Category Archives: Personal Reflections

Clinical Interviewing, Personal Reflections

Working with Emotions in Counseling and Psychotherapy: Part 3

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Most people intuitively know that emotions are a central, complex, and multidimensional part of human experience. Emotions are typically in response to perceptions, include sensations, and are at the root of much of our existential meaning-making. Emotions are at the heart (not literally, of course) of much of the motivation that underlies behavior.

What follows is another excerpt from Clinical Interviewing (7th edition). In this excerpt, we define and explore the use of an interpretive reflection of feeling as a tool to go deeper into emotion and meaning with clients. As with all things interpretive, I recommend proceeding with caution, respect, and humility. . . because sometimes clients aren’t interested in going deeper and will push back in one way or another.

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Interpretive Reflection of Feeling (aka Advanced Empathy)

Interpretive reflections of feeling are emotion-focused statements that go beyond obvious emotional expressions. Sometimes referred to as advanced empathy (Egan, 2014), interpretive reflection of feeling is based on Rogers’s (1961) idea that sometimes person-centered therapists work on emotions that are barely within or just outside the client’s awareness.

By design, interpretive reflections of feeling go deeper than surface feelings or emotions, uncovering underlying emotions and potentially producing insight (i.e., the client becomes aware of something that was previously unconscious or partially conscious). Nondirective reflections of feeling focus on obvious, clear, and surface emotions; in contrast, interpretive reflections target partially hidden, deeper emotions.

Consider again the 15-year-old boy who was so angry with his teacher.

Client: That teacher pissed me off big time when she accused me of stealing her phone. I wanted to punch her.

Counselor: You were pretty pissed off. (reflection of feeling)

Client: Damn right.

Counselor: I also sense that you have other feelings about what your teacher did. Maybe you were hurt because she didn’t trust you. (interpretive reflection of feeling)

The counselor’s second statement probes deeper feelings that the client didn’t directly articulate.

An interpretive reflection of feeling may activate client defensiveness. Interpretations require good timing (Fenichel, 1945; Freud, 1949). That’s why, in the preceding example, the counselor initially used a nondirective reflection of feeling and then, after that reflection was affirmed, used a more interpretive response. W. R. Miller and Rollnick (2002) made this point in Motivational Interviewing:

Skillful reflection moves past what the person has already said, though not jumping too far ahead. The skill is not unlike the timing of interpretations in psychodynamic psychotherapy. If the person balks, you know you’ve jumped too far, too fast. (p. 72)

Interpretive reflections of feeling assume clients will benefit from going “vertical” or deeper into understanding underlying emotions; they can have many effects, the most prominent include the following:

  • If offered prematurely or without a good rationale, they may feel foreign or uncomfortable; this discomfort can lead to client resistance, reluctance, denial, or a relationship rupture (Parrow, 2023).
  • When well stated and when a positive therapy relationship exists, interpretive reflections of feeling may feel supportive because therapists are “hearing” clients at deeper emotional levels; this can lead to enhanced therapist credibility, strengthening of the therapeutic relationship, and collaborative pursuit of insight.

Interpretive reflections of feeling are naturally invasive. That’s why timing and a good working alliance are essential. When using interpretive reflections of feeling, follow these principles.

  • Wait until:
    • You have good rapport or a positive working alliance.
    • Your clients have experienced you accurately hearing and reflecting their surface emotions.
    • You have evidence (e.g., nonverbal signals, previous client statements) that provide a reasonable foundation for your interpretation.
    • Phrase your interpretive statement:
    • Tentatively (e.g., “If I were to guess, I’d say…”)
    • Collaboratively (e.g., “Correct me if I’m wrong, but…”)

The need to phrase statements tentatively and collaboratively is equally true when using any form of feedback or interpretation. Many different phrasings can be used to make such statements more acceptable.

  • I think I’m hearing that you’d like to speak directly to your father about your sexuality, but you’re afraid of his response.
  • Correct me if I’m wrong, but it sounds like your anxiety in this relationship is based on a deeper belief that she’ll eventually discover you’re unlovable.
  • If I were to guess, I’d say you’re wishing you could find your way out of this relationship. Does that fit?
  • This may not be accurate, but the way you’re sitting seems to communicate not only sadness but also some irritation.

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I hope this content has been of some interest or use to you in your work. If you want a bit more, a couple of emotion-related case examples are at the link below (and you can always buy the book:)).

two-emotion-related-case-examplesDownload
Counseling and Psychotherapy Theory and Practice, Happiness, Personal Reflections

Negative and Positive Reflections on Positive Psychology

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In my Group Counseling class, I’ve experienced predictable questioning of or resistance to evidence-based happiness ideas from positive psychology. . . and so I wrote out some of my thoughts . . . which went on and on and ended with a video clip.

Hello Group Class,

I’m writing my group takeaway to your all this week. Feel free to read at your leisure . . . or not at all . . . because I’m a writer and obviously, sometimes I get carried away and write too much.

When I responded to a question last week expressing reservations about the use of positive psychology—perhaps generally and perhaps more specifically with oppressed populations—I launched into a psychoeducational lecture. Upon reflection, I wish I had been more receptive to the concerns and encouraged the class as a group chew on the pros and cons of positive psychology in general and positive psychology with oppressed populations, in particular. I suspect this would have been an excellent discussion.

Given that we have limited time for discussion in class, I’ll share more reflections on this topic here.

1.       The concerns that were expressed (and others have expressed in your takeaways) are absolutely legitimate. I’m glad you all spoke up. Some people have used positive psychology as a bludgeon (claiming things like “happiness is a choice”) in ways that make people feel worse about themselves. Never do that!

2.       Positive psychology is poorly named (even the great positive psych researcher, Sonja Lyubomirsky, hates the name). Among its many naming problems, the word positive implies that it’s better, preferable, and the opposite of negative—which must then be the correct descriptor for all other psychology. None of this is true; positive psychology is not “better” and, in fact, it’s not even exclusively positive.

3.       The point of positive psychology is not to “take over” psychology, but to balance our focus from being nearly always on psychopathology, to being equally about strengths, joy, happiness, etc., and psychopathology. If you think of it as an effort to balance how we work with individuals, it makes more sense. The point isn’t, and never has been, that we should only focus on positive mental health regardless of how our clients and students are feeling. That would be silly and insensitive.

4.       As someone reminded me in the takeaways, the sort of happiness we focus on in positive psych is called eudaimonic happiness. This term comes from Aristotle. It refers to a longer form of happiness that emphasizes meaning, interpersonal connection, and finding the sweet spot where our own virtues intersect with the needs of the community. The other side of happiness is referred to as “hedonic” happiness. Hedonic happiness is more about hedonism, which involves immediate pleasure and material acquisitions. Nearly everyone in positive psychology advocates primarily for eudaimonic happiness, but also recognizes that we all usually need some pleasure as well.

5.       Individuals and groups who have been historically (and currently) oppressed are naturally sensitive to coercion, judgment, and possibility of repeated oppression. What this means for counselors (among many things) is that we need to careful, sensitive, and responsive to their needs and not our assumptions of their needs. They may appreciate us being positive and supportive. Or they may appreciate us explicitly acknowledging their pain and affirming the legitimacy of the reasons for their pain. There’s substantial research indicating that certain ethnic group expect counselors to be experts and offer guidance. If that’s the case, should we avoid offering guidance because a particular theorist (or supervisor) said not to offer guidance? I think not. Many clients benefit from going deep and processing their disturbing emotions and sensations. There are probably just as many who don’t really want to go deep and would prefer a surface-focused problem-solving approach. Either way, my point is that we respond to them, rather than forcing them to try to benefit from a narrow approach we learned in grad school.

6.       Good counselors . . . and you will all become good counselors . . . can use virtually any approach to make connection, begin collaborating, remain sensitive to what clients and students are saying (verbally and non-verbally), and work constructively with them on their emotions, thoughts, sensations/somatics, behaviors, and the current and/or historical conditions contributing to their distress.

7.       We should not blame clients for their symptoms or distress, because often their symptoms and distress are a product of an oppressive, traumatic, or invalidating environment. This is why reflections of feeling can fall flat or be resisted. Feeling reflections are tools for having clients sit with and own their feelings. While that can be incredibly important, if you do a feeling reflection and you don’t have rapport or a rationale, feeling reflections will often create defensiveness. Instead, it can be important to do what the narrative and behavioral folks do, and externalize the problem. When it comes to issues like historical trauma, often clients or students have internalized negative messages from a historically oppressive society, and so it makes perfect sense to NOT contribute to their further internalization of limits, judgments, discrimination, and trauma that has already unjustly taken hold in their psyche. The problem is often not in the person.     

8.       I know I said this in class, but it bears repeating that many people practice simple, superficial, and educational positive psychology using bludgeon-like strategies. Obviously, I’m not in support of that. That said, many people practice simplistic implementation of technical interventions in counseling (think: syncretism from theories class), and many counselors do bad CBT, bad ACT, bad DBT, bad behaviorism, bad existentialist therapy, and bad versions of every form of counseling out there. No matter which approach you embrace, you should do so using your excellent fundamental listening skills . . . so that if your client or student doesn’t like or isn’t benefiting from your approach, you can change it!

I want to end this little 1K word writing project with a video. In the linked clip, I’m doing about a 3 1/2 minute opening demonstrating a “Strengths-based approach” to suicide assessment and treatment planning with a 15-year-old. As you watch, ask yourself, “Is this strengths-based?” Can you identify anything that makes this approach strengths-based or as including even a whiff of positive psychology. [Again, you’re not required to watch this, I’m just rambling.]

Okay. That’s all for this Sunday evening!

John

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

Storming: My Favorite Group Stage (at least for today)

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In group class, we’re covering content related to group stage called “Storming.” The Coreys’, who’ve written about and led many groups, call this the “Transition” stage. During the storming or transition stage, group members start to push against or question group norms and/or the group leader’s authority. Not to be trite, but like roses, no matter what name it, the smell and tension of storming feels the same.

I’ve been waiting and watching for storming to emerge within my class. I know group process unfolds during class groups, just as it unfolds in psychoeducational, counseling, and psychotherapy groups. I thought I might ignite storming, by asking my counseling graduate students to focus on positive psychology. I did get a little push-back from students who emailed me about their “mixed” feelings about positive psychology. My response was to share that I also hold mixed feelings about positive psychology, along with mixed feelings about psychoanalytic theory, behavioral theory, CBT, feminist theory, acceptance and commitment therapy, and every other theory or approach I can think of.

This past week an ever-so-minor edge of a storm found its way into class. After class started, one student expressed negative feelings about a reading I’d assigned, noting that she thought the article was “shaming” to mandated clients. As often occurs with storming, I had an immediate and complex emotional and impulse-ridden response. Rather than acting on my emotions or defending the reading, I managed to welcome the critique. When I say “managed” I mean to communicate that IMHO, welcoming critiques is not easy, and maybe not natural. A few minutes later, I acknowledged that although I wished everyone would love all the class readings, I also wanted people to feel they had permission to not love the readings and speak openly about their opinions. Later that evening, I received an email takeaway from the student who didn’t like the reading. As you may recall, one of my group class assignments is for students to email me two takeaways in the days following class. Because she expressed what I want to communicate better than I can, here’s her email (shared with her permission).

Hey John,

My biggest takeaway from today was watching your modeling of working with storming, both with myself and [with another student]. The way that you allowed for expression of our feelings, were vulnerable with your own, and then used the material to create more conversations, norms, etc., was really helpful to see. I also want to share on this topic that when my oldest kiddo and I were talking this morning about what our days were looking like, I was talking to her about my feelings about an article we read for class that I didn’t agree with, and that I was going to bring it up in class. And her response was, “You’re going to tell your professor that?!?!” She was shocked that I felt like I could say that in class, and I wanted to thank you for creating a space where I felt like that was alright.

My other takeaway is your quote from class today, “We want to give people the chance to be interesting.” I think there are so few opportunities that people have to be seen and heard by others in a way that is meaningful. Coupled with the big, sort of inherent opportunity as a group leader to take up ‘too much space,’ your advice feels like a really important nugget that I want to take with me into leading groups in the future.

What I love best about this email (and I love a lot of it) is my student’s anecdote about her daughter’s reaction: “You’re going to tell your professor that?!?!” And what I love best about that is—consistent with other conversations we’ve been having in class—we should not run groups like cults. As leaders, professors, administrators, clergy, and politicians, we need to be open to independence of thought and listen to unique perspectives. What I think is not the truth and what I value is not necessarily the correct moral philosophy for everyone.

Today. . . I am very happy to have handled a little storming with acceptance and openness. Tomorrow may be different. But for today, I get to feel the good feelings of being able to live my best group leader values—even if it didn’t involve me being right about anything.  

Happiness, Personal Reflections, Writing

Practicing Forgiveness – In Theory

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Last summer, when I taught our Happiness for Teachers course along with Lillian Martz, one of the most powerful assignments involved forgiveness. Even though we emphasized that the teachers taking our class didn’t need to actually engage in a forgiveness process, they shared incredibly deep and profound stories of betrayal, forgiveness, and the struggles in between. Here’s the assignment. Again, we’re not saying you need to engage in a forgiveness process. All we’re suggesting is for you to read this and think about forgiveness. Here’s the assignment:

Whether we’re talking self-forgiveness, forgiving others, or spiritual forgiveness, forgiveness is a big deal and a big ask.

For this learning activity, we don’t expect you to purge yourself of all personal guilt or become free from all resentments. Nevertheless, for this assignment, your job is to explore what forgiving yourself, forgiving others, and being forgiven might look like AND how forgiving yourself, forgiving others, and being forgiven might feel to you.

To do this activity, you’re not expected to actually do the forgiveness work; instead, you get to think about doing the forgiveness work and speculate on its effects. . . FOR YOU. Although forgiveness is probably the biggest issue we’ve tackled in this Happiness Challenge, the plan is for you to just take a small sip from the very large cup of potential forgiveness issues that we all have. If you want to go deeper and take a bigger drink, that’s perfectly fine, but that’s all up to you.

To get yourself oriented toward forgiveness you could (if you want) consider and access some of the following ideas and online resources:

Consider that forgiving others can improve your physical health. As Anne Lamott wrote in Traveling Mercies: “Not forgiving is like drinking rat poison and then waiting for the rat to die.” Is there anyone other there toward whom you might offer forgiveness? You don’t even have to talk with them (although you can, if that works for you). You can just bring yourself to a place where you’ve let go of any lingering anger or resentment that you’re holding.

Listen to the Hidden Brain episode: The Power of Mercy. https://hiddenbrain.org/podcast/the-power-of-mercy/

Listen to or read a short NPR piece on forgiveness: https://www.wvtf.org/2014-12-03/reach-forgiveness#stream/0  

Listen to Greater Good magazine’s podcast Episode 124: Nine Steps to Forgiveness https://greatergood.berkeley.edu/podcasts/item/anoosha_syed_forgiveness_self-compassion_virtues  

Watch Oprah’s “Aha” moment on forgiveness. https://www.findcenter.com/video/24318/oprahs-forgiveness-aha-moment/everything-else

Forgiveness is a multidimensional and dynamic process. It’s also very hard. We wish you well as you consider this big issue.

Cool Counseling, Happiness, Personal Reflections

Writing Your Way to Better Health

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Nothing works for everyone. Not everyone is comfortable writing about their experiences and not everyone can benefit from therapeutic writing. But, for those keen on the expressive writing modality, you can get out your pen or laptop and make a little therapeutic magic.

For this week’s Montana Happiness Challenge, I phrased it this way: What if, by engaging in a simple procedure for three consecutive days, you could obtain the following benefits?

  • A reduced need to go see a physician
  • Improved immune functioning
  • Fewer physical ailments or symptoms
  • Less distress
  • Less negative affect
  • Less depression
  • Improved GPA
  • Less absenteeism from work

As it turns out, according to social psychologist and prominent researcher, James Pennebaker, there is a simple procedure for accomplishing all of the above, right at your fingertips. Literally. At. Your. Fingertips. All you have to do is write about hard, difficult, or traumatic experiences. Here’s an example (summarized) of his instructions:

For the next three days write about your very deepest thoughts and feelings about an extremely important emotional issue that has affected you and your life. When writing, really let go and explore your deepest emotions and thoughts. You might want to tie your writing into your relationships with others or to your past/present/future, or to who you’ve been, who you are, and who you’d like to be in the future. You can write about the same topic every day or a new one every day. Keep your writing confidential. Don’t worry about spelling, grammar, etc., just write for 15-30 minutes straight. (adapted from Pennebaker, 1997) 

I’ve been gobsmacked (aka astounded) by Pennebaker’s research for three decades. So much so that I remember where I was when I first read his 1986 article. Despite my gob-smacked-ness, I think it’s important to remember that Pennebaker is a social psychologist; he isn’t a clinical or counseling psychologist, a clinical mental health counselor, or a clinical social worker. As a consequence, I’m not asking you to leap right into his assignment without support. In fact, most researchers, including Pennebaker, believe you can gain the same benefits by talking about painful emotional experiences with a counselor or psychotherapist. One additional caveat: Pennebaker has also found that when writing or talking about traumatic experiences, often people feel distressed or emotionally worse to start, but over time they begin feeling better than they did in the beginning.

To do this activity, just think about Pennebaker’s method and his claims, and notice: (a) what you think of his idea, (b) whether you would ever like to try his technique, and (c) if you chose to try to process some deeper emotional issues, whether you would prefer writing or talking about them.

If you decide to really try Pennebaker’s method (that’s up to you), remember that your first reaction might be to feel worse. Therefore, having someone you trust to confide in about how you’re feeling through the process might be a good idea.

For me–and I know I’m weird–I like to go back and read some of the early research on these “therapeutic techniques.” Sometimes there’s no research to be found (think: somatic approaches or polyvagal theory); other times, the gaps between what was studied and what the media and popular psychology reports is huge (think: adverse childhood experiences and the research on predicting divorce); but on occasion, the original research is stunningly good. Here’s one of Pennebaker’s early studies. It’s really worth a read:

pennebaker-1988Download

If you want to dive into Pennebaker’s method, you could use one of his books as a guide. Here’s one example: https://www.abebooks.com/Opening-Writing-Down-Expressive-Improves-Health/22531442075/bd?cm_mmc=ggl-_-US_Shopp_Trade-_-new-_-naa&gclid=CjwKCAjw4pT1BRBUEiwAm5QuR4ZmBWoiw2FhWHexwZiPtAnyDc9frTptZr9dimZhEWcsE4HUl70gzxoCd60QAvD_BwE

John S-F

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

The Effectiveness and Potential of Single-Session Therapeutic Interventions

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Imagine the possibility of a scalable single-session intervention that has been shown to be effective with a wide range of mental health issues. In these days of widespread mental health crisis and overwhelmed healthcare and mental health providers, you might think that effective single-session interventions are a fantasy. But maybe not.

This morning, my older daughter emailed me a link to two videos from the lab of Dr. Jessica Schleider of Northwestern University. Dr. Schleider’s focus is on single-session therapeutic interventions. Although I hadn’t seen the website and videos, I was familiar with Dr. Schleider’s work and am already a big fan. Just to give you a feel for the range and potential of single-session interventions, below I’m sharing a bulleted list of titles and dates of a few of Dr. Schleider’s recent publications:

  • Realizing the untapped promise of single‐session interventions for eating disorders – 2023
  • In-person 1-day cognitive behavioral therapy-based workshops for postpartum depression: A randomized controlled trial – 2023
  • A randomized trial of online single-session interventions for adolescent depression during COVID-19 – 2022
  • An online, single-session intervention for adolescent self-injurious thoughts and behaviors: Results from a randomized trial – 2021
  • A single‐session growth mindset intervention for adolescent anxiety and depression: 9‐month outcomes of a randomized trial – 2018
  • Reducing risk for anxiety and depression in adolescents: Effects of a single-session intervention teaching that personality can change – 2016

Single-session therapy or interventions aren’t for everyone. Many people need more. However, given the current mental health crisis and shortage of available counselors and psychotherapists, having a single-session option is a great thing. As you can see from the preceding list, single-session interventions have excellent potential for effectively treating a wide range of mental health issues. Given this good news about single-session interventions, I’m now sharing with you that link my daughter shared with me: https://www.schleiderlab.org/labdirector.html

I’ve been interested in single-session interventions for many years. Just in case you’re interested, here’s a copy of my first venture into single-session research (it’s an empirical evaluation of a single-session parenting consultation intervention, published in 2007).

single-session-consults-with-parentsDownload

I hope you all have an inspiring Martin Luther King, Jr. weekend.

JSF

Happiness, Love, Parenting, Personal Reflections, Writing

What Do You Think of Me?

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When I was teaching social skills to elementary school-aged youth, one boy couldn’t stop talking about himself. Because I wanted the students to be interactive with and interested in each other, I intervened.

“Ask a question about her.”

He nodded, in apparent understanding. Returning to the activity, he followed my instructions (sort of), immediately asking,

“What do you think of me?”

The question, “What do you think of me?” is powerful. We all wonder this, at least occasionally, and perhaps constantly. As I just wrote in a previous blog post, being seen and known by others is a profound experience. Having your strengths and positive qualities reflected back to you by others is a gift: https://johnsommersflanagan.com/2023/12/25/the-gift-of-being-seen/

This week, the Montana Happiness Project happiness challenge activity is called the Natural Talent Interview. You can read the details here: https://montanahappinessproject.com/natural-talent-interviews

The Natural Talent Interview requires vulnerability; it’s a challenging and potentially awkward assignment. I recommend it anyway. 😲

Here’s a link to the version of the Natural Talent Interview that we assign in the Happiness Course. Note: It includes a nice description of self-awareness and the Johari Window.

natural-talent-interviewsDownload

#MHPHappinessChallenge

Happiness, Personal Reflections

Exploring Irritability with CBT

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Irritability is a fascinating experience. It’s hard to perfectly describe, so I looked up the definition online. Dictionary says: “The quality or state of being irritable.” Hahaha. This is the sort of helpfulness I’ve been experiencing from the pesky universe lately. . . with the exception of the IT guy who helped me for 45 minutes a couple weeks ago. He was nice and tried to help, but sadly, I’m the guy who was once told by IT person at UM that maybe I had swallowed a magnet because of how well electronics work in my presence. Maybe it’s my magnetic personality? Even more hahaha.

Let’s get back to irritability. Lately, I’ve been beset with intermittent bouts of irritability, which, I understand is the quality or state of being irritable. The definition of irritable is more illuminating: “having or showing a tendency to be easily annoyed or made angry.”

Yes, I’ve got that. In my defense, there are SO MANY irritating things in the world.

But there’s really no good excuse for my irritability. I feel it burble up, usually in response to something psychologically, emotionally, or physically painful. I’ve had some chronic pain for the past three months, which makes it easier for my irritability button to get pushed. I’ve also had more than my share of tech problems.

After working out at the gym, a particular Dean whom I saw on campus, asked me, “Did you have a good workout?” I muttered something about never having good workouts anymore. Not surprisingly, he noticed my irritability. Then he shared a few Buddhist thoughts about “All is suffering” with me. Despite my internal lean toward being “easily annoyed” (even with my friend the Dean) I listened and immediately glimpsed my lifelong nemesis peeking at me from around the corner. No . . . it wasn’t the Dean, or Lee Jeffries the red-headed bully who tormented me in junior high. Strangely, my lifelong nemesis happens to be the nemesis of many. I’m betting it may be yours as well.

Given that our nemesis has multitudes, let’s give it the pronoun they. They have a name. Expectations.

My expectations are routinely laughably unrealistic. I know that about myself. I also know that when I set myself up with expectations for an hour or a day, the hour or the day includes more irritability. My friend the Dean was commenting on the All-American tendency to expect happiness, whereas the Buddhists embrace that “all is suffering.” 

Several weeks ago, the focus of the Happiness Challenge was on goal-setting. I didn’t do much goal-setting back then, which is okay, because goal-setting should happen when we’re ready for goal-setting. I also know that this week’s Happiness Challenge is about cognitive behavior therapy (CBT). And so this week I’ve been working on a goal to be more immediately self-aware of my expectations and irritability triggers, and to make a concerted effort to manage my irritability in ways I feel good about.

To enhance my self-awareness, I completed the “column technique” for myself and my relationship with irritability. Although I’m not a natural fan of CBT, I found the process helpful, if not illuminating. What was most helpful was to fill out the columns—like a journal—and then read through what I had written. My response was to feel a little embarrassed at the triviality of my irritability triggers. And . . . as Alfred Adler wrote about a century ago, insight (aka self-awareness) is a natural motivator.

For anyone interested, here’s my completed column log activity.

ch-8-lab-tech-irritability-jsfDownload

In the end, glimpsing my process and experiences through the column technique this week has made me more motivated that ever to address my irritability in a positive and constructive way.

Cool Counseling, Happiness, Personal Reflections, Therapy with Adolescents, Writing

Let’s Do the “Three-Step” (Emotional Change Trick)

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This morning’s weekly missive of “most read” articles from the Journal of the American Medical Association included a study evaluating the effects of high-dose “fluvoxamine and time to sustained recover in outpatients with COVID-19.” My reaction to the title was puzzlement. What could be the rationale for using a serotonin specific reuptake inhibitor for treating COVID-19? I read a bit and discovered there’s an idea and observations that perhaps fluvoxamine can reduce the inflammation response and prevention development of more severe COVID-19.

To summarize, the results were no results. Despite the fact that back in the 1990s some psychiatrists and pharmaceutical companies were campaigning for putting serotonin in the water systems, in fact, serotonin doesn’t really do much. As you know from last week, serotonin-based medications are generally less effective for depression than exercise.

For the happiness challenge this week, we’re touting the effectiveness of my own version of what we should put in the water or in the schools or in families—the Three-Step Emotional Change Trick. Having been in a several month funk over a variety of issues, I find myself returning to the application of the Three-Step Emotional Change Trick in my daily life. Does it always work? Nope. Is it better than feeling like a victim to my unpleasant thoughts and feelings? Yep.

I hope you’ll try this out and follow the instructions to push the process outward by sharing and teaching the three steps. Let’s try to get it into the water system.

Active Learning Assignment 9 – The 3-Step Emotional Change Trick

Almost no one likes toxic positivity. . . which is why I want to emphasize from the start, this week’s activity is NOT toxic positivity.

Back in the 1990s I was in full-time private practice and mostly I got young client referrals. When they entered my office, nearly all the youth were in bad moods. They were unhappy, sad, anxious, angry, and usually unpleasantly irritable. Early on I realized I had to do something to help them change their moods.

An Adlerian psychologist, Harold Mosak, had researched the emotional pushbutton technique. I turned it into a simple, three-step emotional change technique to help young clients deal with their bad moods. I liked the technique so well that I did it in my office, with myself, with parents, during professional workshops, and with classrooms full of elementary, middle, and high school students. Mostly it worked. Sometimes it didn’t.

This week, your assignment is to apply the three-step emotional change trick to yourself and your life. Here’s how it goes.

Introduction

Bad moods are normal. I would ask young clients, “Have you ever been in a bad mood?” All the kids nodded, flipped me off, or said things like, “No duh.”

Then I’d ask, “Have you ever had somebody tell you to cheer up?” Everyone said, “Yes!” and told me how much they hated being told to cheer up. I would agree and commiserate with them on how ridiculous it was for anyone to ever think that saying “Cheer up” would do anything but piss the person off even more. I’d say, “I’ll never tell you to cheer up.* If you’re in a bad mood, I figure you’ve got a good reason to be in a bad mood, and so I’ll just respect your mood.” [*Note to Therapists: This might be the single-most important therapeutic statement in this whole process.]

Then I’d ask. “Have you ever been stuck in a bad mood and have it last longer than you wanted it to?”

Nearly always there was a head nod; I’d join in and admit to the same. “Damn those bad moods. Sometimes they last and last and hang around way longer than they need to. How about I teach you this thing I call the three-step emotional change trick. It’s a way to change your mood, but only when YOU want to change your mood. You get to be the captain of your own emotional ship.”

Emotions are universally challenging. I think that’s why I never had a client refuse to let me teach the three-steps. And that’s why I’m sharing it with you now.

Step one is to feel the feeling. Feelings come around for a reason. We need to notice them, feel them, and contemplate their meaning. The big questions here are: How can you honor and feel your feelings? What can you do to respect your own feelings and listen to the underlying message? I’ve heard many answers. Here are a few. But you can generate your own list.

  • Frowning or crying if you feel sad
  • Grimacing and making angry faces into a mirror if you feel angry
  • Drawing an angry picture
  • Punching or kicking a pillow (no real violence though)
  • Going outside and yelling (or screaming into a pillow)
  • Scribbling on a note pad
  • Writing a nasty note to someone (but not delivering it)
  • Using your words, and talking to someone about what you’re feeling

Step two is to think a new thought or do something different. This step is all about intentionally doing or thinking something that might change or improve you mood. The big question here is: What can you think or do that will put you in a better mood?

I discovered that kids and adults have amazing mood-changing strategies. Here’s a sampling:

  • Tell a funny story (“Yesterday in math, my friend Todd farted”)
  • Tell a joke (What do you call it when 100 rabbits standing in a row all take one step backwards? A receding hare-line).
  • Tell a better joke (Why did the ant crawl up the elephant’s leg for the second time? It got pissed off the first time.)
  • Exercise!
  • Smile into a mirror
  • Talk to someone you trust
  • Put a cat (or a chicken or a duck) on your head
  • Chew a big wad of gum

I’m sure you get the idea. You know best what might put you in a good mood. When you’re ready, but not before, use your own self-knowledge to move into a better mood.

Step three is to spread the good mood. Moods are contagious. I’d say things like this to my clients:

“Emotions are contagious. Do you know what contagious means? It means you can catch emotions 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 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 better mood. I’m wondering. Do you think you can make your mom “catch” your good mood?”

How do you share good moods? Saying “Cheer up” is off-limits. Here’s a short list of what I’ve heard from kids and adults.

  • Do someone a favor
  • Smile
  • Hold the door for a stranger
  • Offer a real or virtual hug
  • Listen to someone
  • Tell someone, “I love you”

Step four might be the best and most important step in the three-step emotional change trick. With kids, when I move on to step four, they always interrupt:

“Wait. You said there were only three steps!”

“Yes. That’s true. But because emotions are complicated and surprising, the three-step emotional change trick has four steps. The fourth step is for you to teach someone else the three steps.”

Here’s a youtube link to me doing the 3SECT: https://www.youtube.com/watch?v=ITWhMYANC5c

If you want to chase down an early version/citation, here’s a link for that: https://www.tandfonline.com/doi/abs/10.1300/J019v17n04_02

Happiness, Personal Reflections, Writing

Dance it Off – Moving for Happiness

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I’m a big fan of exercise and movement as a solution for nearly everything. Below is my famous or infamous “Last Dance” video that I filmed after a day when I got beat up pretty bad by all things Moodle, Powerpoint, and Qualtrics. My solution was to Dance it off, which I share with you all despite the fact that this is the sort of thing one should keep private.

I share this video as a challenge to anyone who feels inclined to make their own 1 minute dance-it-off video. Yes please! And share.

[Unless you read this blog regularly] you may be surprised to hear that exercise is more effective in treating depression than antidepressant medications. If so, that’s likely because pharmaceutical companies spend millions every year to tell you their antidepressants are effective. The marketing budget for exercise as a treatment for depression is considerably less.

Movement—along with sleep and a healthy diet—is probably the best way to keep your brain healthy. Nearly all movement helps. In my favorite exercise study on treating depression in youth, preteens and teens who were depressed had a 100% response to cardio (including Jazzercise and Wii) and a 67% response with just stretching. Exercise does so many good things for the brain that it’s hard to track. Also, other than sweat, thirst, and sore muscles, exercise has no real negative side effects—which isn’t the case for medications.

In conclusion, the researchers wrote:

“Compared to antidepressant medication treatment with adolescents, exercise resulted in (a) a faster response rate, (b) a better response rate, (c) fewer relapses (n = 0) at six and 12 month follow-ups, and (d) no side effects or adverse events” (Hughes et al., 2013). One caveat, at the beginning of the study, none of the participants were exercising.

But who were these researchers? Were they anti-drug researchers with an axe to grind?

Nope, and this is my favorite part. The researchers were prestigious academics who mostly do pharmaceutical research. One of them was the guy responsible for the clinical studies that led to FDA approval of Prozac for treating youth with depression. The two biggest names on the study have repeatedly been funded by Eli Lilly, GlaxoSmithKline, Pfizer, and more.

All this leads me to this week’s #MHPHappinessChallenge assignment.

Find your preferred way to move, pair it with your favorite music, and do what the researchers in the Hughes (2013) study did to treat depression. I call this “Dance it off,” because dancing—alone or together—is a fabulous way to make the time fly by while you give your brain a dose of what it’s craving.

Here’s the Hughes et al (2013) study. I’m sharing it because everyone should know about it:

date-exercise-study-2013Download

But you don’t have to dance. You can walk, run, skip, or yoga. You can jump rope, do Wii or Jazzercize, kickbox, or just jiggle your body in the kitchen while you’re cooking. If you ride the elevator, take the stairs. If you’re in a chair, dance with whatever parts of your body that will move. Of course, don’t do anything that’s so excessive that you might hurt yourself.

I’m sure you get the point.

And then, if you feel something-maybe a high or a fun new thought or anything that kicks your mood up a notch, savor it, linger, and then share it with us.

As always, thanks for participating in the Montana Happiness Challenge. Let’s dance it off together this week.