Category Archives: Personal Reflections

Boys and Men, Parenting, Personal Reflections, Therapy with Adolescents, Tough Kids Cool Counseling

Entering the Danger Zone: Why Counselors (and Psychologists) Need to Find the Courage to Talk with Boys about Sex and Pornography

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This article was published in the Reader Viewpoint section of Counseling Today magazine this week. If you get the magazine, you’ll find it on page 52. If not, because it’s not available online, I’m posting the article (with minor modifications) in-full right here. To check out the Counseling Today magazine, click here: http://ct.counseling.org/

Here’s the article:

Reader Viewpoint

Entering the Danger Zone

Why Counselors Need to Find the Courage to Talk with Boys about Sex and Pornography

By John Sommers-Flanagan

For the most part, the United States lacks a coherent and systematic approach to sexual education. Instead, as lampooned in an online issue of The Onion, sex education is typically informal, unorganized, and inaccurate. The Onion article describes a scene in which a 10-year-old boy takes his 8-year-old cousin behind his parents’ garage with a page ripped out of a magazine and shares “the vast misguided knowledge of human sexuality he had gleaned from classmates’ hearsay as well as 12 minutes of a Real Sex episode he watched in a hotel room once.” The older boy recounts his rationale: “Every time people have sex the woman has a baby, and I just want [my younger cousin] to be completely prepared before getting naked with a girl.”

The good news about this is that The Onion is a fictional news source. The bad news is that the current state of sex education in our country isn’t much better than The Onion’s version.

Consider that a report this past April from the Centers for Disease Control and Prevention indicated that more than 80 percent of adolescents between the ages of 15 and 17 have no formal sexual education before actually having sex. If teenagers have no formal sex education, then what informal sex education do you suppose they take with them into their first sexual experiences?

One such source of informal sex education is pornography. In 2009, University of Montreal professor Simon Louis Lajeunesse designed a study to evaluate how pornography use affects male sexual development. He planned to interview 20 males who had viewed pornography and then compare their responses with those of 20 males who had never viewed porn. Remarkably, Lajeunesse had to abandon his project because he couldn’t find any college-aged males who hadn’t already viewed porn.

Other researchers report similar experiences. It appears that most boys, rather than learning about sex from a well-meaning, albeit uninformed cousin, get their information from the pornography industry … and my best guess is that the porn industry isn’t focusing on the best interests of American youth. This is one way in which reality may be worse than The Onion.

The absence of formal and accurate sexual education is a particularly American problem that may find its way into the offices of professional counselors. Many young males probably have very little basic knowledge or hold unhelpful ideas about sex and sexuality. Some will have porn addictions. Others will want to talk about how pornography may be affecting their real sex lives. You may also have clients who are concerned about their partner’s or potential partner’s porn viewing behaviors. Working with young (and older) males (and females) who want to talk about their sexual knowledge, beliefs and behaviors, including watching pornography, is both a challenge and an opportunity for professional counselors.

Counselors have an ethical mandate to strive toward competence. As articulated in the multicultural counseling literature, this requires cultivating personal awareness, gathering knowledge and developing skills.

Awareness: Expanding your comfort zone

Talking about sex, sexuality and sexual attraction can be difficult at every level. Think about yourself: How easy is it to talk about sex with your supervisor, colleagues, students, or clients? Your own experience may give you a glimpse into how challenging it can be to broach the topic of sex — even for professionals.

In comparison, it’s probably an understatement to say that it is especially difficult for boys to initiate a conversation about sex or sexuality with a professional counselor. This is why counselors who work with boys should become comfortable initiating conversations about sex. If you don’t ask at least a few gentle, polite, yet direct questions, you may be waiting a long time for the boy in your office to bring up the subject.

On the opposite extreme, some young clients will jump right into talking about sexuality and push us straight out of our comfort zones. Recently, I was working with a 16-year-old boy who described himself as a polyamorous “furry” (which I later learned involved sexualized role-playing as various animals). Admittedly, it was a challenge to maintain a nonjudgmental attitude. But without such an attitude, we wouldn’t have been able to have repeated open and useful conversations about his sexuality and sexual identity development.

Knowledge: The effects of pornography on boys and men

Many potential areas related to sexuality deserve attention, focus, and discussion in counseling. But because pornography and mixed messages about pornography are everywhere, it can be an especially important subject.

Most counselors probably believe that repeated exposure to pornography has a negative impact on male sexual development. This negative impact is likely exacerbated by the fact that most boys aren’t getting any organized, balanced, and scientific sexual information. Nevertheless, within the dominant American culture, there remains strong resistance to both sex education and pornography regulation. Even in a recent issue of Monitor on Psychology, the authors of an article questioned whether porn is addictive and blithely noted that “people like porn.”

It’s not surprising that porn has advocates. After all, it’s estimated to be a $6 billion-plus industry. In addition, media outlets explicitly and implicitly use pornlike sexuality to attract an audience and sell products. Recently, we’ve seen the increased use of hypermasculine male body types in the media, but most of the rampant sexual objectification still focuses on young female bodies.

Given that sexual development includes a complex mix of culture, biology and life experience, it’s not surprising that researchers have had difficulty isolating pornography as a single causal factor in male sexual developmental outcomes. However, a summary of the research indicates that as the viewing of pornography increases, so does an array of negative attitudes, behaviors, and symptoms. Generally, increased exposure to pornography is correlated with:
• More positive attitudes toward sexual aggression, increases in sexual aggression, multiple sexual partners, and engaging in paid sex
• Increased depression, anxiety and stress, and poorer social functioning
• Positive attitudes toward teen sex, adult premarital sex, and extramarital sex
• More positive attitudes toward pornography and more viewing of violent or hypersexual pornography
• Higher alcohol consumption, greater self-reported sexual desire, and increased rates of boys selling sexual acts

In contrast to these findings, a 2002 Kinsey Institute survey indicated that 72 percent of respondents considered pornography to be a relatively harmless outlet. This might be true for adults. I recall listening to B.F. Skinner talk about how older adults could use pornography as a sexual stimulant in ways similar to how they use hearing aids and glasses.

But the point isn’t whether people like porn or whether porn can be relatively harmless for some adults. The point is that pornography is a bad primary source of sexual information for developing boys and young men. As a consequence, it’s crucial for counselors who work with males to be knowledgeable about the potential negative effects of pornography.

Skills: How can counselors help?

A big responsibility for professional counselors who work with boys is to consistently keep sex and sexuality issues on the educational and therapeutic radar. This doesn’t mean counselors should be preoccupied with asking about sex. Rather, we should be open to asking about it, as needed, in a matter-of-fact and respectful manner.

As with most skills, asking about sex and talking comfortably about sexuality requires practice and supervision. But as Carl Rogers often emphasized, having an accepting attitude may be even more important than using specific skills. This implies that finding your own way to listen respectfully to boys (and all clients) about their sexual views and practices is essential. It also requires openness to listening respectfully even when our clients’ sexual views and practices are inconsistent with our personal values. As with other topics, if we ask about it, we should be ready to skillfully listen to whatever our clients are inclined to say next.

Case example
Some years ago, I had a young client named Ben who was in foster care. We began working together when he was 10 and continued intermittently until he was 17.
When Ben was around 13, I started routinely asking about possible romance in his life. He typically redirected the conversation. Occasionally he gave me a few hints that he wanted a girlfriend, but he mostly still seemed frightened of girls. As my counseling with Ben continued, I became aware that I had been conspiring with him to avoid talking directly about sex, possibly because I was afraid to bring it up.

I finally faced the issue when I realized (far too slowly) that Ben had no father figure in his life and, thus, I was one of his best chances at having a positive male role model. With encouragement from my supervision group, I was able to face my anxieties, do some reading about male sexual development, and finally broach the subject of having a sex talk with Ben.

Toward the end of a session I said, “Hey, I’ve been thinking we’ve never really talked directly about sex. And I realized that maybe you don’t have any men in your life who have talked with you about sex. So, here’s my plan. Next week we’re going to have the sex talk. OK?”

Ben’s face reddened and his eyes widened. He mumbled, “OK, fine with me.”

The next session I plowed right in, starting with a nervous monologue about why talking directly about sex was important. I then asked Ben where he’d learned whatever he knew about sex. He answered, “Sex ed at school, some magazines, a little Internet porn, and my friends.”

I felt a sense of gratitude that he was listening and being open, even if we were both feeling awkward. We talked about homosexuality, pornography, sexually transmitted diseases, pregnancy, contraception, and emotions. I tried to gently warn him that too much porn could become way too much porn. He agreed. He told me that he didn’t feel like he was gay but that he didn’t have anything against gays and lesbians. At the end of the conversation, we were both flushed. We had stared down our mutual discomfort and navigated our way through a difficult topic.

Professional sex educators emphasize that parents shouldn’t have just one sex talk with their kids; they should have many sex talks. What I thought was THE talk with Ben turned into something we could revisit. Over the next two years, Ben and I kept talking — off and on, here and there — about sex, sexuality, and pornography.

Final thoughts

Boys are a unique counseling population, and sex is a hot topic. Together, the two provide both challenge and opportunity for professional counselors. As counselors, we should work to develop our awareness, knowledge, and skills for talking with boys about sex and sexuality. You may not be the perfect sex educator, but when the alternatives for accurate information are pornography or someone’s uninformed older cousin, it becomes obvious that having open conversations about sex with boys is an excellent role for counselors to embrace.

BOX

John Sommers-Flanagan is a counselor educator at the University of Montana and the author of nine books. Get more information on this and other topics related to counseling and parenting at johnsommersflanagan.com.

Letters to the editor: ct@counseling.org

SIDEBAR
Readings and resources for working with boys and men
• A Counselor’s Guide to Working With Men, edited by Matt Englar-Carlson, Marcheta P. Evans & Thelma Duffey, 2014, American Counseling Association
• “Addressing sexual attraction in supervision,” by Kirsten W. Murray & John Sommers-Flanagan, in Sexual Attraction in Therapy: Clinical Perspectives on Moving Beyond the Taboo — A Guide for Training and Practice, edited by Maria Luca, 2014, Wiley-Blackwell
• Guyland: The Perilous World Where Boys Become Men, by Michael Kimmel, 2010, Harper Perennial
• Tough Kids, Cool Counseling: User-Friendly Approaches With Challenging Youth, second edition, by John Sommers-Flanagan & Rita Sommers-Flanagan, 2007, American Counseling Association
• The Macho Paradox: Why Some Men Hurt Women and How All Men Can Help, by Jackson Katz, 2006, Sourcebooks
• The Good Men Project: goodmenproject.com

Cool Counseling, Counseling and Psychotherapy Theory and Practice, Personal Reflections, Therapy with Adolescents, Tough Kids Cool Counseling

Non-Drug Options for Dealing with Depression

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Evidence supporting the efficacy of antidepressant medications continues to be weak. That doesn’t mean they never work; some individuals with depressive symptoms find them very helpful and that’s okay. But for many, antidepressant meds just don’t work very well . . . there are side effects and less than desirable antidepressant effects. This is why many people wonder: What are some of the best non-drug alternatives for treating symptoms of depression?

Here’s a short list that might be helpful.

1. Counseling or Psychotherapy: Going to a reputable and licensed mental-health professional who offers counseling or psychotherapy for depression can be very helpful. This may include individual, couple, or family therapy.

2. Vigorous aerobic exercise: Consider initiating and maintaining a regular cardiovascular or aerobic exercise schedule. This could involve a specific referral to a personal trainer and/or local fitness center (e.g., YMCA). In a recent small study of adolescents with clinical depression, 100% of the teens in the aerobic exercise group no longer met the diagnostic criteria for depression after receiving several months of exercise treatment.

3. Herbal remedies: Some individuals benefit from taking herbal supplements. In particular, there is evidence that omega-3 fatty acids (fish oil) and St. John’s Wort are effective in reducing depressive symptoms. It’s good to consult with a health-care provider if you’re pursuing this option.

4. Light therapy: Some people describe great benefits from light therapy. Specific information on light therapy boxes is available online and possibly through your physician.

5. Massage therapy: Research indicates some patients with depressive symptoms benefit from massage therapy. A referral to a licensed massage therapy professional is advised.

6. Bibliotherapy: Research indicates that some patients benefit from reading and working with self-help books or workbooks. The Feeling Good Handbook (Burns, 1999) and Mind over Mood (Greenberger and Padesky, 1995) are two self-help books used by many individuals.

7. Post-partum support: There is evidence suggesting that new mothers with depressive symptoms who are closely followed by a public-health nurse, midwife, or other professional experience fewer post-partum depressive symptoms. Additionally, new moms and all individuals suffering from depressive symptoms may benefit from any healthy and positive activities that increase social contact and social support.

8. Mild exercise and physical/social activities: Even if you’re not up to vigorous exercise, you should know that nearly any type of movement is an antidepressant. These activities could include, but not be limited to, yoga, walking, swimming, bowling, hiking, or whatever you can do! In the same exercise study mentioned above, 71% of the teenagers in the mild exercise group experienced a substantial reduction in their symptoms of depression.

9. Other meaningful activities: Never underestimate the healing power of meaningful activities. Activities could include (a) church or spiritual pursuits; (b) charity work; (c) animal caretaking (adopting a pet); and (d) many other activities that might be personally meaningful to you.

The preceding list is adapted from a tip-sheet in our book, “How to Listen so Parents will Talk and Talk so Parents will Listen.” See: http://www.amazon.com/How-Listen-Parents-Will-Talk/dp/1118012968/ref=la_B0030LK6NM_1_9?s=books&ie=UTF8&qid=1413432346&sr=1-9
Or: http://lp.wileypub.com/SommersFlanagan/

John and his sister working on their positive emotions.

Peg and John Singing at Pat's Wedding

 

Counseling and Psychotherapy Theory and Practice, Personal Reflections, Writing

Neuro-counseling or Neuro-nonsense: You be the judge

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This is a Book Review written by a current doctoral student, Tara Smart and John SF. It was published this past June in the online journal, The Professional Counselor: http://tpcjournal.nbcc.org/

As you may detect, Ms. Smart and I are circumspect about the neuroscience bandwagon.

Here’s the review:

In A Counselor’s Introduction to Neuroscience, the authors claim that “neurocounseling” is the fifth force in the history of psychology and counseling. Although a precise and detailed definition of neurocounseling is elusive (both in this book and in the professional literature), it is described as the marriage of counseling and neurobiology. They offer a crash course in brain anatomy, function, and development in order to lay the groundwork for how neurocounseling can be used effectively with clients. Several chapters focus on the ways the brain is affected by certain mental disorders, and how specific counseling approaches address various brain regions and functions. The remainder of the book focuses on assessment of brain function and fictional cases to illustrate neurocounseling techniques. The chapters include numerous tables, figures, cases and opportunities to stop and reflect. The overall intent of the book is to arm counselors “with yet another highly effective and efficient way to help clients cope with (overcome, etc.) their personal psychological distress.”

Although the authors are clearly enamored with the interaction between neurobiology and counseling, they purposefully offer honest words of caution regarding the nascent and speculative nature of contemporary brain science. However, on occasion, they also make promising statements without citing scientific evidence and generalize results from animal studies (including rodents) to humans without offering their reasoning for doing so. As with any other resource, practitioners are responsible for weighing information and evaluating whether it is accurate and whether it will be helpful in their work. It is important to note that this book bills itself as an “introduction”—readers should not expect concrete or realistic examples of how professional counselors can use their new neuroscience knowledge to understand and enhance client functioning.

A Counselor’s Introduction to Neuroscience will help counselors begin to grapple with the implications of neuroscience for our profession. Although the neuroscience knowledge base that the authors provide is a good start, scientific rigor in terms of concrete application would be useful. Years from now, neurocounseling may well be a new force in counseling, but presenting it to the counseling community as an effective and efficient way to help clients today is premature. In the end, it is best to consider this book as a reasonable beginning and food for thought rather than a how-to guide for counselors seeking neurocounseling training. Hopefully in the ensuing years, there will be clearer guidance available to help professional counselors integrate neuroscience into their practice.

John using his Star Trek tricorder (cell phone) to do a quick selfie brain scan. The results were not promising.

2014-06-03_15-45-11_474

Personal Reflections, Therapy with Adolescents, Tough Kids Cool Counseling

Hanging Out at Big Sky High School

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This morning I had the fabulous opportunity to hang out with the staff at Big Sky High School. What I like best about this is that it gives me a chance to be in the presence of teachers, school counselors, school psychologists, and other great people without whom our entire civilized culture in the U.S. would devolve. It reminds me of my political platform (should I ever run for public office). Here it is:

If we want a clean and sustainable environment and if we want a functional economy and if we want an excellent health care system and if we want a country where we have justice for all, then we all better remember that the road to all those things runs right through EDUCATION!

Okay. That being said, I told the wonderful staff at Big Sky that I’d post my powerpoint here and so here it is:

BSHS 2014

And here’s a photo of my daughter just before or after my exorcism:)

Rylee

Boys and Men, Personal Reflections, Writing

A Little Something I’ve Been Writing

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Occasionally, against my better judgment, I (John) log into and read discussion boards in various online venues. These venues include sites where the public is invited to comment on newspaper or magazine articles, blog posts, books, and videos. Even worse than reading these discussion boards, I sometimes experience powerful emotions, emotions that draw me to the keyboard and into an internet discussion or debate. When I read something I find provocative or offensive, it can be very difficult to stop myself from commenting. But if I control this urge, after a few minutes, hours, or days, the impulse subsides and I’m then enlightened as to why my initial impulses to deliver a quick and clever retort were misguided. It also helps when I consult with wife on what it is that I’m wanting to write. Her sarcastic analysis of my juvenile impulses helps me inhibit my desire to make a fool of myself.

But there are times when I don’t wait long enough. And there are times when I don’t consult my wife. Instead, I channel the emotion I’m feeling (usually anger) into what I consider, in-the-moment, to be a pithy, clever, or creative retort.

Flaming

The online world has a name for this phenomenon; it’s called flaming. Flaming is defined as a hostile and insulting interaction in an internet forum or discussion. It may include profanity and name-calling. I like to think I never stoop quite that low. Some internet users are intentional flamers who comment on specific topics in an effort to inflame or incite; others, like me, are occasionally drawn into an internet brawl.

In June, 2013, while perusing books about boys and male development, I came across the book: Raising Boys Feminists will Hate by Doug Giles. If the title of the book was a spark, the first page fanned my fire. Giles opened with:

Parent, if you have a young son and you want him to grow up to be a man, then you need to keep him away from pop culture, public school and a lot of Nancy Boy churches. If metrosexual pop culture, feminized public schools and the effeminate branches of evanjellycalism lay their sissy hands on him, you can kiss his masculinity good-bye because they will morph him into a dandy. (p. 1)

In this case, I could have taken a few deep breaths and waited. There was no hurry for me to respond. Why not wait? It also would have been advisable for me to consult my wife. But what fun would that have been? I knew what she would say. I also knew that instead of self-control or restraint, at that moment, mostly I wanted immediate gratification. Such is the nature of contemporary internet flaming. It’s about instant gratification; it’s not so much about thoughtful and reflective discourse. So, before I could fully contemplate my actions and while avoiding contact with anyone who might push me toward a more mature perspective, I quickly wrote a short book review:

This guy clearly has an ego of immeasurable proportions. I think the main problem is that he’s deluded himself to believe that just because he said it or wrote it, it must be true. I’m not sure anyone in the mainstream is against raising boys to be strong men with good character. But I suppose he’s just creating the image of Nazi-feminists so he can blast away at them and consequently increase his media attention. The real title of this book should be: “I hate feminists and because I’m a real man who knows everything, you should too.” I’d like to challenge him to a debate on Fox, but I’m afraid I’d lose control and get into fisticuffs and consequently damage my sissy-feminist reputation.

In retrospect, I see that this wasn’t my greatest moment. When I start a commentary with “This guy. . .” whatever follows isn’t pointed in the direction of intellectual sophistication. And when I deteriorate into mentioning “fisticuffs” well, then it just becomes a process of embarrassing myself.

Fortunately, I was posting on a relatively “quiet” discussion board. The first response to my post didn’t come until months later. Here’s a clipped version of what a person with the online handle “Jeffery Bozo” had to say about Giles’s book and my review of his work:

The Feminists stayed at the party too long and now they are just beating a dead horse. It’s time for them to find another hobby.

Doug’s comments concerning the Feminist takeover of education are spot-on. 90% of public school teachers are female and/or gay. Does that sound diverse and balanced to you? It seems these activists only concern themselves with their diversity pie charts when it favors their natural enemies. Sounds like female-Femi/Stasi-pigs to me. The height of hypocrisy.

What I took from Mr. Bozo’s post was that he was apparently unimpressed with my clever book review. And although much of what he wrote didn’t make any sense to me, I can see why he, and many others, might take offense to what I wrote. I was neither fair nor balanced. I didn’t focus on the book’s content. I was mocking and insulting Giles and his work. Even though it felt clever and gratifying in the moment, it wasn’t helpful or constructive (both of which are more valuable in a book review than offering clever insults).

You may want to come to my defense. After all, Giles was being intentionally provocative in his choice of book title and his opening paragraph. One great way to deny personal responsibility for immature behavior is to claim: “He started it!” And, although there’s truth to that, Giles’s being provocative is no excuse for my flaming response.

Interestingly, a few months later, another reader decided to enter into the discussion and share her feelings. Her post was directed to Mr. Bozo:

Wow, you are a truly special breed of stupid and ignorant, aren’t you? Your last name is perfectly fitting, because you’re a clown.

When this comment initially popped into my email I had the horrific thought that the posting was about me. Although I was relieved to discover that the commenter was on my side and referencing Mr. Bozo, this is still an excellent example of destructive flaming.

Here’s the main point: Flaming responses, whether online or in-person, nearly always have the intent of “teaching someone a lesson” or “putting someone in his or her place.” And here’s the corollary: It doesn’t work because the other person doesn’t want to hear the lesson and doesn’t want to be put in his or her place.

Personal Reflections

Hey Cameron Diaz! Wanna Make a Real Difference?

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Dear Cameron Diaz:

For many years you’ve been a positive and happy highlight on the silver screen. You’re smart, funny, and beautiful, an excellent combination. From your use of sperm as hair gel in There’s Something About Mary to this week’s debut of Sex Tape, you’ve given us twisted, off-beat, and edgy hilarity. You help all of us be a little less uptight.

But as a psychologist, I’m also aware there are lines that we’re better off not crossing, which brings me to my point.

In a 2011 appearance on Jimmy Kimmel Live you exclaimed, “I love porn!” At the time, it seemed all in good fun—and completely consistent with your irreverent, quirky self. However, since then, I’ve come to view public declarations of loving porn as less than harmless.

Lately I’ve been reading pornography research and have discovered some very disturbing facts. As we’ve known for decades, there’s porn, and then there’s PORN. We need better ways to define this vast array of sexual material.

Because you were once a Charlie’s Angel—dedicated to saving the world from all things evil—I want to share with you what behavioral scientists are finding about the darker side of porn. Viewing more porn is associated with:

• Engaging in sexually aggressive acts (including rape or sexual assault)
• Becoming depressed, anxious, and stressed
• Functioning more poorly in real social interactions (and ironically, becoming impotent)

Research also reveals that young boys who view lots of porn are more likely to be sex offenders. And here’s the most disturbing thing I’ve discovered. Over 80% of pornography includes violence towards women. Within this violent category, a common motif involves a man having anal sex with a woman and then having her perform oral sex, so she tastes her own feces. This illustrates why we need to make distinctions between porn that is fun, educational, or artistic, and porn that is just plain destructive.

Here’s one last thing I didn’t know. The porn industry is GARGANTUAN. It hardly needs your endorsement to survive (http://abcnews.go.com/Primetime/story?id=132001). This week, the industry will make hundreds of millions of dollars on films with substantially less plot than Sex Tape, and my best guess is that you wouldn’t intentionally endorse most of these plots.

Although I don’t know you personally, I have trouble believing you “love” the sort of porn that denigrates women, contributes to impotence in young men, or increases sexual assaults. This leads me to a suggestion for how you might help people understand the differences between acceptable and destructive porn.

What if we planned a tour of the late night talk shows to discuss the stark differences between artistic, gently consenting porn and violent, degrading, and damaging porn? This is a discussion our culture desperately needs, and you could take the lead. With this simple, educational message you could save thousands of people from harmful sexual relationships, or no real sexual relationships at all!

Your legacy could include people not only saying, “Cameron Diaz was talented, beautiful, and smart,” but also “After the letter from that psychologist from Montana, she became an amazing role model for healthy and fun consensual sex.”

Thanks for listening and let me know how I can help!

Sincerely,

That psychologist from Montana

 

Clinical Interviewing, Multicultural, Personal Reflections

Cultural Adaptations in the DSM-5: Insert Foot in Mouth Here

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Sometimes it just seems easier to be snarky than balanced. This basic truth comes to mind because of a recent analysis I did of the Cultural Formulation Interview (CFI) from the DSM-5. As I read about the CFI and looked through its Introduction and 16 questions for “patients,” I kept thinking to myself things like,

“Seriously . . . could this really be the best cultural sensitivity that the American Psychiatric Association can manage when it comes to guidelines for interviewing minority cultures?”

And,

“Who wrote this and why didn’t they ask me for some help?” (insert smiley face here; please note that some of my colleagues at the University of Montana have noticed—and commented—on the fact that I tend to insert a smiley face icon right after texting or emailing my personal version of punchy, snarky, sarcasm).

Ha! is all I have to say to them (FYI: Ha! is my programmed default back up to my default smiley face snark signal).

Anyway . . . the point! It’s way easier for me to be critical of the American Psychiatric Association than balanced. In truth, the CFI is a reasonable effort. And, if you think about where the APA is coming from (and likely going to) then the CFI is a massive effort. I should be saying, “Cool! I’m so excited to see the CFI as part of the DSM-5.

All this is prologue for the excerpt I include below. This is an excerpt from a draft chapter I’m writing for the Handbook of Clinical Psychology . . . to be published at some point in the not too distant future. Here’s the excerpt; it focuses on cultural adaptations we can make when conducting initial clinical interviews with minority clients; forgive the roughness of the draft.

Cultural Adaptations

A clinical interview is a first impression, and first impressions are powerful influences on later relational interactions, which is why we need to make cultural adaptations when conducting clinical interviews. One of the best sources for cultural adaptations is the already-existing guidance from psychotherapy research on working multiculturally. These guidelines include: (a) using small talk and self-disclosure with some cultural groups, (b) when feasible, conducting initial interviews in the patient’s native language, (c) seeking professional consultations with professionals familiar with the patient’s culture; (d) avoiding the use of interpreters except in emergency situations; (e) providing services (e.g., childcare) that help increase patient retention, (f) oral administration of written materials to patients with limited literacy, (g) having awareness and sensitivity to client age and acculturation, (h) aligning assessment and treatment goals with client culturally-informed expectations and values, (i) regularly soliciting feedback regarding progress and client expectations and responding immediately to client feedback, and (j) explicitly incorporating cultural content and cultural values into the interview, especially with patients not acculturated to the dominant culture (see Griner & Smith, 2006; Hays, 2008; Smith, Rodriguez, & Bernal, 2011).

Cultural awareness, cross cultural sensitivity, and making cultural adaptations are especially important to assessment and diagnosis. This is partly because mental health professionals have a long history of inappropriately or inaccurately assigning psychiatric diagnoses to cultural minority groups (Paniagua, 2014). To address this challenge, in the latest edition of the Diagnostic and Statistical Manual (DSM-5; American Psychiatric Association, 2014), a Cultural Formulation Interview (CFI) protocol is included to aid the diagnostic interview process.

The CFI is a highly structured brief interview. It is not a method for assigning clinical diagnoses; instead, its purpose is to function as a supplementary interview that enhances the clinician’s understanding of potential cultural factors. It also may aid in the diagnostic decision-making process. The CFI includes an introduction and four sections (composed of 16 specific questions). The four sections include:

1. Cultural definition of the problem
2. Cultural perceptions of cause, context, and support
3. Cultural factors affecting self-coping and past help seeking
4. Cultural factors affecting current help seeking

Questions from each section are worded in ways to help clinicians gently explore cultural dimensions of their clients’ problems. Question 2 is a good representation: “Sometimes people have different ways of describing their problem to their family, friends, or others in their community. How would you describe your problem to them?” (American Psychiatric Association, 2014).

Clinicians are encouraged to use the CFI in research and clinical settings. There is also a mechanism for users to provide the American Psychiatric Association with feedback on the CFI’s utility. It may be reproduced for research and clinical work without permission, which is a cool thing.

If you Google: “Cultural Formulation Interview” the first non-advertised hit should be a .pdf of the CFI.

If you Google: “Clinical Interviewing” the first several hits will take you to some form or another of our text on the topic.

Here’s a photo of me “working” inter-culturally with my brother-in-law (insert smiley face here):

Rebekah.Johnson.photo_0451

 

 

Boys and Men, Personal Reflections, Tough Kids, Tough Kids Cool Counseling

A Short Piece on Disrespecting Teenagers

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The post below is from psychotherapy.net and so you can view it there too: http://www.psychotherapy.net/blog/title/a-short-piece-on-disrespecting-teenagers

Also, I strongly recommend that you check out psychotherapy.net as a potential go-to resource on all things psychotherapeutic. Their video and streaming collection is awesome and extensive. Go to: http://www.psychotherapy.net/

Okay. Here’s the post:

A Short Piece on Disrespecting Teenagers

We have an American cultural norm to disrespect teenagers. For example, it’s probably common knowledge that teens are:
• Naturally difficult
• Not willing to listen to good common sense from adults
• Emotionally unstable
• Impulsively acting without thinking through consequences

Wait. Most of these are good descriptors of Bill O’Reilly. Isn’t he an adult?

Seriously, most television shows, movies, and adult rhetoric tends toward dismissing and disrespecting teens. It’s not unusual for people to express sympathy to parents of teens. “It’s a hard time . . . I know . . . I hope you’re coping okay.” Just last night Stephen Colbert quipped, “Nobody likes teenagers.” Even Mark Twain had his funny and famous disrespectful quotable quote on teens. Remember:

“When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in seven years.”

This is a clever way of suggesting that teens don’t recognize their parents’ wisdom. Although this is partly true, I’m guessing most teens don’t find it especially hilarious. Especially if their parents are treating them in ways that most of us would consider unwise—at least if we were treated similar ways in the workplace.

And now the neuroscientists have piled on with their fancy brain images. We have scientific evidence to prove, beyond any doubt, that the brains of teens aren’t fully developed. Those poor pathetic teens; their brains aren’t even fully wired up. How can we expect them to engage in mature and rational behavior? Maybe we should just keep them in cages to prevent them from getting themselves in trouble until their brain wiring matures.

This might be a good idea, but then how do we explain the occasionally immature and irrational behavior and thinking of adults? I mean, I know we’re supposed to be superior and all that, but I have to say that I’ve sometimes seen teens acting mature and adults acting otherwise. How could this be possible when we know—based on fancy brain images—that the adult brain is neurologically all-wired-up and the teen brain is under construction? Personally (and professionally), I think the neuroscience focus on underdeveloped “teen brains” is mostly (but not completely) a form of highly scientifically refined excrement from a male bovine designed to help adults and parents feel better about themselves.

And therein lies my point: I propose that we start treating teens with the respect that we traditionally reserve for ourselves and each other . . . because if we continue to disrespect teenagers and lower our expectations for their mature behavior . . . the more our expectations are likely to come true.

John and his sister, Peggy, acting immature even though their brains are completely wired up.

Peg and John Singing at Pat's Wedding

Boys and Men, Counseling and Psychotherapy Theory and Practice, Personal Reflections

What Kind of a Man Attends the 4th National Psychotherapy with Men Conference?

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Several years ago a former student caught up with me in the hall outside my office in the College of Education at the University of Montana. He had taken an Intro to Psychology course from me way back in 1982. He re-introduced himself, complimented me on my teaching from three decades previously, and then, glancing at my name on the door, asked, “What kind of a man hyphenates his last name?”

I was speechless (which doesn’t happen all that often). He had just told me of his divorce; he had marveled at me being married for 25 years; and yet there it was, a small-dose of straight on masculine-shaming.

I said what most of us probably say when questioned about our masculinity.

I said nothing.

In retrospect, I wish I’d said: “I hyphenated my name because I’m the kind of man who wants to stay married and have a real partnership with his wife.” Hmm. That might have been over-the-top.
I didn’t have a balanced answer then and I’m not sure I have a good one now. But, how about cutting to the chase and meeting his question with one of my own?

“What kind of a man questions another man about his masculinity?”

That might have been fun, but obviously not perfect. And that’s the point; it can be difficult to find the right words in response to comments on our masculinity.

This past Saturday I had the privilege of embracing all dimensions of my humanity, without needing to worry about sideways—or straight on—masculinity comments. That’s because I had the good fortune of attending the 4th National Psychotherapy with Men Conference. Of course, my comfort might have been because the chief conference organizer, Matt Englar-Carlson, a faculty member in the Department of Counseling at Cal State Fullerton, is also a hyphenator. But more likely it was because this particular conference was all about acceptance, inclusion, listening, understanding, learning . . . and most of all CONNECTION. Masculine shaming was nowhere in the room.

The conference organizers, Englar-Carlson, David Shepard, and Rebekah Smart, set the tone for understanding and inclusiveness in their opening comments. The opening keynote followed and it was BY A WOMAN . . . which this leads me to back to my masculine-shaming theme for today:

“What kind of a MEN AND MASCULINITY organization sponsors a conference on psychotherapy with men and then has an opening keynote speech BY A WOMAN?”

Answer: “The kind of organization populated by people who have the good judgment to be very interested in listening to and understanding women’s perspectives.”

And so we all got to listen to—not just any woman (although that would have been fine too, because the conference wasn’t about status)—but the renowned Judith Jordan, author of many books and co-director of the Jean Baker Miller Institute. How cool is that?

After Jordan explored how we can raise boys to be competent and connected men, we scattered to different break-out sessions. As my adolescent clients would say, this sucked because it’s hard to make hard choices. My principle regret of the whole conference was that even though I have two last names, there’s still only one of me and so I couldn’t attend EVERY SESSION, but instead had make choices. And although I was perfectly happy to start my break-out experiences listening to Christopher Kilmartin, professor of psychology at the University of Mary Washington, as Irvin Yalom would say, it meant the death of the rest of my choices.

But seriously . . . here’s the important question: “What kind of a man accepts a faculty position at an institution named THE UNIVERSITY OF MARY WASHINGTON?”

Answer: “The same kind of man who gets asked to spend a year teaching sexual assault prevention at the Air Force Academy.” Now that’s a pretty good answer.

Kilmartin was awesome (just ask my wife, because I’ve been quoting him all week). But being at his break-out session made me miss the amazing Jon Carlson who might be the kindest, gentlest, and most humble person I know with hundreds of professional publications, video productions, and spare time to raise five children (two adopted) including the hyphenated conference organizer, who happens to have full professor status despite looking like he just shaved for the first time last week.

Naturally, the psychotherapy with men conference lunch had a vegetarian option (at this point I should also mention the Starbucks coffee and whole wheat bagels in the morning and the Panera coffee and cookies in the afternoon). Right after lunch, we gathered to listen to Fredric Rabinowitz, the afternoon keynote. Rabinowitz, who also happens to play tournament poker, talked about Deepening Psychotherapy with Men. He emphasized that, for men, there’s a substantial vocabulary about defenses, but not Department of Connection. For the past 20+ years he has helped men go deep and express their pain and loss in ways that are (surprise!) contrary to how society expects men to express their pain and loss. Unfortunately, Rabinowitz had to miss an annual fancy poker tournament to attend the conference . . . which leads to the obvious question:

“What kind of a man misses a poker tournament to talk with a bunch of sensitive psychotherapy-types?”

Answer: “A pretty cool dude who knows his priorities.”

After Rabinowitz’s keynote, there were more decisions. In my program I had circled presentations by David Shepard and Michele Harway as well as Chris Liang. But I should confess here-and-now that I got slightly intoxicated with Panera coffee and cookies and ended up wandering into the wrong room with three Canadian presenters who were talking about how to help men transition from military to civilian life. It might have partially been the coffee, but the Three Canadians ROCKED MY WORLD . . . which begs the question:

“What kind of a man gets his world rocked by Three Canadians?”

Answer: “The kind of man who recognizes they have such fabulous clinical skills and compassion and cleverness that it makes him wish he was born and raised in Vancouver, B.C. instead of Vancouver, Washington (not that there’s anything wrong with Vancouver, WA).”

After my Canadian experience I staggered into Mark Stevens’s presentation on Engaging Men in the Process of Psychotherapy. Stevens showed photos of little boys and asked us to remember that ALL OF OUR MALE CLIENTS were once sensitive boys (not little men). He urged us to engage men slowly, but to not judge or underestimate them in ways that minimize or shrink their humanity. This was awesome, but I have to ask:

“What kind of a man shows photos of little boys during a professional presentation?”

Answer: “The kind of man who understands how to work effectively with men.”

At this conference you didn’t need a hyphenated name and you didn’t need an un-hyphenated name, because there was no shaming either way. There was just acceptance; acceptance of being scared boys and scared girls who are doing the best we can to openly affirm and connect with each other. And these connections reached across races, to the transgendered, to the women, and even to graduate students. If you’re interested in this sort of thing (and I think you should be), you should check out Division 51 of the American Psychological Association at: http://www.division51.org/

BTW, at the post-conference social I got to meet lore m. dickey, who presented earlier in the day on Affirmative Practice with Transgender Clients. He immediately shared with me that he is a female to male transsexual. That’s the sort of openness and connection you get at the Psychotherapy with Men conference. But I’m sure you know this leads me to another purposely masculinity-shaming question.

“What kind of a man chooses to go through a female to male transgender process?”

“The kind of a man who has achieved clarity about his male identity.”

The day ended with me hanging out with the Three Canadians—whom I should name here (Marvin Westwood, David Kuhl, and Duncan Shields). They welcomed me to their table at the social time where we engaged in an extended international mutual appreciation festival. You should really look them up.

All this brings me to my final question:

“What kind of a man writes an fluffy, complimentary, and sycophantic blog about the 4th National Psychotherapy with Men Conference?”

Answer: “The kind of man who wants to offer the conference organizers and participants the thanks and praise they deserve.”

 

Cool Counseling, Parenting, Personal Reflections, Therapy with Adolescents, Tough Kids, Tough Kids Cool Counseling

How to Listen so Parents will Talk: Strategies for Influencing Parents — DVD filming with Alexander Street Press

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This past week I was in Chicago to be filmed doing three 15 minute TED Talk like speeches for Alexander Street Press. The experience was both exciting and anxiety-provoking. . . as it’s rather challenging to deliver a 15 minute piece in a darkish studio to a camera on one take. Shannon Dermer of Governor’s State University was the smooth as silk facilitator who conducted 15 minute interviews after each speech. I was lucky enough to be filming on the same day as Paul Peluso of Florida Atlantic University. Although it was comforting to see that Paul was just as nervous as I was, it was not comforting watching him absolutely nail a perfect 10 of a presentation on Humor in Psychotherapy just a couple hours before it was my turn in front of the camera.

In the end, the filming went well, but of course during the live filming my imperfect memory led me to miss a few “lines” and so I’m posting here, a text version of the How to Listen so Parents will Talk THERAPY talk.Although my goal was to post an audio version, WordPress has thwarted that particular plan for now. . . sorry about that.

How to Talk so Parents will Listen: Strategies for Influencing Parents

When I talk with large groups about parenting, I like to begin with a survey. I ask: “How many of you ARE parents?” Of course, nearly everyone raises his or her hand. Then I ask a follow up: “How many of you WERE children.” At this question some participants laugh and a few raise their hands and others joke that they’re still immature.

“This reason I start with this survey is because if you’re a parent, you know that being a parent is an amazing and gratifying challenge. You also know that it’s 24-7; and you know it doesn’t end when your child turns 18. You’re a parent for life. And if you WERE a child, and all of you were, then you know how important it is to have a parent or caretaker who makes it perfectly clear that YOU ARE LOVED. But there’s more. If you were a child, then you also know how important it is to have a parent who not only loves you, but who is skillful . . . a parent who is dedicated to being the best parent possible.

Plain and simple: PARENTS NEED SKILLS FOR DEALING WITH THEIR CHILDREN IN THE 21ST CENTURY. And learning to be a better parent never stops.

Once upon a time I had a mom come consult with me about her five year old son. She said: “I have a strong-willed son.” My response was to acknowledge that lots of parents have strong-willed children. She said, “No, no, you don’t get it. I have a very strong-willed son, let me tell you about it. Just the other night, I asked him to go upstairs and clean his room and he put his hands on his hips and said, “NO.” So I said in response, “Yeah, yeah. He sounds very strong willed.” And she said, “Wait. There’s more. I asked him to clean his room a second time and he glared and me, and said “NO. YOU WANT A PIECE OF ME?” Then she told me the real problem. The problem was that, in fact, she did want a piece of him at that particular point in time and so she grabbed him and hauled him up the stairs in a way that was inconsistent with the kind of parent she wanted to be.

This is one of the mysteries of parenting. How can you get so angry at a small child whom you love more than anything else in the world?

Parents are a unique population and deserve an approach to counseling that’s designed to address their particular needs. In this talk I’ll mostly be using stories to talk about
a. what parents want for their children
b. what parents need in counseling
c. and how professionals can be effective helpers.

Most parents want some version of the same thing: To raise healthy and happy children who are relatively well-adjusted. But what do parents need in counseling. WHAT WILL HELP THEM GET WHAT THEY WANT?

First, parents need empathic listening. They need this big time. Our American culture puts lots of social pressure on parents . . . It’s implied that parenting should be easy and all parents should want to spend 24-7 with their child in an altered state of parental bliss. But this isn’t reality and so we need empathy for the general scrutiny parents feel in the grocery store, at church, on the playground, and everywhere else.

But they also need listening and specific empathy: like in the situation where the mom wanted to tell me about her 5-year-old son. She had specific information to share and it was really important for me to take time to listen to her unique story about her son who, unfortunately, may have been watching too many Clint Eastwood movies.

Parents come to counseling or parent education feeling simultaneously insecure and indignant. They feel insecure because of the scrutiny they feel from their parents and in-laws and society, but they also feel indignant over the possibility that anyone might have the audacity to tell them how to parent their children. As professionals, we need to be ready to handle both sides of this complex equation.

Another thing parents have taught me over the years is to never start a parenting session by sharing educational information. You should always wait to offer educational advice, even when parents ask you directly for it. When they do ask, let them know that your ideas will be more helpful later once you get to know what’s happening in their family.

This leads us to the second crucial part of what parents need in counseling. They need collaboration. We can’t be experts who tell parents what to do, instead we have to recognize that parents are the experts in the room. They’re the experts on their children, on their family dynamics, and on themselves. If we don’t engage and collaborate with parents, very little of what we offer has any chance of being helpful.

Parents also need validation to counter their possible insecurity. We call this radical acceptance or validation and it involves explicitly and specifically giving parents positive feedback. We do this by affirming, “You sure seem to know your daughter well.” And by saying, “When I listen to how committed you are to helping your son be successful in life, I can’t help but think that he’s lucky to have you as a parent.”

And so we begin with empathic listening and we move to collaboration and we make sure that we offer radical acceptance or validation and we do all this so we can get to the main point: providing parents with specific parenting tips or guidance.

And there are literally TONS of specific parenting tips that professionals can offer parents. Most of the good ones include four basic principles:

First, getting a new attitude – because developing parenting skills requires a courageous attitude to try things out.

The second one involves making a new and improved plan. Because a courageous attitude combined with a poor plan won’t get you much.

Third is to get support when you need it. Parenting in isolation is almost always a bad idea.

Fourth, underlying all tips there should be the foundation of being consistently loving.

I’d like to tell two parenting stories to illustrate all of the preceding ideas.

This first story is about a parenting struggle I had. I share it for two reasons: One is that it’s a great example of the need for parents to make a new plan to handle an old problem. And two, often it’s good to self-disclose—but not too much—when working with parents.

When my youngest child was 5-years-old, she ALSO was a strong-willed child. I vividly recall one particular ugly scene on the porch. It was time for us to leave the house. But we lived in Montana and there was snow and my daughter needed to put her boots on. Funny thing, she was on a different schedule than I was. This created tension and anger in me. And so I got down into her face and I yelled GET YOUR BOOTS ON! And her eyes got big and she did. Later that evening I was talking with my wife and she saw the scene and she said to me, “I know John, that’s not the kind of parent you want to be.” And even though it’s not easy to take feedback from our romantic partners, she was right and so obviously so, that I had no argument” which led me to tell her, “I’m not going to yell at our daughter any more. I am, instead going to whisper, because I learned in a parenting book, that sometimes when you’re angry it’s more effective to whisper than it is to yell. That was my new plan. Of course, like new plans everywhere, it needed tweaking. But it didn’t take long for me to have an opportunity to test it because if there’s anything on the planet that’s predictable, it’s that we’ll all soon have another chance to manage our anger toward our children more constructively.

It was the next day or week and my daughter did not get her boots on and she was not on the same schedule as me and I got down in her face, once again, but I remembered the plan to whisper and I did my best to transform my anger from the historical yell to the contemporary whisper and what happened was that what came out was sort of like the exorcist and I said to my daughter: “GET YOUR BOOTS ON!”

Now. I wasn’t especially proud of that, but she got her boots on.

It was the beginning of a big change for me because I learned I could play the exorcist instead of yelling; then I learned to growl and then I learned to count to three and then I learned a cool technique called Grandma’s rule where you use the formula, WHEN YOU, THEN YOU to set a limit and build in a positive outcome. Like . . . “Honey, when you get your boots on, then you can have your cell phone back.” Very cool.

What I learned from this experience is that I could be more than a one-trick parenting pony. I became the kind of parent who, although far from perfect, was able to set limits that were in my daughter’s best interest.

And what I like the best about this particular story is that daughter is now 26 years-old and she still says the same thing she used to say to me when she was 15 . . . that is, “Dad, one thing I really love about you is you never yell.” What’s cool is that I did yell, but I worked on it, I made a new plan, and now she doesn’t even remember the yelling.

I’d like to finish with one last story about how much parents need people like you to have empathy, collaborate, validate, and offer concrete parenting ideas.

I was working with a 15-year-old boy. His mom was bringing him to counseling because he and his dad weren’t speaking anymore. I hadn’t met the dad, but one day, when I went to the boy’s IEP meeting at school the dad was there. I saw this as a chance to make a connection and get him to come to counseling.

I did a little chit-chatting and sat next to him in the group meeting. Then, at one point, I asked the boy a question: “If you got an A on a test, who would you show first?” He answered, “I’d show my dad, my mom, and my special ed teacher.” This inspired me to turn to his dad and say, “It’s obvious that you’re very important to your son and so I’d like to invite you to come join him and me in counseling.” Dad gave me a glare and pushed my shoulder and began a 2-minute rant about how the school had failed his son. Everyone was stunned and then he turned back to me and said, “I’ll come to counseling. I been to counseling before and I can do it again.”

At that point I wondered if I could take back my offer.

The day the dad drove to counseling he and his son weren’t speaking, so I met with them separately. The son was clear that he would never speak to the dad again, but the dad was open. When I asked if I could offer him some ideas, he said, “Well I tried MY best and that dog don’t hunt, so I can try something else.” I was wishing for subtitles.
I told the dad I wanted him to keep his high standards for his son, but to add three things. First, I asked, do you love your son? The dad said “Yes” and so I told him, “Okay then. I want you to tell him ‘I love you’ every day.” He said, “Usually I leave that to the wife, but I can do that.” Second, I said, “Everyday, I want you to touch your son in a kind and loving way.” He asked, “You mean like give him a hug?” I said, “that would be great” and he responded, “Usually I leave that to the wife too, but I’ll give it a shot.” Third, I said, “Once a week, you should do something fun with your son, but it has to be something that he thinks is fun.” He said back: “That’s no problem. We both like to go four-wheeling, so we’ll do that.”

And they left my office for an hour-long of what I imagine was a silent trip home.

The next afternoon, I got a call from the mom. She was ecstatic. She said, “I don’t know what you did or what you said, but they’re talking again.” And then she added, “This morning, when they were in the kitchen, I was in the other room and I thought I heard them hug and when I saw my son walking down the driveway to head to school, there were tears running down his cheeks.”

This was obviously a mom who was listening and watching very closely.

Things got much better for the 15-year-old after that. He didn’t get straight As, but he stopped getting straight Fs. And I learned two things: First, I learned just how much that boy needed to get reconnected with his father. And second, I learned that sometimes, no matter how gruff parents may seem, what they need is some clear and straightforward advice about how to reconnect with their son or daughter.

My final thoughts about this topic are very simple. I hope you’re inspired enough to acquire the knowledge and skills it takes to work effectively with parents. I know their children will deeply appreciate it.

Thanks for listening.

The book upon which the talk is based is available here on Amazon:

. . . and here on Wiley: http://www.wiley.com/WileyCDA/WileyTitle/productCd-1118012968.html