Category Archives: Therapy with Adolescents

How to Make a Collaborative Plan for Terminating Counseling without Ever Using the Word Termination

Stone Smirk

Not long ago I noticed some of my excellent and well-intended supervisees talking with their clients about “termination.” They would say things like, “We need to prepare for termination” or “Let’s talk about termination today.” When this happened, I’d get nervous, squirm a bit, and eventually find a way to tell my supervisees that, although we use the word termination all the time when talking with each other ABOUT counseling, we shouldn’t use it when talking with clients DURING counseling.

Instead of saying termination, it’s preferable to talk about final sessions, or the ending of counseling, or to use normal and jargon-free words that speak to the reality that all good things—including counseling—must end. Sometimes the number of counseling sessions possible is dictated in advance by employee assistance program guidelines or insurance companies; other times, clients and counselors have more freedom to work together as long as the work is helpful or productive. Either way, ongoing conversations linking goals to progress is a part of an evidence-based approach to counseling and psychotherapy. Effective counselors connect the “ending” of counseling with the goals that were, in the beginning of counseling, collaboratively identified (and then possibly modified as needed).

Although you should use your own words, statements like some of the following can help you talk with clients or students about termination without using the word termination.

  • “Let’s talk about how our counseling is going and whether we’re making progress toward your goals”
  • “How do you feel about our counseling together?”
  • “I’d love to talk about what I can do differently to keep helping you move forward toward your goals.”

Speaking of termination—and now I’m speaking to you and not my clients—below you’ll find a Termination Checklist that you might find helpful as you talk with your students about preparing for termination. As will everything, this checklist is imperfect, but it’s a good start to help all of us address the ending of counseling, before counseling actually ends.

Termination Checklist

[Adapted from Sommers-Flanagan, J., and Sommers-Flanagan, R., (2007).
Tough Kids, Cool Counseling: User-Friendly Approaches with Challenging Youth.
Alexandria, VA: American Counseling Association]

This is a guide to help you think about termination—even though some of the details will be different for you and your client(s).

_____ 1. At the outset and throughout counseling, identify progress in the movement toward termination (e.g., “Before our meeting today, I noticed we have 4 more sessions left,” or “You are doing so well at home, at school, and with your friends. . . let’s talk about how much longer you’ll want or need to come for counseling”).

_____ 2. Reminisce about early sessions or the first time you and your client met. For example: “I remember something you said when we first met, you said: ‘there’s no way in hell I’m gonna talk with you about anything important.’ Remember that? I have it right here in my notes. You weren’t exactly excited about coming for counseling.”

_____ 3. Identify and describe positive behaviors, attitude, and/or emotional changes. This is part of the process of providing feedback regarding problem resolution and goal attainment: “I’ve noticed something about you that has changed. Do you mind if I share what I’ve noticed?” [Client gives permission]. It used to be that you wouldn’t let adults get close to you. And you wouldn’t accept compliments from adults. Now, from what you and your parents tell me and from how you act in here, it’s obvious that you give adults a chance. You don’t automatically push adults away from you. I think that’s a good thing.”

_____ 4. You should acknowledge, in advance, that the end of counseling is coming up, but there’s a possibility you’ll see each other in the future. “Our next session will be our last session. I guess there’s a chance we might see each other sometime, at the mall or somewhere. If we do see each other, I hope it’s okay for me to say hello. But I want you to know that I’ll wait for you to say hello first. And of course, if we see each other in public, I’ll never say anything about you having been in counseling.”

_____ 5. Identify a positive personal attribute that you noticed during counseling. This should be a personal characteristic separate from your client’s goals: “From the beginning of our time together, I’ve always enjoyed your sense of humor. You’re really creative and really funny, but you can be serious too. Thanks for letting me see both those sides. It took courage for you to get serious and tell me how you’ve been feeling about your mom.”

_____ 6. If there’s unfinished business (and there always will be) provide encouragement for continued work and personal growth: “Of course, your life isn’t perfect, but I have confidence that you’ll keep working on communicating well with your sister and those other things we’ve been talking about.” You may want to say that even though your client doesn’t “need” counseling, choosing to come back for counseling in the future might be helpful: “You know some people come to counseling to work on big problems; other people come because they find counseling helps them be a better person; and other people just like counseling. You might decide you want start up again for any of these reasons.”

_____ 7. Provide opportunities for feedback to you: “I’d like to hear from you. What did you think was most helpful about coming to counseling? What did you think was least helpful?” You can add to this any genuine statements about things you wish you’d done differently. For example, if your client got angry at you for misunderstanding something and this was processed earlier, you might say: “And of course I wish I had heard you correctly and understood you the first time around on that [issue], but I’m glad we were able to talk through it and keep working together.”

_____ 8. If it’s possible, let the client know that he or she may return for counseling in the future: “I hope you know you can come back for a meeting sometime in the future if you want or need to.”

_____ 9. Make a statement about your hope for the client’s positive future: “I’ll be thinking of you and hoping that things work out for the best. Of course, like I said in the beginning, I’m hoping you get what you want out of life, just as long as it’s legal and healthy.”

_____ 10. As needed, listen to and discuss how your client is feeling about ending counseling. Don’t make this into a big deal, but offer opportunities for the client to say “I can hardly wait for the end of this counseling crap” or “I wish we could keep meeting.” Whatever your client is feeling about termination warrants respectful listening.

_____ 11. Consider a parting gift. Although I don’t routinely recommend this with adults, with young clients you might give a meaningful gift at the end of counseling. It could be anything from a painted rock to a blank notebook for writing or a written card. The point is to give a gift that’s not especially expensive, but that might hold meaning for your client in the future.

For more information on termination with youth, go to: https://www.amazon.com/Tough-Kids-Cool-Counseling-User-Friendly-ebook/dp/B00QYU630Q/ref=sr_1_7?s=books&ie=UTF8&qid=1550512844&sr=1-7&keywords=sommers-flanagan

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Your Life is Now: Trapper Creek Reflections

John Sommers-Flanagan

The Road

Note: This is a re-post. I had a chance to drive to Trapper this past week with one of our doc students and I was reminded of the powerful life experiences that happen at Trapper Creek Job Corps.

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Sometimes on Thursday or Fridays I drive from Missoula to Trapper Creek Job Corps. Then I drive back the same day. It’s a 140 mile round trip. Sometimes I have interns with me. The company makes the miles go by more quickly. Sometimes the interns are very nervous sitting next to me for the whole drive and consequently compete to see who gets the back seat. This makes me wonder if maybe I shouldn’t quiz them about theories of counseling and psychotherapy as we drive there together. Although I wonder about this . . . I haven’t changed my behavior. Maybe this means I’m trying to scare them all into the…

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Upcoming Workshops!

John II

Coming up in March and April, I’ve got two, two-day professional workshops scheduled at the University of Montana. Together, these workshops can earn you 2-credits through the U of M . . . or you can enroll for continuing education credit (one workshop = 2 days = 13 CE hours). Whatever you decide, coming to Missoula in early March and early April is pretty fabulous. We’ve scheduled these workshops for the first Friday and Saturday in Missoula to coincide with the First Friday Art Walk. That way you can workshop during the day and walk around downtown Missoula and check out fantastic Montana art Friday evening.

The workshops and their descriptions are below:

March 2 and 3, 8:30am to 4:30pm: Working with Challenging Youth and Parents . . .  and Loving It

Counseling difficult youth and challenging parents can be immensely frustrating or splendidly gratifying. The truth of this statement is so obvious that the supportive reference, at least according to many teenagers is, “Duh!” Using storytelling, video clips, live demonstrations, group discussion, and skill-building break-out sessions, John will present essential evidence-based principles and over 20 specific techniques for influencing “tough” clients or students. Techniques for working with youth will include, but are not limited to: (a) the affect bridge, (b) what’s good about you?, (c) empowered storytelling, (d) generating behavioral alternatives, (e) the three-step emotional change technique, and many more. Dr. Sara Polanchek will join John for the parenting portion of the workshop. They will describe essential principles for working effectively with parents, how to conduct brief parenting consultations using a positive, solution-focused model, and strategies for providing parents with specific suggestions and advice to parents. Issues related to ethics and culture will be highlighted and discussed throughout this two-day workshop.

Here’s a link to the registration form for both workshops. Registration Form for JSF Workshops 2018

If you want to call for more information: Call 406-243-5252 and leave a message if our administrative person is away. Or you can always email me: john.sf@mso.umt.edu

April 6 and 7, 8:30am to 4:30pm: Variations on the Clinical Interview: Collaborative Approaches to Mental Status Examinations, Suicide Assessment, and Suicide Interventions

The clinical interview is the headwaters from which all mental health assessment and interventions flow. In this workshop, following an overview of clinical interviewing principles and practice, skills training for conducting the mental status examination (MSE) and suicide assessment interviews will be provided. Participants will learn MSE terminology, common symptom clusters and presentations, and strategies through which the MSE can be more collaborative and user-friendly. Additionally, participants will learn a flexible model for conducting suicide assessments. This model features eight core suicide dimensions and techniques for directly and collaboratively questioning clients about suicide ideations, previous attempts, hopelessness, and more. Five suicide interventions will be featured: alternatives to suicide; separating suicide intent from the self; interpersonal re-connection; neodissociation; and safety-planning.

One last note: On Wednesday, February 14, I’ll be doing my annual 1/2 day workshop on Tough Kids, Cool Counseling in the Schools at the annual meeting of the National Association of School Psychologists (NASP). We’re in Chicago this year. So if you happen to be in Chicago, check out the NASP conference. https://www.nasponline.org/professional-development/nasp-2018-annual-convention

 

 

 

Upcoming Workshops: L.A., Chicago, Morgantown, and Greensburg (outside Pittsburg)

Rainbow 2017

October is almost always a big month for counseling and psychology conferences and workshops. This October is no exception. I’m posting my October workshop presentation schedule here, just in case you want to say hello and possible collect some continuing education credit.

On Thursday, October 5, I’ll be in Orange County for the California Association for School Psychologists conference. Here’s a link: https://event.casponline.org/#intro

On Sunday, October 8, I’ll be in Chicago for the Association of Counselor Educators and Supervisors to present on the Mental Status Examination with Thom Field of the City University of Seattle.

On Thursday, October 12, I’ll be in Morgantown, WV for an afternoon workshop with counseling and psychology students from West Virginia University.

On Friday, October 13, I’ll be in Greensburg, PA (just outside Pittsburgh) for an all-day workshop sponsored by Indiana University of Pennsylvania. The link: https://www.iup.edu/counseling/centers/upcoming-workshops-and-events/

Today is the first day of Autumn . . . I hope this signals the end of hurricanes, floods, fires, and other challenges so many people are facing.

 

Teenagers and Depression

Every year, every month, and every day, many teenagers complain of feeling down, depressed, or sad and some of them just act with immense irritability. You probably knew that. But, how many teens are experiencing symptoms of depression?

Estimates are wide ranging. The National Institute of Mental Health reported that approximately 12.5% of U.S. youth from 12-17 years-old experienced at least one episode of major depressive disorder. That’s a huge number of American teenagers (about 3 million).

Add to that the many more teenagers who complain of feeling depressed or down, but who don’t officially meet the diagnostic criteria for clinical depression. By some estimates, that brings the number to close to 50% of teens who are consistently bothered by sad, bad, and irritable feelings.

If you’re a parent of a teen, it’s easy to feel concerned about your teenager’s emotional health.

You may have questions like the following

  • Is my teenager clinically depressed or just going through the normal emotional ups and downs of adolescence?
  • Should I take my son or daughter to a mental health professional?
  • What about medications? Are any of the antidepressants safe and effective for teenagers?

The answers to these questions are complex. It’s hard to tell whether a teenager is in a normal emotional angst or experiencing something more insidious and chronic. And, the answer to the question about whether antidepressant medications are safe and effective with teens is a solid: “Maybe, but maybe not.”

In the latest Practically Perfect Parenting Podcast, Dr. Sara and I take on the serious topic of teenage depression. There are no laughs or giggles, but you’ll get to hear Sara ask me many questions about teen depression, and you’ll get to hear me try to answer them, which is sort of funny. You’ll hear the answer to my favorite trivia question: “What percent of children “recovered” from their depressive symptoms in the first-ever double-blind, placebo-controlled study of antidepressant medications?” And yes, once again, you’ll hear Sara find a way to mention sex during our podcast.

If you have teenagers yourself, or you know someone who has teenagers, or you’re a helping professional who works with teenagers, this podcast may be of interest or helpful to you. Check it out here on iTunes: https://itunes.apple.com/us/podcast/practically-perfect-parenting-podcast/id1170841304?mt=2

If you listen and like it, please share it, and then do us one little favor—rate the podcast on iTunes. That way Sara and I can keep climbing up the charts in reality—rather than just in our imaginations.

JSF Dance Party

Handouts from South Carolina

This past Thursday I had the honor of offering a full-day workshop on “Tough Kids, Cool Counseling” to the South Carolina Association of School Psychologists. For anyone who has misplaced their handout or who wants additional content, I’m including two handouts in this post.

The first handout includes all the powerpoint slides (except the cartoons and empowered storytelling).

SCASP 2017 for Handout  

The second handout includes additional content corresponding (mostly) to the content in the powerpoint slides.

SCASP Extra Handout

For more information, you can check out our Tough Kids, Cool Counseling book, published by the American Counseling Association, https://www.amazon.com/Tough-Kids-Cool-Counseling-User-Friendly/dp/1556202741/ref=sr_1_10?s=books&ie=UTF8&qid=1491153299&sr=1-10&keywords=sommers-flanagan:

Tough Kids Image

Or you can check out our book on working effectively with parents: https://www.amazon.com/How-Listen-Parents-Will-Talk/dp/1118012968/ref=sr_1_4?s=books&ie=UTF8&qid=1491153770&sr=1-4&keywords=sommers-flanagan