd comments. It’s a compliment. Be a doll. Orbit around your man. Create a nice home for him. Be his mother and his servant. The way to a man’s heart is through his stomach. Be chaste enough to make him wait but marry him if he knocks you up. Continuously ask yourself whether you are an imposter and when you will be found out. Offer to pay but be ready to and hope he picks up the tab. Say thank you for everything you are given even if you earn it. Apologize for everything that goes wrong even if it’s not your fault. Perpetually wonder if you are good enough, not knowing what you’re wondering you are good enough for.

 

Counseling and Psychotherapy Theory and Practice

From Boring Theory to Exciting Practice: WACES PowerPoints II

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Mondays are my theories evening this semester. Last night was feminist theory and therapy. We rocked our way through Women & Madness; Kinder, Kuche, and Kurche; and the Broverman et al. study to provide us with a foundation of justified anger which helped raise our collective consciousness and stimulate our instinct to tend and befriend and eventually develop an ethic of caring.

Below is the link to powerpoints from my second presentation at the WACES conference in Portland.

WACES Theories

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice

Paper Writing Tips for Grad Students in Counseling and Psychology

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I recently had the honor and privilege of reading the first set of papers submitted to me by graduate students this semester. The papers were generally of good quality, but a few repeating patterns inspired me to provide the following list of basic tips for graduate students seeking to become mental health professionals.

  1. There’s nothing quite like a clear and concise topic sentence in academic writing. The topic (or focus sentence) introduces the content included in the paragraph. When used well, it’s a beautiful organizing force that brings joy and comprehension to the hearts and minds of many a reader (especially moi).
  2. Although I absolutely hate the saying “More is less” (because, in fact, “more” is always “more” even though “less” can better), it’s a good general rule to make your sentences shorter rather than longer because all too often I find students, like myself in this particular sentence, trying to fit too much information into one sentence when it would be clearer and better to break it up into two or three sentences. A corollary to this rule is that fewer quotation marks and exclamation marks are better than more of those particular “Marks!”
  3. A transition sentence or two that describes what you’ll be covering in your paper and placed at the end of your opening paragraph or in your second paragraph is very helpful to your reader.
  4. Unless you’re a Brit, you should put your commas, periods, and ellipsis inside the quotation marks, “Like this. . .” Think about it this way: commas and periods like to be on the inside; they don’t like to be floating outside the quotation marks because, unless they live on the British Isles, it increases their existential sense of isolation.
  5. You don’t need to use a comma when you have a short list of only two thoughts because all you need in that case is the word “and.” For example, notice the absence of a comma in the following sentence: Max was feeling quite spry and decided to post a smiley face to his Facebook status. In this case we do not need or want a comma after the word “spry.”
  6. Keep in mind that in most cases it best to maintain consistency between singular and plural within the same sentence and paragraph. For example, if you write: “The counselor should work to have empathy with their client” it will cause me to wonder why you didn’t go with: “Counselors should have empathy with their clients.” Note: There is also a good reason to use what is now commonly referred to as the singular “they.” Using they or their as singular (representing an individual) is perfectly acceptable–especially when referring to individuals who are averse to the gender binary. However, in most cases, it’s easier and IMHO maintains better grammar-flow to shift to plural-plural whenever reasonable.
  7. Remember that your professor really likes the appropriate use of the Harvard comma. What this means is that when providing a list of more than two items, you should place a comma after the first item, second item, and before the and. An example: John very much enjoys running, walking, and dancing. If you leave out that last comma, it seems like the final two items are somehow joined together. Remember also, that although journalists don’t use it, the Harvard comma is consistent with APA style.
  8. When you’re quoting someone you should use the past tense; this is because the person whom you’re quoting has already said it. For example, in his book Working with challenging youth, Richardson stated: “Yada, yada, and yada.” Although it’s tempting to write, “Richardson states” the past is the past even though Gestalt therapists might want us to bring everything into the here-and-now.
  9. Please include the page number or numbers when you’re quoting someone so your reader, if so inclined, can confirm the accuracy of your quotation. This is also APA style. Always avoid anything that might be viewed as plagiarizing.
  10. In contrast and opposite of how I’m writing in this list of writing tips, APA style doesn’t like contractions. Instead, just like Commander Data in the Star Trek series, you do not use contractions when writing in APA format and you will see a little red mark on your paper if you write with the casual contraction.
  11. You may recall that Michael Jackson sang: “A, B, C is easy as 1, 2, 3.” Well, APA actually thinks that (a), (b), (c). . . is better than 1, 2, 3. . . when it comes to in-paragraph list-making.
  12. If you use capital letters when you don’t need to, I will think you’ve freshly arrived from Germany. Words like counselor and psychologist should not be capitalized and even though specific mental disorders like major depressive disorder are often capitalized, we shouldn’t privilege particular words just because we feel like it or just because the American Psychiatric Association would like those words to take on greater significance.
  13. My old statistics professor always used to say that you write numbers just like you write words. What he meant by this is that justlikeyouwouldneverwritelikethis, when writing an equation you should always put a space between the operation and the integer. For example, it’s always n = 1 and never n=1.
  14. Although corporations are people (according to SCOTUS, not me), people are not corporations. This means you should use “who” when referring to actual people and “that” “them” or “it” when referring to non-people. When it comes to addressing corporations, make no reference at all, just bow your head in deference.
  15. Although it’s very cool and good form to cite your professor’s work in your paper, you should do your best to spell his name correctly.
Counseling and Psychotherapy Theory and Practice

A Quick Look at the Collaborative Cognitive Therapy Process

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Cognitive-behavioral therapy is arguably the most evidence-based of all counseling and psychotherapy approaches. With roots in Adlerian therapy and substantial influences from Albert Ellis, Aaron Beck, and others, the cognitive component of CBT involves therapists working with clients to help develop awareness of automatic thoughts — thoughts that have an adverse or maladaptive affect on client emotions and behaviors. Once clients have awareness of their automatic and maladaptive thinking, cognitive therapists work collaboratively with clients to question the usefulness of the thoughts, possibly even actively disputing them, and eventually revising or replacing them with more adaptive or helpful thoughts.

This past spring and summer, Rita and I produced a DVD with demonstrations of 11 different theory-based counseling and psychotherapy approaches. Our publisher, John Wiley & Sons, recently posted a clip (or teaser) of this cognitive therapy video. In the clip I’m demonstrating the five column technique popularized by Albert Ellis. What I think is most interesting about this clip is the how the five column technique is used as a platform for exploring the client’s anxiety . . . while at the same time, a unique, spontaneous, and collaborative relationship between therapist and client is developing.

If you like, you can watch this video clip at: http://www.youtube.com/watch?v=LQ8hNDHoyDU&list=UUDoXxitLiq5PMruS7AbBJbA&index=1&feature=plcp

 

Counseling and Psychotherapy Theory and Practice, Therapy with Adolescents

The Three-Step Emotional Change Trick

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In theories class this past Monday Adler kicked Freud’s ass. This was, of course, metaphorical because Adler was radically anti-violent. Nevertheless, my Freud action figure ended up on the floor by the door where he had to lay there and listen to Adler’s repugnant (to Freud) ideas about how clients are affected by real (not fantasized) social dynamics or forces.

At the end of class we engaged in the “Three-Step Emotional Change Technique.” For anyone who hasn’t heard of this, Rita and I published a description in our Tough Kids, Cool Counseling book. You can check it out at: http://www.amazon.com/Tough-Kids-Cool-Counseling-User-Friendly/dp/1556202741/ref=sr_1_1?s=books&ie=UTF8&qid=1348446338&sr=1-1&keywords=tough+kids+cool+counseling

Below you can read a version of the Emotional Change Technique adapted from Tough Kids, Cool Counseling:

The Three-Step, Push-Button Emotional Change Technique

            An early and prominent Adlerian therapist, Harold Mosak, originally developed and tested the push-button technique as a method for demonstrating to clients that thinking different thoughts can effectively change mood states (Mosak, 1985). The purpose of Mosak’s technique was to help clients experience an increased sense of control over their emotions, thereby facilitating a sense of encouragement or empowerment (Mosak, 2000, personal communication).

            Mosak’s push-button technique can be easily adapted to work with young clients. When we implement this technique with younger clients, we are playful and call it an emotional change trick. When using this technique with teenagers, we describe it as a strategy for gaining more personal control over less desirable emotions. In essence, the three-step, push-button, emotional change technique is an emotional education technique; the primary goal is to teach clients that, rather than being at the mercy of their feelings, they may learn some strategies and techniques that provide them with increased personal control over their feelings.

The following example illustrates Adlerian emotional education principles and Mosak’s push-button technique expanded to three distinct steps.

Case example.  Sam, a 13-year-old European American boy, was referred because of his tendency to become suddenly stubborn, rigid, and disagreeable when interacting with authority figures. Sam arrived for his appointment accompanied by his mother. It quickly became obvious that Sam and his mother were in conflict. Sam was sullen, antagonistic, and difficult to talk with for several minutes at the outset of the session. Consequently, the Three-Step, Push-Button Emotional Change Technique (TSPB) was initiated:

Preparation/Explanation.

JSF:     I see you’re in a bad mood today. I have this . . . well, it’s kind of a magic trick and I             thought maybe you’d be interested. Want to hear about it?

S:         (Shrugs).

JSF:     It’s a trick that helps people get themselves out of a bad mood if they want to. First, I           need to tell you what I know about bad moods. Bad moods are weird because even             though they don’t really feel good, lots of times people don’t want to get out of their bad      mood and into a better mood. Do you know what I mean? It’s like you kind of want to         stay in a bad mood; you don’t want anybody forcing you to change out of a bad mood.

S:         (Nods in agreement.)

JSF:     And you know what, I’ve noticed when I’m in a bad mood, I really hate it when someone          comes up to me and says: “Cheer up!” or “Smile!”

S:         Yeah, I hate that too.

JSF:     And so you can be sure I’m not going to say that to you. In fact, sometimes the best thing    to do is just really be in that bad mood—be those bad feelings. Sometimes it feels great to            get right into the middle of those feelings and be them.

S:         Uh, I’m not sure what you’re talking about.

JSF:     Well, to get in control of your own feelings, it’s important to admit they’re there, to get to   know them better. So, the first step of this emotional change trick is to express your bad      feelings. See, by getting them out and expressing them, you’re in control. If you don’t   express your feelings, especially icky ones, you could get stuck in a bad mood even             longer than you want.

As you can see, preparation for the TSPB technique involves emotional validation of how it feels to be in a bad mood, information about bad moods and how people can resist changing their moods or even get stuck in them, hopeful information about how people can learn to change their moods, and more emotional validation about how it feels when people prematurely try to cheer someone up.

Step 1: Feel the feeling. Before moving clients away from their negative feelings, it’s appropriate—out of respect for the presence and meaning of emotions—to help them feel their feelings. This can be challenging because most young people have only very simplistic ideas about how to express negative feelings. Consequently, Step 1 of the TSPB technique involves helping youth identify various emotional expression techniques and then helping them to try these out. We recommend brainstorming with young clients about specific methods for expressing feelings. The client and counselor should work together (perhaps with a chalk/grease board or large drawing pad), generating a list of expressive strategies that might include:

  • scribbling on a note pad with a black marker
  • drawing an angry, ugly picture
  • punching or kicking a large pillow
  • jumping up and down really hard
  • writing a nasty note to someone (but not delivering it)
  • grimacing and making various angry faces into a mirror
  • using words, perhaps even yelling if appropriate, to express specific feelings.

The expressive procedures listed above are easier for young clients to learn and understand when counselors actively model affective expression or assist clients in their affective expression. It’s especially important to model emotional expression when clients are inhibited or unsure about how to express themselves. Again, we recommend engaging in affective expression jointly with clients. We’ve had particular success making facial grimaces into a mirror. (Young clients often become entertained when engaging in this task with their counselor.) The optimal time for shifting to Step 2 in the TSPB technique is when clients have just begun to show a slight change in affect. (Often this occurs as a result of the counselor joining the client in expressing anger or sadness or general nastiness.)

Note: If a young client is unresponsive to Step 1 of the TSPB technique, don’t move to Step 2. Instead, an alternative mood-changing strategy should be considered (e.g., perhaps food and mood or the personal note). Be careful to simply reflect what you see. “Seems like you aren’t feeling like expressing those yucky feelings right now. Hey, that’s okay. I can show you this trick some other day. Want some gum?”

Step 2: Think a new thought (or engage in a new behavior). This step focuses on Mosak’s pushbutton approach (Mosak, 1985). It’s designed to demonstrate to the client that emotions are linked to thoughts. Step 2 is illustrated in the following dialogue (an extension of the previous case example with John and Sam):

JSF:     Did you know you can change your mood just by thinking different thoughts? When you think certain things it’s like pushing a button in your brain and the     things you think start making you feel certain ways. Let’s try it. Tell me the funniest thing that happened to you this week.

S:         Yesterday in math, my friend Todd farted (client smiles and laughs).

JSF:     (Smiles and laughs back) Really! I bet people really laughed. In fact, I can see it makes you laugh just thinking about it. Way back when I was in school I had a friend who did       that all the time.

The content of what young people consider funny may not seem particularly funny to adults. Nonetheless, it’s crucial to be interested and entertained—welcoming the challenge to empathically see the situation from the 13-year-old perspective. It’s also important to stay with and build on the mood shift, asking for additional humorous thoughts, favorite jokes, or recent events. With clients who respond well, counselors can pursue further experimentation with various affective states (e.g., “Tell me about a sad [or scary, or surprising] experience”).

In some cases, young clients may be unable to generate a funny story or a funny memory. This may be an indicator of depression, as depressed clients often report greater difficulty recalling positive or happy events (Weerasekera, Linder, Greenberg, & Watson, 2001). Consequently, it may be necessary for the counselor to generate a funny statement.

S:         I can’t think of anything funny.

JSF:     Really? Well, keep trying . . . I’ll try too (therapist and client sit together in silence for       about 20 seconds, trying to come up with a positive thought or memory).

JSF:     Got anything yet?

S:         Nope.

JSF:     Okay, I think I’ve got one. Actually, this is a joke.  What do you call it when 100 rabbits             standing in a row all take one step backwards?

S:         Huh?

JSF:     (repeats the question)

S:         I don’t know.  I hate rabbits.

JSF:     Yeah.  Well, you call it a receding hare line.  Get it?

S:         Like rabbits are called hares?

JSF:     Yup.  It’s mostly funny to old guys like me.  (JSF holds up his own “hare line”)

S:         That’s totally stupid, man (smiling despite himself). I’m gonna get a buzz cut pretty             soon.

When you tell a joke or a funny story, it can help clients reciprocate with their own stories.  You can also use teasing riddles, puns, and word games if you’re comfortable with them.

We have two additional comments for counselors who might choose to use a teasing riddle which the client may get wrong. First, you should use teasing riddles only when a strong therapeutic relationship is established; otherwise, your client may interpret teasing negatively. Second, because preteen and teen clients often love to tease, you must be prepared to be teased back (i.e., young clients may generate a teasing riddle in response to a your teasing riddle).

Finally, counselors need to be sensitive to young clients who are unable to generate a positive thought or story, even after having heard an example or two. If a young client is unable to generate a funny thought, it’s important for you to remain positive and encouraging. For example:

JSF:     You know what. There are some days when I can’t think of any funny stories either. I’m      sure you’ll be able to tell me something funny next time. Today I was able to think of         some funny stuff . . . next time we can both give it a try again if you want.

Occasionally, young clients won’t be able to generate alternative thoughts or they won’t understand how the pushbutton technique works. In such cases, the counselor can focus more explicitly on changing mood through changing behaviors. This involves getting out a sheet of paper and mutually generating a list of actions that the client can take—when he or she feels like it—to improve mood.

Sometimes depressed young clients will need to borrow from your positive thoughts, affect, and ideas because they aren’t able to generate their own positive thoughts and feelings. If so, the TSPB technique should be discontinued for that particular session. The process of TSPB requires completion of each step before continuing on to the next step.

Step 3: Spread the good mood. Step 3 of this procedure involves teaching about the contagion quality of mood states. Teaching clients about contagious moods accomplishes two goals. First, it provides them with further general education about their emotional life. Second, if they complete the assignment associated with this activity, they may be able to have a positive effect on another person’s mood:

JSF:     I want to tell you another interesting thing about moods. They’re contagious. Do you             know what contagious means? It means that you can catch them from being around other    people who are in bad moods or good moods. Like when you got here. I noticed your             mom was in a pretty bad mood too. It made me wonder, did you catch the bad mood from    her or did she catch it from you? Anyway, now you seem to be in a much better mood. And so I was wondering, do you think you can make your mom “catch” your good             mood?

S:         Oh yeah. I know my mom pretty well. All I have to do is tell her I love her and she’ll get       all mushy and stuff.

JSF:     So, do you love her?

S:         Yeah, I guess so. She really bugs me sometimes though, you know what I mean?

JSF:     I think so. Sometimes it’s especially easy for people who love each other to bug each     other. And parents can be especially good at bugging their kids. Not on purpose, but they     bug you anyway.

S:         You can say that again. She’s a total bugging expert.

JSF:     But you did say you love her, right?

S:         Yeah.

JSF:     So if you told her “I love you, Mom,” it would be the truth, right?

S:         Yeah.

JSF:     And you think that would put her in a better mood too, right?

S:         No duh, man. She’d love it.

JSF:     So, now that you’re in a better mood, maybe you should just tell her you love her and      spread the good mood. You could even tell her something like: “Dude, Mom, you really   bug me sometimes, but I love you.”

S:         Okay. I could do that.

It’s obvious that Sam knows at least one way to have a positive influence on his mother’s mood, but he’s reluctant to use the “I love you” approach. In this situation it would be useful for Sam to explore alternative methods for having a positive effect on his mother’s mood.

Although some observers of this therapy interaction may think the counselor is just teaching Sam emotional manipulation techniques, we believe that viewpoint makes a strong negative assumption about Sam and his family. Our position is that successful families (and successful marriages) include liberal doses of positive interaction (Gottman et al., 1995). Consequently, unless we believe Sam is an exceptionally manipulative boy (i.e., he has a conduct disorder diagnosis), we feel fine about reminding him of ways to share positive (and truthful) feelings with his mother.

To spread a good mood requires a certain amount of empathic perspective taking. Often, youth are more able to generate empathic responses and to initiate positive interactions with their parents (or siblings, teachers, etc.) after they’ve achieved an improved mood state and a concomitant increased sense of self-control. This is consistent with social–psychological literature suggesting that positive moods increase the likelihood of prosocial or altruistic behavior (Isen, 1987). Because of developmental issues associated with being young, it’s sometimes helpful to introduce the idea of changing other people’s moods as a challenge (Church, 1994).  “I wonder if you have the idea down well enough to actually try and change your mom’s mood.”

Once in a while, when using this technique, we’ve had the pleasure of witnessing some very surprised parents. One 12-year-old girl asked to go out in the waiting room to tell her grandmother that she was going to rake the lawn when they got home (something Grandma very much wanted and needed). Grandma looked positively stunned for minute, but then a huge smile spread across her face. The girl skipped around the office saying, “See.  I can do it.  I can change her mood.”

One 14-year-old boy thought a few minutes, then brought his mom into the office and said “Now Mom, I want you to think of how you would feel if I agree to clear the table and wash the dishes without you reminding me for a week.” Mom looked a bit surprised, but admitted she felt good at the thought, whereupon I (John) gave the boy a thumbs up signal and said, “Well done.”

Step 4.

At this point, readers should beware that although we’re describing a Three-Step technique, we’ve now moved to Step 4. We do this intentionally with young clients to make the point that whenever we’re working with or talking about emotions, surprising things can happen.

In keeping with the learn-do-teach model, we ask our young clients to teach the TSPB procedure to another person after they learn it in therapy. One girl successfully taught her younger brother the method when he was in a negative mood during a family hike. By teaching the technique to her brother, she achieved an especially empowering experience; she began to view herself as having increased control over her and her family’s emotional states.

John and Davis Improve Their Moods
Counseling and Psychotherapy Theory and Practice, Multicultural, Personal Reflections

A White Male Psychologist Reflects on White Privilege

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I’m a white male writing about white privilege. This irony makes the task all the more challenging.

Gyda Swaney asked if I would write this piece. This brings me mixed feelings. I am honored. I met Gyda in 1981 and I like and respect her as a person and as a Native American leader in Montana. But the fact that she thinks I might have something useful to say to psychologists about white privilege is humbling. Rarely have I been asked to write about something I know so well and understand so little.

On Invisibility

The challenge begins with the definition. White privilege is defined as an “invisible package of unearned assets” (see McIntosh, 1988 or 2001 for more on this).

As a white, male, psychologist, and university professor, I’m pretty much a white privilege poster boy. Consequently, white privilege, by definition, is generally invisible to me . . . although I do occasionally glimpse it from the corner of my eye or notice its shadow if I sneak up on it when it’s not looking. In fact I think I just saw it – as evidenced by my certainty that I can write a sentence as silly as this last one and get it published in the Montana Psych Association Newsletter.

Like most things invisible (think UFOs, Harry Potter with his invisibility cloak on, ghosts) white privilege is problematic and controversial. This is because white privilege is not always invisible; it’s selectively invisible. It’s obvious to many (e.g., oppressed minorities), but beyond the awareness of those who are busily experiencing the luxury of their unearned assets.

Common Responses to White Privilege

This brings up what may be the most fascinating and disturbing component of white privilege: When the idea of white privilege is brought to the attention of those to whom it’s invisible, it typically evokes a response of defensiveness combined with anger, hostility, outrage, and occasionally guilt. And as we know from our work in psychology, dealing with people who are feeling angry, hostile, outraged, and guilty is very difficult.

There’s something about white privilege that has the potential to make everyone angry.

Personal Reflections

Although White privilege precedes me and I hold no responsibility for its origins, I was born into it and have lived with it every day for nearly 55 years. Even my birth, characterized by greater-than-equal access to healthcare, is an example of my white privilege.

Maybe that’s a phrase that captures much of the white privilege experience—greater-than-equal. My whiteness and the whiteness of most Montana psychologists affords us greater-than-equal treatment, greater-than-equal power, greater-than-equal access, and greater-than-equal perceptions of ourselves. But privilege is complicated . . . and so it’s possible that we also have a greater-than-equal means of denying our privilege.

Privilege grows in complexity when we look at all the different factors that contribute to a more privileged status in one person and a less privileged status in others. My wife consistently reminds me of my male privileged status and although I’m inclined to deny this along with my white privilege, I know better. I was born male and being born male is like being dealt an ace as your first card in a round of Texas Hold-Em. In most cultures it’s clear that to be male is to be superior. That’s the case even though, as most males know, being handed an expectation of superiority isn’t always comfortable or easy. Paradoxically or dialectically, being a white male cuts both ways and isn’t only an unearned asset or gift, it’s also an unearned burden. It’s a burden like having to carry too many gold coins and diamonds to the bank. The weight of gold hurts your back and the diamonds cut your hands, but it’s ridiculous to complain about the fact that you have to carry a treasure to the bank.

Solutions

There are no easy ways to make white privilege quickly materialize and become visible. The resistance and pain associated with being told: “You’ve got unearned assets” is natural, partly because most people hold the perception that they’ve worked very hard to get what they deserve. Here’s a short list of ideas:

  • Teaching and learning about Peggy McIntosh’s Invisible Knapsack is a good place to start. One of the items from her knapsack is:

“I can swear, or dress in secondhand clothes, or not answer letters, without having people attribute these choices to the bad morals, poverty, or illiteracy of my race.”

  • Damn. That’s a nice privilege.
  • Teaching and learning about white privilege can be dangerous and so courage is another important factor in dealing with white privilege. Boatright-Horowitz and Soeung (2009) titled their commentary in the American Psychologist, “Teaching White Privilege to White Students Can Mean Saying Good-bye to Positive Student Evaluations.” When I recently posted about white privilege on my blog, I received one response that was so rabidly irrational it was frightening. Speaking out against the status quo always risks blowback.
  • A big part of the solution is to stop clinging to ideas about white superiority and instead, openly embrace and value the lessons we learn from other cultures. We should actively seek out other cultural perspectives. That isn’t about making the other culture better than ours . . . it just places it on the same, equal cultural footing where it belongs.
  • It’s also important to work on calming our anxiety over displacement from the top of the economic and power pyramid. We all get displaced someday; denying reality is dysfunctional. Actively sharing power along with values of egalitarian personal and community relationships is functional. This is part of the very important personal and communal work we need to do.

In closing, I’m painfully aware that I write this short column from a position of unearned privilege in a cabin on former Crow country on the beautiful Stillwater River; thank you Gyda Swaney, for handing me this challenge and opportunity.

This essay was published in the Montana Psychologist Newsletter in September, 2012.

Counseling and Psychotherapy Theory and Practice, Multicultural, Personal Reflections

The White Privilege Piece for the Montana Psychological Association

1 Comment

Michael Smerconish did a feature on White Privilege today on CNN. It was excellent and reminded me of this piece I’d written on White Privilege about 4 years ago. Check it out if you like this sort of thing.

A White, Male Psychologist Reflects on White Privilege

I’m a white male writing about white privilege. This irony makes the task all the more challenging.

Gyda Swaney asked if I would write this piece. This brings me mixed feelings. I am honored. I met Gyda in 1981 and I like and respect her as a person and as a Native American leader in Montana. But the fact that she thinks I might have something useful to say to psychologists about white privilege is humbling. Rarely have I been asked to write about something I know so well and understand so little.

On Invisibility

The challenge begins with the definition. White privilege is defined as an “invisible package of unearned assets” (see McIntosh, 1988 or 2001 for more on this).

As a white, male, psychologist, and university professor, I’m pretty much a white privilege poster boy. Consequently, white privilege, by definition, is generally invisible to me . . . although I do occasionally glimpse it from the corner of my eye or notice its shadow if I sneak up on it when it’s not looking. In fact I think I just saw it – as evidenced by my certainty that I can write a sentence as silly as this last one and get it published in the Montana Psych Association Newsletter.

Like most things invisible (think UFOs, Harry Potter with his invisibility cloak on, ghosts) white privilege is problematic and controversial. This is because white privilege is not always invisible; it’s selectively invisible. It’s obvious to many (e.g., oppressed minorities), but beyond the awareness of those who are busily experiencing the luxury of their unearned assets.

Common Responses to White Privilege

This brings up what may be the most fascinating and disturbing component of white privilege: When the idea of white privilege is brought to the attention of those to whom it’s invisible, it typically evokes a response of defensiveness combined with anger, hostility, outrage, and occasionally guilt. And as we know from our work in psychology, dealing with people who are feeling angry, hostile, outraged, and guilty is very difficult.

There’s something about white privilege that has the potential to make everyone angry.

Personal Reflections

Although White privilege precedes me and I hold no responsibility for its origins, I was born into it and have lived with it every day for nearly 55 years. Even my birth, characterized by greater-than-equal access to healthcare, is an example of my white privilege.

Maybe that’s a phrase that captures much of the white privilege experience—greater-than-equal. My whiteness and the whiteness of most Montana psychologists affords us greater-than-equal treatment, greater-than-equal power, greater-than-equal access, and greater-than-equal perceptions of ourselves. But privilege is complicated . . . and so it’s possible that we also have a greater-than-equal means of denying our privilege.

Privilege grows in complexity when we look at all the different factors that contribute to a more privileged status in one person and a less privileged status in others. My wife consistently reminds me of my male privileged status and although I’m inclined to deny this along with my white privilege, I know better. I was born male and being born male is like being dealt an ace as your first card in a round of Texas Hold-Em. In most cultures it’s clear that to be male is to be superior. That’s the case even though, as most males know, being handed an expectation of superiority isn’t always comfortable or easy. Paradoxically or dialectically, being a white male cuts both ways and isn’t only an unearned asset or gift, it’s also an unearned burden. It’s a burden like having to carry too many gold coins and diamonds to the bank. The weight of gold hurts your back and the diamonds cut your hands, but it’s ridiculous to complain about the fact that you have to carry a treasure to the bank.

Solutions

There are no easy ways to make white privilege quickly materialize and become visible. The resistance and pain associated with being told: “You’ve got unearned assets” is natural, partly because most people hold the perception that they’ve worked very hard to get what they deserve. Here’s a short list of ideas:

  • Teaching and learning about Peggy McIntosh’s Invisible Knapsack is a good place to start. One of the items from her knapsack is:

“I can swear, or dress in secondhand clothes, or not answer letters, without having people attribute these choices to the bad morals, poverty, or illiteracy of my race.”

  • Damn. That’s a nice privilege.
  • Teaching and learning about white privilege can be dangerous and so courage is another important factor in dealing with white privilege. Boatright-Horowitz and Soeung (2009) titled their commentary in the American Psychologist, “Teaching White Privilege to White Students Can Mean Saying Good-bye to Positive Student Evaluations.” When I recently posted about white privilege on my blog, I received one response that was so rabidly irrational it was frightening. Speaking out against the status quo always risks blowback.
  • A big part of the solution is to stop clinging to ideas about white superiority and instead, openly embrace and value the lessons we learn from other cultures. We should actively seek out other cultural perspectives. That isn’t about making the other culture better than ours . . . it just places it on the same, equal cultural footing where it belongs.
  • It’s also important to work on calming our anxiety over displacement from the top of the economic and power pyramid. We all get displaced someday; denying reality is dysfunctional. Actively sharing power along with values of egalitarian personal and community relationships is functional. This is part of the very important personal and communal work we need to do.

In closing, I’m painfully aware that I write this short column from a position of unearned privilege in a cabin on former Crow country on the beautiful Stillwater River; thank you Gyda Swaney, for handing me this challenge and opportunity.

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

John Sommers-Flanagan (Ph.D., 1986, University of Montana) is a clinical psychologist and counselor educator at the University of Montana. His blogsite, featuring material on counseling, psychotherapy, and parenting is at: johnsommersflanagan.com.

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

Introductions and Full Disclosure (at least in part)

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When people ask me what I do for work, I often tell them I have the best job in the world; then I describe it to them: “Every spring our faculty intensely screens a group of about 50 applicants to our graduate programs in counseling down to about 20 students who are admitted. And then I have the summer off. And then the new group of students show up in the fall and they’re all smart and kind and compassionate and because they’re graduate students, they’re motivated and focused and they want to attend class and become the best darn counselors they can become. And then, when I have them in class I’m with this group of incredibly socially skilled and sensitive, nice people and they make eye contact, nod their heads, act like they’re listening to me, and laugh at my jokes and stories.” Pretty much after I describe this scenario whoever asked me the question has either walked away or has crumpled into a heap on the floor racked with pain and jealousy.

This past Friday I got to teach my first full-day class with our new students. And just like Mary Poppins, they were practically perfect in every way.

Students in our graduate programs school and mental health counseling have a plethora of opportunities to engage in role-plays. As you may guess, these opportunities may or may not be met with great enthusiasm. More often than not we suggest to our students that they think of a minor problem in their lives, exercise censorship, and actually play themselves in these role-play encounters. This is totally fun . . . at least for the faculty.

Because we ask so much from our students—we expect them to “bring it” every hour of every class—at the beginning we offer our first year graduate students an activity where they can come to the front of the room as ask faculty members any question they’d like. This is totally fun . . . at least for the students.

On Friday, I had the added joy of listening as our two newest faculty members, Dr. Kirsten Murray and Dr. Lindsey Nichols, got quizzed by the new students. It was fabulous. I was filled with pride and happiness over having colleagues who are amazing and cool. Then it was my turn.

Somehow, the very first question turned into an awkward explanation of my professional status. I’m pretty old and I’ve answered a gazillion student questions about myself over the years, but I still felt the inner warmth, the sudden presence of sweat on my skin, and that funny feeling of hearing my own voice from a distance (totally fun!).

The problem is that I’m trained as a clinical psychologist and I teach in a counselor education program. To some people, this is like blasphemy. It’s like I was born in the country of clinical psychology and immigrated to the country of counselor education. At some tiny level, I sense how it might feel to be in the marginalized category of acculturation. Sometimes, under stress, I start speaking the language of clinical psychology (one time at an editorial board meeting of the Journal of Counseling and Development I accidentally said “A-P-A” instead of “A-C-A” and thought for sure I might be stoned; but everyone acted like they didn’t notice; of course, they also acted like they didn’t notice me after the meeting—or maybe I was just imagining that and isolating myself?).

I love my country of origin—the country of clinical psychology. I could talk about Rorschach cards and what it means for me to have a spike 5 and subclinical 6-9 profile on my MMPI for days. Studying psychopathology was like the coolest thing ever.

But I also love the country I’ve immigrated to. I have pleasant flashbacks of my first ACA conference back in 1992 when I volunteered to participate in a group counseling demonstration with Jerry and Marianne Corey. They were fabulous and I was hooked. I still like going to APA conferences, but for me, ACA conferences are a little less anal and a little more fun. I mean like one time I got my photo taken with William Glasser and last year I got it taken with Robert Wubbolding. They’re starting to think of me like a Reality Therapy groupie. What’s not cool about that?

The problem is that some members of ACA and APA don’t really like each other all that well. And neither of them really like the NASW or that evil “other” APA. The turf issues around professional discipline strike me as silly and overdone. I’m pretty sure that at this point I’m completely unemployable as an academic anywhere but the University of Montana. Psychology departments wouldn’t touch me because of my counseling cooties and Counseling departments now have to abide by a rule where they can’t hire anyone who doesn’t have a doctorate in counselor education. This would be pretty funny stuff if it weren’t so ridiculous. Psychologists want prescription privileges, Counselors want to do psychological evaluations, Social Workers want to do everything and anything, and yet, in many ways, we’re all more alike than we are different. I’ve got no solutions here . . . just observations.

And so in the beginning I experienced only a mild dissociative episode as I squeezed out my full disclosure—admitting before God and the class and my fellow professors that I am, in fact, BOTH a clinical psychologist AND a counselor educator. And in the end, it felt good. We had more discussions and questions later and no one (at least while I was looking) made the sign of the cross and shrunk away. I was just part of an amazing group of people who want to help other people live happier and more fulfilling lives. It could have been a group of students studying psychology or social work or counseling or maybe even all three at once . . . . It was really very nice.

John Dancing at a Wedding Reception