Here’s the ppts for today’s conference:
My apologies for the redundant post . . . but as a counselor friend of mine likes to say, “Redundancy works.” Below is info on the upcoming (tomorrow!) UM Happiness class.
Fact: You can enroll in my Art & Science of Happiness (COUN 195) course through the University of Montana as a non-credit community participant? The course is fully online via Zoom.
When: Live on Zoom every Tuesday and Thursday from 1:00pm to 2:20pm (MST), beginning January 12 and ending April 27. You can attend live, or watch later.
What: You’ll hear and see lectures, demonstrations, video clips, small group lab activities, and role-plays.
Format: Because the course is online, live attendance isn’t required. Although I encourage live attendance, you can watch the course on your own schedule.
Cost: For community participants, the cost is $150 for the whole semester. That’s about $3.50 per instructional hour.
Why: You’ll get an amazing educational experience that just might increase your happiness in 2021. To enroll, go to: https://www.campusce.net/umextended/course/course.aspx?C=627&pc=13&mc=&sc
Please note: if you’re a University of Montana student (or want to become one) you can enroll in the course for three (3) semester credits. Go to Cyberbear, find the course (COUN 195), and enroll: https://www.umt.edu/cyberbear/.
On Monday, August 31, 2020, Paula Ann Sommers passed on to the place where only the kindest and most loving people on the planet go after death. We don’t know the exact location, but she’ll be there, sharing her angelic love and kindness. Paula was 91 years old, living in a small family group home in Woodinville, WA. She was suffering from dementia and had recently tested positive for COVID-19.
Paula was born to Angelo and Lucille Costanzo in Portland, Oregon. She had two older brothers, Robert (Bob) and Lawrence (Larry) Costanzo. Paula loved her parents and her older brothers, often telling stories of their years together growing up on the Oregon coast. Paula’s stories of Seaside and Arch Cape made these locations mystical and magical to the 13 cousins (children of Bob, Larry, and Paula).
After graduating from Seaside High School in 1948, Paula worked at Patty’s Fountain. In the summer of 1948, Max Sommers walked into the restaurant with a mutual friend. The friend, knowing Paula already had a boyfriend (or two), bet Max that Paula wouldn’t accept a ride home with him. Max took the bet. Not long after Paula saw Max—and his new yellow convertible—Max won the bet. In Max’s words, the bigger prize was to be with the love of his life. Last November, 2019, was Paula and Max’s 70th wedding anniversary.
In 1949, with the help of a VA loan, Paula and Max purchased City Shade Company in Vancouver, Washington. She worked at City Shade with Max for over 44 years. Paula regularly confessed to stealing cash from the company’s cash-box. Having absolutely no ability for stealth or deceit, she confessed to her so-called crimes, just as openly as she shared her heart and love with everyone who entered the doors at City Shade. Among her many remarkable gifts, Paula exuded warmth, genuine caring for others, and unmitigated kindness; she created moments in time and space that made people feel loved, accepted, and prized. In the days following her death, we (her children) have heard dozens of stories of how she unselfishly provided comfort to others. Around Christmas, virtually anyone who entered her home received a gift. For several years she gave out gym bags; other years there were shirts, sweaters, and blouses; still other years, games, toys, and fudge. Her kindness and generosity had no bounds.
As the daughter of an Italian American immigrant, Paula experienced discrimination. Then, as a Catholic, she met, fell in love with, and married a Jewish man. These experiences fueled her determination to reject all forms of prejudice and discrimination with an intensity that might have been labeled as hate (but Paula was philosophically opposed to using the word hate for anything). Instead of railing in negativity against racism, sexism, and homophobia, Paula simply lived her values, welcoming everyone into her bubble of love and kindness. The Christian family next door, the Jewish relatives, the Black family up the street, the lesbian daughter of friends, people on the street living in poverty, Muslims she had never met, children at restaurants . . . to be in proximity of Paula put everyone in danger of a hug, a gift, a smile, an empathic ear, and her unwavering love and acceptance.
Children from the neighborhood came to the Sommers home just as much to be with Paula as to see her children. There was only one Black family in the neighborhood. Paula loved that family with all her heart, soul, and spirit. When they were hungry, she fed them. If the boy who was struggling to understand his sexuality needed to talk, he wandered down the street and sought out Paula. Like moths to a flame, children were instantly attracted to “Mrs. Sommers,” because they saw her for what she was, an oasis of love and acceptance in a world of judgment. Despite this, Paula was nearly oblivious of her popularity. As is true with other Catholic saints, Saint Paula walked humbly in the world, never overestimating herself, while quietly living out her deep values of love, acceptance, kindness, and generosity.
Along with her talents for customer service, listening, and parenting, Paula was also an excellent cook. Every meal was an event that didn’t start until everyone was seated. Special guests got the coveted lace tablecloth, but everyone got food and comfort that would linger in their memories. Paula especially loved desserts. Everyone who knew anything knew that if fresh cookies weren’t on the counter, they could find a cache of snickerdoodles, chocolate chip cookies, banana bread, pumpkin bread, or lemon poppyseed bread in the third drawer on the south end of kitchen. If you came for dinner, it was advisable to “save room in your stomach” for Paula’s pies of the lemon meringue, pumpkin, pecan, apple, and other varieties. Her cheesecakes were to die for. Paula had a mathematical formula for calculating precisely how many pies (or cheesecakes or cakes) were required for a particular meal. She took the number of guests, and divided by two. If eight people were expected, she made four pies. Despite being teased by her children for constantly overestimating dessert needs, in the end, rarely did any of Paula’s desserts exist after noon the following day. Either Paula sent generous servings away with happy recipients, or her naysayers ate all the leftover desserts for breakfast.
In the Sommers family, there were very few rules, because when everyone feels loved and prized for their unique personalities, very few family rules are needed. She never yelled at her children. She never hit her children (although she did chase one child around with an eggbeater until they both dissolved in laughter). One of Paula’s most famous rules was, “We never use the word hate in our family.” She offered an alternative, “You can say you dislike something very intensely.” The word hate was simply the opposite of everything Paula believed in and stood for. In rare cases, when one sibling insulted another, Paula would counter, “If John’s dumb, you’re dumb too, because you’re both in the same family.” To this day, the Sommers children have no memory of sibling rivalry. The Sommers family was a team; Paula gently guided us away from conflict and toward love. When angry, she vacuumed and cleaned the house until everything was spotless and her anger had diminished. Freudian sublimation was never so complete. No one went to bed angry. Everyone was valued. No one doubted Paula’s love.
For many years, Paula mailed out so many greeting, sympathy, and birthday cards that we believe she single-handedly drove up the stock price of Hallmark Cards. Consistent with her character and values, she signed every card the same way: “Love always, Paula.”
For Valentine’s Day, 2010, Regence BlueShield of Oregon made a video recording of Paula and Max talking about their relationship and marriage. During the recording, Max said “Paula is the most unselfish person you ever saw, and you can’t help but take on some of those traits for fear of looking bad if you don’t.” This was the essence of Paula Ann (Costanzo) Sommers. Whenever she was, through kindness, love, and generosity, she inspired everyone to be better, lest they not keep up.
Paula is survived by her husband, Max (Vancouver, WA), her children Gayle (Vancouver, WA and Surprise, AZ), Peggy (Kirkland, WA), and John (Absarokee/Missoula, MT), and her grandchildren Chelsea Bodnar (Missoula, MT), Jason Lotz (Chino Hills, California), Patrick Klein (Vancouver, WA), Aaron Lotz (Seattle, WA), Rylee Sommers-Flanagan (Helena, MT), and Stephen Klein (Los Angeles, CA). Paula is also survived by eight great grandchildren, nieces, nephews, and friends of the family, many of whom who refer to her as their “Favorite Aunt,” or “Quite possibly the kindest person I have ever met.”
Memorial plans for Paula are to be arranged. The family is considering online and face-to-face alternatives. Paula was a staunch supporter of people with limited incomes and resources. Memorial donations can be made in honor of Paula Sommers to whatever charity you believe would fulfill her desire to help those in need. More importantly, she would want all who read this to live in ways to spread happiness, unity, and love. In the spirit of Paula’s life and values, we hope—in her honor—you will take a day, a week, a month, a year, or the rest of your life to intentionally share kindness, acceptance, and generosity with others. And, as Paula would say, “Love always.”
On Wednesday, we had about 3,000 people register for the ACA-sponsored webinar, “Treating & Preventing Suicide.” That was a fantastic turn out and I owe a BIG THANKS to Zachary Taylor of PESI for skillfully moderating the event and to Victoria Kress (Distinguished Professor from Youngstown State University) for sharing her insights about suicide assessment, prevention, and non-suicidal self-injury. Questions and comments from participants were excellent; it would have been great to have more than only one hour.
During the webinar we promised I would post additional suicide and NSSI resources on my blog. Other events have conspired (as they will) to delay this posting to this particular moment in time. Because we’re posting this content after the event, I’m aware that we may not efficiently get this out to everyone who was online and interested. Consequently, if you get this post and you know someone who’s not following this blog, but who might want this information, please feel free to forward or share.
The following content is from Victoria:
An article on self-harm published in Psychotherapy Networker:
Vicki also co-authored the following two publications:
Kress, V. E., & Hoffman, R. M. (2008) Non-suicidal self-injury and motivational interviewing: Enhancing readiness for change. Journal of Mental Health Counseling, 30, 311-329.
Stargell, N. A., et al., (2017-2018). Student non-suicidal self-injury: A protocol for school counselors. Professional School Counseling, 21, 37-46. Click here for the pdf.
Vicki also shared this document on suicide assessment:
My top resources include:
Sommers-Flanagan, J. (2018). Conversations about suicide: Strategies for detecting and assessing suicide risk. Journal of Health Service Psychology, 44, 33-45.
Sommers-Flanagan, J. (2018). Suicide assessment and intervention with suicidal clients [Video]. 7.5 hour training video for mental health professionals (produced by V. Yalom). Mill Valley, CA: Psychotherapy.net — https://www.psychotherapy.net/video/suicidal-clients-series
Sommers-Flanagan, J. (2019). Suicide assessment for clinicians: A strength-based model. ContinuingEdCourses.net
Sommers-Flanagan, J. (2019). Suicide interventions and treatment planning for clinicians: A strength-based model. ContinuingEdCourses.net
Because Rita and I just turned in our ACA book manuscript (coming in Feb), I’ve got a huge list of suicide-related citations. Below, I’m listing a few highlights related to our discussion on Wednesday. Books and articles about the top evidence-based approaches have an asterisk (*).
Ahuja, A., Webster, C., Gibson, N., Brewer, A., Toledo, S., & Russell, S. (2015). Bullying and suicide: The mental health crisis of LGBTQ youth and how you can help. Journal of Gay & Lesbian Mental Health, 19(2), 125-144. https://doi.org/10.1080/19359705.2015.1007417
Binkley, E. E., & Liebert, T. W. (2015). Prepracticum counseling students’ perceived preparedness for suicide response. Counselor Education & Supervision, 54(2), 98-108.
Bryan, C. J., Bryan, A. O., & Baker, J. C. (2020). Associations among state‐level physical distancing measures and suicidal thoughts and behaviors among U.S. adults during the early COVID‐19 pandemic. Suicide and Life Threatening Behavior, e12653, 1-7. https://doi.org/10.1111/sltb.12653
*Bryan, C. J., & Rudd, M. D. (2018). Brief cognitive-behavioral therapy for suicidal prevention. Guilford Press.
Cureton, J. L., & Clemens, E. V. (2015). Affective constellations for countertransference awareness following a client’s suicide attempt. Journal of Counseling & Development, 93(3), 352-360. https://doi.org/10.1002/jcad.12033
Erbacher, T. A., Singer, J. B., & Poland, S. (2015). Suicide in the schools: A practitioner’s guide to multi-level prevention, assessment, intervention, and postvention. Routledge.
Finn, S. E., Handler, L., & Fischer, C. T. (2012). Collaborative/therapeutic assessment: A casebook and guide. Wiley.
Freedenthal, S. (2018). Helping the suicidal person: Tips and techniques for professionals. Routledge.
Granello, D. H. (2010a). A suicide crisis intervention model with 25 practical strategies for implementation. Journal of Mental Health Counseling, 32(3), 218-235. https://doi.org/10.17744/mehc.32.3.n6371355496t4704
Granello, D. H. (2010b). The process of suicide risk assessment: Twelve core principles. Journal of Counseling & Development, 88(3), 363-371. https://doi.org/10.1002/j.1556-6678.2010.tb00034.x
Healy, D. (2009). Are selective serotonin reuptake inhibitors a risk factor for adolescent suicide? The Canadian Journal of Psychiatry/La Revue Canadienne De Psychiatrie, 54(2), 69-71. https://doi.org/10.1177/070674370905400201
Hedegaard, H., Curtin, S.C., & Warner, M. (2020). Increase in suicide mortality in the United States, 1999–2018. NCHS Data Brief, 362. National Center for Health Statistics.
*Jobes, D. A. (2016). Managing suicidal risk: A collaborative approach (2nd ed.). Guilford Press.
*Joiner, T. (2005). Why people die by suicide. Harvard University Press.
Large, M. M., & Kapur, N. (2018). Psychiatric hospitalisation and the risk of suicide. The British Journal of Psychiatry, 212(5), 269-273. https://doi.org/10.1192/bjp.2018.22
Large, M. M., & Ryan, C. J. (2014). Suicide risk categorisation of psychiatric inpatients: What it might mean and why it is of no use. Australasian Psychiatry, 22(4), 390-392. https://doi.org/10.1177/1039856214537128
*Linehan, M. (1993). Cognitive behavioral therapy of borderline personality disorder. Guilford Press.
*Linehan, M. (2015). DBT® skills training manual (2nd ed.). Guilford Press.
Maris, R. W. (2019). Suicidology: A comprehensive biopsychosocial perspective. Guilford Press.
*Stanley, B. & Brown, G. K (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256–264. https://doi.org/10.1016/j.cbpra.2011.01.001
Wenzel, A., Brown, G. K., & Beck, A. T. (2009) Cognitive therapy for suicidal patients: Scientific and clinical applications. American Psychological Association.
Over the past decade or so, Rita and I have been involved in some better and worse video production experiences. When I say better and worse, mostly I mean more embarrassing and less embarrassing.
Once, back in 2012, Sara Polanchek volunteered to help me do a psychoanalytic video demonstration. In honor of Freud, I suppose, the videographer begins by over-handling my tie. Then, we officially start the session with me asking Sara to free associate, and Sara takes over. Late in the clip, the other voice you hear in the background is Rita, whom I suspect collaborated with Sara on trying to embarrass me (even more than I would have been naturally embarrassed simply be trying to demonstrate a psychoanalytic session).
I tried posting this clip several years ago, but somehow the version didn’t actually include Sara’s opening disclosure. . . which was the whole point. So here’s the full 1 minute and 55 seconds: https://www.youtube.com/watch?v=SeihJqtenyc
This week I had an OpEd piece published in the Missoulian. It’s a political psychology essay, and so if you don’t like that sort of thing, no need to read it. But if you’re interested, here’s the link to the OpEd piece. https://missoulian.com/opinion/columnists/how-trump-grows-hate-in-america/article_0bd0c8ba-f994-5f17-bcac-5c4008799f8b.html
All this depends on how you define the words “Secret” and “Perfect.” Don’t let linguistic precision interfere with what your heart really wants. You’ve never considered these seven steps yourself, and I’m confident that doing this will help you feel blissfully perfect, albeit briefly, in our palpably imperfect world.
Step 1: Find your special magic hat. Wear your hat around the house or office for at least 10 minutes. Doing this will sync the hat with your brainwaves. Ideally, while wearing your special magic hat, you will read an article or two that includes statistical guidance on how to make great March Madness picks. Even if you don’t understand the articles, your magic hat will absorb the pertinent knowledge through a process that I’m not authorized to share.
Step 2: Find a friend or two who would like to participate with you. You may need to offer food, drinks, or money. Encourage them to wear their own special magic hat. Don’t let them wear yours. Everyone sometimes needs to set limits.
Step 3: Create a bunch of cards or slips of paper with the names of all 64 teams. Even though upsets are fun and feel good, honor reality by creating more slips of paper with the favored team names than the underdogs. For example, put in more little slips of paper with the name “Duke” than “Abilene Christian.” Also, when deciding who’s favored, go with the Vegas odds-makers. Unlike the NCAA selection committee, the Vegas odds-makers actually pay attention to which teams are better; in contrast, the NCAA committee, Ken Pomernutz, ESPN’s “Bogus Power Index” (BPI), Joe Lunaticardi, and other people interested in power, control, and attention, put more emphasis on who they thought was good before the season started, and who won games way back in November and December. Although their information might be helpful, it’s more outdated than Vegas.
Step 4: Take off your special magic hat. You might want to simultaneously bow and say your favorite Harry Potter incantation; or you can just blow on the hat like you might blow on dice. Belching on the hat will not help. Don’t do that. Don’t even think of doing that. Then, put all the small cards or slips of paper into the hat. This is a good time, if you haven’t already started, to have a drink of your favorite beverage . . . but not too many drinks of said beverage. Sit still for a few minutes with your hat filled with team names, your best friend(s) filled with joy and anticipation, your favorite glass or mug filled with your favorite beverage, and a blank copy of the March Madness brackets. This scene is essential for creating magic, miracles, madness, and the right moment. Believe me.
Step 5: Begin drawing team names out of the hat. Let’s say you shout out the words, “Mona Lisa!” and reach in and pick Cincinnati. If that happens, you write Cincinnati down as beating Iowa in the first round. You should feel good about that pick since Cincinnati will be playing Iowa in Columbus, Ohio . . . sort of like a Bearcat home game, which is why you should have more “Cincinnati’s” in the hat than “Iowas.” Feel that goodness, and then put the “Cincinnati” slip to the side. When (or if) you happen to pick Iowa later, just put it aside in a separate loser pile, because you won’t need it until you put all the slips back in the hat for selecting your next bracket. Now, suppose you pick Iona before you pick North Carolina. That’s okay. Write down Iona. You need to trust me, trust the process, and trust the magic. Just remember what happened to Virginia last year. If you knew these seven steps back then, you could have gotten that pick right and you’d already be living in paradise by now.
Step 6: Continue this process until you’ve selected all 32 first round winners. If you pick any additional Cincinnati slips (or more than one of any team), just put them aside. Then, after round one ends, put all the extra “winner” slips back into the hat to start round two, while keeping any the first round “loser” slips in a separate pile outside of the magic hat. Don’t let those losers touch the magic hat (until later). Losers don’t have any magic. Don’t be a loser.
Step 7: Use the same procedure to complete round two, the sweet sixteen, the elite eight, the final four, and the national championship. Get behind the process. Say nice things to the hat. Welcome and cheer whichever slips (teams) get picked. Feel free to trash talk with your friends. Soon, everyone will be jealous of you. Don’t let that go to your head. Remember that magic likes big, beautiful hearts, not big egos
Once you’ve filled out your first bracket, put all the slips of paper back in the hat (even the losers) . . . and repeat this procedure until you’ve filled out as many brackets as you want.
If this procedure doesn’t work, clearly, you’ve done something wrong. Although I feel sad that you’re a loser who couldn’t even manage to get this magic hat thing right the first time, you shouldn’t feel bad. Also, do not contact me for a refund, especially since I just gave you the secrets of filling out a perfect March Madness bracket for free.
If you don’t get a perfect bracket this time, maybe you can fix your mistakes and do the Magic Hat procedure right next year.
Good luck with that.
This handout is an in-depth supplement to a web-based workshop I provided for the Chi Sigma Iota group at the University of the Cumberlands on January 13, 2019. Although it’s designed to go with the workshop, it’s also designed to be a standalone resource for learning more about how to integrate evidence-based relationship factors into counseling and psychotherapy practice.
The following principles, techniques, and strategies are listed in the order in which they were discussed in the workshop. More extensive information is included in the specific resources listed at the end of this handout, particularly, Clinical Interviewing (6th ed., Wiley 2017), Counseling and Psychotherapy Theories in Context and Practice (3rd ed., Wiley, 2018) and Tough Kids, Cool Counseling (2nd ed., 2007, ACA publications).
The 10 Evidence-Based Relationship Factors (EBRFs)
Beginning in the early 21st century, Norcross (2001; 2011) and others have put relational factors (e.g., Rogerian core conditions) on par with “empirically-supported techniques or procedures.” Norcross has done this by using the terminology: Evidence-Based or Empirically-Supported Relationships
What Norcross is talking about is the robust empirical support for specific and measurable relationship factors as contributors to positive counseling and psychotherapy outcomes. You can find the latest articles about empirically-supported relationships in a special issue of the journal Psychotherapy (Norcross & Lambert, 2018).
Here’s a list of the evidence-based relationship factors (EBRFs) that I covered in the workshop, followed by content and resources related to each factor.
- Congruence [Authenticity]
- Unconditional positive regard [Respect]
- Empathic understanding [Emotional attunement]
- Culture Humility and Sensitivity [Equity in worldview]
- Working Alliance 1: Emotional bond [Liking each other]
- Working Alliance 2: Goal consensus [Adler’s goal alignment]
- Working Alliance 3: Task collaboration [To reach client goals]
- Rupture and repair [Fixing relationship tension]
- Managing Countertransference [Self-awareness]
- Progress monitoring [Asking for feedback]
There are many ways to show congruence or authenticity in counseling. Below, I’ve described some of the ways that are relatively easy to apply. Some of this content focuses on working with youth and other content focuses on working with adults, including parents.
Acknowledging Reality: Some young people, as well as older clients, may be initially suspicious and mistrustful of adults – especially sneaky, manipulative, authority figures like mental health professionals, school counselors or school psychologistsJ. To decrease distrust, it’s important to acknowledge reality about the reasons for meeting, about the fact that you don’t know each other, and to notice obvious differences between yourself and the client. Acknowledging reality is a form of transparency or congruence. Researchers consistently report that transparency, congruence, or genuineness is a predictor of positive counseling or psychotherapy outcomes (see Kolden, Klein, Wang, & Austin, 2011). Acknowledging reality includes a straightforward explanation of confidentiality and its limits.
Sharing Referral Information: To gracefully talk about referral information with students, you need to educate referral sources about how you’ll be using information they share with you. Teachers, administrators, probation officers, and parents should be coached to give you information that’s accurate and positive. If the referral information is especially negative, you should screen and interpret the information so it’s not overwhelming or off-putting to students. Simblett (1997) suggested that if therapists are planning to share referral information with clients, they should warn and prepare referral sources. If not, the referral sources may feel betrayed. Also, if you share negative referral information, it’s important to have empathy and side with the student’s feelings, while at the same time, not endorsing negative behaviors. For example, “I can see you’re really mad about your teacher telling me all this stuff about you. I don’t blame you for being mad. I’d be upset too. It’s hard to have people talking about you, even if they have good intentions.” Here’s a case example from Tough Kids, Cool Counseling (2007):
A female counselor is meeting for the first time with a 16-year-old female client. Immediately after introducing herself and offering a summary of the limits of confidentiality, she states, “I’m sure you know I talked with your parents and your probation officer before this meeting. So, instead of keeping you in the dark about what they said about you, I’d like to just go ahead and tell you everything I’ve been told. This sheet of paper has a summary of all that (counselor holds up sheet of paper). Is it okay if I just share all this with you?”
After receiving the client’s assent, the counselor moves her chair alongside the client, taking care to respect client boundaries while symbolically moving to a position where they can read the referral information together. She then reviews the information, which includes both positive information (the client is reportedly likeable, intelligent, and has many friends) and information about the legal and behavioral problems the adolescent has recently experienced. After sharing each bit of information, she checks in with the client by saying, “It says here that you’ve been caught shoplifting three times, is that correct?” or “Do you want to add anything to what your mom said about how you will all of a sudden get really, really angry?” When positive information is covered, the counselor says thing like, “So it looks like your teachers think you’re very intelligent and say that you’re well-liked at school . . . do you think that’s true . . . are you intelligent and well-liked?” If referral information from teachers, parents, or probation officers is especially negative, the counselor should screen and interpret the information so it is not overwhelming or off-putting to young clients. (from Sommers-Flanagan and Sommers-Flanagan, 2007, p. 32)
Authentic Purpose Statements: One technical manifestation of congruence or transparency is the use of an authentic purpose statement. This requires you to be clear about your own “why” of being in the room and then concisely sharing that with your student or client. Examples include: “My job is to help you be successful here” or “Your goals are my goals, as long as they’re legal and healthy.” Authentic purpose statements can also serve, in part, as an initial role induction.
Responding to Client or Student Questions: Authenticity may be the most robust factor linked to positive treatment outcomes. How you handle client or student questions is one way to display congruence or authenticity. The following model can be helpful.
- Answer directly or explain why you’re not answering directly – “I think you’re asking a good question, but before I answer, I want to dive a little deeper into what’s under your question. That’s the sort of thing we do in counseling.”
- Use a reflection/paraphrase – “It sounds like you’re not sure I can be of any help.”
- Validate the underlying message/curiosity – “I don’t blame you for thinking that. Lots of people aren’t sure if counseling can work for them. I’d probably feel the same way as you.”
- Use psychoeducation, then answer after exploring – “Before answering, I’d like to ask you a few questions that might be important. First, if I say, ‘Yes’ I’ve done some drugs, I wonder how you would react? Second, if I say ‘No’ I haven’t done drugs, I wonder how you would react to that?”
- Use psychoeducation to explain not answering – Most of the time I’m happy to answer your questions. But this one feels like it’s too much about me . . . and of course the focus in counseling is supposed to be more on you than it is on me.”
- Use interpretation or confrontation – “It’s not unusual in counseling for clients to want to avoid talking about their personal situation and feelings. One way to avoid that is to ask me lots of questions. I’m wondering if that might be one of the reasons why you seem like you want to keep the focus on me.”
- Articulate a dilemma (Yalom) – “I have a dilemma. One part of me really wants to answer your question. But another part of me is worried it will move the focus of counseling away from you and onto me.”
Self-Disclosure: Although authenticity is important, it’s quite possible to be too open or to have too much self-disclosure. To prevent excessive self-disclosure, consider the following guidelines.
When to Self-Disclose
- When you’re asked a direct question and it makes good sense to answer directly and briefly.
- When a disclosure is likely to increase interpersonal connection (“I enjoy meeting with you”).
- When disclosure is likely to facilitate transparency and therefore make it less likely for clients to “wonder” if you’re judging them (“my theoretical foundation is person-centered. That means I want to listen to you talk about your life, your experiences, and your emotions. That means I’ll probably listen more than I talk”).
- When it’s helpful for psychoeducation purposes (mindfulness takes lots of discipline; I struggle with it too.” If you’re interested, I can share with you a couple tips that really helped me”)
When NOT to Self-Disclose
- When you’re talking too much about yourself and muddying the focus.
- When you’re trying to slip in advice (e.g., “being assertive in that sort of situation worked for me”). This is especially a bad idea with minority clients because we shouldn’t assume they have our values or that what worked for us will work for them.
- When it takes away from any of the EBRFs.
- When it’s more about you and for you and less about the client (“I’m really proud of my children’s work ethic”).
2. Unconditional Positive Regard
Unconditional positive regard involves accepting clients and showing them immense respect. As Rogers said long ago, when clients feel accepted, then they become free to explore their insecure “nooks and crannies.”
For all of the person-centered core conditions, it’s not good to express them directly. That means you want to avoid saying “I accept you fully as you are.” There are many reasons for not expressing the core conditions directly (which we talk about in the book, Clinical Interviewing). The following counselor/psychotherapist behaviors are ways to show respect and positive regard indirectly. I’ve elaborated on a few of these.
- Being on time
- Non-directive listening
- Asking clients what is important to them
- Remembering client details
- Asking permission
- Second session first question
- Using interactive summaries
Asking Permission: Asking permission is a basic technique that clearly expresses your respect for your client. When using any technique, it’s useful to (a) ask permission to describe the technique (“Is it okay if we take a few minutes for me to describe this thing called progressive muscle relaxation?”); (b) describe the technique; and then (c) check in on your client’s reaction or thoughts about the technique. I even like to ask permission to self-disclose or give feedback (“Is it okay with you to share something I’ve noticed?”).
Second Session First Question: The time between session #1 and session #2 can include many different experiences. It’s tempting to start the second session with a social question like, “How was your week?” My opinion is that social openings tend to defocus counseling and mostly aren’t appropriate (unless you’re modeling social skills and/or have an anxious client who is uncomfortable with a more formal opening. The second session first question is: “What did you find memorable or important to you from our meeting last week?”
3. Empathic Understanding
Most counselors and counseling students are well-versed in how to use empathy. One situation that can challenge your empathic responding occurs when you’re working with a client who is depressed and suicidal. The following is an adapted excerpt from an article published in the Journal of Health Service Psychology:
Many or most suicidal patients are probably experiencing depression and/or hopelessness. If this is the case, they will be predisposed to discussing what makes them more suicidal; it may be more difficult for them to identify factors linked to feeling less suicidal. States of depression and hopelessness drive patients toward negative rumination and act as fogging agents when it comes to exploring or considering positives.
Exploring and Addressing Hopelessness
Hopelessness is a common feature linked to clinical depression and suicidality. Although hopelessness can manifest in different ways, having a general strategy for assessing and working through hopelessness can be helpful. Specifically, Beck (Wenzel, Brown, & Beck, 2009) has emphasized that treatment of suicidal patients must address hopelessness. Here are two examples of how to empathically explore and work with hopelessness.
Exploring intent, addressing hopelessness, and initiating problem-solving in the context of getting help. Once you have information about active suicide ideation or a previous attempt or attempts, you have a responsibility to acknowledge and explore suicidality. One common strength-based tool is a solution-focused question.
“You’ve tried suicide before, but you’re here with me now . . . what has helped?”
Unfortunately, if you’re working with a patient who is severely depressed, it is not unusual for your solution focused question to elicit a response like this:
“Nothing helped. Nothing ever helps.”
In response, one error clinicians often make is to venture into a yes-no questioning process about what might help or what might have helped in the past. However, if you are working with a patient who is extremely depressed and experiencing mental constriction, your patient will discount every idea you come up with and insist that nothing ever has helped and that nothing ever will help. This process can increase hopelessness and consequently a different assessment approach is required. Even the most severely depressed patients can, when given the right frame, acknowledge that every attempt to address depression and suicidality isn’t equally bad. Using a continuum where severely depressed and mentally constricted patients can rank interventions strategies (instead of a series of yes-no questions) is a better approach:
Counselor: It sounds like you’ve tried many different things to help with your depressed feelings and suicidal thoughts. Let’s look at all them. I’m guessing some of them are worse than others. For example, I know you’ve tried physical exercise, you’ve tried talking to your brother and sister and one friend, and you’ve tried different medications. Let’s list these out and see which has been worse and which has been less bad.
Client: The meds were the worst. They made me feel like I was already dead inside.
Counselor: Okay. Let’s put meds down as the worst option you’ve experienced so far. Which one was a little less worse than the meds?
You’ll notice the counselor emphasized that some efforts at dealing with depression/suicide were worse than others. Focusing on “worse” resonates with the patient’s negative emotional state. It will be easier to begin with the most worthless strategy of all and build up to strategies that are “a little less bad.” Building a unique continuum of helpfulness for your patient is the goal. Then, you can add new ideas that you suggest or that the patient suggests and put them in their appropriate place on the continuum. If this approach works well, you will have collaboratively generated several ideas (some new and some old) that are worth experimenting with in the future.
Addressing hopelessness and initiating problem-solving in the context of social disconnection. As you explore Susan’s social relationships, you ask, “Who is in your life that might provide you with support during this difficult time?” She answers, “I just don’t get on with people. No one understands. There’s no point talking to anyone.” With this disclosure, Susan has revealed interpersonal disconnection, along with hopelessness about being socially disconnected forever. At this point, it’s easy for clinicians to fall into an unproductive problem-solving pursuit in an effort to identify someone in Susan’s environment who would show her kindness and compassion (e.g., “How about your mother?”). Instead, because Susan is experiencing depressive symptoms, one way in which she might display problem-solving impairment is by denying that anyone in her world could be helpful. Consequently, the problem-solving process should begin with the counselor resonating with Susan’s hopelessness, and then move forward. Here’s an illustration:
Counselor: It feels like there’s no one to turn to. Nobody really gets what you’re going through.
Susan: That’s the way it has always been.
Counselor: This might sound weird, but I’m wondering who is the worst person for you to talk with? Who would really not get it and just make you feel worse?
Susan: That’s easy. My dad doesn’t get me. He would tell me I need a kick in the ass to get myself going.
Counselor: And that would feel really not helpful. Not helpful at all.
Susan: That’s never helpful to me.
Counselor: How about someone who’s not quite as bad as your dad? Who would be a little better than him, but still not especially good to talk with?
You can also use a visual version of this approach. To do so, you draw a circle in the middle of the page and write your patient’s name in the circle. Then, you say you want to get a visual sense of who, in the patient’s universe of social contacts, is most and least likely to be responsive and show support. In Susan’s case, you would place her father as a very distant circle in orbit around Susan. Then as you generate additional names, you would follow Susan’s guidance and place the circles closer or further away from the circle representing Susan. In the end, you will have a map of who—in Susan’s social universe—is closest (and furthest) and most (and least) supportive.
With patients who are depressed and experiencing problem-solving deficits, a good general strategy is to show empathy for the hopelessness and social disconnection, but then build a continuum from the bottom toward people who are “less bad” to talk with.
This method: (a) provides empathy; (b) addresses hopelessness; (c) addresses problem-solving deficits through the identification of alternative social support people; and (d) initiates problem-solving (by building a continuum that moves upward toward the best or “least bad” people for social connection).
4. Culture and Cultural Humility
Competent counselors and psychotherapists are able to reach across cultural divides with respect and sensitivity. In preliminary research, cultural humility has been linked with positive therapeutic outcomes.
Here’s a short excerpt on cultural humility from the Clinical Interviewing textbook:
Over the past decade researchers and writers have begun making distinctions between cultural competence and cultural humility. Cultural humility is viewed as an overarching multicultural orientation or perspective that mental health providers may or may not hold. It springs from the idea that individuals from dominant cultures—or any culture—often have a natural tendency to view their cultural perspective as right and good and sometimes as superior. This tendency implies that attaining multicultural competence isn’t enough for clinicians to be effective with culturally diverse clients. Clinicians need to be able to let go of their own cultural perspective and value the different perspective of their clients (Hook, Davis, Owen, Worthington, & Utsey, 2013).
Three interpersonal dimensions of multicultural humility have been identified:
- An other-orientation instead of a self-orientation
- Respect for others and their values/ways of being
- An attitude that includes a lack of superiority
Cultural humility is closely aligned with, but not the same thing as multicultural competence. It’s generally presented as a supplement to multicultural competence. It has its own research base and appears to independently contribute to clinician effectiveness. In a recent research study, when clients viewed therapists as having higher levels of cultural humility, they also (a) endorsed higher ratings of the working alliance and (b) perceived themselves as having better outcomes (Hook et al, 2013).
The Working Alliance
Clinical research on the working alliance is immense. The section below is another excerpt from Clinical Interviewing.
The idea that therapist and client collaborate in ways that support positive outcomes originated with Freud (1912/1958). Later, psychoanalytic theorists introduced the terms therapeutic alliance and working alliance (Greenson, 1965; Zetzel, 1956). Greenson (1965, 1967) distinguished between the two, viewing the working alliance as the client’s ability to cooperate with the analyst on psychoanalytic tasks and the therapeutic alliance as the bond between client and analyst. Eventually, Bordin (1979; 1994) introduced a pantheoretical model that he referred to as the working alliance. Bordin’s model includes three dimensions:
- Goal consensus or agreement
- Collaborative engagement in mutual tasks
- Development of a relational bond
5. Goal Consensus (Mutual Goal-Setting)
Goal-Setting with Young Clients: I use the following procedure for setting mutual goals with young clients. This technique is used to help students or young clients begin to articulate their own goals (and not goals that have been defined FOR THEM by adults).
Working with adolescents is different from working with adults. In this excerpt from a 2013 article, we briefly focus on how the opening interaction with an adolescent client might look different than an opening interaction with an adult client (from: Sommers-Flanagan, J., & Bequette, T. (2013). The initial interview with adolescents. Journal of Contemporary Psychotherapy, 43(1), 13-22.)
When working with adults, therapists often open with a variation of, “What brings you for counseling” or “How can I be of help” (J. Sommers-Flanagan & Sommers-Flanagan, 2012). These openings are ill-fitted for psychotherapy with adolescents because they assume the presence of insight, motivation, and a desire for help—which may or may not be correct.
Based on clinical experience, we recommend opening statements or questions that are invitations to work together. Adolescent clients may or may not reject the invitation, but because adolescent clients typically did not select their psychotherapist, offering an invitation is a reasonable opening. We recommend invitations that emphasize disclosure, collaboration, and interest and that initiates a process of exploring client goals. For example,
I’d like to start by telling you how I like to work with teenagers. I’m interested in helping you be successful. That’s my goal, to help you be successful in here or out in the world. My goal is to help you accomplish your goals. But there’s a limit on that. My goals are your goals just as long as your goals are legal and healthy.
The messages imbedded in that sample opening include: (a) this is what I am about; (b) I want to work with you; (c) I am interested in you and your success; (d) there are limits regarding what I will help you with. It is very possible for adolescent clients to oppose this opening in one way or another, but no matter how they respond, a message that includes disclosure, collaboration, interest, and limits is a good beginning.
Some adolescent clients will respond to an opening like the preceding with a clear goal statement. We’ve had clients state: “I want to be happier.” Although “I want to be happier” is somewhat general, it is a good beginning for parsing out more specific goals with clients. Other clients will be less clear or less cooperative in response to the invitation to collaborate. When asked to identify goals, some may say, “I don’t know” while others communicate “I don’t care.”
Concession and redirection are potentially helpful with clients who say they don’t care about therapy or about goal-setting. A concession and redirection response might look like this: “That’s okay. You don’t have to care. How about we just talk for a while about whatever you like to do. I’d be interested in hearing about the things you enjoy if you’re okay telling me.” Again, after conceding that the client does not have to care, the preceding response is an invitation to talk about something less threatening. If adolescent clients are willing to talk about something less threatening, psychotherapists then have a chance to listen well, express empathy, and build the positive emotional bond that A. Freud (1946, p. 31) considered a “prerequisite” to effective therapy with young clients.
Some adolescents may be unclear about limits to which psychotherapists influence and control others outside therapy. They may imbue therapists with greater power and authority than reality confers. Some adolescents may envision their therapist as a savior ready to provide rescue from antagonistic peers or oppressive administrators. Clarification is important:
Before starting, I want to make sure you understand my role. In therapy you and I work together to understand some of the things that might be bugging you and come up with solutions or ideas to try. But, even though I like to think I know everything and can solve any problem, there are limits to my power. For example, let’s say you’re having a conflict with peers. I would work with you to resolve these conflicts, but I’m not the police, and I can’t get them sent to jail or shipped to military school. I can’t get anyone fired, and I can’t help you break any laws. Does that make sense? Do you have any questions for me?
A clear explanation of the therapist’s role and an explanation about counseling process can allay uncertainties and fears about therapy. Inviting questions and allowing time for discussion helps empower adolescent clients, build rapport, and lower resistance.
Wishes and Goals: Wishes and goals is a specific mutual goal-setting procedure that I’ve used with youth. It’s described in the Tough Kids, Cool Counseling book. You can watch a youtube video demonstration of the procedure being used as part of a session opening with a 12-year-old client named Claire. Here’s the link: https://www.youtube.com/watch?v=rHHrMC8t6vY&feature=youtu.be
6. Collaborative Therapeutic Tasks (aka task collaboration)
In psychotherapy, tasks and techniques are also referred to as procedures. Even if counselors are employing a highly relational approach, it is still crucial to engage clients in specific tasks, activities, or procedures that are conceptually linked to solving their problems and achieving their goals. This may be a more implicit process, as when a solution-focused counselor helps clients identify and elaborate on exceptions, or more explicit, as when counselors teach clients how to make decisions using a four-step problem-solving process.
Though engaging clients in therapeutic tasks involves applying specific techniques, it quickly becomes relational. From the evidence-based relationship perspective, which specific procedures to apply is far less important than how they are applied. They must be applied collaboratively:
- The procedure—such as progressive muscle relaxation, Socratic questioning, or eye movements—must be explained clearly and linked to client goals (a psychoeducation process).
- Before the procedure is employed in the session, the client gives explicit permission or informed consent (e.g., “Is it okay with you if we try out this progressive muscle relaxation technique?”). This permission-seeking interaction is sometimes referred to as an invitation for collaboration.
- This part of the relational piece is crucial: after implementing the task or procedure, evidence-based counselors intermittently check in with clients (e.g., “What was your reaction to the role play we just tried?”). This requires sensitivity, empathic listening skills, and reassurance. Again, it makes no difference whether the specific task or procedure is free association (psychoanalytic theory), active listening and encouragement of the emergence of the self (as in person-centered counseling), reflecting as-if (Adlerian counseling), mindfulness meditation (cognitive-based mindfulness therapy), or another option. The point is that the relational activity of working together on a task contributes to positive outcomes (the preceding is from Sommers-Flanagan, 2015).
7. Forming an Emotional Bond
A good example of a positive emotional bond occurs when counselors and clients experience mutual liking and mutual positive anticipation of counseling sessions. The following excerpt is from Sommers-Flanagan (2015).
The formation of a positive emotional bond begins with informed consent, continues in the waiting room and during first impressions, includes creation of a pleasant and comfortable counseling space, and involves specific counselor responses throughout each session, such as empathic reflections, positive strength-based feedback, and validating feelings. It also involves letting clients talk about their problems and the past as they wish—even when the counselor is operating from an approach that typically does not place much value on gathering historical information, such as CBT or solution-focused counseling. For example, Judith Beck (2011) emphasized that cognitive-behavior therapists should talk freely with clients about the past either when the client is stuck or when clients want to talk about the past. This is one of the ways in which relational and technical aspects of counseling merge. For all theoretical perspectives—from existential to reality therapy to CBT—counselors take special care to bond with clients, and part of that bonding involves letting them talk about what they want to talk about.
Recommendations for Developing a Positive Working Alliance
Again, from Clinical Interviewing.
Therapists who want to develop a positive working alliance (and that should include everyone) will employ alliance-building strategies beginning with first contact. Using Bordin’s (1979) model, alliance-building strategies focus on (a) collaborative goal setting; (b) engaging clients in mutual therapy-related tasks; and (c) development of a positive emotional bond. Progress monitoring is also recommended. The following list includes alliance-building concepts and illustrations:
Initial interviews and early sessions are especially important to alliance-building. Many clients will be naïve about psychotherapy. This makes role inductions essential. Here’s a cognitive-behavioral therapy (CBT) example:
For the rest of today’s session, we are going to be doing a structured clinical interview. This interview assesses a range of different psychological difficulties. It is a way to make sure that we “cover all of our bases.” We want to see if social anxiety is the best explanation for your problems and also whether you are having any other difficulties that we should be aware of. (Ledley, Marx, & Heimberg, 2010, p. 36)
Asking clients direct questions about what they want from counseling and then integrating that information into your treatment plan helps build the alliance. In CBT this includes making a problem list (J. Beck, 2011).
Clinician: What brings you to counseling and how can I be of help?
Client: I’ve just been super down lately. You know. Tough to get up in the morning and face the world. Just feeling pretty crappy.
Clinician: Then we definitely want to put that on our list of goals. Can I write that down? [Client nods assent] How about for now we say, “Find ways to help you start feeling more up?”
Client: Sounds good to me.
Engaging in collaborative goal-setting to achieve goal consensus is central to alliance-building. In CBT this involves transforming the “problem list” into a set of mutual treatment goals.
Clinician: So far I’ve got three goals written down: (1) Find ways to help you start feeling more up, (2) Help you deal with the stress of having your sister living with you and your family, and (3) Improving your attitude about exercising. Does that sound about right?
Client: Totally. It would be amazing to tackle those successfully.
Problem lists and goals are a good start, but clients engage with clinicians better when they know the treatment plan (TP) for moving from problems to goals. The TP includes specific tasks that will happen in therapy and may begin in the first clinical interview. Here’s an example of a “Devil’s Advocacy” technique where the clinician takes on the client’s negative thoughts and then has the client respond (Newman, 2013). You’ll notice that collaboratively engaging in mutual tasks offers spontaneous opportunities for deeper connection and clinician-client bonding:
Clinician: You said you want a romantic relationship, but then you start thinking it’s too painful and pointless. Let’s try a technique where I take on your negative thinking and you respond with a reasonable counter argument. Would you try this with me?
Client: Sure. I can try.
Clinician: Excellent. Here we go: “It’s pointless to pursue a romantic relationship because they always come to a painful end.”
Client: That’s possible, but it’s also possible to have some good times along the way toward the painful end.
Clinician: [Smiles, breaks from role, and says] . . . That’s the best come-back ever.
Soliciting feedback from clients from the first session on to monitor the quality and direction of the working alliance contributes to the alliance. Although you can use an instrument for this, you can also ask directly:
We’ve been talking for 20 minutes and so I want to check in with you on how you’re feeling about our time together so far. How are you doing with this process?
Making sure you’re able to respond to client anger without becoming defensive or counterattacking is essential to positive working relationships. We usually apply radical acceptance (Linehan, 1993). Here’s an excerpt from an initial session with an 18-year-old male where the clinician accepted the client’s aggressive message and transformed it into a relational issue:
Clinician: I want to welcome you to therapy with me and I hope we can work together in ways you find helpful.
Client: You talk just like a shrink. I punched my last therapist in the nose (client glares at therapist and awaits a response) (J. Sommers-Flanagan & Bequette, 2013, p. 15).
Clinician: Thanks for telling me that. I’d never want to have the kind of relationship with you where you felt like hitting me. And so if I ever say anything that offensive, I hope you’ll just tell me, and I’ll stop.
8. Rupture and Repair
In many counseling situations there are inevitable strains, impasses, resistance, and intermittent weakening of the therapeutic relationship. These things happen naturally and both client and the counselor contribute to these therapeutic ruptures. As counselors, sooner or later, we all “fail” to get it right; we might miss with our paraphrases, let out a little judgment, or recommend a therapeutic task that the client finds aversive.
There are two basic signs of therapeutic rupture. These include (a) when clients withdraw and (b) when clients behave in an aggressive or confrontational manner.
If/when you notice there may be a rupture, you have several options. These include:
- Repeating the therapeutic rationale
- Changing tasks or goals
- Clarifying misunderstandings at a surface level
- Exploring relational themes and taking responsibility for the rupture (this might include cultural misunderstandings)
Of course, repair doesn’t happen instantly, but over time, you can regain trust and deepen the relationship.
Noticing Process and Making Corrections (Rupture and Repair): When there’s a clear pattern that begins to manifest itself in the counseling session, it’s best to acknowledge that pattern. In one session I had with a Black 19-year-old male, I offered a half-dozen paraphrases and most of them were rejected. The client said things like, “Nah” and “Not exactly.” Eventually, after several paraphrases “misses” I managed to notice the pattern and share with the client, “I noticed that I’m trying to listen to you and understand what you’re saying, but I keep getting it wrong and you keep correcting me. I’m sorry for this and I appreciate you letting me know when I don’t quite get things right. If it’s okay with you, I’ll keep trying and you can keep correcting me when I get things wrong.” In situations like this one, it’s recommended that the counselor acknowledge the process reality in the session. Because, as Yalom has so articulately noted, commenting on process can be intense, it can be better to begin process commentary by noticing your own less-than-optimal patterns.
9. Managing Countertransference
Research suggests that our countertransference reactions can teach us about ourselves, our underlying conflicts, and our clients (Betan, Heim, Conklin, & Westen, 2005; Mohr, Gelso, & Hill, 2005). For example, based on a survey of 181 psychiatrists and clinical Counselors, Betan et al., reported “patients not only elicit idiosyncratic responses from particular clinicians (based on the clinician’s history and the interaction of the patient’s and the clinician’s dynamics) but also elicit what we might call average expectable countertransference responses, which likely resemble responses by other significant people in the patient’s life” (p. 895). Countertransference is now widely considered a natural phenomenon and useful source of information that can contribute to counseling process and outcome (Luborsky, 2006). In fact, clinicians from various theoretical orientations have historically acknowledged the reality of countertransference.
Speaking from a behavioral perspective, Goldfried and Davison (1976), the authors of Clinical Behavior Therapy, offered the following advice: “The therapist should continually observe his own behavior and emotional reactions, and question what the client may have done to bring about such reactions” (p. 58). Similarly, Beitman (1983) suggested that even technique-oriented counselors may fall prey to countertransference. He believes that “any technique may be used in the service of avoidance of countertransference awareness” (p. 83). In other words, clinicians may repetitively apply a particular therapeutic technique to their clients (e.g., progressive muscle relaxation, mental imagery, or thought stopping) without realizing they are applying the techniques to address their own needs, rather than the needs of their clients. There are many moments to reflect on how countertransference dynamics might affect the counseling process during the workshop. More recent research affirms that identifying and working through countertransference is associated with positive counseling and psychotherapy outcomes (see: Norcross, 2011).
To deal effectively with countertransference requires the following possibilities:
- The counselor is aware of the possibility
- The counselor seeks supervision
- The counselor gets counseling
- The counselor owns his/her/their countertransference reaction in the session and makes a commitment to dealing with it effectively
10. Progress Monitoring
Progress monitoring occurs when counselors routinely and formally check in with clients regarding the clients’ progress. This “checking in” can focus on the counseling relationship/alliance or on symptom improvement. At a very basic level, counselors can check in informally, like Carl Rogers often did (e.g., “Am I getting that right?”
More formal progress monitoring can involve use of formal scales like the session rating Scale and the Outcomes Rating Scale. You can find these instruments online.
The most important part of progress monitoring may be as simple as you, the counselor, showing interest in the client.
A Bonus Technique
As a method for deepening your understanding of the EBRFs, I recommend that you watch some counseling sessions with the intent to “see” the EBRFs in action. To give you an opportunity for that, I’m offering this bonus technique and an accompanying video clip.
The Three-Step Emotional Change Trick: Emotions are complex. Young people need strategies for dealing with negative affect. The three-step emotional change trick is one method for providing emotional education. For details, and a video demonstration, see: https://johnsommersflanagan.com/2017/03/12/revisiting-the-3-step-emotional-change-trick-including-a-video-example/
John S-F Resources
The main resources from which this handout is drawn are below, starting with my own publications and then continuing to additional citations.
Sommers-Flanagan, J. (2018). Conversations about suicide: Strategies for detecting and assessing suicide risk. Journal of Health Service Psychology, 44, 33-45.
Sommers-Flanagan, J., & Shaw, S. L. (2017). Suicide risk assessment: What psychologists should know. Professional Psychology: Research and Practice, 48, 98-106.
Sommers-Flanagan, J. (2015). Evidence-based relationship practice: Enhancing counselor competence. Journal of Mental Health Counseling, 37, 95-108.
Sommers-Flanagan, J. (2018). Suicide assessment and intervention with suicidal clients [Video]. 7.5 hour training video for mental health professionals. Mill Valley, CA: Psychotherapy.net.
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2018). Counseling and psychotherapy theories in context and practice: Skills, strategies, and techniques (3rd ed.). Hoboken, NJ: Wiley.
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2017). Clinical Interviewing (6th ed.). Hoboken, NJ: Wiley.
Sommers-Flanagan, J. (2016). Assessment strategies. In M. Englar-Carlson (Ed.). The skills of counseling [Video]. Alexandria, VA: Alexander Street Press.
Sommers-Flanagan, J. (2015). Evidence-based relationship practice: Enhancing counselor competence. Journal of Mental Health Counseling, 37, 95-108.
Sommers-Flanagan, J., & Bequette, T. (2013). The initial psychotherapy interview with adolescent clients. Journal of Contemporary Psychotherapy, 43(1), 13-22.
Sommers-Flanagan, J., Richardson, B.G., & Sommers-Flanagan, R. (2011). A multi-theoretical, developmental, and evidence-based approach for understanding and managing adolescent resistance to psychotherapy. Journal of Contemporary Psychotherapy, 41, 69-80.
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2007). Tough kids, cool counseling: User-friendly approaches with challenging youth (2nd ed.). Alexandria, VA: American Counseling Association.
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2018). Clinical interviewing (6th ed.). Hoboken, NJ: John Wiley & Sons.
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2017). Counseling and psychotherapy theories in context and practice: Skills, strategies, and techniques (3rd ed.). Hoboken, NJ: Wiley.
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2004). The challenge of counseling teens: Counselor behaviors that reduce resistance and facilitate connection. [Videotape]. North Amherst, MA: Microtraining Associates.
Betan, E., Heim, A.K., Conklin, C. Z., & Westen, D. (2005). Countertransference phenomena and personality pathology in clinical practice: An empirical investigation. American Journal of Psychiatry, 162 (5), 890 – 898.
Castro-Blanco, D., & Karver, M. S. (2010). Elusive alliance: Treatment engagement strategies with high-risk adolescents. Washington, DC: American Psychological Association.
de Shazer, S. (1985). Keys to solution in brief therapy. New York: Norton.
Feindler, E. (1986). Adolescent anger control. New York: Pergamon Press.
Kolden, G. G., Klein, M. H., Wang, C., & Austin, S. B. (2011). Congruence/genuineness. Psychotherapy relationships that work: Evidence-based responsiveness (2nd ed.) (pp. 187–202). New York, NY: Oxford University Press.
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Preparing people for change (3rd ed.). New York: Guilford Press.
Norcross, J. C. (Ed.). (2011). Evidence-based therapy relationships. Psychotherapy relationships that work: Evidence-based responsiveness (2nd ed.). New York, NY: Oxford University Press.
Norcross, J. C., & Lambert, M. J. (2018). Psychotherapy relationships that work III. Psychotherapy, 55(4), 303-315.
Rogers, C. R. (1961). On becoming a person. Boston: Houghton Mifflin.
Shirk, S. R., Karver, M. S., & Brown, R. (2011). The alliance in child and adolescent psychotherapy. Psychotherapy, 48, 17-24.
Villalba, J. A., Jr. (2007). Culture-specific assets to consider when counseling Latina/o children and adolescents. Journal of Multicultural Counseling and Development, 35(1), 15-25.
Watkins, J. G. (1971). The affect bridge: A hypnoanalytic technique. International Journal of Clinical and Experimental Hypnosis, 19, 21-27.
Weisz, J., & Kazdin, A. E. (2010). Evidence-based psychotherapies for children and adolescents (2nd ed.). New York: Guilford.
If you have questions about this handout, or are interested in having John SF conduct a workshop or keynote for your organization, contact John at: email@example.com. You may reproduce this handout if you like, but please provide an appropriate citation. For additional free materials related to this workshop and other topics, go to John’s Blog at: johnsommersflanagan.com
The Slate Magazine article where I use Theodore Millon’s personality descriptions to articulate possible challenges linked to Trump and the U.S. Presidency is out. Here’s the link: https://slate.com/technology/2018/08/no-matter-how-bad-it-gets-trump-will-never-give-up.html
As always, feel free to comment. You can do that here or on the Slate article itself.
Today I’m with the fabulous mental health professionals from the Western Montana Community Mental Health Center. We’ll be talking about suicide assessment and intervention. Here are the powerpoint slides:
It should be another amazing day in Montana.
See you soon.