Category Archives: Therapy with Adolescents

Getting Your Buttons Pushed by Teenage Clients

The following material is adapted from Tough Kids, Cool Counseling.

Although we generally suggest not taking your client’s degrading comments personally, in the real world, we all get our buttons pushed sometimes. A graphic example of a therapist over-reacting to provocative client behavior was captured in the feature film, Good Will Hunting (Van Sant, 1997). 

You may recall the scene. The main character, Will, played by Matt Damon, is an extremely intelligent but emotionally disturbed young man with mathematical genius. His would-be mentor, in an effort to help Will fulfill his potential, sends him to several different counselors, none of whom are able to help Will. Finally, Will ends up in the office of Sean McGuire, played by Robin Williams.

During his initial session with McGuire, Will is his provocative and nasty self. He begins insulting McGuire’s deceased wife which “activates” McGuire’s emotional buttons. The result: McGuire grabs Will around the neck and slams him up against the wall. Of course, McGuire also decides to take on Will as a client and eventually (and rather magically) he successfully helps Will move forward in his life.

We’d like to emphasize two key points related to this excellent example of resistance and countertransference from Good Will Hunting. First, be aware of your emotional buttons. If you’re getting your buttons pushed, seek support and counseling for yourself. Second, no matter how provocative your young clients may act, avoid using Robin Williams’s “Choking the client” technique.  It may play well in Hollywood, but physical contact with resistant, aggressive, and/or angry clients is highly ill-advised. If you think rationally about the “Will Hunting” character and the fact that he had a history of physical trauma, touching him in an aggressive way would be ESPECIALLY contraindicated.

 If you’re having your emotional buttons pushed occasionally by teenage clients or students, consider yourself normal. On the other hand, if the button pushing begins to cause you to contemplate acting on destructive impulses, it’s time to get therapy for yourself, and/or support from a collegial supervision group. Many psychoanalytically-oriented writers have warned about the powerful regressive countransference impulses that young clients can ignite in their counselors (Dass-Brailsford, 2003; Horne, 2001). 

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Flaws in the Satanic Golden Rule

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Nearly always I learn tons of good stuff from my adolescent clients. A few years ago I learned what “Macking” meant. When I asked my 16-year-old Latino client if it meant having sex (I gently employed a slang word while posing my question), his head shot up and he made eye contact with me for the first time ever and quickly corrected me with a look of shock and disgust. “Macking means . . . like flirting,” he said. And as he continued shaking his head, he said, “Geeze. You’re crazy man.”

The next half hour of counseling was our best half hour ever.

I’m not advocating using the F-word or being an obtuse adult . . . just pointing out how much there is to learn from teenagers.

More recently I learned about the Satanic Golden Rule. A 17-year-old girl told me that it goes like this: “Do unto others as they did unto you.”

Now that’s pretty darn interesting.

Ever since learning about the Satanic Golden Rule I’ve been able to use it productively when counseling teenagers. The Satanic Golden Rule is all about the immensely tempting revenge impulse we all sometimes feel and experience. It’s easy (and often gratifying) to give in to the powerful temptation to strike back at others whom you think have offended you. Whether it’s a gloomy and nasty grocery cashier or someone who’s consistently arrogant and self-righteous, it’s harder to take the high road and to treat others in ways we would like to be treated than it is to stoop to their level to give them a taste of their own medicine.

There are many flaws with the Satanic Golden Rule . . . but my favorite and the most useful for making a good point in counseling is the fact that, by definition, if you practice the Satanic Golden Rule, you’re giving your personal control over to other people. It’s like letting someone else steer your emotional ship. And to most my teenage clients this is a very aversive idea.

After talking about the Satanic Golden Rule many teenage clients are more interested in talking about how they can become leaders. . . leaders who are in control of their own emotions and who proactively treat others with respect.

An excellent side effect of all this is that it also inspires me to try harder to be proactively respectful, which helps me be and become a better captain of my own emotional ship.

Serious Advice for Parents of Teens

When Parenting Teenagers — Age Matters

Most parents easily recognize that when it comes to parenting, age matters a great deal.  If you’re not convinced, try giving your teen a nice, cuddly hug, preferably in public.  Not surprisingly, what’s fun and rewarding for one age group, is stupid, incomprehensible, or embarrassing for another.

Teens can be especially challenging for parents. Forgive the blunt language, but the truth is:  Teens often think adults in general, and their parents in particular, don’t know squat.  When I recently shared this well-known fact with a teenager, she gently corrected me by saying, “I think what you mean to say is that adults only know squat.”  I just rolled my eyes and said, “Whatever.”

In contrast to some of my teenage friends, I happen to believe that adults usually do have their squat together.  Therefore, I’ve written a short guide (with attitude) for anyone who has the daunting task of communicating with teenagers.

Principle 1: Always remember, on average, adults are usually smarter and wiser than teenagers.  This fact comes with a certain responsibility.  It means we should strive to really act like we’re smarter and wiser than teenagers.  This means, unfortunately, we have to act mature.  Sometimes we have to go the extra mile when trying to understand today’s youth.  It also means quickly forgiving them when their brains seem to malfunction.

Think about what it means to be more mature – and maybe even wiser – than your teenager.  Think of how to demonstrate your adult maturity in a way that your teen will respect.  Be concrete and specific.  For example, don’t think: “I’ll show my wisdom and maturity by trying to be more patient when he talks on and on about skateboarding.”  Instead, think something like: “I’ll make a point of asking him about his skateboarding at least twice a week. Then, if he’s up for talking, I’ll pay attention to him for at least 5 minutes before I change the subject or get distracted with something else.”

Principle 2: Many teenagers have a special invisible antenna that sticks out from the top of their head. Don’t bother looking for this antenna because it’s invisible.  It’s a “Respect Antenna.”  It functions to instantly ascertain whether a given adult likes or respects a given teen.  Consequently, although teens may act like they’re not paying any attention to you, they’ll still be able to psychically determine whether or not you like and respect them.  And if their invisible antennae signals that you don’t like or respect them, they’ll treat you miserably. Oh yeah. One more thing about this: Like everyone else, the teenager invisible respect antenna regularly malfunctions.

Principle 3: Many teens have dysfunctional eye rolls that appear completely beyond their voluntary control.  For some unknown reason, these eye rolls are triggered when adult authority figures make serious comments.  If you notice teens having this eye roll problem try your best to treat them with the sympathy they deserve.  This means you should smile while looking deeply into their eyes with every ounce of kindness left in your heart. You may think your teen is being disrespectful, but really she or he really needs your sympathy for this problem.

Principle 4: Teenagers are insecure.  Often, they cover their insecurity with a thin veneer of self-confidence and bravado.  This veneer has the effect of making adults assume that young people are confident or overconfident. Such an assumption can cause adults to back off and not offer help, when sometimes, help is exactly what your teen needs.

Principle 5: Young people are very good at tuning out adults while following the sometimes incredibly bad advice of their peers.  The best weapon we have against this sad trend is to sit and listen to young people as they talk about their lives, while, at the same time, resisting the impulse to give them our sage advice.  After listening for a considerable length of time, it can be effective to dress up one of your good ideas as one of their bad ideas and pretend that they came up with it.  If this subtle technique for influencing young people gathers no moss, then you may be forced back into the Dr. Science approach.  The Dr. Science approach essentially involves informing the youth that you know more than they do and therefore they MUST abide by your wishes.  This approach is usually effective only if you have way more money and way more valuable property than the young person.

Principle 6: Scientific research has clearly shown that, down deep, young people really want positive relationships with adults. . . AND that they greatly profit from such relationships.  Try to ignore the fact that adults conceived and conducted this research.  Instead, just go right on doing your best to develop positive relationships with as many teenagers as possible and go right on assuming they want those relationships.

Principle 7: In the end, you’ll find that communicating with teenagers is a lot like baseball.  In professional baseball, if you get a base hit 3 out of 10 times you go to the plate, you have a great chance of getting voted onto the All Star team.  The same is true for communicating with teens.  If you’re a lifetime .300 hitter, your child will probably eventually vote for your induction into the parental Hall of Fame!

If you want additional information about how to communicate more effectively with teens, we recommend parent education classes. You might discover several things: (a) there are other parents out there, besides you, who are struggling and want a better relationship with their teens; (b) many parents (and maybe even the class leaders) will have great ideas about how to improve your teen communication skills; and (c) by meeting with parents and talking opening about our challenges, we’re conspiring to prove that we’re indeed wiser than our teenagers.

[This blog is adapted from an old newspaper article in the Missoulian and from “The Last Best Divorce Workbook” (written by John and Rita Sommers-Flanagan and published by Families First Missoula, 2005)]

Thoughts on Sharing Parental Power

The following parenting strategy is an excerpt adapted from “How to Listen so Parents will Talk and Talk so Parents will Listen” (http://www.amazon.com/How-Listen-Parents-Will-Talk/dp/1118012968/ref=sr_1_1?ie=UTF8&qid=1328919870&sr=8-1). As with all techniques, this is just a tool and it may or may not fit with your personal family situation.

Give Information—Then Back Off

Most parents, at least initially, feel drawn toward actively and directly teaching life lessons to children. After all, as adults, we have far more accumulated wisdom than children and therefore it makes perfect sense to tell them what decisions they should make and warn them of potential life dangers. Many parents also use direct power strategies of lecturing, criticism, praise, and advice-giving to teach their children important life lessons. Unfortunately, life lessons based on direct power are often ineffective.  This is likely true because, as Carl Rogers might say, children are more interested in learning about life based on their own experiences rather than learning indirectly from parental lectures.

Praise, punishment, lectures, advice, and criticism are external means of influence (Glasser, 2002). When talking with parents, we usually emphasize that praise and punishment strategies involve “outside-in” or external learning. Punishment is a message from the outside that tells children they’ve done something wrong; praise is a message from the outside that tells children they’ve done something right.

All learning is partially outside-in and partially inside-out. Children can learn from what others say (often through praise and punishment) and they can learn from their own judgments of their own direct experiences. Generally, children’s developmental issues (e.g., individuation, identity formation) make it desirable for parents to intentionally use inside-out learning strategies with their children, at least some of the time.

Inside-out learning emphasizes personal experience and judgment rather than judgments imposed by others. Most parents agree that, although they want their children to be open and sensitive to others’ opinions, they want their children to have an internal sense of direction and integrity even more. Unfortunately, using direct power to tell children what to think often backfires.  Some children oppose their parents simply for the sake of opposing their parents. In these cases, children seem to gain a sense of identity through opposition or rebellion instead of learning to personally reflect on their experiences and then consciously choose their own behaviors.

Troy’s Three Choices

Troy, a teenage boy, came for counseling. Troy was in conflict with his parents about his relationship with his girlfriend. His parents were concerned and had made it clear that they disapproved of the girlfriend and of his relationship with her. This communication left Troy feeling deprived of his personal choice and so he stubbornly clung to his relationship despite the fact that he also had doubts about whether the relationship was a good fit for him. As we worked in counseling, it became clear that Troy had three general choices: (1) He could comply with his parents’ wishes and discontinue the relationship; (2) he could oppose his parents and insist on his right to have this relationship; or (3) he could think about his parents’ opinions as information and then step back and critically evaluate the relationship himself and decide what he thought was best. We discussed the most challenging outcome of all: that he might end up agreeing with his parents and terminate the relationship and then they (and he) might think they had “won” the power struggle.

As a result of our discussions, Troy decided he wanted a joint meeting with his parents. During the meeting he effectively communicated to them that they had made their position and their concerns very clear. He then emphatically asked them to back off so he could decide how to proceed with his relationship. In the end, Troy broke off the relationship and thanked his parents for giving him the space and time to make his own decision.

This case illustrates the give information and then back off technique. The parents communicated their concerns directly. Although they were initially overbearing about what their son should do, eventually, with encouragement, they backed away and gave their son time to independently consider the issues. In essence, by backing off after expressing their concerns, they also communicated trust in their son’s ability to make a reasonable decision. One problem underlying this situation is the fact that after expressing concerns, it’s often difficult for parents to keep their mouths shut and let their children make their own decisions on their own timeline rather than the parents’ timeline.

Asking Permission

Troy’s parents might have been even more influential if they had started the process by asking Troy if they could share their opinion with him. For example, they might have asked: “Would you like to hear our thoughts on how your relationship seems to be going?”

By asking for Troy’s permission, a new power dynamic is intentionally established. The new dynamic includes some of the following characteristics:

  • The parents give a signal to Troy that they have important information they’d like to share with him, but they’re giving this signal before they provide the information.
  • Asking permission gives Troy a sense of empowerment. He may choose to (a) receive the information, or (b) reject the information. He’s less likely to feel as though his parents are shoving the information down his throat.
  • Even if Troy initially rejects the information by saying “I don’t want to hear what you think” or “I know what you’re going to say,” he can still change his mind and ask for the information later.
  • If the parents approach Troy with an attitude of concern, he may feel cared for, which is always a good thing in a parent–child relationship.
  • If the parents can respect Troy’s right to reject the information, paradoxically, he may become more open to hearing their opinion later.
  • Overall, by asking permission, the parents are at least expressing partial faith or trust in Troy and his problem-solving ability.

Exceptions

There are exceptions to every rule. This particular problem-solving technique provides an excellent foundation for exploring exceptions to all indirect and problem-solving strategies. Because these approaches intentionally and explicitly give away parental power, they should be used only when parents feel at least somewhat comfortable trusting their children with the problem-solving process. For example, if Troy’s girlfriend is obviously abusing drugs and pulling Troy toward a destructive lifestyle, it may be necessary for the parents to insist on more extreme and directive steps. These steps might include:

  • Family therapy
  • A drug/alcohol intervention
  • More intensive supervision of Troy’s behaviors
  • Severe limitations regarding Troy’s freedom outside the home contingent upon specific communication and “checking-in” standards
  • Involvement with law enforcement (if appropriate and/or warranted)

Although not exhaustive, the preceding list provides a sense of how the nature of the parent–child relationship and the parents’ trust in their child’s judgment interact with the level of directiveness.  More directive, limit-setting, and monitoring parenting approaches may be necessary, depending on the severity of the situation.

Good Ideas about Multicultural Counseling and Psychotherapy – Part II

Three More Ideas About Multicultural Counseling

4.  Developing your Self-Awareness is Central

Both the American Counseling Association and the American Psychological Association place self-awareness of the therapist as a central factor in developing multicultural competency. This is a great, but tricky idea. It’s tricky because of the nature of awareness is such that it’s all too easy for us to remain unaware to very significant multicultural issues. If you’re interested in exploring your multicultural awareness further, you should check out the Implicit Association Test at: https://implicit.harvard.edu/implicit/.

I have a friend who often claimed: “I’m not insensitive, I’m just oblivious!” Of course this was offered in humor, but obliviousness—especially if you’re aware of it—is no good excuse for being insensitive to diversity issues. I’m also reminded of the insensitive and oblivious response of many White Montana students to multicultural discussions. It’s not unusual for some of them to say things like, “I just haven’t had much contact with people from other cultures because we don’t have many minorities in Montana.” When I hear this I try not to gasp aloud as I, or a Native or First Nations Person points out that, in fact, 6.8% of Montana’s population is Native American and that several people IN THE ROOM are Native American.

The initial splash of multicultural awareness is often accompanied by an emotional response . . . and occasionally a bit or a bundle of defensiveness.

5.  As you Work Towards Multicultural Competence, Remember the Concept of Multicultural Humility

Although it’s standard procedure in the counseling and psychotherapy literature to refer to multicultural competence, one major problem with the term multicultural competence is that it implies that there’s an endpoint in the multicultural awareness, knowledge, and skill acquisition process. For this reason, I prefer the terms multicultural humility or multicultural sensitivity.

Similar to awareness, I think humility is central to good multicultural work. Unfortunately, within the dominant cultural media-based messages humility is typically viewed as being weak and confidence, swagger, and even arrogance is seen as more desirable. Thomas Merton (quoted in part I of this blog series) has a quotation that speaks to the tendency for entire countries to engage in self-superiority. He wrote:

“The greatest sin of the European-Russian-American complex which we call the West (and this sin has spread its own way to China) is not only greed and cruelty, not only moral dishonesty and infidelity to the truth, but above all its unmitigated arrogance toward the rest of the human race.”

It’s crucial for multicultural counselor and psychotherapists to move beyond thinking in terms of competence and tolerance (both of which speak to Merton’s ideas of arrogance). Instead, we need to embrace our fallibilities and humility and approach cultural and individual differences with what Marcia Linehan might call radical acceptance and what Carl Rogers would have referred to as unconditional positive regard.

6.  Keep Making Efforts to Understand a Collectivist Cultural Perspective.

In collectivist cultures, values and norms are shared. The self and the personality are defined in terms of group memberships, and the group needs and values are more central than those of the individual. Some people with collectivist perspectives avoid the whole idea of the concept of self or self-esteem or self-image. Instead, Collectivists tend to evaluate themselves based on attaining group goals.

For lots of us folks who have been deeply involved in American individualism, the idea of collectivism can feel odd and repeatedly difficult to grasp. This is where exposure, discussion, and real listening to others becomes so important. Rather than trample on the idea of collectivist being, we need to persistently take extra steps to maintain awareness of this concept that can be so slippery for individualists to grasp.

To close this blog, in 1975 Robert Hogan wrote,

A central theme in Western European history for about 800 years has been the decline of the medieval synthesis or, alternatively, the emergence of individualism. Two hundred years ago individualism was a moral and religious ideal capable of legitimizing revolutions and inspiriting sober and thoughtful minds. Sometimes in the last century, however, social thinkers began to regard individualism in more ambivalent terms, even in some cases as a possible indicator of social decay. (p. 533)

This is interesting stuff, even if it’s sometimes difficult to completely and consistently understand.

Happy New Year . . .

Non-Drug Options for Dealing with Depression

                               “When it comes to treating depressive symptoms, there’s no better                     medicine than healthy and loving relationships”

 The following options can be very effective for relieving depression symptoms. Although antidepressant medications are also an option, because they’re so widely marketed only non-drug alternatives are listed and described here.

  1. Psychotherapy – Going to a reputable and licensed mental health professional who offers counseling or psychotherapy for depression can be very helpful. This may include family, couple, or group counseling or therapy.
  2. Vigorous Aerobic Exercise – Consider initiating and maintaining a regular cardiovascular or aerobic exercise schedule. This could involve a referral to a personal trainer and/or local fitness center (e.g., YMCA).
  3. Herbal Remedies – Some individuals benefit from taking herbal supplements. For example, there is evidence that Omega-3 Fatty Acids (Fish oil) can reduce 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. Information on light therapy boxes is available online and possibly through your physician.
  5. Massage Therapy – Research indicates that massage therapy can relieve depressive symptoms. A referral to a licensed massage therapy professional is advised.
  6. Bibliotherapy – Research indicates that some people 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 popular self-help books.
  7. Mild Exercise and Physical/Social Activities – Even if you’re not up to vigorous exercise, you should know that nearly any type of movement has antidepressant effects. These activities could include, but not be limited to yoga, walking, swimming, bowling, hiking, or whatever you can do!
  8. Relationship Enhancement – As suggested by the opening quotation, the most potent medicine available for addressing depressive symptoms is a healthy and loving relationship. You can work on improving relationships in many ways, especially by developing effective communication skills, engaging in mutually enjoyable activities, and making a commitment to behaving in ways that support both your own mental health and that of your partner.
  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) other activities that might be personally meaningful to you.

 For information about this tip sheet, contact John Sommers-Flanagan, Ph.D. at johnsf44@gmail.com

A Few Facts about Children and Teenagers and Antidepressant Medications

Information about Antidepressant Medications: What Parents and Concerned Adults Should Know

By John Sommers-Flanagan, Ph.D.

Why You Shouldn’t Have Your Sad, Cranky, or Depressed Child Take Antidepressant Meds?

Several million American children and teenagers take antidepressant meds. This use of antidepressants is unjustified. Here’s why:

1.   Commonly used antidepressants (like Prozac, Zoloft, Paxil, Celexa, Cymbalta, etc.) don’t have much scientific support. Much of the research shows that antidepressants are no more effective than a sugar pill for reducing depressive symptoms.

2.   Antidepressants have side effects that include hyperactivity, insomnia, stomach pain, agitation, and increased suicide potential.

3    Sexual side effects are of special concern. For example, most antidepressants delay orgasm and can be used to effectively treat premature ejaculation in males; they also may inhibit orgasm in females. No one knows how these side effects influence sexual development

4.   Several years ago the FDA released a Public Health Advisory warning about increased reports of suicidality in youth who had been treated with antidepressants.

5.   Even psychiatric journals acknowledge that non-drug approaches to treating child and adolescent depression should be used before trying medication treatment.

6.   Generally, adding antidepressant medications to non-drug treatments are no more effective than the non-drug treatments by themselves.

7.   As we all know, life is hard and we all have to face challenging situations—situations that can make us feel sad, angry, and guilty. The problem is that antidepressants don’t teach young people anything about handling difficult emotions and coping with life. As our behavior therapy friends like to say, remember, “a pill is not a skill.”

Why You Should Consider Putting Your Child on Antidepressant Medications?

Here are some reasons you might ask a doctor to prescribe antidepressants to your child.

1.   When other, less risky approaches to dealing with depression, such as exercise, a healthier diet, more time listening and caring about the huge stresses of the teen years, and family assistance coping with life’s joys and disappointments have not provided relief.

2.   When counseling or psychotherapy with a credentialed professional who has a positive reputation working with youth has been tried for at least 10 sessions with no improvement. Studies have shown that counseling or psychotherapy is effective in treating depressed youth and the effects may be maintained after the treatment has ended (in contrast to medications, which often must be continued indefinitely).

3.   Your child is actively suicidal and other options haven’t helped. As strange as it may sound, although newer antidepressants appear to increase suicide risk among non-suicidal youth, they can sometimes reduce suicide risk in youth who are already suicidal.

4.   You, or another parent, have a strong history of depression and that depression was dramatically relieved by an antidepressant drug; if so, it may be reasonable, if your child becomes severely depressed, to begin the same medication. Of course, the medication should be closely monitored and you should make sure you’re not confusing your personal struggles with depression with your child’s unique condition.

5.   For personal reasons, it may be your preference and your child’s preference to try medications. If so, you should proceed with caution and work with a physician with a positive reputation.

This information is provided, in part, to balance most of the promotional advertising generated by pharmaceutical companies. It’s very important for consumers to have access to balanced information. Of course, much more information is available on the internet, but I recommend that you do your best to find balanced informational sources. Pharmaceutical companies tend to overstate antidepressant effectiveness and other organizations may demonize antidepressants. The truth is that antidepressant medications help some young people, but they’re not generally very effective, and they produce disturbing side effects. Choosing whether to have your children or teens take antidepressants is a very difficult decision. This handout is designed to provide you a small amount of information that may be helpful to you as you face this challenging decision.