September has been quiet for this blog as it included family traveling as well as immersion into the 6th edition revision of Clinical Interviewing. While re-working Chapter 7 (Evidence-Based Relationships), we developed three new case examples. As with all case examples, these are inspired by real cases of our own or of other professionals, but also include plenty of fictional components. The fictional components allow for concise articulation of specific learning goals, while preserving anonymity.

On a related note, one highly-esteemed reviewer of the 5th edition commented—repeatedly—that the text was filled with “bloat.” This was helpful feedback, albeit difficult. Ouch! And so we are striving in the 6th edition to consistently de-bloat everything:). What fun! Don’t worry; we’re still hydrating (this is exactly the sort of commentary that gets us into bloating trouble)

Here are the Case Examples.

Case Example: 7.1

Congruence across Cultures

Cultural identity has many dimensions (Collins, Arthur, & Wong-Wylie, 2010). In this example, during an initial clinical interview with an African American male teenager, the clinician is using congruence or authenticity across several different cultural domains.

Client: This is stupid. What do you know about me and my life?

Clinician: I think you’re saying that we’re very different and I totally agree with you. As you can probably guess, I’ve never been in a gang or lived in a neighborhood like yours. And you can see that I’m not a Black teenager and so I don’t know much about you and what your life is like. But I’d like to know. And I’d like to be of help to you in some way during our time together.

This clinician is being open and congruent and speaking about some of the obvious issues that might interfere with the clinician-client relationship. It would be nice to claim that this sort of openness always results in clinician-client connection, but nothing always works. However, as researchers have reported, there’s a tendency for congruence to facilitate improved treatment process and it also appears to contribute to positive outcomes, at least in a small way (Kolden et al., 2011; Tao, Owen, Pace, & Imel, 2015).

Case Example 7.2:

Intermittent Unconditional Positive Regard and Parallel Process

Michelle is a 26-year-old graduate student. She identifies as a White Heterosexual female. After an initial clinical interview with Hugo, a 35-year-old who identifies as a male heterosexual Latino, she meets with her supervisor. During the meeting she expresses frustration about her judgmental feelings toward Hugo. She tells her supervisor that Hugo sees everyone as against him. He’s extremely angry toward his ex-wife. He’s returning to college following his divorce and believes his poor grades are due to racial discrimination. Michelle tells her supervisor that she just doesn’t get Hugo and that she thinks she should refer him instead of having a second session.

Michelle’s supervisor listens empathically and is accepting of Michelle’s concerns and frustrations. The supervisor shares a brief story of a case where she had difficulty experiencing positive regard toward a client who had a disability. Then, she asks Michelle to put herself in Hugo’s shoes and imagine what it would be like to return to college as a 35-year-old minority person. She has Michelle imagine what might be “under” Hugo’s palpable anger toward his ex-wife. The supervisor also tells Michelle, “When you have a client who views everyone as against him, it’s all the more important for you to make an authentic effort to be with him.” At the end of supervision Michelle agrees to meet with Hugo for a second session and to try to explore and understand his perspectives on a deeper level. During their next supervision session, Michelle reports great progress at experiencing intermittent unconditional positive regard for Hugo and is enthused about working with him in the future.

One way to enhance your ability to experience unconditional positive regard is to have a supervisor who accepts your frustrations and intermittent judgmental-ness. If the issues that arise in therapy are similar (or parallel) to the issues that arise in supervision, it’s referred to as parallel process (Searles, 1955). This is one reason why when you get a dose of unconditional positive regard in supervision, it may help you pass it on to your client.

Case Example 7.6

Mutual Empathy – A Feminist Relationship Factor

Chantelle, a 25-year-old woman attending community college, came to the student health service for counseling. She was intermittently tearful as she described her abusive childhood. Her counselor, a 25-year-old female counseling intern, listened, paraphrased, offered feeling reflections, and stayed connected with the client through the stories and tears. At one point, the client expressed hate for herself and then described repeated scenarios where she felt coerced into providing sexual favors for males in her household in order to have access to transportation and food. With tears of empathic resonance in her eyes the therapist said, “I have this image of you in prison and the men in control only hand you the keys to temporarily go out on leave if they shame you by giving them sexual gratification.”

The client noticed her counselor’s emotion. In response she had a powerful emotional outpouring. Later, when asked about what was helpful in her work with the counseling intern, the client identified her counselor’s tears. She said that her mother and sisters always minimized and humiliated her for “complaining” about living in a home where she had food and shelter. For the client, the whole idea and experience of someone else having an empathic emotional response to her shame and self-revulsion played a big role in her healing.

And this is the end of the case examples. Comments–excluding comments about bloating–are always welcome.

Just because I know you all want in on the new introductory comments for Chapter 3 of the 6th edition of Clinical Interviewing.

And just because I’m wondering if my reference to Csikszentmihalyi’s fish cutter is too enigmatic.

Here’s the text; note it’s a draft with incomplete citations and likely grammar challenges.

Chapter 3

One vision for this chapter (and the next two) is to identify, describe, and illustrate every technical skill that therapists might employ during a clinical interview. We hope to do this so clearly that you can easily acquire and practice these skills. If we accomplish this vision, then you’ll know how to help clients:

• Talk openly about themselves, their problems, and their hopes;
• Have insights or new ideas about what they can do to manage their problems and achieve their personal goals; and
• Begin engaging in positive behavior change.

Other scholars and practitioners have referred to clinical interviewing technical skills as facilitative behaviors, helping skills, microskills, counseling behaviors, and more.

As we focus like a laser on skill-building, we also feel a troubling discomfort. This discomfort stems from our awareness that the great Carl Rogers would NOT AGREE IN THE LEAST with what we’re writing. Rogers would vehemently disagree because, for him, the special ingredients that make therapy work were NOT techniques or skills or behaviors. Instead, he repeatedly and emphatically claimed that successful therapy (even one-session clinical interviews) were all about therapist ATTITUDE—and the subsequent development of a “certain type of relationship” (Rogers, 1942, 1957, 1961; more on this in Chapter 6).

It’s always difficult to argue with Carl Rogers. His gentle, caring, and reflective voice keeps urging us to abandon skill development in the service of empathy training. And his point is exceptionally valuable, essential, and profound (we hope we’re making our thoughts on this clear). Many contemporary therapists, academics, and others don’t understand the essence of what Carl Rogers wrote and said about person-centered therapy. Too often his ideas are dumbed down to reflection skills (e.g., paraphrasing and reflection of feeling). The consequence of this dumbing down is that far too many helping professionals-in-training end up learning parroting skills. And we should note that parroting skills—unless emanating from an actual parrot and not a human counselor—are universally annoying and not particularly therapeutic.

As we open this chapter, we cannot in good conscience risk having you conclude that all you need to do is learn a couple dozen behavioral skills to become a good therapist or clinical interviewer. Rogers was right; that’s just not how it works.

Adopting a Therapeutic Attitude

Back in the 1940s, 50s, and 60s, Rogers repeatedly wrote about his core conditions or counselor attitudes. The conditions he viewed as necessary and sufficient to establish a therapeutic relationship were congruence, unconditional positive regard, and empathic understanding. If he were alive today, he would probably cringe at the modern emphasis on teaching therapeutic behaviors or skills, noting that nothing clinicians do can be therapeutic unless the clinician experiences and expresses the attitudes of congruence, unconditional positive regard, and empathic understanding. For the most part, research on counseling and psychotherapy has borne out his claims. As you’ll see, even contemporary neuroscience research is also broadly supportive of Rogers’s ideas.

Neurogenesis refers to the birth of neurons and is the biggest revelation in recent brain research. Although neurogenesis primarily occurs during pre-natal brain development, the so-called new brain research emphasizes adult neurogenesis; this is the discovery that humans can generate new neurons (brain cells) throughout the lifespan and not just during prenatal brain development). When adult neurogenesis happens, new neurons are integrated into existing neuro-circuitry.

From our perspective, the adult neurogenesis revelation is neither new nor particularly revelatory. For example, over 25 years ago, it was demonstrated that repeated tactile experiences produced functional reorganization in the primary somatosensory cortex of adult owl monkeys (Jenkins et al., 1990). This finding and subsequent research supporting neurogenesis essentially articulates a common sense principle that counselors and psychotherapists have utilized for decades. That is: Whatever behavior you rehearse, practice, or repeat, is likely to strengthen your skills in that area; and then, whatever skills you repeatedly practice will lead to you developing a brain that allows you to demonstrate these skills more efficiently. This is probably why Mihaly Csikszentmihalyi’s (1990) famous fish-cutter became able to experience optimal “flow” while fileting fish. It’s also how Carl Rogers became so adept at empathic understanding. For you, it’s the explanation and prescription for how you will become more like Carl Rogers than Csikszentmihalyi’s famous fish-cutter.

Research on the neuroscience of emotions is in its infancy. Consequently, you should take everything we write about it here (and that anyone writes about it anywhere) with a grain of salt. With that caveat in mind, let’s look at how modern brain science might support ideas for training yourself to be like Carl Rogers.

Researchers have recently been developing theories about what’s happening in different brain regions during an empathic experience. To summarize a large body of research, it appears that various brain regions and structures are especially activated when individuals have an empathic response. One particularly important brain structure involved in empathy experiences, self-regulation, and other behaviors linked to being helpful and compassionate is the insula.

More specifically, it appears that compassion meditation (aka lovingkindness meditation) is associated with neural activity and structural development (or strengthening) of the insula (or insular cortex). Researchers have reported that individuals who are highly experienced with compassion meditation have a thicker insula and that when they view or hear someone in distress they experience more neural activity in that brain region than individuals without much compassion meditation experience (Hölzel, Carmody, Vangel, Congleton, Yerramsetti, Gard, & Lazar, 2011). Other researchers have reported meta-analyses and other reviews indicating that during cognitive-emotional perception, regulation, and response, several brain structures are activated and the relationships among them are highly complex and integrated. In describing the role of the anterior insular cortex in empathic responding, Mutschler, Reinbold, Wankerl, Seifritz, and Ball (2013) wrote:

Accumulating evidence indicates a crucial role of the insular cortex in empathy: in particular the anterior insular cortex (AIC)—a brain region which is situated in the depth of the Sylvian fissure and anatomically highly interconnected to many other cortical regions (p. 1).

At the risk of oversimplifying a complex neurological process, it appears generally safe to conclude that compassion meditation and other human activities related to empathic experiencing may contribute in some way to the thickening of the insula and subsequently enhance empathic responsiveness.

Overall, at this early stage, it’s difficult for anyone to definitively declare how individuals can develop their brains to become more empathic. It’s tempting to conclude that, if you want to improve your empathic abilities, then you should engage in rigorous training to strengthen and grow your insula (and some of its empathy and self-regulation cohort like the middle cingulate cortex and pre-supplementary motor area; Kohn, Eickhoff, Scheller, Laird, Fox, and Habel, 2014). This brings to mind silly images of you engaging your insula in a series of cross-fit type workouts focusing particularly on its anterior muscular structure. Although the analogy and our knowledge about what’s really happening in the brain break down rather quickly, we nevertheless believe it makes sense for you to participate in a “training regime” that includes the following general steps:

1. Commit yourself to the intention of becoming a person who can listen to others in ways that are accepting, empathic, and respectful.

2. Similar to how meditators develop a meditation practice, develop an empathic listening practice. This could involve any form of regular interpersonal experience where you devote time to using the active listening skills described in this chapter. As you engage in this practice it is important to have listening with compassion as your primary goal.

3. Engage in the active listening, multicultural, and empathy development activities sprinkled throughout this text, offered in your classes, and that you obtain from additional outside readings.

4. When you watch television, read literature, and obtain information via technology, let yourself linger on and experience the emotions triggered during these normal daily activities.

5. Reflect on these experiences and then . . . repeat . . . repeat . . . and repeat some more.

Rogers wrote in very personal ways about his core conditions for counseling and psychotherapy. In the following lengthy quotation, he’s discussing obstacles that prevent most people from allowing themselves to step into another’s shoes and experience empathic understanding. Reading this excerpt (and following the preceding five steps and contemplating Multicultural Highlight 3.1) is part of our prescription for helping you adopt an empathic orientation toward individuals with whom you will work.

I come now to a central learning which has had a great deal of significance for me. I can state this learning as follows: I have found it of enormous value when I can permit myself to understand another person. The way in which I have worded this statement may seem strange to you. Is it necessary to permit oneself to understand another? I think that it is. Our first reaction to most of the statements which we hear from other people is an immediate evaluation or judgment, rather than an understanding of it. When someone expresses some feeling or attitude or belief, our tendency is, almost immediately, to feel “That’s right”; or “That’s stupid”; “That’s abnormal”; “That’s unreasonable”; “That’s incorrect”; “That’s not nice.” Very rarely do we permit ourselves to understand precisely what the meaning of his [or her] statement is to him [or her]. I believe this is because understanding is risky. If I let myself really understand another person, I might be changed by that understanding. (Rogers, 1961, p. 18; specific italics from the original are missing here)

All this makes me want to ask: How will you work to be more like Carl Rogers today?

The link below takes you to the powerpoints for Day one (4/16/15) of the Grief Institute:

Suicide for the Grief Institute

Hello Mental Health Professionals.

I’m writing to remind you to register for our Spring LOVE Workshop series through the Department of Counselor Education. Although the WHOLE conference includes content that can be useful in your professional and personal lives, in particular, I want to point out that, for the Friday, March 20 date we have the honor of hosting and learning from Dr. Jon Carlson and it’s not often we get someone with the immense experience and expertise of Jon Carlson.

If you don’t already know who Jon Carlson is, here’s an official bio on him:

Jon Carlson, PsyD, EdD, ABPP is Distinguished Professor, Psychology and Counseling at Governors State University and a psychologist at the Wellness Clinic in Lake Geneva, Wisconsin. Jon has served as editor of several periodicals including the Journal of Individual Psychology and The Family Journal. He holds Diplomates in both Family Psychology and Adlerian Psychology. He has authored 175 journal articles and 60 books including Time for a Better Marriage, Adlerian Therapy, Inclusive Cultural Empathy, The Mummy at the Dining Room Table, Bad Therapy, The Client Who Changed Me, Their Finest Hour, Creative Breakthroughs in Therapy, Moved by the Spirit, Duped: Lies and Deception in Psychotherapy, Never Be Lonely Again, Helping Beyond the Fifty Minute Hour, How a Master Therapist Works and Being a Master Therapist. He has created over 300 professional trade video and DVD’s with leading professional therapists and educators. In 2004 the American Counseling Association named him a “Living Legend.” In 2009 the Division of Psychotherapy of the American Psychological Association (APA) named him “Distinguished Psychologist” for his life contribution to psychotherapy and in 2011 he received the APA Distinguished Career Contribution to Education and Training Award. He has received similar awards from four other professional organizations. He has also syndicated the advice cartoon On The Edge with cartoonist Joe Martin. Jon and Laura have been married for forty-seven years and are the parents of five children.

Obviously, Jon Carlson is highly acclaimed within both the Counseling and Psychology disciplines and I don’t think you should pass up a chance to see him live in Montana.

**************************

There are now two ways to register for the WHOLE conference or for a single session.

1. You can print and fill out the registration form that follows and mail it in the old fashioned way, or
2. You can go online and register and pay through the Children’s Museum website. Go to: https://www.childrensmuseummissoula.org/ and scroll down about half a page.

If you decide to pay online and you don’t want to fill out and mail the registration form, drop me an email at: John.sf@mso.umt.edu and let me know you’re signed up and I’ll make sure we have a form ready for you to fill out at the workshop so you can avoid having to hassle with mailing it.

Finally, for those of you have read this far and want to know more about Jon Carlson’s presentation in Missoula, here’s a description in his own words:

Adlerian Brief Couples Therapy

There has been considerable debate and negative press in recent times over brief therapy and whether or not it is in the best interests of clients. Most therapists/counselors fail to realize that most clients want brief treatment. They want to get help as soon as possible. People do not have unlimited time or money to spend on therapy no matter how valuable counselors and therapists think their services are. Most want help and are not looking for a paid-for friend.

Another truth is that most therapy is brief as clients attend treatment for usually less than 6 sessions with one being the modal number. Managed care companies are quick to remind us that most gains in therapy occur early and tend to diminish as treatment continues. It would unprofessional to act as if some clients cannot benefit from long term treatment. There are conditions in which longer treatment is necessary but this is the exception and not the rule.

Most clients really do not want to be seeing therapists. They wish there lives worked and that they were “normal.” It is important for effective therapy to understand that this is the case and to provide as efficient a treatment as possible.

This program will focus on how to do brief therapy with couples. I will talk about brief therapy from an Adlerian theoretical orientation as well as the skills of a healthy relationship. The participants will also be able to see the process applies as I work with an actual couple and help them resolve some of their current challenges.

That sounds pretty cool to me and so I’m planning to be there.

That’s it for now. Have a great rest of the week and I hope to see you at one or more of the workshops.

Sincerely,

John SF

John Sommers-Flanagan, Ph.D., Professor
Department of Counselor Education
Phyllis J. Washington College of Education and Human Sciences
University of Montana
32 Campus Drive
Missoula, MT 59812
406-243-4263 (office); 406-721-6367 (cell)
John.sf@mso.umt.edu
Johnsommersflanagan.com

And here’s a photo of Dr. Carlson

In honor of the upcoming holidays, I’ll be posting information on suicide assessment and intervention in the coming days. You might think this is because December, the holidays, or Winter are highly linked to death by suicide, but in fact, although the holidays can be a depressive trigger for some individuals, Winter is NOT associated with especially high suicide rates. Instead, somewhat surprisingly, Spring is consistently the season when suicide rates are highest.

Suicide risk factors are the main focus of today’s post . . . along with an embracing of the reality that even with the best suicide risk factors and predictors available, predicting suicide and managing suicidal behaviors is exceedingly difficult. The following material is adapted from our textbook titled, “Clinical Interviewing” and published by John Wiley and Sons (2014).

I hope you’re all having the best time possible in the run-up (as the Brits would say) to the holidays.

Suicide Risk Factors

A suicide risk factor is a measurable demographic, trait, behavior, or situation that has a positive correlation with suicide attempts and/or death by suicide. Not surprisingly, given the immense number of variables involved in human decision-making, the science of predicting suicide risk is challenging and complex. For example, in 1995 a renowned suicidologist wrote:

At present it is impossible to predict accurately any person’s suicide. Sophisticated statistical models . . . and experienced clinical judgments are equally unsuccessful. When I am asked why one depressed and suicidal patient commits suicide while nine other equally depressed and equally suicidal patients do not, I answer, “I don’t know.” (Litman, 1995, p. 135)

Since Litman’s 1995 statement, research on suicide risk has accumulated. This is good news in that research potentially aids in the prediction and prevention of death by suicide. However, as researchers have increased their focus, the number and range of potential suicide risk factors have multiplied and when considered in the context of a practical suicide assessment, can feel overwhelming. To help clinicians deal with so many possible suicide-related variables, researchers and practitioners have developed various acronyms to use as a guide to risk factor assessment (see my IS PATH WARM post:https://johnsommersflanagan.com/2013/07/12/is-path-warm-an-acronymn-to-guide-suicide-risk-assessment/).

As you read this post and my next post, keep in mind that although knowledge of suicide risk factors is useful, developing a positive working alliance with potentially suicidal clients is of far greater import. Additionally, at the end of this risk factor frenzy, we will step back and look at another model for anticipating suicide. Finally, always remember that an absence of risk factors in an individual client is no guarantee that he or she is safe from suicidal impulses.

Sex, Age, and Race as Suicide Predictors

Historically, various client demographics have been used to estimate suicide risk. For example, because males, in general, commit suicide at approximately three to four times the rate of females, boys and men are usually considered a higher risk for suicide than girls and women.

Unfortunately, most demographic variables include moderating and mediating factors that increase uncertainty when trying to predict suicide risk. To return to the example of sex as a suicide predictor, it also happens to be true that females attempt suicide at approximately three times the rate of males. Although there are many potential explanations for these apparently contradictory trends, no one really knows why these patterns exist and persist. However, preventing suicide attempts (primarily among females) is nearly as important as preventing death by suicide (primarily among males). Consequently, every male and female who enters your office should receive equal care, attention, and if appropriate, a suicide assessment interview and intervention. Similarly, just because Black females have extremely low suicide base rates and older Asian women have somewhat elevated suicide base rates doesn’t mean that we should always conduct a suicide assessment interview with Chinese American women, while never conducting one with Black American women. Obviously, whether a suicide assessment interview is conducted and how extensive that interview is, depends on the characteristics of the specific client in the consulting room.

Despite these unique patterns of suicide potential associated with sex, age, and race, there are some trends in the data worth committing to memory. Based on 2005–2009 mortality data from the Centers for Disease Control, these include:

• White males over 65 have very high suicide rates (32.4/100.000).
• Alaskan Native and American Indian males, ages 10 to 24 have very high suicide rates (31.3/100,000).
• White males from 25 to 64 years old and American Indian/Alaskan Native males have similarly high suicide rates (slightly over 29/100,000)
• The lowest suicide rates seem to consistently be among Black females at less than 2/100,000.
• Across all ages and races, males are about 4 times more likely to commit suicide than females.
• Although suicide rates typically increase with age, rates among Alaskan Native and American Indian males typically decrease with age.

To get a sense of how difficult it is to predict suicide even in the highest risk demographic group, the percent of completed suicides among White males over 65 is 0.032 percent or approximately 1 per every 3,125. The good news is that suicide continues to be a rare event, even in high-risk populations. The bad news is that it remains highly improbable that we can efficiently predict, in advance, which one white male over 65 out of a group of over 3,000 will commit suicide.

Race and religion may sometimes function as suicide protective factors. For example, African American women have exceedingly low suicide rates. It has been speculated that these rates may be associated with a high sense of familial responsibility, which in turn may be associated with specific religious beliefs or convictions (C. L. Davidson & Wingate, 2011). suicide rates and speculation suggests that these rates may be associated with a high sense of familial responsibility, which in turn may be associated with specific religious beliefs or convictions (C. L. Davidson & Wingate, 2011).

Overall, remember that knowledge about suicide risk factors is important and sometimes useful, but nothing replaces positive relationship connections among friends, family, social groups, and/or with competent mental health professionals.

More on risk factors soon.

On November 6 (in Missoula) and November 20 (in Billings) Western Montana Addiction Services will be sponsoring a day-long workshop for professionals. The title of both workshops is the same: Working with Challenging Parents and Youth . . . and Loving it. Here’s a description of the workshop, along with workshop objectives:

Working with Challenging Parents and Youth . . . and Loving It.

John Sommers-Flanagan

Counseling difficult youth and challenging parents can be immensely frustrating or splendidly gratifying. Using storytelling, video clips, live demonstrations, group discussion, and skill-building break-out sessions, John Sommers-Flanagan will present essential evidence-based principles and over ten specific techniques for influencing “tough students” and “challenging parents.” Techniques for working with youth and parents will include (a) concession, (b) asset flooding, (c) cognitive storytelling, (d) generating behavioral alternatives, (e) grandma’s rule, and many more. Issues related to ethics, addictions, and culture will be highlighted and discussed throughout the workshop.

Workshop Objectives:

1. Understand the nature of resistance as often displayed by youth and parents

2. Identify and apply techniques for responding quickly and effectively when youth and parents resist counseling

3. Acquire skills for using numerous cognitive, emotionally, and constructive engagement and intervention strategies that facilitate youth interest in, and motivation for, counseling—even in situations when clients are using substances

4. Learn four specific parenting techniques that participants can immediately use to help parents respond more effectively to their children’s problems or challenges.

5. Increase awareness and articulation of important multicultural counseling issues with youth and parents

6. Understand how substance-related problems can directly contribute to client resistance and impede engagement with youth and parents

The link for registering through Western Montana Addiction Services for either workshop is here: http://www.westernmontanaaddictionservices.org/store/p2/Working_with_Challenging_Parents_and_Youth…_and_Loving_It.html

If you can make either workshop I will look forward to meeting or seeing you. If you think it’s a topic that would be useful for someone you know, feel free to pass this information on.

And have a great rest of the week.

John SF

Before I head out to climb Mount Sentinel on this gloriously beautiful day in Missoula, I’m posting this short commentary with some ideas on how to talk with parents about positive reinforcement.

More often than not, children’s behavior can be understood in terms of contingencies. In fact, when parents are trying to persuade their children to do something (like chores), children and teens will make their awareness of behavioral contingencies clear with a one-word response: “Why?!”

Children and teenagers are notorious for asking why; they ask why they have to take out the garbage, why they have to be home by midnight, why they can’t go out and drink some beers with their friends, why they can’t experiment with drugs and why they can’t stay home alone when their parents go away for the weekend. It’s important for parents and therapists to be sensitive to children’s questions about why they should or should not engage in particular behaviors. This is because why questions are questions about contingency and motivation. When young clients ask why, they’re trying to understand: “What’s the payoff?” or “What’s the reason?” or “What’s in it for me?” or “How does this fit with our family values?” And, like most adults, they’re interested, to at least some degree, in obtaining external or intrinsic rewards or reinforcement in return for their cooperative behaviors.

Depending on their own values and upbringing, parents may insist children not be bribed to get good grades, complete their chores, or comply with curfew. They may insist that children of this generation are spoiled and too dependent on external rewards and in many ways, these parents are right; children are bombarded with messages about acquisition and materialism. However, complete denial of external motivators and rewards is impossible and ill-advised. The process by which external motivation becomes internal motivation is an important area of psychological research. Very generally, research shows that modest external rewards that convey performance information to children can contribute to the development of intrinsic motivation. In contrast, if rewards are used to control children’s behavior, children may work hard to obtain the reward, but intrinsic interest in the target behavior won’t be developed. Obviously, intrinsic motivation and/or self-reinforcement systems are crucial to the development of self-discipline. Consequently, as counselors, we preach moderate reinforcement strategies designed to provide performance feedback to young clients instead of large-scale reinforcements designed to control child behavior. However, before focusing on reinforcement, we suggest using a behavioral assessment technique: Analyze the existing contingencies.

Parents and children usually focus on different sets of behavioral contingencies. Parents focus on long-term contingencies (e.g., “Doing your homework will help you get good grades and getting good grades is important to getting into college”). In contrast, children and teenagers focus on short-term contingencies (e.g., “I need money for the movie tonight”). Therapists may need to help parents stop lecturing about the great benefits of long-term contingencies because these lectures aren’t typically well-received (Rarely do seven year olds say, “Hey mom, thanks for reminding me to save money for college). Instead, to be developmentally attuned to children and teens requires that parents and therapists be sensitive to short-term contingencies. In a sense, therapists function as developmental translators; they help parents understand the motivational language of children. Defining Bribery

Many parents mistakenly confuse positive reinforcement with bribery. They discount positive reinforcement strategies by saying things like: “Oh, we’ve tried bribery.” Or if the therapist uses an incentive to encourage a teenager to effectively communicate within a session, parents sometimes say: “You just bribed her to get her to do that. She won’t do it without being bribed.” Consequently, when using contingency programs or positive reinforcement techniques with young clients, we explain to parents the difference between bribery and positive reinforcement.

“Before we talk about using positive reinforcement techniques with Jennifer, let’s talk about the difference between positive reinforcement and bribery. Do you know the definition of bribery? (Short pause, usually parents just look at you.) The definition of bribery is to pay someone—in advance—to do something illegal. So if we come up with a plan to pay Jennifer something, whether it’s fruit snacks, a trip to the mall, or a new CD, for consistently completing her homework, it’s not the same as bribery . . . because there’s nothing illegal about Jennifer doing her homework and we won’t be rewarding her in advance.”

All of us, especially adults, respond to positive reinforcement every day. Most of us go to work either because we get paid for it or because we enjoy it. And if we enjoy it, it’s because there’s something about going to work that we perceive as positively reinforcing. So if our goal is to have Jennifer consistently complete her homework, we’ve got to figure out how to make doing homework more rewarding (and less aversive) to her.

In addition to defining bribery, parents usually benefit from hearing how important it is to NOT give children excessively large or excessively frequent reinforcements designed to control behavior. Therefore, we usually inform them of research showing that providing children with too much reinforcement to control behavior can undermine development of intrinsic motivation.

This excerpt is adapted from the book: Tough Kids, Cool Counseling. The Amazon link is here: http://www.amazon.com/Tough-Kids-Cool-Counseling-User-Friendly/dp/1556202741/ref=la_B0030LK6NM_1_8?s=books&ie=UTF8&qid=1410025206&sr=1-8

Three grandchildren getting some natural positive reinforcement: