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The 6th Edition of Clinical Interviewing is Now Available

Way back in 1990, a university book salesman came by my faculty office at the University of Portland. He was trying to sell me some textbooks. When I balked at what he was offering, he asked, “Do you have any textbook ideas of your own?” I said something like, “Sure” or “As a matter of fact, I do.” He handed me his card and a paper copy of Allyn & Bacon’s proposal guidelines.

Not having ever written a book, I never thought they’d accept my proposal.

They did. But after three years, A & B dropped our text.

Lucky for us.

Two  years later, Rita and I decided to try to resurrect our Clinical Interviewing text. We polished up a proposal, sent it out to three excellent publishers, and immediately got contract offers from W. W. Norton, Guilford, and John Wiley & Sons.

We went with Wiley.

Here we are 18 years later in the 6th edition. It’s been fun and a ton of work. Over the past five years we’ve started recording video clips and interviewing demonstrations to go along with the text. For the 6th edition, we got some pretty fantastic reviews from some pretty fancy (and fantastic) people. Here they are:

“I’m a huge admirer of the authors’ excellent work.  This book reflects their considerable clinical experience and provides great content, engaging writing, and enduring wisdom.”
John C. Norcross, Ph.D., ABPP, Distinguished Professor of Psychology, University of Scranton

“The most recent edition of Clinical Interviewing is simply outstanding.  It not only provides a complete skeletal outline of the interview process in sequential fashion, but fleshes out numerous suggestions, examples, and guidelines in conducting successful and therapeutic interviews.  Well-grounded in the theory, research and practice of clinical relationships, John and Rita Sommers-Flanagan bring to life for readers the real clinical challenges confronting beginning mental health trainees and professionals.  Not only do the authors provide a clear and conceptual description of the interview process from beginning to end, but they identify important areas of required mastery (suicide assessment, mental status exams, diagnosis and treatment electronic interviewing, and work with special populations).  Especially impressive is the authors’ ability to integrate cultural competence and cultural humility in the interview process.  Few texts on interview skills cover so thoroughly the need to attend to cultural dimensions of work with diverse clients.  This is an awesome book written in an engaging and interesting manner.  I plan to use this text in my own course on advanced professional issues.  Kudos to the authors for producing such a valuable text.”
—Derald Wing Sue, Ph.D., Professor of Psychology and Education, Teachers College, Columbia University

“This 6th edition of Clinical Interviewing is everything we’ve come to expect from the Sommers-Flanagan team, and more!  Readers will find all the essential information needed to conduct a clinical interview, presented in a clear, straightforward, and engaging style.  The infusion of multicultural sensitivity and humility prepares the budding clinician not only for contemporary practice, but well into the future.  Notable strengths of the book are its careful attention to ethical practice and counselor self-care. The case studies obviously are grounded in the authors’ extensive experience and bring to life the complexities of clinical interviewing.  This is a ‘must-have’ resource that belongs on the bookshelf of every mental health counselor trainee and practitioner.”
Barbara Herlihy, PhD. NCC, LPC-S, University Research Professor, Counselor Education Program, University of New Orleans

You can check out the text on Amazon  or Wiley  or other major (and minor) booksellers.



The Sweet Spot of Self-Control

The Sweet Spot of Self Control (and Anger Management)

The speedometer reads 82 miles per hour. The numbers 8 and 2, represent, to me, a reasonable speed on I-90 in the middle of Montana. Our new (and unnecessary) speed limit signs read eight-zero. So technically, I’m breaking the law by two miles per hour. But the nearest car is a quarter mile away. The road is straight. Having ingested an optimal dose of caffeine, my attention is focused.

Slowly, a car creeps up from behind. He has his cruise control set at 83 mph. He lingers beside me and edges ahead. Then, with only three car lengths between us, he puts on his blinker and pulls in front of me. Now, with no other cars in sight, there’s just me and Mr. 83 mph on I-90, three car lengths apart.

An emotion rises into awareness. It’s almost anger. But nope, it not anger, it’s anger’s close cousin, annoyance. I feel it in my psyche and immediately know it can go in one of three directions: It could sit there and remain itself, until I tire of it; if I feed it, it could rise up and blossom into full-blown anger; or, I can send it away, leaving room for other thoughts and actions.

This is fabulous. This is the Sweet Spot of Self-Control.

Anger is lurking there, I know. I see it peeking over the shoulder of its cousin. “Hello anger,” I say.

In this sweet spot, I experience expanding awareness, a pinch of energy, along with an unfolding of possibilities. I love this place. I love the feelings of strength and power. I also recognize anger’s best buddy, the behavioral impulse. This particular impulse (they vary of course), is itching for me to reset my cruise control to 84 mph.  It’s coming to me in the shape of a desire—a desire to send the driver in front of me a clear message.

“You should cut him off,” the impulse says, “and let him know he should get a clue and give you some space.”

The sweet spot is sweet because it includes the empowered choice to say “No thanks” to the impulse and “See you later” to anger.

Now I’m listening to a different voice in my head. It’s smaller, softer, steadier. “It doesn’t matter” the voice whispers. “Let him creep ahead. Revenge only satisfies briefly.”

I feel a smile on my face as I remember an anger management workshop. With confidence, I had said to the young men in attendance, “No other emotion shifts as quickly as anger. You can go from feeling completely justified and vindicated, but as soon as you act, you can feel overwhelmed with shame and regret.”

A man raised his hand, “Lust” he said. “Lust is just like anger. One second you want it more than anything, but the next second you wish you hadn’t.”

“Maybe so,” I said. “Maybe so.”

There are many rational reasons why acting on aggressive behavioral impulses is ill-advised. Maybe the biggest is that the man in the car wouldn’t understand my effort to communicate with him. This gap of understanding is common across many efforts to communicate. But it’s especially linked to retaliatory or revenge-filled impulses. When angry, I can’t provide nuance in my communication and make it constructive.

The quiet voice in my brain murmurs: “You’re no victim to your impulses. You drive the car; the car doesn’t drive you.” That doesn’t make much sense. Sometimes the voice in my head speaks in analogy and metaphor. It’s a common problem. I want straight talk, but instead I get some silly metaphor from my elitist and intellectual conscience.

But I do get it and here’s what I get. I get that my conscience is telling me that this sweet spot is sweet because I get to see and feel my self-control. Not only do I get to see my behavioral options, I get to see into the future and evaluate their likely outcomes. I get to reject poor choices and avoid negative outcomes linked to aggressive actions. I’m not a victim of annoyance, anger, or aggressive impulses. I get to make the plan. I get to drive the car.

Now that other driver is far ahead.

Being on a Montana freeway, it’s hard to not think of deer. It’s clear now, but at dusk, deer will be everywhere. They have an odd instinct. Freud and my elitist conscience are inclined to call it a death instinct. Here’s how it works:

When I drive up alongside a deer on the side of the road, it dashes ahead, running alongside me; then it tries to cut across in front of me. This is the coup de gras of bad judgment. I’m in a big metal machine. The deer isn’t. So the deer dies. Not a good choice for the deer.

Yesterday, my phone alerted me to a Youtube speech by an unnamed alt right big-man. I watched and listened. So much smugness I was sick. In the end he shouted out “Hail Trump” and a few others jumped up and gave the “Heil Hitler!” salute.

Like a crazed deer, I felt an instinct. I wanted to drive to D.C. or Whitefish, Montana and find unnamed alt-right man and cut him off with some uncivil discourse. Instead, because I have a frontal lobe, I walked to the gym. Upon arriving, I discovered I’d stepped in dog poop. I’m sure this was an annoying but meaningful metaphor for something. At least that’s what my metaphor-loving conscience suggested. I didn’t buy it. Instead, I muttered “WTF” to myself. Okay, so maybe I muttered “WTF” several times. Then I walked outside in my socks and started cleaning the poop off my shoe. Not an easy task, especially if you’re wearing brand new trail-runners. I had to find a restroom near my office, an old toothbrush, lots of foamy soap, and mindfully scrub away the poop.

I was reminded of something my daughter Rylee once said at age three. She was being carried down a hill and there were many small piles of deer scat. She noticed, commenting: “I didn’t know the poop was so deep.”

Neither did I.

But the good news is that I (like you) own a functional frontal lobe that gifts me with the Sweet Spot of Self-Control. Many of us will be mindfully removing the metaphorical shit from our shoes for some time into the future. So let’s make some plans. Not revenge-laced plans; they don’t last. Yes. Let’s pause in the special sweet spot, evaluate our alternatives, and make some excellent plans.


Why You Should Listen to the Practically Perfect Parenting Podcasts

The Practically Perfect Parenting Podcast is live at:

That’s the good news.

The bad news is that even though the PPPP has been live since October 31, John and Sara still haven’t become famous podcasters.

Apparently, these things take time.

Even so, we’ve gotten a couple fabulous reviews. Here’s one from Brittany Moreland: “For whatever reason, I have avoided “parenting manuals” of any type BUT folks this is awesome. Not only can I attest that one of the hosts (John Sommers-Flanagan) is a great person and parent, but objectively this is worth any parent’s time.”

Don’t delay. Right now you can access three PPPP episodes on our podcasting website:

You can also listen to all of the live episodes on iTunes:

If you listen on iTunes, be sure to give it a rating. If you’re uncertain about what rating to give, we generally recommend 5 STARSJ.

On Monday, a new episode goes live. It’s titled: Get Curious, Not Furious: Discipline Again and Again and Some More.

Just so you’re up-to-date, here’s a list and description of the line-up through January:

Podcast Schedule

New podcasts will become live on a twice-monthly schedule.

October 31 – Episode 1: Dear Mom and Dad, Please be my Parent and Not my Bestie

Modern parents want high-quality relationships with their children. In this podcast Dr. Sara and Dr. John discuss the downside of forgoing parental responsibilities in favor of parent-child friendships. A balanced relationship where parents have strong emotional connections combined with parental decision-making authority is recommended.

November 14 – Episode 2: Practically Perfect Positive Discipline

Discipline can be a dirty (and misunderstood) word. In this episode, Dr. Sara and Dr. John knock-out old negative notions about discipline and replace them with new and research-based methods for using positive approaches to discipline.

November 28 – Episode 3: Discipline, Part 2

Dr. John and Dr. Sara continue their discussion of how parents can maintain structure and discipline in the family. In this episode they focus like a laser on specific techniques parents can use to set limits and teach their children positive family values and helpful lessons about about life.

December 12 – Episode 4: Get Curious, Not Furious: Discipline Again and Again and Some More.

You can’t get too much information about positive approaches to discipline. Seriously. That’s why Dr. Sara and Dr. John can’t stop talking about it. This episode will help parents step back and get curious about what causes misbehavior. John and Sara will review the four psychological reasons why children misbehave and focus on how to break through the obstacles that get in the way of using positive discipline strategies. This episode’s special guest: Meg Akabas, author of “52 Weeks of Parenting Wisdom: Effective Strategies for Raising Happy, Responsible Kids.”

December 26 – Episode 5: Sleep Well in 2017 and Beyond

As a locally renowned expert on helping children sleep, Dr. Sara shares her story of being an exhausted parent and offers her tips for parents who want to embrace the value of healthy sleep in their families. Special Guest: Chelsea Bodnar, M.D., a Chicago-based pediatrician and co-author of “Don’t Divorce Us: Kids’ Advice to Divorcing Parents.”

January 9, 2017 – Episode 6: Sleeping like a Baby (Should)

In this episode Dr. Sara continues providing tips on healthy sleep habits, this time focusing on babies. Medical and developmental guidance is included. Special Guest: Chelsea Bodnar, M.D., a Chicago-based pediatrician and co-author of “Don’t Divorce Us: Kids’ Advice to Divorcing Parents.”

January 23 – Episode 7: Post-Partum Depression

In this post-Thanksgiving special, Dr. Sara and Dr. John discuss the natural challenges of pregnancy, childbirth, and parenting. The signs and symptoms of postpartum or peri-natal depression are described and specific recommendations for coping with PPD are offered.  Special Guest: Jane Honikman, M.S., author of “I’m Listening: A Guide to Supporting Postpartum Families.”

General Program Description and Co-Host Bios

The Practically Perfect Parenting Podcast features Dr. Sara Polanchek and Dr. John Sommers-Flanagan discussing cutting-edge parenting issues, offering specific guidance, and sharing parenting resources. This podcast is a valuable resource for all parents interested in the art of parenting well. It’s also recommended listening for parenting educators, counselors, psychologists, social workers, teachers, and other school personnel who want more information on basic and contemporary parenting issues.

Sara Polanchek, EdD, (aka the Sleep Guru) is a licensed clinical social worker and Clinical Director in the University of Montana’s Counselor Education department.  Previously she was the Parenting Director at Families First in Missoula and continues to present at workshops and write articles on many issues pertaining to parenting and intimate relationships.

John Sommers-Flanagan, PhD, is a licensed clinical psychologist and Professor of Counselor Education at the University of Montana. He is the former cohost of “What is it with Men?” on Montana Public Radio and former executive director of Families First Missoula. He is author or co-author of nine books (including, “How to Listen so Parents will Talk” published by John Wiley and Sons) and many professional articles, blogs, and rants.

*All podcasts are sponsored in part by a grant from the Engelhard Foundation and support from the National Parenting Education Network.



Emotional Dysregulation: Finding the Way Out

Sometimes we call it affect dysregulation. It creeps around like a metaphorical tarantula, sometimes popping up—big and frightening—and always best viewed from a distance. Just like shit, emotional dysregulation happens.

In counseling and psychotherapy, we throw around jargon. It can be more or less helpful. When it’s helpful, it facilitates important communication; when it’s not, it distances us from the experiences of our clients, students, and other mental health consumers.

So what is emotional dysregulation? Here’s what Wikipedia says:

Emotional dysregulation (ED) is a term used in the mental health community to refer to an emotional response that is poorly modulated, and does not fall within the conventionally accepted range of emotive response. ED may be referred to as labile mood (marked fluctuation of mood) or mood swings.

I hereby declare that definition not very helpful.

I have a better definition. Emotional dysregulation (ED) is the term of the month. Why? Because I’ve been intermittently emotionally dysregulated since November 9 and I see emotional dysregulation nearly everywhere I look.

I’ve seen many clients for whom the term emotionally dysregulated is an apt description. These clients report being frequently triggered or activated (more jargon) by specific incidents or experiences. Many of these incidents are interpersonal, but as many of us know from the recent election, they can also be political and, for many, reading about or directly experiencing social injustice is a big trigger. After being emotionally triggered, the person (you, me, or a client) is left feeling emotionally uneasy, uncomfortable, and it can be hard to regain emotional equilibrium, calm, or inner peacefulness.

What are common emotional dysregulators? These include, but are certainly not limited to: Being misunderstood, experiencing social rejection or social injustice, harassment, or bullying, or being emotionally invalidated. Consider these (sometimes well-meaning) comments: “Smile.” “What’s wrong with you?” “You’re overreacting.” “Chill.” “Cheer up.”). One time I overheard a father tell his son, “Do you think I give a shit about what you’re feeling?” Yep. If someone says that to you or you overhear someone saying it to a 10-year-old, that might trigger emotional dysregulation.

Emotional dysregulation passes. That’s the good news. But sometimes it doesn’t pass soon enough. And other times, like when I see he-who-will-not-be-named on the television screen or hear his voice on the radio, repeated re-activation or re-triggering can occur. It becomes the Ground Hog’s Day version of emotional dysregulation.

In the clinical world, emotional dysregulation is linked to post-traumatic stress disorder, borderline personality disorder, clinical depression, and a range of other anxiety disorders. Suicidal crises often have emotional triggers. The point: emotional dysregulation is a human universal; it occurs along a continuum.

The Fantastic Four

Emotional dysregulation usually involves one of the fantastic four “negative” emotions. These include:

  • Anger
  • Sadness
  • Fear
  • Guilt

To be fair, these emotions aren’t really negative. They have both negative and positive characteristics. In every case, they can be useful, sooner or later, to the person experiencing them. For example, anger is both light and energy. It can clarify values and provide motivation or inspiration. Unfortunately, the light and energy of anger is also confusing and destabilizing. It’s easy for anger to cloud cognition; it’s easy for anger to send people out on misguided behavioral missions. Funny thing, these misguided, anger-fueled missions often feel extremely self-righteous, right up until the point they don’t. Less funny thing, immediately after the punch, the flip-off, the profanity, the broken window or door or relationship or whatever—regret often follows. Ironically then, the emotional dysregulation (anger) leads to behavioral dysregulation (aggression), which leads right back to emotional dysregulation (guilt and remorse).

Dysregulation can be experienced via any of a number of dimensions. You can experience behavioral, mental, social, and spiritual dysregulation. What fun! Who designed this system where we can get so dysregulated in so many different ways? Never mind. It was probably he-who-will-not-be-named.

One of the most perplexing things about emotional dysregulation is that so very often, we do it to ourselves. We do it repeatedly. And more or less, we usually know we’re doing it. We seem to want to embrace our anger, sadness, fear, and guilt. What’s wrong with that? Nothing, that is, until we want out.

For most people, the fantastic four feel bad. They stay too long. They adversely affect relationships. They’re bad company.

There’s one best way out of emotional dysregulation. I’ll say it in a word that I’m borrowing from Alfred Adler. Gemeinschaftsgefühl. I’ll say it in another word: Empathy. Empathy for yourself and others. The kind of empathy that moves you to being interested in other people and motivated to help make our communities and the world better, safer, and more filled with justice.

Okay then. Let’s get out there and start Gemeinschaftsgefühling around. We’ve got at least four years of work ahead.


For another, less profound way out of the Fantastic Four negative emotions, check out the Three-Step Emotional Change Trick:



Why Learn Theories?

Happy Sunday morning. I’m at my standing desk, working on the revision of our Counseling and Psychotherapy Theories text. What fun. Actually, because I’ve been getting great and constructive feedback from many different reviewers, THIS IS much more fun than it might be otherwise.

Today I’m posting a potential new start to the theories text. It came to me because some academics have questioned the value of teaching counseling and psychotherapy theories. If you’re interested, I’d love to hear your opinion on that. Also, if you have feedback on whether the following piece makes for a good start to a theories text (or not), I’d love to hear your opinion on that too.

Here it is:

Why Learn Theories?

About a decade ago, I (John) was flying back from a professional conference when a professor (we’ll call him Darrell) from a large Midwestern university spotted an empty seat next to me. He sat down, and being aware that I have a book on counseling and psychotherapy theories, initiated the sort of conversation that probably only happens among counseling, psychology, or social work professors.

He plunged right in, “I think counseling and psychotherapy theories are passé. There has to be a better way to teach students how to actually do counseling and psychotherapy.”

When confronted like this, I like to pretend I’m Carl Rogers, so I paraphrased, “You’re thinking there’s a better way.”

“Yes!” he said. “All the textbooks start with Freud and crawl their way to the present. Too much time is wasted reviewing outdated theories that were developed by old White men. What’s the point of that?”

“The old theories seem pointless to you.” I felt congruent with my inner Rogers.

“Worse than pointless,” he glared, “they’re not just unnecessary; they’re destructive! We live in a diverse culture. Those theories weren’t built for today. I’m a White heterosexual male and they don’t even fit for me. We need to focus our students on empirically-supported treatments and then teach them the technical skills they need to implement those approaches. We live in a time and a place that values action and effectiveness. That’s what our clients want and deserve. For the next edition of your theories text you should put traditional theories of counseling and psychotherapy in the dumpster where they belong.”

I lost my connection to Carl Rogers and was about to go all Albert Ellis on him when the intercom crackled to life. The flight attendant directed everyone to return to their seats. My academic colleague reluctantly rose and bid me farewell.


On the surface, Darrell’s argument is compelling. Counseling and psychotherapy theories must adjust themselves to address unique issues of women as well as racial, ethnic, sexual, and religious minorities. Theories also need to be more practical. “Crusty” old theories need updating and need to be more user-friendly. Students should be able to read a theories chapter and finish with a clear sense of how to apply that theory in practice.

But Darrell’s argument is also off target. Although he’s advocating an evidence-based (scientific) orientation, he doesn’t seem to appreciate the central role of theory to science. As Carl Zimmer (2016) of the New York Times recently wrote: “Theories are neither hunches nor guesses. They are the crown jewels of science” (p. D6).

Counseling and psychotherapy theories are well-developed systems for understanding, explaining, predicting, and controlling human behavior. When someone on Twitter writes, “I have a theory, that cats are actually in a liquid state some of the time,” it’s not a theory (Zimmer, 2016). More likely, it’s a thought or a guess or a goofy statement pertaining to that person’s idiosyncratic take on reality. It might be a fascinating thought or statement, but it’s still not a theory.

Instead of “crown jewels,” we like to think of theories as the “foundations” from which we build our understanding of human development, suffering, self-destructive behavior, positive change, and other human experiences. Without theory, we can’t understand why people engage in self-destructive behaviors or why they sometimes suddenly stop engaging in those behaviors. If we can’t understand why people behave in certain ways, then our ability to identify and apply effective treatments is compromised. In fact, every evidence-based or empirically-supported approach that exists rests on the shoulders of counseling and psychotherapy theories.

In life and psychotherapy, there are often repeating patterns. I recall making an argument similar to Darrell’s, way back in the 1980s. I complained to a professor that I just wanted to focus on learning the essentials of becoming a great therapist. Her feedback was direct: I could become a technician who applied specific procedures to people with specific problems or I could grapple with deeper issues and become a real therapist with a more profound understanding of human problems, who could articulate the benefits and limitations of specific psychological change strategies, and who could modify those strategies to fit unique and diverse clients.

Just like Darrell, my professor was biased, but in the opposite direction. She valued nuance, human mystery, and existential angst. She devalued what she viewed (at the time) as the superficiality of behavior therapy.

Looking back, I can see both perspectives. Therapists need technical skills for implementing research-based treatments. But we also need respect and empathy for the idiosyncratic individual who comes to us for compassion and insight. We need to be able to view clients and problems from many perspectives—ranging from the indigenous to the contemporary medical model. To be really good at applying specific technical skills, we need to understand the nuance and dynamics of psychotherapy and how human change happens. And in the end, that means we need to study theories.

Contemporary Theories, Not Pop Psychology

Despite Darrell’s argument that traditional theories belong in the dumpster, all the theories in this text—even the old ones—are contemporary and relevant. They’re contemporary because they (a) have research support and (b) have been updated or adapted for working with diverse clients. They’re relevant because they include specific strategies and techniques that facilitate emotional, psychological, and behavioral change. Although some of these theories of human development and change are more popular than others, they shouldn’t be confused with “pop” psychology. In fact, these theories usually aren’t well understood or accurately portrayed in the popular media.

Another reason why these theories don’t belong in the dumpster is because they’re exciting and intellectually stimulating. Put simply, the drama associated with the development and application of these theories rivals anything Hollywood has to offer. The theories in this text are woven into and derived from great literature, myth, religion, and our dominant and minority political and social systems. They can explain and predict ways we interact with each other, including how we define mental health, whether we believe in mental illness, and our views on love, meaning, death, rehabilitation, and personal responsibility. They also help us answer big questions like:

  • What motivates people to do what they do?
  • What disturbs thinking processes, triggers unmanageable anger, diminishes personal productivity, and destroys relationships?
  • What causes one person to be satisfied with a simple and cheerful life, while others claw their way ruthlessly to the top?
  • What makes some people come out stronger after facing tragedy or hardship, while others are weakened or permanently damaged?

If you’ve come this far in your studies of psychology and counseling, you know there’s no single answer to these questions. It’s common for mental health professionals to strongly disagree with each other on just about every topic under the sun. Therefore, it should be no surprise that this book—a book about the major contemporary theories and techniques of psychotherapy and counseling—will contain stunning controversies and conflict. In the following pages, we do our best to bring you more than just the theoretical basics; we also bring you the thrills and disappointments linked to these theories of human motivation, functioning, and change.


Ethical and Cultural Considerations in Non-directive Listening

This week I’m back to reviewing the page proofs for the 6th edition of Clinical Interviewing. It’s tons of fun. I’m consistently surprised when I find typos or bad sentences in material that I’ve already reviewed five times previously. Ugh. Oh well. Life is generally good . . . and once in a while I run into some interesting new content that I think is worth sharing. Here’s one excerpt. It’s toward the end of Chapter 4, titled: “Nondirective Listening Skills.” The 6th edition is coming soon:

Ethical and Multicultural Considerations

It’s likely that each client will respond to you and your listening skills differently. Some clients will love having you as a listener. They’ll be instantly impressed with your excellent interviewing skills. Other clients will be neutral. Still others will think (and possibly tell you) that your education and training are worthless and that they resent having to spend time with you.

The Ethics of Not Directing

Listening well is an essential therapeutic skill, but many clients don’t come for counseling looking for an excellent listener. They come because they want an expert. They desire guidance. They may even want to be told what to do and how to do it.

The desire for an authoritative counselor may be particularly salient within ethnic and cultural groups. For example, Asian American clients tend to want more direct guidance from their counseling professionals (Chang & O’Hara, 2013). Of course this is a generalization, but knowing that some Asian clients want an expert and will be disappointed if you don’t act in more directive ways is valuable information.

Some presenting problems, such as those present in crises or severe mental disorders, also might require more active and directive interventions. Cultural and personal expectations, presenting problem(s), and theoretical orientations can call for more directive, authoritative interactions. If so, it might be unethical for you to persist with nondirective listening and not advance to the skills and techniques described in Chapters 5 and 6. See Case Example 4.2 for a concrete example.

Case Example 4.2: When Being Nondirective Might Be Unethical

While reading the referral information, you discover that your new client is a seventeen-year-old Chinese American female with a history of cutting and parasuicidal behavior. Early in the interview she tells you, “I want to stop cutting.” This is especially good news because you know something about skills training for clients who cut. Although your active listening provides an excellent foundation, if you only listen to her, you’ll be doing her a disservice. The point is this: If you know about something that fits with your client’s specific condition and you withhold it without an exceptionally good rationale, you’re in ethical hot water. In this case, you should actively begin teaching your client alternative emotional management skills.

In another situation, you could make a case for withholding your advice and being less direct. For example, if your client is Native American and rapport development is slow and you’re not certain that she’s motivated to stop cutting, you would have a solid rationale for maintaining a nondirective listening stance with plenty of self-disclosure and a focus on developing a working alliance. Staying less direct with Native clients and respecting their process are reasonable strategies. Your client might not be ready or willing to work on developing alternative coping strategies until session 2 or 3 or 4. If you were to jump in too soon with advice on how to stop cutting, your client might not show up for session 2.

Gender, Culture, and Emotion

Imagine that you’re in an initial clinical interview with a Latino male. Your impression is that he’s angry about his wife’s employment outside the home. You’re aware that some Latinos have more traditional ideas about male and female roles in the home. This knowledge provides you with evidence to support your hypothesis about your client’s emotional state. So you intentionally use a reflection of feeling to focus in on your client’s anger:

I’m getting the sense that you’re a little angry about your wife deciding to go back to work.

He responds,

Nah. She can do whatever she wants.

You hear his words. He seems to be empowering his wife to do as she pleases. But his voice is laden with annoyance. This leads you to try again to connect with him on a deeper level. You say,

Right. But I hear a little annoyance in your voice.

This reflection of feeling prompts an emotional response, but not the one you had hoped for.

Sure. You’re right. I am annoyed. I’m fucking annoyed with you and the fact that you’re not listening to me and keep focusing on all this feelings shit.

This is a dreaded scenario for many clinicians. You take a risk to reflect what seems like an obvious emotion, and you get hostility in return. For several possible reasons, your emotional sensitivity backfires. The client moves to a defensive and aggressive place, and a relationship rupture occurs (see Chapter 7 for more on dealing with relational ruptures).

It’s tempting to use culture and gender to explain this client’s negative reaction to your reflection of feeling. But it’s not that simple.

Although culture, gender, race, and other broad classification-based variables can sometimes predict whether a specific client will be comfortable with emotional expression, individual client differences are probably more substantial determinants. In particular, comfort in expressing emotion is often a function of whether the client comes from a family-neighborhood-cultural context where emotional disclosure was a norm. For example, Knight (2014) reported that black and Latino males who were unlikely to disclose to their peers attributed this tendency directly to their experiences living in violent communities. These young men had learned that emotional expression and trusting others were bad ideas in their neighborhoods. Conversely, emotional disclosure is more likely to be in the comfort range of black and Latino males who are raised in safer community environments. This makes good common sense: Whether clients perceive you as safe to talk with about emotional concerns probably has more to do with the clients’ background and past experiences than it has to do with you.

Overall, it’s likely that clients’ willingness to tolerate feeling reflections is based on a mix of their cultural, gender, and individual experiences. To move these ideas toward application, if you have reason to suspect that your client is less comfortable focusing on emotions, you should avoid words that are emotionally specific and therefore more provocative. Examples of emotionally specific words include angry, sad, scared, and guilty.

Instead of using emotionally specific words, you can initially substitute words that are emotionally vague (and less intense). Later, as trust develops, it may be possible to use more specific emotional words. Consider the following phrases:

  • You found that frustrating.
  • It seems like that bothered you a bit.
  • It’s just a little upsetting to think about that.

Putting It in Practice 4.4 lists examples of emotionally vague words you might use instead of emotionally specific words.

Putting It in Practice 4.4: Using Vague and Emotionally Safe Words

Emotionally Specific Words    Substitute (Safer) Words

Angry                                           Frustrated, upset, bothered, annoyed

Sad                                              Down, bad, unlucky, “that sucked”

Scared                                         Bothered, “didn’t need that,” “felt like leaving”

Guilty                                           Bad, sorry, unfortunate, “bad shit”

Embarrassed                               Less than comfortable, bugged, annoyed

Note: These words may work as substitutes for more emotionally specific words, but they also may not. It will be more effective for you to work with your classmates or work setting to generate less emotionally threatening words and phrases that are culturally and locally specific.


APA2016 in Denver — A Symposium on Publishing Books in Psychology

Today I had the honor and privilege of chairing an APA symposium in Denver, titled: Publishing Books on Psychotherapy: Insights and Strategies from Psychologist-Authors

The cool part was that I got to listen to and comment on Melba J. Vasquez, Derald Wing Sue, and John C. Norcross as they shared their ideas about how to publish books. The other cool part was that this symposium was attended by most of the other people I know and recognize at this APA conference: Nick Heck and Nick Livingston (both grads of the U of Montana’s doc program in clinical psych) and Jerry and Marianne Corey—who just happened to drop by.

In addition to listening to three amazing authors talk about publishing, I also had a short presentation . . . and so here it is:

Publishing Books on Psychotherapy: Tips from John Sommers-Flanagan

Tip 1: Get your Writer Identity on: Writing as Professional Identity. It’s a good idea to have excellent writing role models. That’s the whole point of today’s symposium. Melba Vasquez, Derald Wing Sue, and John Norcross are perfect examples of excellent writing role models. My best first advice on writer identity is for you to have at least one role model from a distance and one close to home. Even better (maybe), being in a local or online writer’s group can get you moving toward having a WRITER identity.

One way of thinking about identity is the concept of intersectionality. The old magic 8-ball can be a useful metaphor. For most of us, many different parts of our identity are “present” most the time. There could be LGBTQ, ethnicity, familial values, age, ability/disability, occupational components, etc. Usually one or two of these “pop” up and guide our behavior. As Mary Pipher wrote (paraphrasing now)—if you want to be a writer, you need to begin thinking of yourself as a writer. That means one of the sides on that multidimensional or intersectional piece of your personal identity 8-ball should say: “Writer.” For me, one way I’ve embraced this idea is to ALWAYS (as much as I can) act like a writer. That means I proofread EVERYTHING I write, even emails! Check out this link to my blog for two readings on writer identity:

Tip 2: Face your Fears: Writing as an Act of Courage. Rejection sucks. This is true for nearly everyone. The sort of rejection that especially sucks is the rejection that comes when you’re feeling vulnerable. And writing, because it can be very personal and something you deeply identify with, can be a BIG place of vulnerability. The great writer, Cynthia Ozick once wrote that writing is essentially, “an act of courage.” So make a plan for dealing with your fears and bolstering your courage and keep on writing. Feedback can be hard. But without feedback, it’s harder to grow and develop as a writer. If you like, check out this blog post on rejection:

Tip 3: Say What You’ll Do and Do What You Said: Writing as Professional Discipline. The most popular mantra for writers is: “Writer’s write.” Well okay. That’s a good idea . . . but it’s hard to find your destination without a plan or a map. So let’s be good behavioral scientists and make a clear plan (including positive reinforcements) for how to achieve that general goal. When will you write? Where will you write? What time of day is best for you? Standing, sitting, coffee shop, private space? How will you reward yourself after or during an excellent writing day? One of the best goals for writers who want to write is to set a 300 words a day goal. That way you write at least a bit every day, and can always write more on good days when the opportunity presents itself or the muse is with you. Another part of being a disciplined writer is to be good at the grammar part of writing. Don’t forget to consult Grammar Girl, a positive online resource. Here’s a blog that touches on APA style.

Tip 4: Choose with Whom You Schmooze: Writing as Relationship. If you’re at the APA conference (today) or any other national conference (in the future), you’ll find the exhibition hall is filled with book publishers. If writing a book in psychology or counseling is a goal for you, now is not the time to be shy. Many book publishers are looking for new authors and book proposals. They all have their own particular book-writing guidelines. When you’re at a conference, go to the exhibit hall, hang out, schmooze, see what different publishers are looking for in a proposal, and talk about your excellent ideas. In most cases, you have a better chance of publishing a book if you know the publisher and the people who represent the publisher.


John Sommers-Flanagan is a Professor of Counselor Education at the University of Montana and a clinical psychologist. He is coauthor (with his wife, Rita) of the following books published with John Wiley & Sons: Clinical Interviewing (2017, 6th edition forthcoming); Counseling and Psychotherapy Theories in Context and Practice (2012, 2nd edition; 3rd edition forthcoming in 2018); How to Listen so Parents will Talk and Talk so Parents will Listen (2011); and Becoming an Ethical Helping Professional (2007).