Category Archives: Personal Reflections

The Benefits and Limitations of Rhyming and Alliteration

Smoky Sunrise Aug 2017

Don’t get me wrong. I’m not anti-rhyming and I’m not anti-rap.

Truth is, I think rhyming slogans are pretty darn cool. Ask my students, I use them all the time. Here are a few that have been known to slip out my mouth and into a class lecture from time to time:

  • A pill is not a skill.
  • Get curious, not furious.
  • Your goal should be within your personal control
  • To function to the best of your ability, you should embrace your multicultural humility
  • An alcoholic drink, will not help you think (better)

The benefits of rhyming (and I daresay, alliteration) is that messages emerge with might and mass, which makes them more memorable. What I meant to say here before my alliterative self took over is that rhyming produces a powerful and memorable message. That’s the good news.

The “less good” news (as us therapist types like to say) is that rhyming and alliteration, although clever and appealing, usually don’t capture ALL OF THE TRUTH, and, are often misleading.

All this initial commentary is my way of leading up to my recent critique of the liberal use of a couple of F-words (nope, I’m not talking about “Fire and fury” although that could be an alliterative example of something that’s simply not soothing the simmering psyches of people who need to settle down). Instead, the target of my critique today is the all-too-common utterance, “Fight or flight.”

What follows is an excerpt of a slight rambling rant that was included in my keynote speech at the Montana Prevent Child Abuse Conference this past April.

The context: I had just shown a video of a Harvard professor who happened to mention (without checking with me first) the clever and popular phrase, “fight or flight.” Here’s what came next:

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You may not be aware of this, but I’m an official, self-appointed member of the counseling and psychotherapy theories police. I don’t have a badge, but I’ve got a book. What this book means is that I’ve done a little background reading on lots of theoretical concepts, like “Fight or Flight.” “Fight or Flight” – We hear that a lot, even from, as my older daughter would say, that fancy Harvard guy on the video.

The problem with most rhyming concepts is that they tend to oversimplify whatever it is we’re talking about. Take for example, “No pain, no gain.” There’s some truth to that, but that statement probably doesn’t hold for everyone, everywhere.

Well, the troubling truth is that fight or flight isn’t really all that accurate. Stress doesn’t just trigger two behavioral options. There are other behaviors activated by stress, some of which also start with an F, but don’t rhyme so neatly.

There’s Faint. And there’s Freeze. Chronic stress can also increase Feeding; some of us know that first-hand. My favorite stress food comes from places that rhyme with Fakery, so I guess that’s another F word. But, then again, stress can also dull your appetite, so the feeding thing isn’t a universal response.

Then there are the “P” words, like poop and pee. High stress can affect those, sometimes rather dramatically.

But what most people—even fancy Harvard guys—don’t tell you or don’t know, is that much of the Fight or Flight research was conducted on White Males.

And as if that wasn’t bad enough, the research was actually conducted on White, Male, Rats.

After re-analyzing old data and new studies focusing on female rats and female humans, years ago, Shelly Taylor and her research colleagues at UCLA discovered that for females of the species, there was a tendency toward a different set of rhyming words. The females coped with stressors using a strategy referred to as “Tend and Befriend.” And to further complexify the situation, sometimes males do the tend and befriend thing too. . . although not quite so frequently as the white, male, rats.

The point . . . I know I’ve strayed from it, is that financial and workplace interventions are very good for decreasing child abuse, but IMHO. . . interventions that increase social support and connection (the tending and befriending as methods for helping highly stressed families cope) are equally important . . . and that brings us right back to you and what you can do to prevent child abuse.

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Today’s blog is just a reminder that although powerful and memorable communication is remarkably powerful and memorable, it’s usually incomplete, not always accurate, and a function of the speaker’s need or desire to be powerful and memorable. This is just as true when I say “a pill is not a skill” or when other people say other things that make use of rambling and reckless rhetoric of the alliterative or rhyming ilk.

To finish, I’ll leave you with what Shelly Taylor said back in the year 2000, as excerpted from our forthcoming textbook, Counseling and Psychotherapy in Context and Practice (John Wiley and Sons, 2018). This particular excerpt ends with brief comments from us that also, in case you are wondering, might be relevant to the recent Google manifesto brouhaha.

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Stress researcher and social psychologist Shelly Taylor made a similar contribution when researching the well-known fight or flight phenomenon (Taylor et al., 2000). She and her colleagues wrote:

A little-known fact about the fight-or-flight response is that the preponderance of research exploring its parameters has been conducted on males, especially on male rats. Until recently, the gender distribution in the human literature was inequitable as well. Prior to 1995, women constituted about 17% of participants in laboratory studies of physiological and neuroendocrine responses to stress. (2000, p. 412)

Reanalysis of existing data and new research revealed significant differences in the ways in which females and males respond to stressful situations. Taylor and colleagues (2000) concluded:

We propose a theory of female responses to stress characterized by a pattern termed “tend-and-befriend.” Specifically, we propose that women’s responses to stress are characterized by patterns that involve caring for offspring under stressful circumstances, joining social groups to reduce vulnerability, and contributing to the development of social groupings, especially those involving female networks, for the exchange of resources and responsibilities. We maintain that aspects of these responses, both maternal and affiliative, may have built on the biobehavioral attachment caregiving system that depends, in part, on oxytocin, estrogen, and endogenous opioid mechanisms, among other neuroendocrine underpinnings. (p. 422)

The preponderance of the research suggests that in fact, that White male ways of being aren’t always normative for females, or even for all males. There are physical and psychological similarities between females and males, but there are also differences. In this case, it would be inappropriate to make the case that a typical male fight-or-flight response is superior to a typical female tend-and-befriend response. There is likely an evolutionary benefit to both stress-related behavior patterns (Master et al., 2009; Taylor & Gonzaga, 2007; Taylor & Master, 2011). Sometimes differences are just differences and there’s no need to advocate for one sex-related pattern as superior over another (although if they feel threatened by this information, white male rats are highly likely to fight for their position…or run and hide in little holes in our cupboards). In this case it seems clear: Neither behavior pattern represents psychopathology…and neither will always be the superior response to threat.

 

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Boy Brains, Girl Brains, and Neurosexism

Black White Bikes

Sorry to say, I’ve been irritable the past couple days. If you don’t believe me, just ask my internet provider . . . or my editor . . . or ask me about my upcoming book deadline. There’s evidence everywhere for my irritability and impatience. You might even see evidence for it in this short excerpt from our forthcoming Theories of Counseling and Psychotherapy textbook. In fact, you should read this now, because I’m pretty sure it will get censored before appearing in our text.

Here you go.

You may be aware of popular books describing and delighting in the differences between female and male brains. Here’s a short list, along with my snarky comments:

  1. The essential difference: Male and female brains and the truth about autism (Baron-Cohen, 2003). Baron-Cohen is an autism researcher. His book allegedly, “. . . proves that female-type brains are better at empathizing and communicating, while male brains are stronger at understanding and building systems-not just computers and machinery, but abstract systems such as politics and music.” Comment: It’s so good to finally understand why most of our politicians are smirky White males who look like Baron-Cohen (heads up, this statement is sarcasm).
  2. The female brain (Brizendine, 2006): Brizendine is a neuropsychiatrist. Her book is touted as bringing “. . . together the latest findings to show how the unique structure of the female brain determines how women think, what they value, how they communicate, and who they love.” Comment: In Delusions of gender (2011), Cordelia Fine reduces Brizendine’s arguments to rubble. Nuff said.
  3. Teaching the female brain: How girls learn math and science (James, 2009). Comment: It’s hard to know how this book could be more than two pages given that there’s extremely sparse scientific evidence to support what this book’s title implies.
  4. Female brain gone insane: An emergency guide for women who feel like they are falling apart (Lundin, 2009). No comment. I couldn’t bring myself to read beyond this book’s title.
  5. The male brain: A breakthrough understanding of how men and boys think (Brizendine, 2011). Comment: The main breakthrough finding is that when you sell a million+ copies of your first book, a sequel, with similar drama, but equally slim scientific support, is essential.
  6. Unleash the power of the female brain: Supercharging yours for better health, energy, mood, focus, and sex (Amen, 2014). Comment: Better health, energy, mood, focus, and sex? I want a female brain!

The dangers of over-stating what’s known about the brain is significant, but nowhere are the dangers bigger than when you’re talking about sex and gender. Over time, physical differences between females and males have nearly always been used to justify systemic mistreatment of females (and limitations for males, as well). Some examples:

Plato didn’t think women were created directly by God and so they didn’t have had souls.

Aristotle thought women were deficient in natural heat and therefore unable to cook their menstrual fluids into semen.

Gustav Le Bon (1979) concluded that women’s intellectual inferiority was so obvious that no one could contest it. He wrote: “All psychologists who have studied the intelligence of women, as well as poets and novelists, recognize today that they represent the most inferior forms of human evolution and that they are closer to children and savages than to an adult, civilized man” (see Women’s Brains by S. J. Gould). Le Bon purportedly based his ideas on Broca’s measurements of 6 female and 7 male skulls. Not surprisingly, Le Bon strongly opposed the whole idea of educating women.

More recently, over the past 30 years, I’ve seen and heard and read many different descriptions and explanations about female and male brain differences. Nearly always, there’s the same old story: Women are more “right brained” and intuitive and less “left brained” and rational. Of course the actual brain hemisphere research is sketchy, but the take home messages are much like Baron-Cohen’s and Brizendine, which happen to be much like the philosophy of the Nazi Third Reich, which is that girls and women are well-suited for working in the kitchen and the church, and especially good at caring for children, but that women had best leave politics and the corporate world – where steady rationality is essential – to the men.

All this reminds me of the time my daughter, then a senior in high school, was shown a film in her science class depicting the female brain as structurally less capable of science and math. She came home in distress. We showed up at school the next day. What do you suppose happened next? We’ll leave that story to your imagination.

Genderizing the brain marginalizes and limits females, but it can also do the same for males. Take, for example, this quotation from “Dr.” Kevin Leman.

“Did you know that scientific studies prove why a woman tends to be more ‘relational’ than her male counterpart? A woman actually has more connecting fibers than a man does between the verbal and the emotional side of her brain. That means a woman’s feelings and thoughts zip along quickly, like they’re on an expressway, but a man’s tend to poke slowly as if he’s walking and dragging his feet on a dirt road.” (pp. 5-6).

Just FYI, even though my emotional quotient is just barely dragging along Leman’s dirt road, I can quickly intuit that what he wrote is sheer drivel. It’s not partial drivel because . . . as Cordelia Fine might say, “He just made that shit up.”

Seriously? Am I making the claim that male and female brains are relatively equivalent in terms of empathic processing? Yes. I. am.

Using the best and most rigorous laboratory empathy measure available, empathy researcher William Ickes found no differences between males and females in seven consecutive studies. However, based on a larger group of studies, he and his colleagues acknowledged that there may be small sex-based differences favoring women on empathy tasks. It should be noted that he and his research team (which includes females who may be more limited in their scientific skills than Baron-Cohen) offer at least two caveats. First, they believe that females being raised in social conditions that promote a communal orientation may account for some of the differences. Second, females are especially likely to be better at empathy when they’re primed, directly or indirectly, to recall that they (women) are better at emotional tasks than men. The converse is also true. When men are primed to think all men are empathic dullards, they tend to perform more like empathic dullards.

What all this boils down to is that females and males are generally quite similar in their empathic accuracy, not to mention their math and science and language abilities. It appears that the minor observable differences between females and males may be explained by various environmental factors. This means that if you want to stick with scientific evidence, you should be very cautious in making any conclusions about brain differences between females and males. To do otherwise is to create what has been eloquently termed, a neuromyth.

In summary, the safest empirically-based conclusions on sex- and gender-based brain differences are:

  1. The differences appear to be minimal
  2. When they exist, they may be largely caused by immediate environmental factors or longer-term educational opportunities
  3. To avoid mistakes from the past, we should be cautious in attributing female and male behavioral or performance differences to their brains
  4. If and when true neurological differences are discovered, it would be best if we viewed them using the Jungian concept of Gifts differing (Myers, 1995).
  5. Consistent with Cordelia Fine’s excellent recommendation in Delusions of Gender, we shouldn’t make things up—even if it means we get to sell more books.

When Babies Fly

Nora Flies Crop

The plane vibrated, shook, rattled, and lost altitude. Passengers gasped. The seatbelt light illuminated.

Our pilot had said, “We’ll be having a few bumps.” But when I look out the window, I don’t see bumps. But the name doesn’t matter. A rose or bump by any other name still smells like nausea.

Those so-called bumpy plane rides usually trigger, for me, a mental image of turbulence ripping the wings off the plane. Then we all crash and die. This isn’t a helpful mental image. I know that.

Having repeated images of falling out of the sky to certain death has been unpleasant, but motivating. I’ve been motivated to work on countering turbulence with meditation, deep breathing, and calmness. I’m happy to report that I can keep my heart rate at under 60 beats per minute through the bumps. Is it dissociation or coping? I don’t care. Nausea is minimal and instead of dread and anxiety, I feel accomplishment. I decided that if I’m going to crash and die, I might as well be relaxed.

Until a couple months ago, I was sure I’d worked out the best method ever for flight turbulence. But then, during a particularly series of bumps from Portland to Missoula, I learned how babies fly.

The bumps started. Gasps followed. Then, about three rows ahead, I heard a mom comforting her toddler. I was expecting the typical, “It’s okay . . . we’ll be fine . . . hold my hand.” But this particular mom cranked the ball out of the park with Just. One. Word.

“Weeeeeeee!”

The plane transformed from gasps to chuckles.

“Wooooooo!”

It didn’t take a minute. Not even 10 seconds. The effect was immediate. No longer were we enduring a bumpy flight. We were transported to a fantastic amusement park ride.

I turned to the burly man next to me (I always get seated by another burly man; they like to put us in pairs) and said. “Wow. That’s cool.”

He was smiling. The toddler was laughing. The mom was oohing and ahhing. Several other passengers joined in.

We landed.

Later, I realized that in the midst of my admiration, I had forgotten all about breathing and meditating and tracking my pulse. Instead, I learned an even BETTER METHOD. Not only did this mom transform the flight for herself and her baby, she transformed it for everyone.

It was SO GOOD, I just had to share it with you.

“Weeeeeeeee!”

Pass it on.

Brain Science May be Shiny, but Exposure Therapy is Pure Gold

Spidey Cropped

In honor of Joseph Wolpe, let’s start with mental imagery.

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Imagine you’ve travelled back in time. You’re in your first week of high school. You look around and notice that one of your classmates is named Mary Jones.

Mary is an ordinary girl with an ordinary name. Over the years, you don’t notice her much. She seems like a nice person, a fairly good student, and someone who doesn’t get in trouble or draw attention to herself.

Four years pass. A new student joined your class during senior year. His name is Daniel Fancy Pants. Toward the end of your senior year, Daniel does a fantastic Prezi presentation about a remarkable new method for measuring reading outcomes. He includes cool video clips and boomerang Snapchat. When he bows at the end, he gets a standing ovation. Don’t get me wrong. Daniel is a good student and a hard worker; he partnered up with a college professor and made a big splash. Daniel deserves recognition.

But, as it turns out, over the WHOLE four years of high school, Mary Jones was quietly working at a homeless shelter; week after week, month after month, year after year, she was teaching homeless children how to read. In fact, based on Daniel’s measure of reading outcomes, Mary had taught over 70 children to read.

Funny thing. Mary doesn’t get much attention. All everybody wants to talk about is Daniel. At graduation, he wins the outstanding graduate award. Everyone cheers.

Let’s stop the mental imagery and reflect on what we imagined.

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Like birds and raccoons, humans tend to like shiny things. Mary did incredible work, but hardly anyone noticed. Daniel did good work, and got a standing ovation and top graduate award.

The “shiny-thing theory” is my best explanation for why we tend to get overly excited about brain science. It’s important, no doubt. But brain imaging isn’t the therapy; it’s just a cool way to measure or validate therapy’s effects.

Beginning in at least 1924, when Mary Cover Jones was deconditioning fear out of little children, behavior therapy has shown not only great promise, but great outcomes. However, when Schwartz (and others) showed that exposure therapy “changes the brain,” most of the excitement and accolades were about the brain images; exposure therapy was like background noise. Obviously, the fact that exposure therapy (and other therapies) change the brain is great news. It’s great news for people who have anxiety and fear, and it’s great news for practitioners who use exposure therapy for treating anxious and fearful clients.

This is all traceable to neuroscience and human evolution. We get distracted by shiny objects and miss the point because our neural networks and perceptual processes are oriented to alerting us to novel (new) environmental stimuli. This is probably because change in the form of shiny objects might signal a threat or something new and valuable. But we need to stay focused in order to not overlook that behavior therapy in general, and exposure therapy in particular, has been, is, and probably will continue to be, the most effective approach on the planet for helping people overcome anxiety and fear. And, you know what, it doesn’t really matter that it changes the brain (although that’s damn cool and affirming news). What matters is that it changes clients’ lives.

Exposure therapy, no matter how you package it, is highly effective for treating anxiety. This statement is true whether we’re talking about Mary Cover Jones and her evidence-based counterconditioning cookies or Francine Shapiro and eye movement desensitization reprocessing (EMDR). It’s also true whether we’re talking about virtual reality exposure, imaginal exposure, massed exposure, spaced exposure, in-vivo exposure, interoceptive exposure, response prevention (in obsessive-compulsive disorder) or the type of exposure that acceptance and commitment therapists use (n.b., they like to say it’s “different” from traditional classical conditioning exposure, but it works, and that’s what counts).

In the end, let’s embrace and love and cheer brain imaging and neuroscience, but not forget the bottom line. The bottom line is that exposure therapy works! Exposure therapy is the genuine article. Exposure therapy is pure gold.

Mary Cover Jones is the graduate of the century; she’s the bomb. Because of her, exposure therapy has been pure gold for 93 years. And now, we’ve got cool pictures of the brain to prove it.

Note: Mary Cover Jones passed away in 1987. Just minutes before her death, she said to her sister: “I am still learning about what is important in life” (as cited in Reiss, 1990). We should all be more like Mary.

When the Yellow Grows into Gold and Happy Breaks Out

Lower Grove Creek 7 14 17This morning the clock said 3:51am. My lungs felt refreshed. Then a memory from last night bubbled up. You know how they do.

Rita and I discovered mold in our garden. It was yellow and green and it shared its spores with my lungs before we recognized or best option: retreat inside to formulate our battle plan in response  to the attack of the multicolored mold.

Google was waiting. All the postings were about White mold or Black mold, or even yellow dog-vomit mold. Nothing fit our mold. I read with great and trepidiacal interest of a U.K. man who died from inhaling compost mold; my lungs were burning. Not good.

But sleep came.

Then 3:51am came.

And then the thoughts came.

At 3:52am it seemed odd that I could hear my pulse in my ear on the pillow. It seemed fast. That U.K. man had a rapid pulse. I could either choose to lift my head and take my pulse and while waiting for the digital clock to move to the next minute, or I could look at my fit bit. But my fit bit is charging. But I decide, anyway, to roll over and grab it and attach it to my wrist and look at the pulse rate. It flashes, 113. Not good. I check again, 112. Not good. Not normal. I compulsively check again, 111. The fit bit is probably still adjusting, now it’s 109. Stop checking, the voice in my head says. Let it be. Let it settle. Thirty seconds later, it’s 55. I am normal again.

At 3:54am, I find another troubling thought. Today is July 14, 2017. My Theories text revision is due in 31 days. I have five more chapters to revise. That’s six days per chapter. Plus references. Plus table of contents and preface and . . . . Not good. I’m a bad author.

At 4:12am, I’m up, turning on the computer. I’m a bad author and a bad husband and a bad father and a bad friend. All I do is write meaningless drivel that maybe 12 people a year will read and then immediately forget. Forgettable, I am. Even my own students can’t answer my pop theories quiz questions when they drop by my office. I wonder why they don’t stop in so much anymore.

Good thing I’m revising CBT today. God and Albert Ellis know, I sure as Hell need it.

One of today’s content areas is called, Thinking in Shades of Gray. It’s a description of a cognitive technique to help people get out of destructive, irrational, and maladaptive black-white (aka polarized) thinking. It’s boring. Of course it’s boring. Shades of gray? It’s a technique to help with depressive thoughts. I can hear the Albert Ellis voice in my head. WTF? You work with depressed people and you teach them how to think in shades of gray. What the Holy Hell are YOU thinking?

Later this morning, as I ride through Lower Grove Creek with yellow flowers and the Beartooth Mountains looming, I stop for a photo. There are no cars, no deer, and not even a trace of fungal spores. Just me and my breath and my bike and the yellow flowers and shades of gray, black, and white rising above. Why are there no colors in the shades of gray activity? There’s more to our thinking (and our client’s) thinking than black, white, and gray. Today, with the wind in my face and Tippet Rise to my starboard, I want to be an art therapist. “Let’s put a little yellow there,” I say. And the yellow grows into gold and happy breaks out.

But sooner or later, you and I know. We. Know. The yellow will catch dust and lose its sparkle and turn to mold, until a future morning at 3:51am, when a red seed of awareness gets planted among the anxiety bushes and purple flowers bloom, replacing the moldy browned-up yellow, and then we will remember. We have been here before. And it was wondrous and terrible and everything in between.

At that point, it’s not a bad idea to find your fit bit, take your pulse, and embrace the ever disintegrating now that is morning. You have your next 31 days and I have mine. Let’s meet somewhere in the middle and celebrate the next disintegrating now with all the passion and monotony we can muster. You know we can. We’ve done it before.

Three Pounds of Theoretical Elegance in 888 Words

Rita and Driftwood 2017

As you may or may not recall, we have several new features in our forthcoming Counseling and Psychotherapy Theories in Context and Practice (3rd ed.) text. Here’s a draft of what we’ve tentatively titled a “Brain Box” from Chapter One.

Brain Box 1.1

Three Pounds of Theoretical Elegance

John Sommers-Flanagan

This Brain Box is a brief, oversimplified, description of the brain. I apologize, in advance, to you and to brains everywhere for this oversimplification and likely misrepresentation. The problem is that even if I took a whole chapter or a whole book to describe these three pounds of elegance, it would still be an oversimplification. Such is the nature of the human brain.

You may already be familiar with the concepts described here. If so, it’s a review. You may be less familiar; then, it’s an introduction. For more information on neuroscience and therapy, we recommend Neuroscience for counselors and therapists: Integrating the sciences of mind and brain by Chad Luke.

Brain Structure: The human brain has indentations, folds, and fissures. It’s slick and slimy. Put simply, it’s not a pretty sight. But the brain’s form maximizes its function. One example: If you could lay out and spread its surface area onto a table, it would be about the size of two pages of a newspaper. The folds and fissures allow more surface area to fit within the human skull.

Scientists describe the brain as having four lobes: The frontal, parietal, occipital, and temporal (see Figure 1.2). The fissures or sulci of the brain demarcate the four lobes. At the bottom of the brain is the brainstem and cerebellum.

Each lobe is generally associated with different brain functions. I say generally because brains are specific and systemic. Although individuals have similar brain structures, individual brains are more unique than a fingerprint on a snowflake.

The frontal lobe is primarily associated with complex thought processes such as planning, reasoning, and decision-making (much, but not all, of what psychoanalysts refer to as ego functions). The frontal lobe also appears involved in expressive language and contains the motor cortex.

The parietal lobe includes the somatosensory cortex. This surface area involves sensory processing (including pain and touch). It also includes spatial or visual orientation.

The temporal lobes are located symmetrically on each side of the brain (just above the ears). They’re involved in auditory perception and processing. They contain the hippocampus and are involved in memory formation and storage.

The occipital lobe is located in the back of the brain and is the primary visual processing center.

I’m using all four lobes right now to type, read, edit, re-think, re-type, re-read, shift my position, and recall various relevant and irrelevant experiences. The idea that we only use 10% of our brains is a silly myth. They even busted it on the Mythbusters television show.

The brain includes two hemispheres. They’re separated by the longitudinal fissure and communicate with each other primarily via the corpus callosum. The hemispheres are nearly mirror images of each other in size and shape. However, their neurotransmitter quantities and receptor subtypes are quite different. The right hemisphere controls the left side of the body and is primarily involved in spatial, musical, and artistic/creative functions. In contrast, the left hemisphere controls the right side of the body, and is involved in language, logical thinking, and linear analysis. There are exceptions to these general descriptions and these exceptions are larger in brains of individuals who are left-handed. Woo-hoo for lefties.

The limbic system is located deep within the brain. It has several structures involved in memory and emotional experiencing. These include, but are not limited to the: amygdala, basal ganglia, cingulate gyrus, hippocampus, hypothalamus, and thalamus. The limbic system and its structural components are currently very popular; they’re like the Beyoncé of brain science.

Neurons and Neurotransmitters: Communication within the brain is electrical and chemical (aka electrochemical = supercool).

Neurons are nerve cells (aka brain cells) that communicate with one another. There are many neuron types. Of particular relevance to counseling and psychotherapy are mirror neurons. Mirror neurons fire when you engage in specific actions (e.g., when waving hello) and the same neurons fire as you observe others engaging in the same actions. These neurons are central to empathy and vicarious learning, but many other brain structures and systems are also involved in these complex behaviors (see Chapter 5).

Neurotransmitters are chemicals packed into synaptic vesicles. They’re released from an axon (a part of a neuron that sends neural transmissions), travel through the synaptic cleft (the space between neurons), and into a connecting dendrite (a part of a neuron that receives neural transmissions), with some “leftover” vesicles re-absorbed into the original axon (referred to as “reuptake,” as in serotonin-specific reuptake inhibitors).

There are somewhere between 30 and 100 (or more) neurotransmitters (NTs) in the brain, divided into three categories: (a) Small molecule NTs (e.g., acetylcholine, dopamine, GABA, Glutamate, histamine, noradrenaline, norepinephrine, serotonin, etc.); (b) neuropeptides (e.g., endorphins, oxytocin, etc.); and (c) “other” (e.g., adenosine, endocannadinoids, nitric oxide, etc.). Neurotransmitters are classified as excitatory or inhibitory or both. For example, norepinephrine is an excitatory neurotransmitter, dopamine is both excitatory and inhibitory, and serotonin is inhibitory. Although several chemical imbalance hypotheses regarding the etiology of mental disorders have been promoted (e.g., “low” serotonin at the synaptic cleft causes depression), when it comes to the brain, I caution you against enthusiastic acceptance of any simplistic explanations. A significant portion of the scientific community consider the dopamine and serotonin hypotheses to be mostly mythical (see Breggin, 2016; Edwards, Bacanu, Bigdeli, Moscati, & Kendler, 2016; Moncrieff, 2008, 2015).

Figure 1.2: A Look at the Brain — If the image was here, you would see it. In its absence, use your brain to imagine it. Yes. It’s beautiful. In the real textbook, we’ll have a real image of a brain and not my snarky suggestion that you use more than 10% of your brain to imagine a brain.

A Tasty Sample of Reality Therapy

With WubboldingAs far as I know, reality therapists don’t typically use food or eating metaphors. My use of it here might be a leftover from my Gestalt therapy chapter revision, because Gestalt theory happily incorporates swallowing, biting, and other oral dimensions. Then again, maybe it’s just time for lunch.

Choice theory is the foundation for reality therapy. Or, as William Glasser and Robert Wubbolding (featured with me in this photo) put it, reality therapy is the train and choice theory is the track. No gustatory metaphors here either. But I’ll keep looking.

The following is a smattering of tasty revisions for the forthcoming 3rd edition of Counseling and Psychotherapy Theories in Context and Practice.

What is Choice Theory and Reality Therapy?

Glasser developed reality therapy in the 1960s. Later, recognizing that he needed a theoretical foundation for his therapeutic approach, he began exploring cybernetics and control system theory (Powers, 1973; Wiener, 1948). Initially, following Powers, Glasser used control theory to explain reality therapy. Later, he adapted the theoretical model and shifted to using choice theory (Glasser, 1998).

Choice theory is based on the idea that conscious behaviors are chosen in an effort to satisfy one of five internal basic human needs (Wubbolding & Brickel, 2017). The human mind or brain acts as a “negative input control system,” providing feedback to individuals so that we can correct out behaviors and continue getting what we need and want (Wubbolding, 2012, p. 13).

Reality therapy is a present-focused, directive therapeutic approach designed to help individuals identify and satisfy their needs and wants more consistently and adaptively. As Wubbolding (2012) has written, “If choice theory is the track, reality therapy is the train that delivers the product” (p. 5).

Reality Therapy in Action: Brief Vignettes

Similar to Adlerian therapy, reality therapy involves encouragement and intentional planning. The counselor establishes a positive working relationship and then persistently keeps the therapeutic focus on what’s within the client’s solving circle or circle of control. Maintaining a clear focus on positive actions and thoughts is what makes reality therapy an efficient and brief counseling approach.

Vignette I: Using Encouragement—Not Critical Confrontation

The following is an example of the type of confrontation often inaccurately associated with reality therapy. The counselor is confronting a teenage client on his efforts to find a job.

Counselor: Where else did you go?

Client: I tried a couple other [gas] stations, too. Nobody wants to look at me. They don’t pay too good anyway. [Screw] them!

Counselor: So you haven’t really done too much looking. Sounds like you want it served on a silver plate, Joe. Do you think looking at a couple of gas stations is really going to get you a job? (XXXX et al., 2002, p. 219)

Based on this brief exchange it appears the counselor is trying to help the client be successful in obtaining employment. Consequently, we can assume that having gainful employment (or at least making money) is a “want” (the W in WDEP) and in the client’s quality world. Although this counselor is supposedly doing reality therapy, his critical statements (“you haven’t done too much looking” and “you want it served on a silver platter”) are inconsistent with reality therapy principles. A reality therapist would use a more supportive and encouraging approach. For example:

Counselor: Where else did you go?

Client: I tried a couple other [gas] stations, too. Nobody wants to look at me. They don’t pay too good anyway. [Screw] them!

Counselor (Reality therapy response): It sounds like you really want a job and you feel very frustrated. What else could you do to help get what you want?

Notice that the reality therapist keeps the focus on what the client wants, empathizes with the frustration, and ignores the client’s desire to quit trying. This approach is encouraging because the counselor is expresses confidence in the client’s ability to act and think in ways that will move him toward his quality world.

Generally, when counselors use confrontation, the goal is to help clients engage in self-examination. The process for nearly all therapy approaches is similar—counselors help clients increase their awareness or have insights, which then leads to motivation and eventual change. Consistent with this process, Wubbolding referred to client self-evaluation as a “prelude to change” (1999, p. 196).

In working with this young man on employment issues, the following exchange uses concepts and questions adapted from Wubbolding (1999).

Counselor: Hey Joe, do you think the overall direction of your life is more of a plus or more of a minus?

Client: I don’t know. I suppose it’s kind of a neutral. I don’t have a job and I’m not really going any direction.

Counselor: That’s interesting. No direction. I guess my question about that is whether going no direction is really the direction you want . . . or whether maybe you want something else?

Client: Yeah. I’d love to have some money. Right now the economy sucks, so I don’t really see the point of looking for work.

Counselor: The odds of getting a job right now aren’t great, that’s for sure. Do you suppose the odds are better if you stay home or better if you get out and drop off a few applications?

Client: I see what you’re saying. My odds are a little better if I get out there. But I think my odds of making money are probably better if I just got out there and sold drugs, like some other guys I know are doing.

Counselor: I’m just trying to follow along and track what you want. It does sound like you want money. And you might be right about the drug selling scene, I don’t know much about that. But let’s be serious, do you think selling drugs would genuinely be good for you? I guess another way of asking that is, “Will selling drugs help or hurt you in getting what you want in the long run?” [This confrontation does what a reality therapy confrontation is supposed to do: It directly questions the usefulness of excuses.]

Client: I’m not saying I think selling drugs is a good thing to do. I’m just frustrated and sick of being broke and poor.

Counselor: Yeah. It’s very hard. But I’m your counselor and it’s my job to keep pushing you in positive directions. I’m asking you this because I think you can do better than how you’re doing. Is the way you’re thinking about this—that it’s too hard, the economy sucks, and you’re likely to fail—is that line of thinking helping you get a job or hurting your prospects?

Client: Yeah. I guess having a pity-party isn’t helping much.

Counselor: I’m sure having a pity party can feel good sometimes. But I’m with you on the fact that it’s not helping much. So we’ve got to try out something different.

Because the preceding questions ask the client to look at himself and self-evaluate, they’re inherently confrontational, but also supportive and encouraging. Many additional reality therapy questions that help clients self-reflect and plan are in Wubbolding’s (2000, 2017) publications.

Vignette II: Collaborative Planning

This vignette extends the previous case into the reality therapy collaborative planning process.

Client: Well. What sort of different approach do you suggest?

Counselor: If it were up to me, I’d suggest we make a very clear plan for you to try out this week. The plan would focus on how you can get what you want: a job so you can start earning money. And we’d develop this plan together and we’d be honest with each other about whether our ideas would give you the best chances to get a job.

Client: How about I go down to the Job Service and sign up there?

Counselor: That’s one good idea. It doesn’t guarantee you a job, but nothing will because you don’t have control over whether someone hires you, you only have control over your strategy or plan. Do you know what I mean?

Client: Not really.

Counselor: Thanks for being honest about that. When you make a plan or set a goal, it’s important for it to be completely within your control and not dependent on anyone else. That’s because the only behavior you can control is your own. For example, if your plan is to “get hired,” you can be doomed to frustration and anger because you don’t make the hiring decision. Instead, a good plan involves developing a detailed, step-by-step process. Your plan could be to revise your resume and then submit it along with a well-crafted cover letter to 10 places where you think your skills are a good fit. You have complete control over all that.

Client: Okay. I get it. I could do that, but I’m not very good with writing and resumes and all that.

Counselor: How can you make sure those things are in good shape then?

Client: I could get my sister to look it over.

Counselor: When could you do that?

Client: Next week, I suppose.

Counselor: What would make it possible to do that sooner, like this week?

Client: You know, you’re really kind of pushy.

Counselor: Do you think you’d do better with someone who lets you put things off until next week? Would that be more helpful in getting you a job sooner?

Client: Right. Right. Okay. I call my sister tonight and ask if she can help me as soon as she’s available.

Counselor: That’s sounds like a great start. What time will you call her tonight?

Client: Seven o’clock. I know. Why not six? Well I figure she’ll be done with dinner by seven, that’s why.

Counselor: Good planning. Maybe I don’t have to be so pushy after all.

The preceding dialogue illustrates how counselors can use gentle and persistent questioning to lead clients toward planning that’s consistent with Wubbolding’s principles (i.e., SAMI2C3). It also illustrates how reality therapists function as collaborators to help clients or students plan for success.

Concluding Comments

The mission of the William Glasser Institute is to teach all people Choice Theory® and to use it as the basis for training in reality therapy, lead management, and Glasser Quality School education (http://www.wglasser.com/). The institute has existed for more than 44 years and there are now approximately 8,000 certified reality therapists worldwide and over 86,000 who have obtained substantial advanced reality therapy training.

William Glasser passed away in 2013. Although his advocacy for conscious, noncoercive human choice is missed, there are many other contributors to the national and international dissemination of choice theory and reality therapy. As examples, Robert Wubbolding is the director of the Center for Reality Therapy. Thomas Parish is the editor of the International Journal of Choice Theory and Reality Therapy. Patricia Robey, Nancy Buck, Jim Roy, and John Brickell are prolific contributors to the CT/RT literature (Buck, 2013; Parrish, 2017; Robey, 2017; Roy, 2014, 2017; Wubbolding & Brickell, 2017).

In Dr. Glasser’s eulogy, Wubbolding shared the following anecdote:

Quite recently, a woman approached him at his home and begged him for advice for how to deal with her 3 year-old son. He paused for a long time and then reached deep down inside his soul and gave her 2 suggestions: “Always treat him as if he is good.” And “Set up circumstances where he can only succeed.” These wise words could serve as his suggestions for all counselors. They represent for us a worldview, an attitude toward clients and his perception of all human beings. These two sentiments transcend a particular counseling system in that they summarize his legacy (September 10, 2013; http://www.realitytherapywub.com/index.php/easyblog/entry/dr-william-glasser).  

In support of Glasser’s legacy, we end this chapter with a quotation that reflects his idealism and ambition:

It is my vision to teach choice theory to the world.

I invite you to join me in this effort.

—William Glasser, Unhappy Teenagers (2002, p. 190)