The following information is excerpted from the soon-to-be-forthcoming 5th edition of Clinical Interviewing, published by John Wiley & Sons. This includes information that I didn’t get a chance to cover during my ACA pre-conference Learning Institute yesterday. For information on the Clinical Interviewing text, see: http://www.amazon.com/Clinical-Interviewing-John-Sommers-Flanagan/dp/1118270045/ref=dp_ob_title_bk
Safety Planning
The primary thought disorder in suicide is that of a pathological narrowing of the mind’s focus, called constriction, which takes the form of seeing only two choices; either something painfully unsatisfactory or cessation of life. (Shneidman, 1984, pp. 320–321)
Helping clients develop a thoughtful and practical plan for coping with and reducing psychological pain is a central component in suicide interventions. This plan can include relaxation, mindfulness, traditional meditation practices, cognitive restructuring, social outreach, and other strategies that increase self-soothing, decrease social isolation, and decrease the sense of being a social burden (Joiner, 2005).
Instead of the traditional approach of implementing no-suicide contracts, contemporary approaches emphasize obtaining a commitment to treatment statement from the client (Rudd et al., 2006). These treatment statements or plans go by various names including, “Commitment to Intervention,” “Crisis Response Plan,” “Safety Plan,” and “Safety Planning Intervention” (Jobes et al., 2008; Stanley & Brown, 2012); they’re more comprehensive and positive in that they describe activities that clients will do to address their depressive and suicidal symptoms, rather than focusing narrowly on what the client will not do (i.e., commit suicide). These plans also include ways for clients to access emergency support after hours (such as the national suicide prevention lifeline 1(800) 273-TALK or a similar emergency crisis number; Doreen Marshall, personal communication, September 30, 2012).
As a specific safety planning example, Stanley and Brown (2005) developed a brief treatment for suicidal clients, called the Safety Planning Intervention (SPI). This intervention was developed from evidence-based cognitive therapy principles and can be used in hospital emergency rooms as well as inpatient and outpatient settings (Brown et al., 2005). The SPI includes six treatment components:
Recognizing warning signs of an impending suicidal crisis
Employing internal coping strategies
Utilizing social contacts as a means of distraction from suicidal thoughts
Contacting family members or friends who may help to resolve the crisis
Contacting mental health professionals or agencies
Reducing the potential use of lethal means (Stanley & Brown, 2012, p. 257)
Stanley and Brown (2012) noted that the sixth treatment component, reducing lethal means, isn’t addressed until the other five safety plan components have been completed. Component six also may require assistance from family members or a friend, depending on the situation.
Identifying Alternatives to Suicide
Suicide is a possible alternative to life. Engaging in a debate about the acceptability of suicide or whether with clients with suicidal impulses “should” seek death by suicide can backfire. Sometimes suicidal individuals feel so disempowered that the threat or possibility to take their own life is perceived as one of their few sources of control. Consequently, our main job is to help identify methods for coping with suicidal impulses and to identify life alternatives that are more desirable than death by suicide—rather than taking away clients’ rights to consider death by suicide.
Suicidal clients often suffer from mental constriction and problem-solving deficits; they’re unable to identify options to suicide. As Shneidman (1980) suggested, clients need help to improve their mood, regain hope, take off their constricting mental blinders, and “widen” their view of life’s options.
Shneidman (1980) wrote of a situation where a pregnant suicidal teenager came to see him in a suicidal crisis. She said she had a gun in her purse. He conceded to her that suicide was an option, while pulling out paper and a pen to write down other life options. Together, they generated 8-10 alternatives to suicide. Even though Shneidman generated most of the options and she rejected them, he continued writing them down, noting they were only options. Eventually, he handed the list over to her and asked her to rank order her preferences. It was surprising to both of them that she selected death by suicide as her third preferred option. As a consequence, together they worked to implement options one and two and happily, she never needed to choose option three.
This is a practical approach that you can practice with your peers and implement with suicidal clients. Of course, there’s always the possibility that clients will decide suicide is the best choice (at which point you’ve obtained important assessment information). However, it is surprising how often suicidal clients, once they’ve experienced this intervention designed to address their mental constriction symptoms, discover other, more preferable options that involve embracing life.
Separating the Psychic Pain From the Self
Rosenberg (1999; 2000) described a helpful cognitive reframe intervention for use with suicidal clients. She wrote, “The therapist can help the client understand that what she or he really desires is to eradicate the feelings of intolerable pain rather than to eradicate the self” (p. 86). This technique can help suicidal clients because it provides much needed empathy for the clients’ psychic pain, while at the same time helping them see that their wish is for the pain to stop existing, not for the self to stop existing.
Similarly, Rosenberg (1999) recommended that therapists help clients reframe what’s usually meant by the phrase “feeling suicidal.” She noted that clients benefit from seeing their suicidal thoughts and impulses as a communication about their depth of feeling, rather than an “actual intent to take action” (p. 86). Once again, this approach to intervening with suicidal clients can decrease clients’ needs to act, partly because of the elegant cognitive reframe and partly because of the therapist’s empathic message.
Yesterday was Day One of my American Counseling Association conference experience and it has led me to notice that whenever I dish up my plate, it always seems there’s a little food that falls off the edges. My grandmother used to say my eyes were bigger than my stomach, but that’s silly because I’ve looked at my stomach; if my eyes really were bigger, I’d look like a brother from another planet. Obviously, this is a metaphor.
The point is that I always try to fit too much material into my presentations. Yesterday I presented a 6 hour “Learning Institute” titled, “Counseling Challenging Teenagers.” It was a very nice experience with about 20 participants who care enough about working with teenagers to show up in Cincinnati 2 days before the conference actually starts for a spendy workshop. I was impressed with the participants and the questions and the dedication to learning and serving teenagers. Very cool.
However, not surprisingly, because as Robert Frost would undoubtedly contend, my reach consistently exceeds my grasp, I didn’t quite fit every part of the workshop content into the workshop . . . which brings me to the purpose of this post . . . which is to describe my next two postings . . . which will be on alternative to suicide and neodissociation as a suicide intervention . . . which were the two parts of the workshop that exceeded my grasp.
Highlights of Day One: The man who drove 18 hours from Maryland to attend (and managed to mostly stay awake); the woman who helped with the workshop as a volunteer and then was super-giddy about getting me to take a photo of her with Bob Wubbolding (and then, I think to humor me, acted excited to include me in an additional photo with the two of them); finding a Starbucks, Panera Bread, and Chipotle within blocks of the Convention Center.
As I sit stranded in the Minneapolis airport on my way to the ACA conference in Cincinnati, I remembered that although this blog was posted on the ACA blogsite, I haven’t posted it here yet . . . and so here it is. Feels like it’s about time for a nap.
Why Big Boys Should Cry
By John Sommers-Flanagan
Aaron was asleep on the couch in my office. I decided not to wake him, even though I don’t advocate napping during counseling. But Aaron had just spent several minutes intensely sobbing and unable to speak and so a short nap seemed reasonable.
Experiencing calmness after an emotional storm can be therapeutic. This is partly because holding back strong emotions requires physical effort. When strong sad or painful feelings are present, the body seems to want to naturally express those feelings, as if to unload an extra burden. Holding onto emotions may cause a lump to form in your throat or stinging in your eyes. Letting sad or painful feelings come out can be a great relief.
Research shows that identifying and expressing feelings of sadness, fear, or emotional pain promotes health. This is true whether people write, talk, or nonverbally express emotional pain. The body, unburdened by the need to inhibit or suppress feelings, responds with improved immune functioning.
Generally, boys and men have more trouble acknowledging and expressing painful emotions than girls and women. Some people believe this difference partially explains why males are more violent than females. Others have suggested that inhibiting sad feelings contributes to the fact that, on average, males die younger than females. Most researchers and theorists agree that inhibiting sad, hurt, or fearful feelings is a health liability for boys and men.
It could be argued that biological differences cause males to have more trouble expressing painful feelings (perhaps higher testosterone levels interfere with emotional expression). However, it’s also obvious that boys are systematically taught to inhibit certain feelings. For example, one study showed that mothers—yes, even mothers—were less emotionally responsive to baby boys than baby girls. There also are many gender-based emotionally hardening edicts present in our society, summed up in the old expression: “Big boys don’t cry.” The message to boys is loud and clear: To be accepted, you need to walk, talk, and act like a man (which does NOT include crying because you’ve gotten your feelings hurt).
For boys and men, it’s socially acceptable to experience and express anger, instead of sadness, fear, or hurt feelings. Male teens I work with often brag that they DON’T cry—they just get angry or seek revenge. They’re thoroughly socialized and proud of it. In an interesting contrast, I’ve talked with men who tell me—with regret and not pride—that they haven’t cried for 20 (or more) years. They worry about their inability to cry and speak of it as a loss. The spigot, having been closed so many years ago, feels rusted shut. They want to cry, but don’t know how.
It’s sad that society does this to boys. But it’s especially sad when parents, sometimes inadvertently, other times intentionally, discourage boys from experiencing and expressing emotional pain. It’s also sad when boys are encouraged to be aggressive—instead of sensitive (because, as you know, boys not only will be boys, they mustbe real boys). Instead, parents need to be a safe haven for the full range of their son’s emotions.
The following suggestions may be helpful to parents who want their boys to learn that big boys should cry.
Don’t be afraid that if your son cries, he will turn out to be a sissy.
Let your sons cling to you—to both mother and father—for comfort and security. They’ll grow up and distance themselves from you on their own. There’s no need to push them away.
When your son looks distressed and you ask him how he’s doing, he’ll often respond by saying: “Fine.” If so, continue to be gently curious. Keep listening. Let him know you’re interested. For boys, the first few “Fine” responses are often a defense against their emotions.
Spend time with your sons. Do active things together. Boys often talk best when they’re hiking, biking, hunting, fishing . . . or cleaning the kitchen.
Never let there be any doubt in your son’s mind that you love him.
Because of society’s harsh condemnation, when boys or men cry, it can be a harrowing experience. Years ago, I worked with Michael, a Vietnam veteran. He was macho and angry. He told me of a 60 Minutes episode about how Vietnam vets were never welcomed home by American citizens. He was pissed about how his country had treated him.
At the end of the hour, I stood up, reached out, shook his hand, looked him in the eye, and said, “Welcome home Michael.” In response, his anger melted away, his eyes filled with tears, and he fell forward and gave me a short hug. Later, he told me he was ashamed of this embarrassing emotional outburst.
Everyone in our society needs to be open to loving and hugging our boys. We need to let them cry openly and without shame. No one should feel ashamed to experience natural feelings of hurt or sadness. Boys should be helped to accept and experience their feelings. They shouldn’t have to go to counseling to learn to cry again.
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John Sommers-Flanagan, Ph.D. is a counselor educator at The University of Montana. You can follow his personal blog at johnsommersflanagan.com
Children become adults by practicing. Some of this practicing involves having the right to make choices, even bad and painful choices. For parents who have not learned to back down, we offer the seven magic words. These are words derived from our study of choice theory (Glasser, 1998, 2002). The good news is that by using these words parents can share their thoughts, feelings, and wishes with their children in way that might help a rebellious child hear their viewpoint. The bad news is that after carefully expressing themselves, parents then acknowledge that ultimately, compliance is not mandatory. And there’s even more bad news: These words aren’t really magic and parents will need more than seven of them to make them work at all.
The seven magic words are a frame for direct, powerful, and noncontrolling communication. They are: “I want you. . . but it’s your choice.” These framing words allow parents to express whatever they want (we encourage positive words) while at the same time acknowledging their child’s power and right to self-determination. By explicitly acknowledging their children’s right to self-determination, parents may reduce their children’s need to prove their independence. Examples of the seven magic words in action include:
I want you to stay clean and sober at the party tonight because I love you, and I know if you get caught, you might end up kicked off the basketball team, and also, your dad and I can’t trust you with the car if we know you drink, but of course I know I can’t control you, so it’s your choice.
I want you to graduate from high school, go to college, have a great job, and get rich, but whether or not that happens is really up to you.
You know I want you to be healthy, eat well, and exercise, but whether you do that is your business. I’ll help you any way I can, but it’s your choice.
As you can see, the magic words are a frame for parents to express their own beliefs and convictions. This technique allows parents to directly express heartfelt feelings, and even describe the consequences they fear, but to then turn the choice back over to the child.
Some parents will be disappointed with the seven magic words. They wish for true magic and true control. Instead, this frame merely offers an opportunity to briefly and succinctly communicate personal and family values directly to children. In many families, one of these values is to acknowledge and honor the children’s individual freedom and ultimate rights to choose how to live their lives. Most parents want their children to learn how to make responsible, life-enhancing choices.
All too often, very bad and traumatic things happen in the world. Many of these terrible things find their way into the news. This can be shocking and depressing not only for the people who were directly affected, but also for the general public. We are often repeatedly exposed to words and images that can trigger emotional and behavioral reactions in adults and children. Below is a short list with brief descriptions of how adults can help children deal effectively with traumatic information from the news and other media sources.
TALKING WITH CHILDREN: CONVERSATIONS ABOUT REALITY
The first step in talking with children is always the opposite of talking. LISTEN. Listen for how children have been affected. Listen for what they’ve seen and heard. Listen for their fears and fantasies. Listen for their personal coping strategies and solutions.
It’s important to listen closely, but if you listen too hard for children to talk about trauma, you run the risk of making them think they SHOULD be traumatized. If this happens, then children often will start giving you what they think you want . . . they’ll start talking about trauma. Therefore, a big challenge for adults is to listen in a balanced way. Don’t spend too much time everyday encouraging children to talk about their deepest fears. If you do, it’s possible that everyone will get more and more scared — including you!
Perhaps the biggest deal when talking with kids about real tragic events, is being able to answer their questions. They may ask you terribly hard questions, like, “Will there be a plane crashing in our neighborhood?” or “Do you think a shooter might come to our school?” or “Will I be safe at home?” or “Teacher, are you scared?”
Children often ask very good and very hard questions. An important guideline for teachers, parents, and counselors is to stay balanced. This means you can admit to being scared — as long as you also admit to being strong. Some children can quickly pick up on false reassurance, which is one reason why I’m not in agreement with Dr. Joyce Brothers who suggested after 9/11 that it was a good time to lie to your children. Instead, I recommend acknowledgement that the world is not always a safe place, but that you’ll do everything you can to be strong and help keep the child or children safe.
With preschoolers, there are some conversational topics that are best to avoid. For example, there’s no need to go into graphic detail about specific injuries, etc. This is similar to the fact that very young children don’t need to know all the details about sexuality. It’s better to speak generally about violence and destruction. It’s also very important to protect your children from too much exposure to media coverage of violent events.
It’s also important to never forget about focusing on children’s strengths. Listening first provides you with a foundation for giving children feedback about their strengths. Be sure to listen for children’s strengths . . . and then reflect them back. You can also encourage children to tell you about their strengths – including both ways they’ve handled hard things in the past and ways they might handle hard things in the future.
PLAYING WITH CHILDREN: REENACTMENT, PRETEND PLAY, AND MASTERY
Younger children will typically play out or reenact their traumatic experiences. For preschoolers pretend play will be the dominant way they deal with the trauma of what they’ve seen and heard. Around 9/11 children were likely to build towers and have them knocked down. They also enacted play activities involving airplanes, police, terrorists (or other “evil/bad” people). If they’ve been exposed to images and heard about school shootings you might see some play activities involving guns and death and loss. For the most part, it’s best to just sit back and watch children as they enact these scenes. By allowing them un-directed play time and some nondirective commentary, you’ll be helping them take their first steps toward healing (more information on non-directive play is included on the “Special Time” tip sheet on this blogsite).
On the other hand, sometimes children get stuck in the same repeated play pattern. This more chronic form of play is referred to as post-traumatic play. When children seem genuinely stuck repeating pretend interactions through non-interactive play that provides no apparent gratification, you may need to interact with them in ways that help them get un-stuck. You might want to try these strategies: (a) have the child stand up and take some deep breaths before resuming play; or (b) interact with the child in a way that disrupts the pattern (for example, you might ask, “what would happen if . . . ?”).
Obviously, rigid post-traumatic play patterns indicate a need for professional assistance.
DRAWING WITH CHILDREN: CAPTURING THE FEAR ON PAPER
Children’s fears can seem big and intimidating. That’s true for people of any age. Maybe that’s why, for adults and older children, writing about specific fears and trauma can be so helpful. Somehow, writing things down on paper can help to put it in perspective.
Younger children aren’t able to use the written word effectively for personal journaling. That’s where drawing comes in. When children color, draw, paint, or sculpt their fears, the fears become more manageable.
STORYTELLING STRATEGIES
Storytelling is a very powerful tradition and technique for dealing with many human problems and challenges. Stories can be designed or obtained through published materials. In response to tragedy, it can be helpful for children to hear stories of bravery under difficult or perilous conditions.
If you choose to invent your own stories, be sure to create a story with a main character and a clear beginning, middle, and ending. If you’re comfortable with it, you can even have the children help invent characters and their own stories.
There are many ways to encourage children to make up stories of their own. The advantage of this is that you get to listen for the dynamics of the children’s story and so it provides some assessment information. As a counseling technique, it’s possible to use a pretend radio or television show. You can invite children to be guests on your “show” and interview them about their experience or have them share a story.
HELPING WITH TRANSITIONS:
Separation anxiety is a common reaction that children have to stressful news or situations. This means children may have trouble saying goodbye to their parents and being left at school or day care. In most cases, it’s best for parents, children, and staff to develop an individualized goodbye and hello routine for drop-offs and pick-ups. These routines will be less necessary as time goes by, but it’s good to have goodbye and hello rituals there when you need them. For example, having a hello and goodbye song, transitional objects, and other objects of comfort can ease the pain of separation.
HAVING FUN: USING DISTRACTION, HUMOR, AND PLAY TO MOVE PAST TRAUMA
Don’t forget, it’s easy to pay way too much attention to the traumatic news and ignore regular daily play routines. Don’t fall into this trap. It’s good to keep kids active and keep them having fun. It’s good to be prepared with some games, songs, or activities that you can rely on to engage children and help them forget about the bad news for a while.
LEARNING ACTIVITIES: MASTERY THROUGH EDUCATION, SAFETY, AND SERVICE
Not only does life go on after a trauma; it’s important for life to keep getting better. Ways to move forward include (a) continuing with educational, skill-building, and stress management activities, (b) promoting safety strategies and skills, and (c) involving children in basic service activities . . . possibly even service activities that include teaching other children strategies for coping with trauma or difficult situations.
GET HELP AS NEEDED
It’s a sign of strength to get help when it’s needed. You may notice specific reactions or experiences in children or yourself that indicate it’s time to for professional assistance. Some of the primary symptoms of trauma and vicarious trauma that can develop in these situations include the following:
Repetitive and intrusive thoughts and images.
Sleep problems: Insomnia, nightmares, and night terrors.
Separation Anxiety and clingy-ness.
Specific fears/phobias.
Hypervigilence.
Regression.
SELF CARE NOW AND INTO THE FUTURE
Remember to take good care of yourself so you can be of greater help for others. This could involve many different activities including vigorous exercise, maintaining healthy eating and sleeping routines, and scheduling time for social contact and social support.
This Tip Sheet was written by John Sommers-Flanagan, Ph.D., professor of Counselor Education at the University of Montana.
In theories class this past Monday Adler kicked Freud’s ass. This was, of course, metaphorical because Adler was radically anti-violent. Nevertheless, my Freud action figure ended up on the floor by the door where he had to lay there and listen to Adler’s repugnant (to Freud) ideas about how clients are affected by real (not fantasized) social dynamics or forces.
Below you can read a version of the Emotional Change Technique adapted from Tough Kids, Cool Counseling:
The Three-Step, Push-Button Emotional Change Technique
An early and prominent Adlerian therapist, Harold Mosak, originally developed and tested the push-button technique as a method for demonstrating to clients that thinking different thoughts can effectively change mood states (Mosak, 1985). The purpose of Mosak’s technique was to help clients experience an increased sense of control over their emotions, thereby facilitating a sense of encouragement or empowerment (Mosak, 2000, personal communication).
Mosak’s push-button technique can be easily adapted to work with young clients. When we implement this technique with younger clients, we are playful and call it an emotional change trick. When using this technique with teenagers, we describe it as a strategy for gaining more personal control over less desirable emotions. In essence, the three-step, push-button, emotional change technique is an emotional education technique; the primary goal is to teach clients that, rather than being at the mercy of their feelings, they may learn some strategies and techniques that provide them with increased personal control over their feelings.
The following example illustrates Adlerian emotional education principles and Mosak’s push-button technique expanded to three distinct steps.
Case example. Sam, a 13-year-old European American boy, was referred because of his tendency to become suddenly stubborn, rigid, and disagreeable when interacting with authority figures. Sam arrived for his appointment accompanied by his mother. It quickly became obvious that Sam and his mother were in conflict. Sam was sullen, antagonistic, and difficult to talk with for several minutes at the outset of the session. Consequently, the Three-Step, Push-Button Emotional Change Technique (TSPB) was initiated:
Preparation/Explanation.
JSF: I see you’re in a bad mood today. I have this . . . well, it’s kind of a magic trick and I thought maybe you’d be interested. Want to hear about it?
S: (Shrugs).
JSF: It’s a trick that helps people get themselves out of a bad mood if they want to. First, I need to tell you what I know about bad moods. Bad moods are weird because even though they don’t really feel good, lots of times people don’t want to get out of their bad mood and into a better mood. Do you know what I mean? It’s like you kind of want to stay in a bad mood; you don’t want anybody forcing you to change out of a bad mood.
S: (Nods in agreement.)
JSF: And you know what, I’ve noticed when I’m in a bad mood, I really hate it when someone comes up to me and says: “Cheer up!” or “Smile!”
S: Yeah, I hate that too.
JSF: And so you can be sure I’m not going to say that to you. In fact, sometimes the best thing to do is just really be in that bad mood—be those bad feelings. Sometimes it feels great to get right into the middle of those feelings and be them.
S: Uh, I’m not sure what you’re talking about.
JSF: Well, to get in control of your own feelings, it’s important to admit they’re there, to get to know them better. So, the first step of this emotional change trick is to express your bad feelings. See, by getting them out and expressing them, you’re in control. If you don’t express your feelings, especially icky ones, you could get stuck in a bad mood even longer than you want.
As you can see, preparation for the TSPB technique involves emotional validation of how it feels to be in a bad mood, information about bad moods and how people can resist changing their moods or even get stuck in them, hopeful information about how people can learn to change their moods, and more emotional validation about how it feels when people prematurely try to cheer someone up.
Step 1: Feel the feeling. Before moving clients away from their negative feelings, it’s appropriate—out of respect for the presence and meaning of emotions—to help them feel their feelings. This can be challenging because most young people have only very simplistic ideas about how to express negative feelings. Consequently, Step 1 of the TSPB technique involves helping youth identify various emotional expression techniques and then helping them to try these out. We recommend brainstorming with young clients about specific methods for expressing feelings. The client and counselor should work together (perhaps with a chalk/grease board or large drawing pad), generating a list of expressive strategies that might include:
scribbling on a note pad with a black marker
drawing an angry, ugly picture
punching or kicking a large pillow
jumping up and down really hard
writing a nasty note to someone (but not delivering it)
grimacing and making various angry faces into a mirror
using words, perhaps even yelling if appropriate, to express specific feelings.
The expressive procedures listed above are easier for young clients to learn and understand when counselors actively model affective expression or assist clients in their affective expression. It’s especially important to model emotional expression when clients are inhibited or unsure about how to express themselves. Again, we recommend engaging in affective expression jointly with clients. We’ve had particular success making facial grimaces into a mirror. (Young clients often become entertained when engaging in this task with their counselor.) The optimal time for shifting to Step 2 in the TSPB technique is when clients have just begun to show a slight change in affect. (Often this occurs as a result of the counselor joining the client in expressing anger or sadness or general nastiness.)
Note: If a young client is unresponsive to Step 1 of the TSPB technique, don’t move to Step 2. Instead, an alternative mood-changing strategy should be considered (e.g., perhaps food and mood or the personal note). Be careful to simply reflect what you see. “Seems like you aren’t feeling like expressing those yucky feelings right now. Hey, that’s okay. I can show you this trick some other day. Want some gum?”
Step 2: Think a new thought (or engage in a new behavior). This step focuses on Mosak’s pushbutton approach (Mosak, 1985). It’s designed to demonstrate to the client that emotions are linked to thoughts. Step 2 is illustrated in the following dialogue (an extension of the previous case example with John and Sam):
JSF: Did you know you can change your mood just by thinking different thoughts? When you think certain things it’s like pushing a button in your brain and the things you think start making you feel certain ways. Let’s try it. Tell me the funniest thing that happened to you this week.
S: Yesterday in math, my friend Todd farted (client smiles and laughs).
JSF: (Smiles and laughs back) Really! I bet people really laughed. In fact, I can see it makes you laugh just thinking about it. Way back when I was in school I had a friend who did that all the time.
The content of what young people consider funny may not seem particularly funny to adults. Nonetheless, it’s crucial to be interested and entertained—welcoming the challenge to empathically see the situation from the 13-year-old perspective. It’s also important to stay with and build on the mood shift, asking for additional humorous thoughts, favorite jokes, or recent events. With clients who respond well, counselors can pursue further experimentation with various affective states (e.g., “Tell me about a sad [or scary, or surprising] experience”).
In some cases, young clients may be unable to generate a funny story or a funny memory. This may be an indicator of depression, as depressed clients often report greater difficulty recalling positive or happy events (Weerasekera, Linder, Greenberg, & Watson, 2001). Consequently, it may be necessary for the counselor to generate a funny statement.
S: I can’t think of anything funny.
JSF: Really? Well, keep trying . . . I’ll try too (therapist and client sit together in silence for about 20 seconds, trying to come up with a positive thought or memory).
JSF: Got anything yet?
S: Nope.
JSF: Okay, I think I’ve got one. Actually, this is a joke. What do you call it when 100 rabbits standing in a row all take one step backwards?
S: Huh?
JSF: (repeats the question)
S: I don’t know. I hate rabbits.
JSF: Yeah. Well, you call it a receding hare line. Get it?
S: Like rabbits are called hares?
JSF: Yup. It’s mostly funny to old guys like me. (JSF holds up his own “hare line”)
S: That’s totally stupid, man (smiling despite himself). I’m gonna get a buzz cut pretty soon.
When you tell a joke or a funny story, it can help clients reciprocate with their own stories. You can also use teasing riddles, puns, and word games if you’re comfortable with them.
We have two additional comments for counselors who might choose to use a teasing riddle which the client may get wrong. First, you should use teasing riddles only when a strong therapeutic relationship is established; otherwise, your client may interpret teasing negatively. Second, because preteen and teen clients often love to tease, you must be prepared to be teased back (i.e., young clients may generate a teasing riddle in response to a your teasing riddle).
Finally, counselors need to be sensitive to young clients who are unable to generate a positive thought or story, even after having heard an example or two. If a young client is unable to generate a funny thought, it’s important for you to remain positive and encouraging. For example:
JSF: You know what. There are some days when I can’t think of any funny stories either. I’m sure you’ll be able to tell me something funny next time. Today I was able to think of some funny stuff . . . next time we can both give it a try again if you want.
Occasionally, young clients won’t be able to generate alternative thoughts or they won’t understand how the pushbutton technique works. In such cases, the counselor can focus more explicitly on changing mood through changing behaviors. This involves getting out a sheet of paper and mutually generating a list of actions that the client can take—when he or she feels like it—to improve mood.
Sometimes depressed young clients will need to borrow from your positive thoughts, affect, and ideas because they aren’t able to generate their own positive thoughts and feelings. If so, the TSPB technique should be discontinued for that particular session. The process of TSPB requires completion of each step before continuing on to the next step.
Step 3: Spread the good mood. Step 3 of this procedure involves teaching about the contagion quality of mood states. Teaching clients about contagious moods accomplishes two goals. First, it provides them with further general education about their emotional life. Second, if they complete the assignment associated with this activity, they may be able to have a positive effect on another person’s mood:
JSF: I want to tell you another interesting thing about moods. They’re contagious. Do you know what contagious means? It means that you can catch them from being around other people who are in bad moods or good moods. Like when you got here. I noticed your mom was in a pretty bad mood too. It made me wonder, did you catch the bad mood from her or did she catch it from you? Anyway, now you seem to be in a much better mood. And so I was wondering, do you think you can make your mom “catch” your good mood?
S: Oh yeah. I know my mom pretty well. All I have to do is tell her I love her and she’ll get all mushy and stuff.
JSF: So, do you love her?
S: Yeah, I guess so. She really bugs me sometimes though, you know what I mean?
JSF: I think so. Sometimes it’s especially easy for people who love each other to bug each other. And parents can be especially good at bugging their kids. Not on purpose, but they bug you anyway.
S: You can say that again. She’s a total bugging expert.
JSF: But you did say you love her, right?
S: Yeah.
JSF: So if you told her “I love you, Mom,” it would be the truth, right?
S: Yeah.
JSF: And you think that would put her in a better mood too, right?
S: No duh, man. She’d love it.
JSF: So, now that you’re in a better mood, maybe you should just tell her you love her and spread the good mood. You could even tell her something like: “Dude, Mom, you really bug me sometimes, but I love you.”
S: Okay. I could do that.
It’s obvious that Sam knows at least one way to have a positive influence on his mother’s mood, but he’s reluctant to use the “I love you” approach. In this situation it would be useful for Sam to explore alternative methods for having a positive effect on his mother’s mood.
Although some observers of this therapy interaction may think the counselor is just teaching Sam emotional manipulation techniques, we believe that viewpoint makes a strong negative assumption about Sam and his family. Our position is that successful families (and successful marriages) include liberal doses of positive interaction (Gottman et al., 1995). Consequently, unless we believe Sam is an exceptionally manipulative boy (i.e., he has a conduct disorder diagnosis), we feel fine about reminding him of ways to share positive (and truthful) feelings with his mother.
To spread a good mood requires a certain amount of empathic perspective taking. Often, youth are more able to generate empathic responses and to initiate positive interactions with their parents (or siblings, teachers, etc.) after they’ve achieved an improved mood state and a concomitant increased sense of self-control. This is consistent with social–psychological literature suggesting that positive moods increase the likelihood of prosocial or altruistic behavior (Isen, 1987). Because of developmental issues associated with being young, it’s sometimes helpful to introduce the idea of changing other people’s moods as a challenge (Church, 1994). “I wonder if you have the idea down well enough to actually try and change your mom’s mood.”
Once in a while, when using this technique, we’ve had the pleasure of witnessing some very surprised parents. One 12-year-old girl asked to go out in the waiting room to tell her grandmother that she was going to rake the lawn when they got home (something Grandma very much wanted and needed). Grandma looked positively stunned for minute, but then a huge smile spread across her face. The girl skipped around the office saying, “See. I can do it. I can change her mood.”
One 14-year-old boy thought a few minutes, then brought his mom into the office and said “Now Mom, I want you to think of how you would feel if I agree to clear the table and wash the dishes without you reminding me for a week.” Mom looked a bit surprised, but admitted she felt good at the thought, whereupon I (John) gave the boy a thumbs up signal and said, “Well done.”
Step 4.
At this point, readers should beware that although we’re describing a Three-Step technique, we’ve now moved to Step 4. We do this intentionally with young clients to make the point that whenever we’re working with or talking about emotions, surprising things can happen.
In keeping with the learn-do-teach model, we ask our young clients to teach the TSPB procedure to another person after they learn it in therapy. One girl successfully taught her younger brother the method when he was in a negative mood during a family hike. By teaching the technique to her brother, she achieved an especially empowering experience; she began to view herself as having increased control over her and her family’s emotional states.
If you’ve been given this homework assignment, you’re probably already using many good parenting techniques with your child. This assignment will help you refine your parenting approach to intentionally include even more ways of being positive with your child.
Imagine that a father is busy taking care of household chores while he’s parenting his 5-year-old daughter. She’s creating some excellent 5-year-old crayon art and approaches her daddy with a finished product and a beaming smile. Dad looks up and takes a break from his chores to admire his daughter’s artwork. He returns her grin and says one of the following:
“This is beautiful!” (An example of praise—a form of direct power)
“Thanks for showing me your drawing. You look very happy with your picture.” (An example of emotional mirroring or encouragement—a form of indirect power)
“You love doing artwork!” (An example of character feedback—another form of indirect power)
“How did you manage to create this beautiful drawing?” (An example of a solution-focused question—a form of problem-solving power)
If you can increase your awareness of these different strategies, you’ll feel more capable of being intentional and positive when interacting with your children. The result usually includes fewer power struggles and more positive parent–child relationship dynamics.
Using Praise
Using praise is simple. For example, praise includes statements like: “Great work,” “I’m proud of you,” and “Look at what a good job you’ve done cleaning the bathroom!” When you use praise, you are clearly communicating your expectations and your approval to your child.
Think about how much praise you use with your children. Are you being clear enough with them about what you want and are you letting them know when they’ve done well? As a part of this homework assignment, consider increasing how much you praise your child and then see how your child reacts.
Using Mirroring
Sometimes children don’t have a clear sense of how their behaviors look to others (which can also be true for adults). The purpose of mirroring is to help children see themselves through your eyes. After seeing (or hearing) their reflection, your child becomes more aware of his or her behavior and may choose to make changes.
For now, we recommend that you practice using mirroring only to reflect your child’s positive behaviors. For example, if your daughter has a play date and shares her toys with her friend, you could say, “I noticed you were sharing your toys.” Or if your son got home on time instead of breaking his curfew, you might say, “I noticed you were on time last night.” The hard part about using mirroring is to stay neutral, but staying neutral is important because mirroring allows your children to be the judge of their own behaviors. If you want to be the judge, you can use praise.
Using Character Feedback
Character feedback works well for helping your children see themselves as having positive character traits. For example, you might say, “You’re very honest with us,” or “You can really focus on and get your homework done quickly when you want to,” or “You’re very smart.”
Usually, as parents, instead of using character feedback to focus on our children’s positive qualities, we use it in a very negative way. Examples include: “Can’t you keep your hands to yourself?” “You’re always such a big baby,” and “You never do your homework.”
For your homework assignment, try using character feedback to comment on your children’s positive behaviors, while ignoring the negative. You can even use character feedback to encourage a new behavior—all you have to do is wait for a tiny sign of the new behavior to occur and then make a positive character feedback statement: “You’re really starting to pay attention to keeping your room clean.”
Using Solution-Focused Questions
Problem-focused questions include: “What’s wrong with you?” and “What were you thinking when you hit that other boy at school?” In contrast, solution-focused questions encourage children to focus on what they’re doing well. For example, “How did you manage to get that puzzle together?” “What were you thinking when you decided to share your toy with your friend?” and “What did you do to get yourself home on time?”
Solution-focused questions require us to look for the positive. For practice, try asking your child questions designed to get him or her to think about successes instead of failures. After all, it’s the successes that you want to see repeated. Of course, when you ask these questions, don’t expect your child to answer them well. Instead, your child will most likely say, “Huh? I don’t know.” The point is that you’re focusing on the positive and eventually these questions get your children to focus on the positive as well.
This case and the discussion that follows is excerpted from “How to Listen so Parents will Talk.”
Father: I’m a single dad and so I have the job of two parents. It’s hard, but it’s especially hard because I’m a worrier. My girls don’t have a mom around and so I get obsessed about their self-esteem. What can I do to boost their self-esteem?
Consultant: That’s a great question . . . and a big question. But before we talk about the answer, tell me, what sorts of things are you doing now to build their self-esteem?
Father: I compliment them as much as I can. I praise them. I constantly say “I love you.”
Consultant: Can you give me an example of how you compliment them?
Father: Like last night. The girls were coloring and they kept showing me their pictures and I would say, “That’s beautiful!” and “That’s wonderful!” and “You two are great artists.” Stuff like that.
Consultant: I should say first that I think it’s wonderful that you’re so positive with your daughters. I wish more parents were positive like you.
Father: Thanks, but, uh, what else can I do?
Consultant: You’re great at using praise and compliments and that’s really important, but I’ve got other ideas about how to expand your self-esteem-building repertoire. Can I share a few?
Father: Go for it.
Consultant: Let’s take the coloring and picture-drawing example. You’re giving out praise and compliments, which is very important. But praise and compliments are what we call “external” or “outside-in” strategies. They build your daughters’ self-esteem from the outside in. You’re the outside expert and you tell them they’re great. There are three other things you could add to that. I’ll describe these three options now, but I have a tip sheet that describes them, too.
First, instead of praising and complimenting, sometimes you could use a technique called “mirroring.” Mirroring is more of an “inside-out” technique for building self-esteem. To use mirroring, you should watch your children and mirror their positive feelings back to them. For example, you could say, “You look really happy about your drawing,” or you could ask a question: “What do you like best about your drawing?” By using these mirroring responses, you’re encouraging your children to judge their own drawings. That’s why we call it an inside-out approach, because it draws out your children’s internal feelings and judgments.
Father: Okay. I think I get that, but what if one of my daughters doesn’t like her drawing—or, even worse, what if she says ‘I hate my drawing’?
Consultant: Good questions. You’re so good at praise, your daughters may be depending on you for their compliments. If one daughter can’t think of anything positive, that’s okay. No need to get worried. We all sometimes produce things we don’t like. But you might try several things. You could just reflect back her feelings and see what happens by saying, “I guess you don’t like this drawing so much.” Or you could push her to identify to positives and negatives with a comment like, “Well, I see something about it I like, but I don’t want to go first. So, first you tell me what you like and then I’ll say what I like.” Or, you could help her focus on her next drawing with empathy and encouragement by saying, “Hmmm. You don’t seem too happy with this drawing. Maybe you’ll like your next one better.” The thing that’s important to remember is that false praise or too much praise doesn’t help your children build self-esteem from the inside out. Pretty soon, they’ll recognize that you always say something positive and they might start wondering if you really mean it.
Father: Okay. I get it.
Consultant: That’s mirroring. The key is to draw out or reflect your child’s judgments. It’s even okay to mirror back if she doesn’t like her drawing. This is part of respecting her judgment. If she doesn’t like the drawing, that’s okay, just reflect that back. You can even move a little bit away from mirroring and if you really like her drawing you can disagree with her and say something like, “I see you don’t like your drawing, but here’s what I like about it.”
Father: All right.
Consultant: The next method after praise and mirroring is character feedback. Character feedback is when you say something like, “You’re the kind of girl who loves to draw.” What you’re doing with this method is you’re making a positive behavior into a character trait. Try that out. Think of a character trait that one of your daughters has and put it into the sentence, “You’re the kind of girl who . . .”
Father: My older daughter likes to keep all her school stuff organized. So would I say, “You’re a girl who’s organized”?
Consultant: Sure. Almost anyway you say it is fine. What you’re doing is helping her build positive character traits so she begins seeing herself as an organized person.
Father: How about my other daughter? She’s very disorganized. Do I tell her, “You’re a disorganized girl”? That doesn’t seem like a good idea.
Consultant: Exactly. When we use character feedback, we almost always use it for positive character traits. With your less organized daughter, you might wait for a time when she displays even a tiny bit of organizational skill and then say, “I notice you can really get organized when you want to.” For character feedback, just think of yourself as a mirror that reflects positive behaviors and forms them into character traits. What’s interesting about this is that most parents, including me, tend to watch for our children’s weaknesses and negative qualities and comment on them. For example, lots of parents and teachers see children misbehaving and can’t resist making comments like, “What’s wrong with you? Can’t you keep your hands to yourself?” or “You’re lying again, aren’t you? You need to get over that lying problem.” Basically, when we repeatedly comment on our children’s negative behaviors we help them construct a more negative character. They end up thinking, “I’m the kind of kid who just keeps getting into trouble.” The magic of character feedback is that we can use it to intentionally construct positive character traits. I know it’s manipulative, but it’s being manipulative in a positive way.
Father: That’s interesting. I do have trouble not commenting when my daughters misbehave. Should I ignore misbehavior?
Consultant: Not always. We should just focus most of our attention on our children’s positive behaviors and only a little of our attention on the negative behaviors. Sometimes our children need corrective feedback or input. But if we focus too much on the negative, the negative will tend to grow, because it’s getting so much attention.
Father: Okay. I think I get that. You said you have a handout on this, right?
Consultant: Right. And there’s one last method. The last method is called solution-focused questioning. Here’s an example with your less organized daughter. Let’s say she shows a flash of organizational skill. Then, you could ask something like, “Wow. How did you manage to get your school work all organized?” Be careful to be curious and impressed, but not too surprised. You know how some parents will say things like, “Who are you and what have you done with my child?” as a joke. Well, that’s a funny joke, but it plays on the fact that the child is acting in an unusual way. What we want to communicate is that it’s normal for your daughter to be organized when she wants to and so you’re showing curiosity about how she manages to get organized. Solution-focused questions with children almost always ask them to reflect on how they accomplished something positive. For example, you could say: “How did you manage to be honest and tell the truth in that hard situation?” or “How did you figure out how to get that puzzle together?”
Father: Okay. This one is about focusing on solutions.
Consultant: Right. Let’s try one. What’s something one of your daughters did well this past week?
Father: My organized daughter had a terrible tantrum and then apologized to me.
Consultant: That’s great. What would be a solution-focused question?
Father: Um, how about this? “What were you thinking when you decided to apologize?”
Consultant: Yeah. That’s pretty good. But that might feel like you’re investigating or analyzing her thoughts. I might change it a little and throw in a positive character trait, like, “How did you find the courage to come and apologize to me?” That sends her a message that it takes courage to apologize and as long as you agree with that, it might be a nice way to combine a solution-focused question and a little character feedback.
Father: I like that.
Consultant: I should also say that often when we ask solution-focused questions of children they just shrug their shoulders and say, “I don’t know,” which is perfectly fine. The point is that hopefully we’re building into them a tendency to reflect on how they managed to do something that was positive or successful.
Father: Right. I can imagine my daughter saying “I don’t know.”
Consultant: Now, I know we’ve covered a whole lot of ground in the last few minutes, but parenting can be complicated sometimes.
Father: You’re telling me? I’ve got two daughters and pretty soon they’ll be attracting boys and that will be even worse.
Consultant: Yeah. I guess I don’t need to tell you that parenting is complicated, but what I want to say is that I’ve got this tip sheet for you on praise, mirroring, character feedback, and solution-focused questions and you can take it and just try out the ideas we talked about today that are in this tip sheet. Just practice away and see what happens and we can talk about it more next week.
In this case we see the consultant squeezing lots of nuanced parenting information into a brief time period. This is a very educational approach and most likely to work after the practitioner has established a positive working relationship with parents who are in the action stage of Prochaska and DiClemente’s (2005) transtheoretical model. Even in the action stage, most parents can’t absorb all this information at once, which is why tip sheets and homework assignments can be so important.
Although the methods illustrated (praise, mirroring, character feedback, and solution-focused questions) are fairly complex, most parents intuitively understand the differences. These methods are only partly designed to improve parent–child relationships; they’re also good behavior management and self-efficacy-building techniques and so they can be used with parents who are being either too negative or too positive with their children.
The Beauty and Power of Natural and Logical Consequences
Life is not easy and children (and adults) learn through struggles, failures, and disappointments. Your goal, as a parent, is to create a reasonable, consistent, and loving home and then let your child struggle with the demands of life. These demands include very basic things like:
Not getting to watch television after a certain time
Participating in housecleaning
Not getting attention 100 percent of the day
Having to get ready and get to school on time
Having to wait your turn to get served dessert or to play with an especially fun toy
Not getting to eat your favorite food for every meal
Having to tie your own shoes
As you might gather from the preceding list, even little things in life can be hard for a growing child; but to learn, children need to directly experience frustration and disappointment.
Natural or logical consequences are a necessary part of learning. They help your child get better at surviving disappointments in the world and in your family home. Natural and logical consequences are always related in some way to the misbehavior and are not given out with anger or as “punishment.”
Here are some examples:
1. Your children leave toys in a public area of the house, even though they’ve been told to put toys away when done playing. Logical consequence: Use a “Saturday box” or put the toys in timeout. This involves picking up the toys and putting them in a box and storing them away until the next Saturday (or whatever day), when they’re given back. This logical consequence avoids the overreaction (“If you don’t put your toys away, then I’ll give them away to someone else”) and the attention-giving lecture (“Let me tell you about when I was a child and what would happen if I left my toys out . . .”) and instead provides children with a clear, consistent, and reasonable consequence.
2. Your children argue with you about a consequence or about you being unfair. Logical consequence: You let your children know, “I don’t feel like arguing about this” and leave the area. You may want to go to the bathroom to take time away to further develop your planned response. While remaining friendly, another important message to give is, “I know you’d like things your way, but we have rules and consequences for everyone in our family.” Of course this may trigger another argument and you can walk away again and tell your children, “I know you can figure this out and not have this consequence next time.”
3. You cook dinner, but your children don’t show up on time. Reasonable rules and logical consequences: If you cook dinner, everyone needs to show up on time and be respectful about the dinner-eating process. That doesn’t mean everyone has to eat every bite or provide you with lavish praise for your most excellent meal, but respectful attendance is a reasonable expectation. If your child is late for dinner, one reminder is enough. No drama or excess attention is needed. Just sit down and start eating and enjoying the mealtime process. Possible logical and natural consequences include: (1) Your child prepares the next meal; (2) you put away foods after you dish yourself up and so the child has to get them out and serve himself; (3) you got there early and prepared the food and so your child gets to stay afterward and clean up; (4) no special rewards (e.g., eating dinner in front of the television); instead, your child eats alone at the table.
To do logical and natural consequences, it’s helpful to work on the following:
1. Take the “punishing” quality out of your voice and the interactions. This is not about punishment; it’s about what’s logical, reasonable, and natural. You can even be friendly and positive.
2. Prepare in advance. Because you’ll be emotional when your children are noncompliant, it’s critical that you have a list of logical and reasonable and natural consequence ideas in your head. Otherwise, you will overreact. Going to parenting classes or talking with other parents can help you identify a wider range of reasonable consequences.
3. Use small consequences. Your purpose is to teach your child. Your purpose is not to hurt or humiliate. Learning occurs best if children are not emotionally overwhelmed by large consequences. Small consequences provide plenty of feedback.
4. Use mirroring and encouragement. Reflect back to your children what they’re feeling (“It’s very upsetting that you can’t play with your toys for the rest of the week”). Let your child know that you think things will go better the next time around (“I know, if you want to, you’ll be able to remember to put your toys away next time”).
5. Don’t lecture or shame. Let the small consequence do its work.
The natural and logical consequences (for Leah and Tommy) of growing up in Absarokee, MT.
Choice Theory Communication Skills Training: How to Provide Information and Then Back Off, Instead of Trying Too Hard to Control Your Child’s Decision Making
As a loving parent, if you’re concerned about your children’s behaviors, you’ll probably have a strong and nearly irresistible impulse to tell them how to live their lives. After all, you’re the adult and they should listen to your excellent advice. You may feel the urge to say:
You need to clean your room now because being disorganized and undisciplined is a bad habit that will make your life miserable.
Alcohol and drugs are illegal and so if you go out and behave illegally, I’ll call the police and have you ticketed.
You need to start caring about your grades at school and that means scheduling time for homework and studying for tests.
Swearing is unacceptable in this house and if you do it again, I’ll wash your mouth out with soap.
Unfortunately, as you may recall from your own childhood, when parents are bossy and insistent about how things should be, children often become more stubborn and resistant. Then parents begin to nag and lecture and the pattern of advice-giving and advice-rejection deepens. This assignment is designed to help you communicate important information to your children without starting an all-out power struggle or negative nagging pattern. The following suggestions are appropriate only if the situation isn’t dangerous and you don’t need to jump in and directly and forcefully protect your children:
1. Ask permission. If you have a strong opinion that you’d like your child to hear, try asking permission to share it. Say something like, “Can I share my opinion on this with you?” Then, either your child will say “yes” and you can share your opinion or she’ll say “no” and then you’ll need to accept her boundary (in response to a “no,” you might say, “Okay. Thanks for being honest with me. Let me know if you change your mind” and then walk away).
2. Express your intention not to express your opinion. You could try telling your child, “I have an opinion on this, but I trust that you can work it out, or that you’ll ask me for help if you need it. So I’m going to try to keep my mouth shut for now.” This gives your child the message that you’re trying to respect his ability to work out his own problems. You can also add humor into this or other power-sharing techniques by adding: “You should really appreciate this, because you know how hard it is for me to keep my mouth shut and not give you advice.”
3. Provide your information or opinion and then back off. If you can’t resist giving your opinion, just do it and then back off and let your child consider your input. The key to this strategy is patience. Undoubtedly, you’ll provide excellent advice and then your child will look like she’s not considering your advice and so you’ll have the urge to repeat your advice over and over until you see action. Instead of falling into this pattern, try saying, “Look. I’ve got an opinion, which you probably already know. But instead of staying quiet, I’m just going to say it and then let you make your own decision on how to handle your situation. It’s your life. You have to make your own decisions. But I love you and can’t stop myself from telling you what I think, so here it is.”
As you probably already know, if you express your opinion you may get a strong emotional response (e.g., “I’m fifteen years old and I can make my own decisions!”). Although this seems weird, if you give lots of advice, your children may see your ideas and opinions as evidence that you don’t believe they’re competent to make their own decisions. This is why you should always express your advice with love and concern; avoid sounding as if your main goal is to control your child’s behavior.
Finally, if the situation is dangerous or potentially so, skip the less direct parenting recommendations listed above and instead think strategically about how to deliver direct advice that will be heeded. You’ll probably need to use a more direct approach than is described here, and you may need to consult with a professional.
John Sommers-Flanagan 