Category Archives: Personal Reflections

Clinical Interviewing, Personal Reflections

The Art and Science of Clinical Interviewing (in Chicago)

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In about 10 days I’ll be on my way to Chicago to video-record five short lectures on Clinical Interviewing. Alexander Street Press is producing this video project and Dr. Sharon Dermer of Governor’s State University is hosting. The project is titled “Great Teachers, Great Courses.” [This is pretty cool and my thanks to JC for getting me included.]

I’ll be recording the morning of Tuesday, May 19, which happens to be just before Debbie Joffe Ellis, who just happens to be the wife of the late Albert Ellis. She asked to switch times with me and so I obliged, noting in an email to Dr. Dermer:

Sure. I can do morning. Besides, if I said no I would end up with the Ghost of Albert Ellis’s scratchy voice in the back of my head saying things like, “What the Holy Hell is wrong with you?”

I’d just as soon avoid that.

All this is my slightly braggy way of explaining why I’ll be writing about five upcoming blogs on Clinical Interviewing. Here we go.

What is a Clinical Interview?

Definitions can be slippery. This is especially true when our intention is to define something related to human interaction.

One of my favorite descriptions of clinical interviewing is scheduled for inclusion in the forthcoming “Handbook of Clinical Psychology.” Mostly I suppose I like this description because I wrote it (smiley face). Here it is:

In one form or another, the clinical interview is unarguably the headwaters from which all mental health interventions flow. This remarkable statement has two primary implications. First, although clinical psychologists often disagree about many important matters, the status of clinical interviewing as a fundamental procedure is more or less universal. Second, as a universal procedure, the clinical interview is naturally flexible. This is essential because otherwise achieving agreement regarding its significance amongst any group of psychologists would not be possible. (page numbers tbd)

When it comes to formal definitions, it’s clear that clinical interviewing has been defined in many ways by many authors. Some authors appear to prefer a narrow definition:

An interview is a controlled situation in which one person, the interviewer, asks a series of questions of another person, the respondent. (Keats, 2000, p. 1)

Others are more ambiguous:

An interview is an interaction between at least two persons. Each participant contributes to the process, and each influences the responses of the other. However, this characterization falls short of defining the process. Ordinary conversation is interactional, but surely interviewing goes beyond that. (Trull & Prinstein, 2013, p. 165)

Others emphasize the development of a positive and respectful relationship:

. . . we mean a conversation characterized by respect and mutuality, by immediacy and warm presence, and by emphasis on strengths and potential. Because clinical interviewing is essentially relational, it requires ongoing attention to how things are said and done, as well as to what is said and done. The emphasis on the relationship is at the heart of the “different kind of talking” that is the clinical interview. (Murphy & Dillon, 2011, p. 3)

From my perspective, the BIG goals of this “different kind of talking” can be broken into two main parts: (1) ASSESSMENT and (2) HELPING That said, I’m likely to further break these two main parts into four interrelated and overlapping parts that may or may not be formally including in a single clinical interview:

1. Establishing a therapeutic relationship
2. Collecting assessment information
3. Developing a case formulation or treatment plan
4. Providing a specific educational or psychotherapeutic intervention

What are the Goals of a Clinical Interview?

[In the following two paragraphs I’m including a more wordy and erudite way of saying the preceding . . . which is one of the things that we academics are wont to do. I should note these paragraphs are excerpted from my entry in the Encyclopedia of Clinical Psychology (2015). This piece, very recently published, is cleverly titled, “The Clinical Interview” and coauthored with Drs. Waganesh Abeje Zeleke, and Meredith H. E. Hood.]

Perhaps the clearest way to define a clinical interview is to describe its purpose or goals. Generally, there are four possible goals of a clinical interview. These include: (a) the goal of establishing (and maintaining) a working relationship or therapeutic alliance between clinical interviewer and patient; research has suggested the relationship between interviewer and patient is multidimensional, including agreement on mutual goals, engagement in mutual tasks, and development of a relational bond (Bordin, 1979; Norcross & Lambert, 2011); (b) the goal of obtaining assessment information or data about patients; in situations where the goal of the clinical interview is to formulate a psychiatric diagnosis, the process is typically referred to as a diagnostic interview; (c) the goal of developing a case formulation and treatment plan (although this goal includes gathering assessment information, it also moves beyond problem definition or diagnosis and involves the introduction of a treatment plan to a patient); (d) the goal of providing, as appropriate and as needed, a specific educational or therapeutic intervention, or referral for a specific intervention; this intervention is tailored to the patient’s particular problem or problem situation (as defined in items b and c).

All clinical interviews implicitly address the first two primary goals (i.e., relationship development and assessment or evaluation). Some clinical interviews also include, to some extent, case formulation or psychological intervention. A single clinical interview can simultaneously address all of the aforementioned goals. For example, in a crisis situation, a mental health professional might conduct a clinical interview designed to quickly establish rapport or an alliance, gather assessment data, formulate and discuss an initial treatment plan, and implement an intervention or make a referral.

What Happens During a Clinical Interview?

The range of interactions that can happen during a clinical interview is staggering. This could partly explain why we (foolishly) wrote a textbook on this topic that’s 598 pages long and includes an instructional DVD.

My son-in-law says one good way to get a flavor for any book is to put together the first and last words. In this case, our Clinical Interviewing text reads (not including the front or back matter), “This . . . culture.” To give you a further taste of “This . . . Clinical Interviewing . . . culture,” here’s a modified excerpt from the text:

Imagine sitting face-to-face with your first client. You carefully chose your clothing. You intentionally arranged the seating, set up the video camera, and completed the introductory paperwork. You’re doing your best to communicate warmth and helpfulness through your body posture and facial expressions. Now, imagine that your client:

  • Refuses to talk.
  • Talks so much you can’t get a word in.
  • Asks to leave early.
  • Starts crying.
  • Tells you that you’ll never understand because of your racial or ethnic differences.
  • Suddenly gets angry (or scared) and storms out.

Any and all of these responses are possible in an initial clinical interview. If one of these scenarios plays out, how will you respond? What will you say? What will you do?

From the first client forward, every client you meet will be different. Your challenge or mission (if you choose to accept it) is to make human contact with each client, to establish rapport, to build a working alliance, to gather information, to instill hope, and, if appropriate, to provide clear and helpful professional interventions. To top it off, you must gracefully end the interview on time and sometimes you’ll need to do all this with clients who don’t trust you or don’t want to work with you. (pp. 3-4)

In my opening Great Teachers, Great Courses lecture I’ll be focusing on the definition of the clinical interview and then limit myself to describing and demonstrating about 18 different interviewing “behaviors” or responses that clinicians who conduct clinical interviewing have at their disposal. These behaviors are named and organized into three categories. And so to help myself stop writing this blog and get back to work, I’ll wait and write about them later.

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Personal Reflections, Writing

My Adams State University Chi Sigma Iota Initiation Speech

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It’s an honor to be here on this excellent almost-spring-day in Alamosa, Colorado. Thanks to Jazmin, Chris, and Lori for inviting me here and arranging this visit. I’m so touched about this that I wrote a song especially for this event. And so you’ve got that to look forward to.

When it comes to giving speeches and workshops, one of my former professors used to say this: If you ask me to give a 15 minute talk, I’ll need all day to prepare; if you ask me to talk for a couple hours, I’ll likely need a couple hours of prep. But if you want me to talk all day . . . I’m ready.

This is why I have some verbatim notes here. Tomorrow I’ll be talking all day and therefore be way more spontaneous. Today, I need a guide to keep me focused.

The first thing I’d like to report is that the profession and discipline of Counselor Education is doing well . . . and maybe even booming. Just last night at the University of Montana we held our live group admissions interview for our CACREP-accredited Clinical Mental Health and School Counseling M.A. Programs. We have a total of 18-20 openings for these degrees and 71 applicants. About 45 applicants showed up for a 2 ½ hour group interview. After the interview, late into the night, we were discussing the applicants and one of our current students who was helping with the process exclaimed, “Thanks for letting me be a part of this. This was like Fantasy Football in February.” We took that as a compliment.

This is why I LOVE being a Counselor Educator. I don’t love it for the Listserv, or the ACA convention, or the status and prestige of being a Counselor Educator and teaching at the University of Montana. I love it because every year I get to spend most of my time teaching the kindest and most respectful graduate students on the planet; students who are deeply committed to helping others and to making the world just a little bit better place for individuals, couples, families, groups, schools, and communities. I have the honor of teaching these great people and maybe partly because we teach them how to have awesome listening skills, when I teach, they actually look like they’re listening to me. This is the best job ever.

And so thanks for letting ME be a part of THIS Excellent Day and CSI Induction Ceremony. It’s definitely better than fantasy football in February.

What I hope is that this is not just an initiation ceremony . . . it should also be a celebration . . . which brings up an important question: “How shall we celebrate?”

Well, of course, there should be dancing . . . and singing . . . and maybe some slam poetry . . . and of course, high fives all around, and arms raised in the air, and clapping and cheering (woo hoo) and toasting and smiling and laughing and eating desserts. Let’s do it all!

Counseling is a profession and identity that comes from the people. From way back in 1909, with Frank Parsons publishing “Choosing a Vocation” (with Pauline Agassiz Shaw’s unwavering financial and emotional support), it had become clear that modern citizens from the early 20th Century could benefit from assistance in making important decisions.

Think about that. Where do we learn to make decisions? Not just decisions about vocation and career, but other important life decisions? Did your parents explicitly teach you? Did you take a “Decision-Making” course in high school or college? Did you enroll in a life decision-making workshop? Probably not. Sometimes I think it’s mostly only in graduate school where Counselor Education students get taught how to make decisions and how to help people make important decisions.

This is still a big part of what we, as counselors, do. We help people make everyday life decisions. We help them sort through the thoughts, feelings, impulses, and social and cultural forces that make decision-making so challenging. And we help them make bigger decisions too.

Counseling is a profession with roots back in the early 1900s with Frank and Pauline, but professional counseling is a much more recent development.

Not long before Thomas Sweeney of Ohio University founded CSI in 1983, it was becoming apparent that Psychiatry, Psychology, and Social Work weren’t adequately serving the needs of all the people. In the 1960s and 70s, Psychiatry was mostly taking the BIG PHARMA road, Social Work mostly linked hands with Medical professionals, and Psychology mostly decided to embrace Ph.D.-only training, a sort of scientific fundamentalism, and the pursuit of becoming mini-physicians.

IMHO, this was a mass exodus from the needs of most people. Helping became much more about the medical model – assessment, diagnosis, and treatment – and less about helping people achieve what most of us really want in our daily lives, good health and positive wellness.

So there was something big missing. People wanted to work with professional practitioners who were empathic, kind, compassionate, and positive, and interested in helping them feel WELL, instead of just helping them not feel sick. This is the breech into which professional counseling stepped. And this is probably why, in a study conducted in the Psychology Department at the University of Montana in 1991, it was reported that consumers rated Counselors as warmer, kinder, more genuine, and more desirable to see than Psychiatrists or Psychologists.

At the University of Montana we have an MSW, a Clinical Psychology, and our Counselor Education graduate programs. Not surprisingly, we have a bit of a friendly competition for graduate students. Don’t get me wrong, I love my colleagues in Psychology and Social Work and I think they do a fantastic job educating their students; I just think their professional disciplines have gotten drawn a bit too far over into the medical model. Consequently, when prospective students ask me what program they should choose, I find it very easy to say, “If you want to learn how to do, I mean, really how to do individual, couple, family, and group counseling, then you should join us in the Department of Counselor Education.” Even the graduate students in these respective programs recognize that Counselor Education students learn these skills faster than other disciplines . . . principally because that’s what we focus on.

This brings me to some concerns for the future.

There will always be medical creep, pharmaceutical creep, and insurance company creep. The medical model is strong and compelling. We have to watch out for that. For example, right now we’re right in the middle of a Neuroscience party that’s dominating popular discourse. This reminds me of a Psychiatrist with whom I worked at a Psychiatric Hospital back in 1981. He said it wouldn’t be long until we were all taking drugs to manage and moderate our emotions and behaviors. Well, mostly he was wrong.

Now we have “brain-based” this and “brain science” that and to be “in the dominant cultural discourse club” we have to put “neuro” in front of every other word or sentence.

But there are some surprising ways in which the medical model and neuroscience don’t provide much guidance or truth.

There’s really no such thing as a chemical imbalance. If you speak Spanish and I don’t, then our unique brains have to be different. The chemical imbalance as an explanation for mental health problems has no particular scientific support.

In addition, the track record of psychiatric medications curing illness is rather abysmal. I’m not saying that medications never work, I’m just saying they work less well than most of the public has been led to believe.

And the majority of the quantitative research published in psychology journals is, to borrow Carl Rogers’s words from 1957, “for the most part, a colossal waste of time.”

My point here is: Let’s be damn good professional counselors, and not try to be like those other professional disciplines. They have their niche; they’re needed in some ways for some things. But let’s stick with what we’re doing well.

As I’m sure you all know, because I don’t have a portable MRI or PET scanner in my office—which wouldn’t allow me to really “see” what’s happening in someone’s brain anyway—there’s really only one good method for me to know what’s going on in my client or student’s brain.

The best way to do this is to sit with the person and listen well and develop a trusting relationship and ask things like:

• What are you thinking right now?
• What do you want?
• What emotions are coming up for you?
• What feelings and sensations do you have in your body?

Being with people in positive therapeutic relationship and sometimes asking no questions at all, is the best brain scanner we’ve got.

And here are a few more important truths:

1. A pill is not a skill
2. There’s no better medicine than a healthy and caring relationship, and
3. The profession that is currently doing the best at focusing on skills and relationships is Counselor Education!

As the EMDR therapists would say, “Let’s go with that.”

Before ending, I’d like to tell one short story; then we can officially start celebrating.

Meeting Jesus at the Portland VA Story: What this psychotic patient wanted and what he responded to was what most of us want and respond to . . . to be listened to . . . and to be treated with respect and as an individual, not as a psychiatric label.

Now let’s begin our official celebration with a song that I wrote especially for this auspicious occasion. Ready? I’ll sing it through first and then you can all stand if you like and join me:

Oh, I wish I were a counselor-in-training, counselor-in-training . . .
Oh, I wish I were a counselor-in-training, counselor-in-training . . .
I think it’d be rather swell
To help everyone be well
Oh, I wish I were a counselor-in-training, counselor-in-training.”

Everybody now . . .

Thanks for listening and my BIG congratulations to all of the initiates and the faculty here at Adams State University.

Boys and Men, Parenting, Personal Reflections

Wishing for a Super Bowl that Promotes Non-Violence

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It’s been a tough year for the National Football League. There was renewed emphasis (for a while) on the devastating brain damage caused by repeated concussions. Then there was the Ray Rice domestic violence incident. And then there was the Adrian Peterson child abuse incident. And now there’s the Aaron Hernandez trial for murder and weapons charges that started a couple days ago. All these scandals added up to big, bad publicity . . . so much so that the Fiscal Times noted in a recent headline that these incidents “Rocked the NFL.”

Then there was deflate-gate, the ridiculousness that led us to wonder if our football heroes might just be a bunch of cheats.

But wait.

Through all these scandals the NFL has continued laughing its way to the Bank with obscene gobs of money that could be used to wipe out Ebola or end child abuse. Last year, NFL commissioner Roger Goodell made about $44 million. Vegas odds are that he’ll do better this year. Super Bowl advertisings are doing just fine, thank-you. And Katy Perry may or may not have a wardrobe malfunction tomorrow evening, but you can bet there will be millions of viewers. The NFL is right on pace to increase its economic worth to something well over being a $9 billion dollar industry. Not bad. Talk about Teflon.

It’s clear the situation is hopeless and that the Juggernaut that is the NFL will stroll into the future without substantially addressing anything that might be remotely linked to a social virtue. Nevertheless, I can’t stop cheering for underdogs, and that leaves me with an array of dreams that are so silly that I’m embarrassed to admit them. That said, I’ll go ahead and embrace my embarrassment and tell you what I’m watching for tomorrow.

I’ll be watching to see how many advertising bucks are used to promote domestic violence or child abuse prevention. Will we see NFL players, coaches, owners, and the commissioner go on record to support sexual assault prevention? Might there be room for the tiniest of sprinklings of valuable educational public service announcements during the four hour Super Bowl feast?

I think not; but I hold out hope.

And here’s my biggest irrational wish. I’m wishing for the NFL to provide educational information about the dangers of corporal punishment. Adrian Peterson said something to the effect that all he did was send his kiddo out to get a stick so he could beat him with it, just like his Momma did to him. Peterson was talking about our great American tradition of believing that it’s a good thing for parents to hit their children.

Even more disturbing than the single Adrian Peterson incident is the fact that during a typical 4 hour time period (about the length of the Super Bowl broadcast) there are approximately 1,500 reports of child abuse . . . and so maybe, just maybe, we could use a little NFL-sponsored education here.

But what really smacks my pigskin is the fact that Adrian Peterson’s parenting philosophy is still alive and well on the internet. In particular, it’s featured on the website of Christian “parenting expert” James Dobson. Seriously. It’s on a Christian-based website. This is stunning not only because there’s a truckload of science telling us that hitting kids is linked to bad outcomes, but also because it’s pretty difficult to imagine the Jesus that I read about in the Bible hitting children with a stick . . . or advocating the hitting of children with a stick.

Now that it’s the 21st century and time for Super Bowl XLIX, shouldn’t we know better? Shouldn’t we know that we shouldn’t send our kids out to get sticks so we can beat them? Come on NFL . . . just share that fun fact. Just come out and say you don’t support beating children . . . and how about you take 0.001% of your net worth and use it to launch an educational campaign that will teach parents what to do instead of hitting kids.

That’s what I’ll be watching for tomorrow . . . if I can manage to stomach turning on the game at all.

Counseling and Psychotherapy Theory and Practice, Multicultural, Personal Reflections

A Guest Essay on the Girl Code and Feminism

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The past several years I’ve offered a few extra credit points for students in my theories class who write me a short essay on the Girl Code. The Girl Code is defined–using William Pollack’s Boy Code as a guide–as the unhealthy societal and media-based rules by which girls and women are supposed to live. These rules are typically limiting (e.g., women who get angry are considered bitches) and are often damaging to girls and women.

This year students had to watch three feminist-related video clips as a part of this extra credit assignments and then write a short essay. The clips are listed below so you can click on the links and watch them if you like:

Eve Ensler doing a TED talk: Embrace Your Inner Girl — https://www.youtube.com/watch?v=YhG1Bgbsj2w

Emma Watson speaking to the U.N.: https://www.youtube.com/watch?v=c9SUAcNlVQ4

Cameron Russell’s TED talk: http://www.ted.com/talks/cameron_russell_looks_aren_t_everything_believe_me_i_m_a_model?language=en

The following essay was written by Tristen Valentino. He gave me permission to post it here.

I’m featuring Tristen’s essay not only because I found it to be well-written and insightful, but also because his ideas stretch my thinking. Frequently I find myself puzzled as to why so many people in our society have such negative reactions to the word “feminist.” Why would anyone be against equal rights and opportunities for males and females? What’s the problem with that? In fact, this past year Time Magazine went so far as to suggest it be eliminated from the dictionary (inserted stunned silence here). For me, Tristen’s essay is important because, although he strongly criticizes what he sees as the overly generalized messages within the assigned video clips (which I happen to like), he also explicitly condemns the mistreatment of women based on gender.

Here’s Tristen’s essay. I hope you enjoy it . . . or at least find it thought-provoking.

Extra Credit Commentary on Feminism Clips
Tristen Valentino
COUN 485
November 24, 2014

Advocating equal rights is a noble and admirable pursuit. The video clips featuring Eve Ensler, Emma Watson, and Cameron Russell each speak about sexual discrimination, and their own personal roles in feminism. While I fully support equality in opportunity, and applaud their intention, I believe their execution was flawed. The three of them generalized men across the globe, lumping all men from all cultures and nations together in the oppression of women. The three of them claimed that male chauvinism is not only prevalent but pervasive in all societies.

Eve Ensler speaks briefly of her violent and abusive father and alludes that her experiences at the hands of her father set her in motion to help end the victimization of women. In this case I feel that Eve Ensler is looking at everything through the same tinted lens. In her world, the lens with which she views the world is completely blue (victimization of women), so when she looks upon the world she sees everything as blue. While not incorrect, since there are many things blue in the world, this view is incomplete as there are many things not blue. So too with her view on victimization and the causes of it.

Emma Watson’s speech appealed to emotion, but wilted under even slight pressure from a factual basis. She claimed that in her country (United Kingdom) women were oppressed and drew comparisons between the UK and African nations. She failed to mention that in her country the longest serving Prime Minister was a female (Margaret Thatcher) and that the longest living monarch, and second longest reigning monarch, is a female (Queen Elizabeth II).

Cameron Russell speaks about how damaging the media can be to female self-esteem and the female identity. She attributes insecurity, eating disorders, and other self-image issues with fantastical, and often fictional, portrayals of the female form. I find this to be incredibly hypocritical and disingenuous coming from someone who is an active participant in the very mechanism that she claims is doing harm to the female psyche.

However, those issues aside, the issue of gender equality is a serious one, and one that deserves our attention. There is little doubt that acts of female oppression and victimization are completely evil. There is no arguing that in some areas, horrible atrocities happen to women simply because they are women. This culture of male predatory behavior resulting in the victimization of women needs to be addressed and halted immediately. The damage that is caused is not always as easily seen and overt as physical injury. The mental and psychological injuries inflicted by the gender expectations of such things as the “Girl Code” apply pressure to already stressed women to perform up to a standard, and in such a way, as to be unrealistic. Expectations—such as women must always look pretty, must always be as thin as they can be, or must be sexy, but not too sexy—place the value of women on their physical appearance. It prevents their self-expression and their validation of life by stripping away the value of all their other qualities. Women are not objects to be used or abused at the whims of men. Women are not toys to be played with and then discarded. They are equal partners in the venture of life. They are doctors, lawyers, teachers, police officers, and politicians. They are mothers, daughters, sisters, friends, confidants, and mentors. They are strong, intelligent, indomitable, competent, and capable. They are all that and more. They are women. They are human.

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.

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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