In concert with my Webinar today with Western Montana Addiction Services, below are links to two Conduct Disorder assessment articles. One is by Rita and me from 1998; the other is a 2013 article in Professional Psychology.
Tomorrow at noon Mountain Time, Western Montana Addiction Services is sponsoring a one-hour webinar on the diagnosis and assessment of oppositional defiant disorder and conduct disorder. I’ll be the presenter. If you’re interested in tuning in, you’ll need to email Erin Wenner at: firstname.lastname@example.org to get instructions on how to gain access. This month I’ll be focusing on very basic diagnosis and assessment issues related to ODD and CD. Next month on June 10th at noon, I’ll be focusing counseling or treatment issues.
Attached to this post are the handouts from the May 1 “Tough Kids, Cool Counseling” workshop in Spearfish, South Dakota.
It was a great day with about 85 wonderful, amazing, and exceptionally nice school and mental health counselors from throughout South Dakota.
This is the powerpoint:
And this is the supplementary handout:
I hope this information is helpful!
What follows is a reprint from the ACA blog I wrote a couple weeks ago just in case you didn’t catch that. Have an excellent weekend.
Some of you may already be aware of Rosalind Wiseman’s work. She initially became recognized as a national parenting authority with the publication of her popular book, “Queen Bees and Wannabees” (2003). This book inspired the movie “Mean Girls.” Despite her lack of academic credentials (a B.A. in Political Science from Occidental College), she has done some good work around the topic of girl bullying.
In her latest book, Masterminds and Wingmen: Helping Our Boys Cope with Schoolyard Power, Locker-Room Tests, Girlfriends, and the New Rules of Boy World she ventures into new and exciting territory. But from the perspective of a grown up boy, I think, despite her best intentions, she doesn’t really get the boy world. This is probably because she never was a boy and can only try to understand the internal struggles and experiences of boys from an external perspective. This doesn’t make her effort bad or unimportant . . . but it does limit her reach. For the purposes of this blog, I want to focus on one particular excerpt that I found both ridiculous and potentially damaging.
On p. 87, she wrote:
“It’s important to allow him [your boy] to have a wide range of feelings. Moms, if he’s feeling so angry that he wants to release his anger by punching a pillow or a punching bag, or going into his room and yelling at the top of his lungs, or playing really loud music, or even playing a violent video game, let him do it. If he punches the wall, that’s okay too, as long as he isn’t threatening someone else when he’s doing it. Plus, after he’s calmed down, he can then learn the skill of drywall patching. The bottom line is that a lot of women can be intimidated in the presence of men’s anger (with good reason). But at the same time, your son needs a healthy outlet to express his anger without feeling like you think he’s a violent, crazy person for having his feelings.”
Let me just say this, “Like OMG. This is like some really gnarly bad advice.”
As you can see, I’m about as good at channeling my inner girl as Wiseman is at channeling her inner boy. To get back to my adult male persona, what I really want to say is that in this short excerpt, Wiseman’s ideas are so limited that I find them disturbing.
Perhaps the worst part is that Wiseman doesn’t seem to understand the basic and crucial difference between emotions and behaviors. It is and should be completely acceptable for all boys and all girls to experience anger. Anger is a natural and inevitable human emotion. But the emotion of anger is not the same as aggressive behavior. The fact is that boys CAN acknowledge and express their anger WITHOUT PUNCHING THINGS. And they SHOULD be expected to NOT PUNCH THINGS.
Let me emphasize this by saying it again: Boys can and should be expected to express their angry emotions without becoming violent or aggressive. It’s absolutely crucial for boys to learn to use their words and to control or inhibit their aggressive behaviors. A big problem with Wiseman’s message is that she’s coaching moms (and other adults) to accept inappropriate and unacceptable aggressive behaviors—from boys. She seems to be advocating the all-American excuse that boys will be boys and so therefore we should tolerate their aggression and not expect anything different. This is an unhelpful and potentially destructive message. Instead, the message from parents and caring adults needs to be: “I accept your angry emotions; but aggressive behavior is unacceptable.”
Part of what Wiseman is suggesting isn’t terrible. The idea of a natural consequence of drywall patching after an unacceptable aggressive outburst is reasonable. And the idea that moms shouldn’t be intimidated in response to their son’s anger or aggression is very important. But there’s a big difference between accepting an emotion and tolerating an aggressive behavior. Boys need to know that punching and destroying things is an unacceptable way to express their anger.
I think one of Wiseman’s limitations is that she’s never experienced anger and aggressive impulses from the inside of a male body.
As for myself:
I remember the last time I punched a wall . . .
I remember the last time I broke down a door . . .
I remember the last time I ripped a cupboard door off its hinges . . .
I also recall the last time I lashed out in anger and used a particularly unacceptable word to describe a woman. And I’m thankful to the person who taught me very clearly and very directly that I was engaging in an unacceptable behavior. It took me one firm but gentle lesson from a caring adult to learn to never use that disparaging word again.
I remember getting laid out as flat as a pancake by a 290 pound offensive tackle at Reser Stadium in 1978. And I remember wanting nothing more than another chance to get him back.
I also remember how I learned to watch my anger instead of acting on it. I remember the lessons my parents taught me. I remember practicing a deep breath and talking with my psychotherapist about my angry rages. I remember learning to deal more constructively with my revenge impulses even though I wanted so badly to give another male a physical pay-back. And I remember NEEDING SOMEONE to set limits on my aggressive behaviors.
It’s not easy for boys to learn to control their behavior. It’s also not easy for boys to learn to talk about anger (rather than acting on it). But this isn’t all about biology and testosterone. It’s also—and perhaps primarily—about the social expectations that most people hold for boys. If we expect and tolerate aggressive behavior as just part of being a boy, then we have very little chance of changing or improving how boys are capable of behaving.
The bottom line for me (and I know this is personalized and not completely unbiased) is that boys need caring and loving adults to raise the bar for them. I needed—and many boys need—higher (not lower) expectations when it comes to dealing with our anger.
My memories (and my counseling and psychotherapy work with boys) inspire my conclusions. Here they are:
IT IS ESSENTIAL for caring and loving adults to actively teach their boys that anger and sadness and fear and guilt and joy are all acceptable and expected emotions.
It’s equally essential for these same caring and loving adults to teach boys that aggressive behavior is NOT ACCEPTABLE.
If we don’t teach boys these lessons, then we’re lowering the bar to the point that we have no right to expect them to behave in civilized and non-violent ways.
And most of us are far better off when boys and men understand and manage their anger—rather than acting on their aggressive impulses.
Please help spread the word that we should expect more (not less or the same old thing) from boys. I know Ms. Wiseman is well-intended, but in this case we need to counter her bad advice with some good ideas.
While in Cincinnati, I ran short on time and we missed a chance to watch a video clip on “Generating Behavioral Alternatives.” And so as a substitute, I’m posting the verbatim script of the clip we were supposed to watch, and although we’ll miss out on discussing, the clip is fun on its own. Here it’s an excerpt from our Counseling and Psychotherapy Theories book and placed in the context of “Problem-Solving Therapy.”
Generating Behavioral Alternatives With an Aggressive Adolescent
As noted previously, problem-solving therapy (PST) focuses on teaching clients steps for rational problem solving. In this case vignette, the therapist (John) is trying to engage a 15-year-old White male client in stage 2 (generating solutions) of the problem-solving model. At the beginning of the session, he client had reported that the night before, a male schoolmate had tried to rape his girlfriend. The client was angry and planning to “beat the s*** out” of his fellow student. During the session, John worked on helping the boy identify behavioral alternatives to retributive violence.
The transcript below begins 10 minutes into the session.
Boy: He’s gotta learn sometime.
JSF: I mean. I don’t know for sure what the absolute best thing to do to this guy is . . . but I think before you act, it’s important to think of all the different options you have.
Boy: I’ve been thinking a lot.
JSF: Well, tell me the other ones you’ve thought of and let’s write them down so we can look at the options together.
Boy: Kick the shit out of him.
JSF: Okay, I know 2 things, actually maybe 3, that you said. One is kick the [crap] out of him, the other one is to do nothing . . .
Boy: The other is to shove something up his a**.
JSF: And, okay—shove—which is kinda like kicking the s*** out of him. I mean to be violent toward him. [Notice John is using the client’s language.]
Boy: Yeah, Yeah.
JSF: So, what else?
Boy: I could nark on him.
Boy: Tell the cops or something.
JSF: And I’m not saying that’s the right thing to do either. [Although John thinks this is a better option, he’s trying to remain neutral, which is important to the brainstorming process; if the client thinks John is trying to “reinforce” him for nonviolent or prosocial behaviors, he may resist brainstorming.]
Boy: That’s just stupid. [This response shows why it’s important to stay neutral.]
JSF: I’m not saying that’s the right thing to do . . . all I’m saying is that we should figure out, cause I know I think I have the same kind of impulse in your situation. Either, I wanna beat him up or kinda do the high and righteous thing, which is to ignore him. And I’m not sure. Maybe one of those is the right thing, but I don’t know. Now, we got three things—so you could nark on him. [John tries to show empathy and then encourages continuation of brainstorming.]
Boy: It’s not gonna happen though.
JSF: Yeah, but I don’t care if that’s gonna happen. So there’s nark, there’s ignore, there’s beat the s**. What else?
Boy: Um. Just talk to him, would be okay. Just go up to him and yeah . . . I think we need to have a little chit-chat. [The client is able to generate another potentially prosocial idea.]
JSF: Okay. Talk to him.
Boy: But that’s not gonna happen either. I don’t think I could talk to him without, like, him pissing me off and me kicking the s*** . . . [Again, the client is making it clear that he’s not interested in nonviolent options.]
JSF: So, it might be so tempting when you talk to him that you just end up beating the s*** out of him. [John goes back to reflective listening.]
Boy: Yeah. Yeah.
JSF: But all we’re doing is making a list. Okay. And you’re doing great. [This is positive reinforcement for the brainstorming process—not outcome.]
Boy: I could get someone to beat the s*** out of him.
JSF: Get somebody to beat him up. So, kind of indirect violence—you get him back physically—through physical pain. That’s kind of the approach.
Boy: [This section is censored.]
JSF: So you could [do another thing]. Okay.
Boy: Someone like . . .
JSF: Okay. We’re up to six options. [John is showing neutrality or using an extinction process by not showing any affective response to the client’s provocative maladaptive alternative that was censored for this book.]
Boy: That’s about it. . . .
JSF: So. So we got nark, we got ignore, we got beat the s*** out of him, we got talk to him, we got get somebody else to beat the shit out of him, and get some. . . . [Reading back the alternatives allows the client to hear what he has said.]
Boy: Um . . . couple of those are pretty unrealistic, but. [The client acknowledges he’s being unrealistic, but we don’t know which items he views as unrealistic and why. Exploring his evaluation of the options might be useful, but John is still working on brainstorming and relationship-building.]
JSF: We don’t have to be realistic. I’ve got another unrealistic one. I got another one . . . Kinda to start some shameful rumor about him, you know. [This is a verbally aggressive option which can be risky, but illustrates a new domain of behavioral alternatives.]
Boy: That’s a good idea.
JSF: I mean, it’s a nonviolent way to get some revenge.
Boy: Like he has a little dick or something.
JSF: Yeah, good, exactly. [John inadvertently provides positive reinforcement for an insulting idea rather than remaining neutral.]
Boy: Maybe I’ll do all these things.
JSF: So we’ve got the shameful rumor option to add to our list.
Boy: That’s a good one. (Excerpted and adapted from J. Sommers-Flanagan & R. Sommers-Flanagan, 1999)
This case illustrates what can occur when therapists conduct PST and generate behavioral solutions with angry adolescents. Initially, the client appears to be blowing off steam and generating a spate of aggressive alternatives. This process, although not producing constructive alternatives, is important because the boy may be testing the therapist to see if he will react with judgment (during this brainstorming process it’s very important for therapists to remain positive and welcoming of all options, no matter how violent or absurd; using judgment can be perceived and experienced as a punishment, which can adversely affect the therapy relationship). As the boy produced various aggressive ideas, he appeared to calm down somewhat. Also, the behavioral alternatives are repeatedly read back to the client. This allows the boy to hear his ideas from a different perspective. Finally, toward the end, the therapist joins the boy in brainstorming and adds a marginally delinquent response. The therapist is modeling a less violent approach to revenge and hoping to get the boy to consider nonphysical alternatives. This approach is sometimes referred to as harm reduction because it helps clients consider less risky behaviors (Marlatt & Witkiewitz, 2010). Next steps in this problem-solving process include:
- Decision making
- Solution implementation and verification
As the counseling session proceeds, John employs a range of different techniques, including “reverse advocacy role playing” where John plays the client and the client plays the counselor and provides “reasons or arguments for [particular attitudes] being incorrect, maladaptive, or dysfunctional” (A. M. Nezu & C. M. Nezu, 2013).
For me, the hardest thing about presenting professional workshops is time management. I want participants to comment, but how can I plan in advance for exactly how long their comments will be? Even worse, how can I accurately estimate the length of my own impromptu moments? It seems obvious that there’s a need for spontaneity. I don’t want to cut off potentially valuable comments from participants . . . and I don’t want to cut off my own creative musings either. Clearly, the clock is my workshop enemy.
For example, how could I know in advance that I would suddenly feel compelled to share a personal dream of mine with 85 of my new Cincinnati counselor friends? Never before had I shared with a workshop audience that 45 years-ago I dreamt I was Felix-the-Cat and then while crossing the road (as Felix), I got hit by a car . . . and died.
But then I woke up and have kept on living.
I like to think that particular disclosure is a perfectly normal thing to do when you’ve got a group of professional counselors to listen to you.
The point was to bust the myth that some teenage client have (and will talk about in counseling) that if they dream they die, it is prophetic and means they’ll die soon in real life also.
And beyond my personal dream disclosure, how would I know that one of the participants would have such passion that he would accept an invitation to come up to the microphone and share a physical relaxation technique that he uses with elementary school students.
These are just two samples of the sort of thing you missed because you weren’t in Cincinnati at the Schiff Center on the Xavier University campus yesterday.
But you also missed the start of the workshop where I decided on the spot that it was just the right time and place for me to open the workshop with a story of the most embarrassing moment in my life. It struck me as an awesome idea at the time . . . and it really was the most embarrassing moment of my life . . . until a few hours later when I shared my Felix-the-Cat dream.
There are always bigger mountains to climb.
You also missed meeting my incredibly gracious hosts from the Greater Cincinnati Counseling Association including, Butch Losey (who’s the most humble and understated guy who should be famous I’ve ever met), Kay Russ (who’s right up there with the most responsible person I’ve ever met), and Brent Richardson (who is as irreverent and insightful as ever), and Robert Wubbolding (who may be on his way to Casablanca to do a week long choice theory/reality therapy workshop by the time I post this and yet took eight hours out of his life to attend the workshop anyway).
So that’s just a little taste of what you missed in Cincinnati.
I’ll bet you wish you were there. I know I’m glad I was.
Just in case you’re planning to be in or around the Cincinnati area this weekend, the Greater Cincinnati Counseling Association (GCCA) is offering a day and a half of workshops starting on Friday afternoon, January 10 and two workshops with one of my favorite workshop presenters on Saturday, January 11. Here’s the info:
On Friday, January 10, there are two Ethics workshops to choose from:
School Counselor Ethics: Case
Discussions and Current Trends
Ethical and Professional Issues:
Therapeutic Alliance Building and
Ethical Considerations When
Working with Children and
On Saturday, January 11, I’m doing two separate ½ day workshops:
Tough Kids, Cool Counseling
Therapy with adolescents can be immensely frustrating or splendidly gratifying. The truth of this statement is so obvious that the supportive reference, at least according to many adolescents is, “Duh!” In this workshop participants will sharpen their therapy skills by viewing and discussing video clips from actual sessions and participating in live demonstrations. Over 20 specific cognitive, emotional, and constructive therapy techniques will be illustrated and/or demonstrated. Examples include acknowledging reality, informal assessment, the affect bridge, therapist spontaneity, early interpretations, asset flooding, externalizing language, and more. Countertransference and multicultural issues will be highlighted.
Suicide Assessment Interviewing
Freud once said, “By words one person can make another blissfully happy or drive him to despair.” Ironically, traditional adolescent suicide assessment and intervention procedures overemphasize a pathology-based biomedical model that orients adolescents toward despair. In this workshop suicidal crises are reformulated as normal expressions of human suffering and a specific, positive, and practical approach to adolescent suicide assessment interviewing is described. This contemporary adolescent suicide assessment model has a constructive focus, addresses diversity issues, and integrates differential activation theory and Jobes’s approach to Collaborative Assessment and Management of Suicidality. Specific suicide intervention procedures will be described and reformulated.
You can register for these workshops by phone by calling: 513-688-0092