Category Archives: Writing

Informed Consent in Counseling and Psychotherapy: Problems and Potential

A quick review of recent informed consent research leads me to think that informed consent should be a perfect blend of evidence-based information about the benefits, risks, and process of psychotherapy. Like all good hypnotic inductions, informed consent, has the potential to stir positive expectations or activate fear. But when I look at all that we’re supposed to include in informed consents I wonder, does anyone really read them? Informed consent could have significant effects on treatment process and outcome. But only if clients actually read the written document.

The alternative or a complementary strategy is a good oral description of informed consent. Again, as someone trained in hypnosis and sensitive to positive placebo effects, I’m inclined to use informed consent to set positive expectations. I think that’s appropriate, but it’s also easy for us, as practitioners, to become too enthusiastic and unrealistic about what we have to offer. The truth is that no matter how much passion I may have for a particular intervention, if there’s absolutely no scientific evidence to support my niche passion, and there is evidence to support other approaches, then I could come across like someone promoting ivermectin for treating COVID-19. If you think about the people who promote ivermectin, it’s likely they’re either (a) uninformed/misinformed and/or (b) profit-driven. To the extent that all professional helpers or healers aim to be honest and ethical in our informed consent processes, we should strive to NOT be uninformed/misinformed and to NOT be too profit-driven. I say “too profit-driven” because obviously, most clinical practitioners would like to make a profit. All this information about being balanced in our informed consent highlights how much we need to read and understand scientific research related to our practice and how much we need to check our enthusiasm for particular approaches, while remaining realistic, despite potential financial incentives. 

Informed Consent: Who Reads Them? Who Listens?

If informed consents are difficult to read and comprehend, they may be completely irrelevant. On the other hand, in their obtuseness, they may function like the confusion technique in hypnosis and psychotherapy. Although the confusion technique is pretty amazing and I’ll probably write more about it at some point, it’s inappropriate and unethical to use the confusion technique in the context of informed consent.

In medical and some therapy settings, informed consent often feels sterile. If you’re like me, you quickly sign the HIPAA and informed consent forms, without taking much time to read and digest their contents. The process becomes perfunctory. 

I recall a particularly memorable pre-surgery informed consent experience. After hearing a couple of low probability frightening outcomes and experiencing the sense of nausea welling up in my stomach, I stopped listening. I even recall saying to myself, “I can choose to not listen to this.” It was an act of intentional dissociation. I knew I needed the surgery; hearing the gory details of possible bad outcomes only increased my anxiety. Here’s a journal article quote supporting my decision to stop listening, “Risk warnings might cause negative expectations and subsequent nocebo effects (i.e., negative expectations cause negative outcomes) in participants” (Stirling et al., 2022, no page number)

Informed consent flies under the radar when clients or patients stop listening. Informed consent also flies under the radar because many people don’t bother reading them. In our theories textbook we have nice examples of how therapists can write a welcoming and fantastic informed consent that cordially invites clients to counseling. Do these informed consents get read? Maybe. Sometimes.

Informed consent has the potential to be powerful. To fulfill this potential, we need to contemplate on big (and long) question: “How can we best and most efficiently inform prospective clients about psychotherapy and maintain a balanced, conversational style that will maximize client absorption of what we’re saying, while appropriately speaking to the positive potential of our treatment and articulate possible risks without activating client fears or negative expectations?”

Here’s an abbreviated guide: Provide essential information. Use common language. Be balanced.

For example:

“Most people who come to counseling have positive responses and after counseling, they’re glad came. A small number of people who come to counseling have negative experiences. If you begin to have negative experiences, we should talk directly about those. Sometimes in life, confronting old patterns and talking about emotionally painful memories will make you feel bad, sad, or worse, but these negative feelings should be temporary. Getting through negative or difficult emotions can open us up to positive emotions. My main message to you is this: No matter what you’re experiencing in counseling, it’s good and important for you to share your thoughts, feelings, and reactions with me so we can make the adjustments needed to maximize your benefits and minimize your pain.”

I could go on and on about informed consent, but that might reveal too much of my nerdiness. These are my reflections for today. Tomorrow may be different. I just thought I should inform you in advance that consistency may not be my forte.

To Complain or Not to Complain: Reflections on Publishing in Academic Journals

This is one wide-ranging perspective

I like to THINK of myself as not being a complainer, but in reality, I do my share of complaining. One of my personal goals is to complain less and thereby avoid becoming a whining old curmudgeon. That’s a tall order because for me, there are always a few particular moments and experiences when it just feels VERY GRATIFYING to let the complaints fly.

Today, I’m offering some small complaints about the process of publishing in academic journals. I’m limiting my complaining and keeping a positive tone because too much complaining would be inconsistent with my anti-curmudgeon goal AND inconsistent with my topic: publishing happiness research.

Over the past year, I’ve started working on three different happiness manuscripts. We (my research team and I) submitted the first one (Manuscript 1) to a good journal, waited 3+ months and got a rejection. The rejection was understandable, but the reviews were IMHO uninspiring and uninformed. The reviewers critiqued parts of the manuscript that were absolutely solid, raised questions about non-issues, and completely missed the biggest flaw (of which I am very familiar, because I analyzed the data). In response, because reviews should nearly always be two-way, I provided a bit of congenial feedback to Editor 1. Editor 1 responded quickly and we had a cordial and constructive email discussion.

Manuscript 1 is now out to a second unnamed journal. We’re closing in on four months and so after recovering from my CACREP virtual site visit hangover (more minor complaining here in the midst of my major complaint) and using my congenial colleague voice, I emailed Editor 2. Again, I got a speedy and pleasant response. As it turns out, academic journal editors are generally lonely people who field so many hostile emails, that they’re very chatty when they get something nice. The editor of journal 2 shared a few frustrations. I responded with commiseration, and Editor 2 let me know we should hear about our manuscript’s status by the end of the week. Just in case you’re a lonely and frustrated academic journal editor and want to steal away this manuscript and publish it before Friday, I’ve pasted the abstract below. My Email is john.sf@mso.umt.edu.   

Effects of a Brief Workshop on Counseling Student Wellness in the Age of COVID-19

Abstract

Counselors-in-training (CITs) often experience stress, anxiety, depression, and other mental health issues. Teaching counseling students wellness and positive psychology skills, particularly in the age of COVID-19, may help CITs cultivate greater well-being. The purpose of this study was to investigate the effects of a brief happiness-oriented workshop on CIT well-being. Forty-five CITs participated in either a 2.5 hour online experiential evidence-based happiness workshop or control condition. Eight wellness-oriented self-report questionnaires were administered pre-and post-intervention. Compared with the control group, CITs who attended the online workshop reported significant reductions in depressive symptoms. At six-month follow-up, workshop participants were reported using several of the interventions (i.e., gratitude, savoring, and three good things) with themselves and in their work. Despite methodological limitations, this study provides initial evidence that a brief, online happiness workshop has promise for helping CITs cope with the emotional burdens of graduate school and COVID-19.

Manuscript 2 is based on one of my recent doctoral student’s dissertations. It’s a solid quantitative, quasi-experimental, pretest-posttest design with interesting and positive outcomes. We submitted it to a journal, waited 3 months, and then were informed that they liked the manuscript, but that it wasn’t a good fit for their journal. Being that I’ve become pretty chummy with various journal editors, I emailed the Editor using my happy voice, while also noting that it didn’t seem quite right that we waited 3 months to hear the manuscript wasn’t a good fit. We didn’t even get reviews. . . other than the editor’s mildly positive feedback. Editor 3 got right back to me and essentially agreed with my concerns and shared frustrations about journal editor and editorial board transitions. Just in case you’re tracking the pattern, it appears that academic journal editors are super into professional email exchanges. After getting Manuscript 2 rejected, I decided to start pre-emailing journal editors to check to see if the topic is a good fit for their journals. The responses have been fast and helpful. If by chance, you’re a fancy journal editor who’s feeling frustrated and wants a colleague like me for some email chats, you could increase your chances of hearing from me if you contact me and offer to publish Manuscript 2 . . . and so here’s the abstract.

Effects of a Multi-Component Positive Psychology Course on College Student Mental Health and Well-Being During COVID-19

Abstract

Even before COVID-19, college student mental health was an escalating problem. As a supplement to traditional counseling, positive psychology (aka happiness) courses have shown promise for improving college student well-being. We evaluated a unique, four-component positive psychology course on student mental health and wellness outcomes. Using a quantitative, quasi-experimental, pretest-posttest design, we compared the effects of the happiness course (n = 38) with an alternative class control condition (n = 41), on eight different mental health and well-being measures. Participants who completed the happiness course reported significantly higher positive affect, increased hope, better physical health, and greater perceived friendship support. In a post-hoc analysis of six happiness class participants who scored as severely depressed at pretest, all six had substantial reductions in self-reported depressive symptoms at posttest. Multicomponent positive psychology courses are a promising supplementary strategy for addressing college student mental health.

I know you’re probably wondering now, about Manuscript 3, which is under construction. The bottom line for Manuscript 3 is that it’s fabulous. Of course, because I haven’t submitted it anywhere yet, I’m the only reviewer offering feedback at this time. Manuscript 3 is the sort of manuscript that, I’m sure, a number of journals and journal editors will get in a bidding war over.

In the end, complaining is mostly unhealthy. Complaining can be like noxious weeds, with the negativity taking root, and spreading into areas where we should be staying positive and grateful. Too much complaining contributes to a sour disposition and outlook. On the positive side, complaining offers an opportunity for emotional ventilation, and can recruit interpersonal commiseration, both of which feel good. But IMHO the biggest potential benefit from complaining comes from social feedback. When people hear you complain, they can provide perspective. And yes, we all need perspective.

Happy Wednesday to everyone! May your complaints be minor and your perspective be multidimensional.

JSF

Robb Elementary School, Highland Park, and Other Mass Shootings: Let’s Talk about Young Males and Semi-Automatic Weapons

Nearly every mass shooting in the U.S. includes three main factors, the first two of which no one seems to want to talk about.

  1. The shooter is male.
  2. The shooter is under 25-years-old
  3. The weapon is a semi-automatic.

Why don’t we talk about the fact that the Highland Park shooter, along with so many others before him, was a male under age 25?

Last week, in an article on The Good Men Project website, I proposed banning sales of semi-automatic weapons to males under 25-years-old. Obviously, this guidance still holds.

Below I’ve pasted a couple excerpts from The Good Men Project article. For the whole thing, go to: https://goodmenproject.com/featured-content/age-to-own-guns-should-be-25-not-21-heres-why-kpkn/

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Why target age 25? Because brain and developmental research indicates that male brains have greater variability in structure and development and may not be completely mature until age 25. After age 25, males become less impulsive and more capable of moral decision-making. Automobile insurance companies recognize this truth with hefty rate reductions after males turn 25. In addition, due to American socialization pressures around masculinity, older boys and young men are especially reactive to threats to their perceived manhood. These reactions often include acts of violence designed to restore a sense of masculine honor.

Anyone paying attention knows young American males are not doing well. They’re lost. They’re angry. They’re confused. They have few constructive rituals to help them become men. Manhood may be overrated and outdated, but boys need to strive for something. Becoming a man is a tried and true tradition that’s hard to escape—if only because the media pushes it so hard. Boys need to man-up, but what does that even mean? Join the military? Smoke cigars? Take stupid risks? Watch American football? Hunt? Fish? Play violent video games? Retreat to a “man cave,” Join the Proud Boys? Grow beards? Deny COVID? Fight? Have sex? Get revenge? Never apologize or show weakness? Demean women and gays? Buy an AR-15?

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We need to address the emotional and psychological well-being of boys and young men. We also need to stop allowing them access to semi-automatic weapons.

To access the full article, click here: https://goodmenproject.com/featured-content/age-to-own-guns-should-be-25-not-21-heres-why-kpkn/

New Article on Firearms, Young Males, and Mass Shootings

Here’s a link to an article published today on the Good Men Project site. In the article, I make the case for (a) restricting semi-automatic weapon sales to males over 25, (b) focusing on healthier psychosocial-emotional development for boys and young males, and (c) how it’s reasonable to ask people to make sacrifices for their country.

If you have interest in this area, check it out.

Teaching Group Counseling

I forgot how much I love teaching group counseling.

Maybe I forgot because I haven’t taught Group Counseling at the University of Montana since 2017. Whatever the reason, last week, I remembered.

I remembered because I got to provide a group-oriented counseling training to seven very cool program managers and staff of the Big Sky Youth Empowerment program in Bozeman. We started with a structured question and answer opening, followed with a self-reflective debrief, and then re-started with a different version of the same opening so we could engage in a second self-reflective debrief. I’ve used this opening several times when teaching group; it’s getting better every time.

I love the experiential part where I get to flit back and forth between process facilitator and contributor. I love the opportunity to quote Irvin Yalom about the “self-reflective loop” and “The group leader is the norm-setter and role model.” Then I love getting to quote Yalom again, “Cohesion is the attraction of the group for its members.”  And again, “I have a dilemma . . .” Boom. When teaching group counseling, the Yalom quotes never stop!

Groups are about individuals and groups and individuals’ learning from the power of groups. I get to learn and re-learn about strong openings, monopolizers, closing for consolidation, and the natural temptation of everyone in the group to fix other group members’ problems—and the need for group facilitators to tightly manage the problem-solving process. We get to “go vertical” and back out through linking and then “go horizontal.”

Tomorrow I head back to Bozeman for more training with the fabulous BYEP staff. Part of the day we’ll focus on specific group facilitation techniques, which reminded me of a handout I created back in 2017. The handout lists and provides examples for 18 different group counseling techniques/strategies. For anyone interested, the group techniques handout is here:

I hope you’re all having a great Memorial Day and engaging in something that feels like just the right amount of meaningful or remembrance for you on this important holiday when we recognize individuals who made huge sacrifices for the sake of the greater and common good of the group.

All my best,

John

Grief 101

Grief is always personal and universal. Nobody understands anyone else’s grief . . . except possibly everyone and anyone capable of empathy. You don’t have to be an empath to resonate with another person’s grief; you just need a heart that lets you feel along with someone who’s suffering pain and loss. At some point or another, we all experience pain and loss. Grief is always a unique and common experience.

I’ve written about and practiced psychotherapy for about 35 years. In my classes I give impassioned lectures about the power and significance of emotion. Nevertheless, I’m still stunned and puzzled and humbled when the waves of emotion roll on in. There’s nothing quite like the rush of powerful sadness.  

Last Thursday I made the mistake of playing a melancholy song of loss at the beginning of my University of Montana Happiness class. Maybe it wasn’t a mistake, because I learned that if you want to cry about the death of a loved one, this particular song—Golden Embers by Mandolin Orange—will help with that. If you want to cry now or later, you can listen here: https://www.youtube.com/watch?v=fEt2lf7L13g.

On the other hand, if you don’t want to begin your online Happiness course by struggling to contain your tears and grief, take my advice, don’t play it right before class starts.

I’m a fan of emotional openness, honesty, and vulnerability. But choking back tears as you welcome everyone to Happiness class isn’t the nuanced and titrated professional vulnerability I prefer. Perhaps no one noticed my misty eyes via Zoom; perhaps they also didn’t notice my brief my slide toward verbal incoherence.

After a long unplanned, and unpleasant dementia experience, my mother gracefully died of COVID last year. We (my sisters, family, and I) were all very sad. My mother was the Queen of Caring. She never let a conversation end without an “I love you” and never let an in-person meet-up end without a hug. For me, the long, drawn-out dementia experience muted my grief. I was glad for her passing. I believe, had my mother had a functional brain, she would have been even gladder. We had lost my mother several years earlier. COVID just made it official.

But that damn Mandolin Orange song punched the mute button off my grief. Had the class not been ready to start, I could have been in heaving sobs. You probably know what I’m saying. Have you ever had the experience of envisioning and knowing how deeply emotional you could be, while barely managing to keep it at a distance? I could see myself sobbing . . . and . . . I stopped myself from sobbing.

Ironically, the first focus of class was a quick recap of James Pennebaker’s 1986 study on the physical toll of emotional inhibition. Seriously. Who writes these scripts? Pennebaker’s hypothesis, later affirmed through many more studies, was that emotional expression plus insight is emotionally and physically healthy. The opposite, the stuffing of significant emotions, along with the deadening or distancing from understanding our emotions, is emotionally and physically unhealthy. The physical unhealthiness seems linked to the physical exertion it takes to engage in chronic restraint of emotional expression.

Emotions are more like a river than not. You can try to dam them up, but they prefer flowing freely.

The next day, my partially unexpressed emotional river of grief over my mother joined up with my relatively unexpressed anticipatory grief for my father. As I write this, I’m in the Seattle airport waiting for a flight to take me to see him and possibly say goodbye. He’s been on this particular deathbed for years (literally), and so this may or may not be the end. Being the cosmic inverse of his wife (my mother), his brain has continued to process information, crunch numbers, and engage in abstract reasoning. Instead of dementia, his body wore down. He’s been bedridden for about three years. . . bouncing back from a broken hip, then a re-broken hip, then a stroke, then two collapsed lungs, and a myriad of other near-death experiences. In his latest medical exam, the verdict was that his skin is wearing out, splitting, coming unhinged, revealing muscle and bone.

Despite all this, the next day (after my Seattle airport writing and late arrival into Portland), when I walk into his room, he briefly awakens, offers a grin, and exclaims, “Hi John.” He says nothing more, and quickly drops back to sleep, because talking has become immensely difficult; it takes all he’s got to get out two words.

On this visit, I’ve been on the emotional edge, remembering vividly his reliable presence for me and for others. Being self-employed, he worked long hours, including many evenings and weekends. Being self-employed also gave him flexibility. He might go back to his shop to bend steel pipe in the evening, but he managed his work schedule so as to never miss one of my baseball, football, and basketball games. When I got in my first (and only) fight in 8th grade, he found me walking home alone, ashamed, embarrassed, and with a swollen eye. When my sister and I were in a car wreck, he got there nearly as quickly as the ambulance. When the Black kids or the Gay kids down the street wanted to come over to shoot baskets, swim in the pool, or eat food, he’d open the gate or the door and his heart, and let them all in . . . never scolding, never yelling, never criticizing. He even welcomed the White Christian kids.

For this visit, I brought old photos, scrapbooks, my old baseball glove, and game balls from the two no-hitters I pitched my senior year of high school. I had hoped for some mutual reminiscence. Instead, he slept, awakening occasionally with looks of confusion, while I murmured on about our trips to Boston and New York, his favorite dog, being dumped into the Belize River, the first time he let me work with him, and random memories that only we share.

Today, that’s the hardest pieces of my particular grief. We have shared memories. No one else has them. As soon as he passes, I will be the sole keeper of our mutual memories. The loneliness of that thought crushes my heart.

In the world of grief, there’s a thing called complicated grief. Grief becomes increasingly complicated when the person grieving has mixed feelings and bad memories of the person dying. My grief is simple. I loved my father. He was as near to perfect as I can imagine. I am grateful to have no bad memories to complexify my grief. In my simple grief, I only have the stunning and painful emptiness of a world without him.  

Before I leave for the day, I wake him up. His eyes struggle open. I say, “Dad, I’m going now. I love you. You know I love you.” I watch his massive effort to respond, “I love. . .” He tries for the third word, but comes up empty. I say, “I know. You love me.” He relaxes, and immediately loses his grip on the slippery slice of consciousness he has remaining, and drops back to sleep.

Evaluating Interpersonal Dynamics in the Initial Clinical Interview

As we begin the revision process for Clinical Interviewing, I’m discovering content here and there that I want to share. Below is a short excerpt from the Intake Interviewing chapter where we’re discussing the process of evaluating clients’ interpersonal behavior patterns. Please email me your reactions and recommendations if you have some.

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Evaluating Interpersonal Behavior

Interpersonal behavior is central in the development and maintenance of client problems. Some theorists claim that all client problems have their roots in relationship problems (Glasser, 1998). Evaluating client interpersonal behavior is an essential part of an intake interview.

Intake interviewers have five potential data sources pertaining to client interpersonal behavior.

  1. Client self-report. This includes self-report of (a) past relationship interactions (e.g., childhood) and (b) contemporary relationship interactions.
  2. Clinician observations of client interpersonal behavior during the interview.
  3. Formal psychological assessment data.
  4. Information from past psychological records/reports.
  5. Information from collateral informants.

Although some behaviorists and in-home family therapists also observe clients outside the office (e.g., in school, home, and work environments), it’s unusual to have those data available prior to an intake.

Evaluating interpersonal behavior is difficult. Each of the preceding data sources can be suspect. For example, client self-report may be distorted or biased; often clients cast their interpersonal behaviors in a favorable light, or they may excessively blame themselves for negative interpersonal experiences. Clinician observations are also subjective. When you’re evaluating client interpersonal behavior, it’s wise to use several basic assessment principles to temper your conclusions:

  1. Single observations are often unreliable. This is partly because interpersonal behavior can shift dramatically from situation to situation. Multiple observations of behavior patterns (e.g., interpersonal aggression or interpersonal isolation) are more reliable.
  2. Just as construct validity is established through multimethod, multitrait assessments (Campbell & Fiske, 1959), interpersonal assessments are more valid when you have converging data from more than one source (e.g., self-report plus clinician observation).
  3. The literature is replete with theory-based models for interpersonal assessment. When clinicians hold strong theoretical beliefs, confirmation bias is more likely (in other words, you will make observations that confirm your theoretical stance or hypothesis). Therefore, you should regularly question conclusions about client interpersonal behavior based on your preexisting ideas.

One of the most popular models for conceptualizing interpersonal behavior is attachment theory. Adherents to this perspective believe that early caregiver-child relationship interactions create internal working models about how relationships work. Essentially, this leaves clients with consistent (and sometimes rigid) interpersonal expectations and reactions. For example, clients with insecure attachment styles may expect or anticipate rejection or abandonment, while clients with ambivalent attachment styles alternate between pushing others away and clinging to them. Typically, maladaptive components of client internal working models are activated during the early stages of new relationships or during times of significant stress, when support and reassurance are needed (O’Shea, Spence, & Donovan, 2014).

Interpersonal assessment based on attachment theory is a psychodynamic approach and involves a depth-oriented assessment process. However, the idea that individuals have internal working models that guide their interpersonal behaviors is consistent across many different theoretical perspectives. Specifically,

  • Cognitive therapists emphasize client schema or schemata that shape what clients expect in interpersonal relationships (Young, Klosko, & Weishaar, 2003).
  • Adlerian therapists use the term lifestyle assessment to refer to the evaluation of client expectations about the self, the world, and others (Carlson, Watts, & Maniacci, 2006).
  • Psychoanalytic therapists refer to the client’s core conflictual relational theme (CCRT) as a target for treatment (Luborsky, 1984).
  • The whole emphasis of the empirically supported interpersonal psychotherapy for depression is based on addressing problematic interpersonal relationship dynamics (Markowitz & Weissman, 2012).

It’s always advisable to attend to feelings and reactions that clients elicit in you (Teyber & McClure, 2011). For example, some clients may trigger boredom, arousal, sadness, or annoyance. These personal and emotional reactions can be viewed as countertransference (Luborsky & Barrett, 2006). However, if there’s convergent evidence that reactions the client is evoking in you are also evoked in others, it’s likely that the client’s interpersonal behavior is the culprit. If your reactions are unique, then your countertransference reaction may be more about you and less about the client.

Evaluating a client’s personal history and interpersonal behaviors is a formidable task that could easily take several sessions. Expecting that you should have a precise sense of your client’s interpersonal style after a single interview is unrealistic. A better goal is to have a few working hypotheses about your client’s interpersonal behavior patterns (see Case Example 8.2).

CASE EXAMPLE 8.2: DESCRIBING INTERPERSONAL OBSERVATIONS

The following intake note focuses on interpersonal observations and, consistent with a collaborative/therapeutic assessment model, uses a descriptive rather than a labeling approach.

Miriam, a 36-year-old White, married female, described herself as suffering from tension and stress in her marital relationship. She reported, “My husband always calls me controlling, and I hate that, but sometimes he’s right.” During our session, Miriam repeatedly (about five times) asked for more information, complaining that she “really needed” to understand exactly what counseling was about before she could be sure she wanted to proceed. As we discussed her husband’s comments in greater detail, Miriam noted that she believed her “need for control” was related to anxiety. Together we identified several triggers that elicit anxiety and are then followed by self-identified controlling behaviors. These comprised (a) new situations (like counseling), (b) her husband leaving the house without telling her his plans, and (c) when she feels neglected by her husband. Overall, these triggers may be related to an internal working model where Miriam’s sense of relational security is threatened. Consequently, one of our first therapy tasks is for Miriam to engage in a self-monitoring homework assignment to help further refine our understanding of the interpersonal triggers that activate her “controlling” behaviors.

Send Me Your Feedback and Ideas for the 7th Edition of Clinical Interviewing

And the beat goes on. . .

Rita and I are signing a contract with John Wiley & Sons to update our Clinical Interviewing text to the 7th edition. Clinical Interviewing was first published in 1993 under the title, Foundations of Therapeutic Interviewing with Allyn & Bacon publishers. As one of my academic friends once said, it was a good book, but it fell apart in the end. I was instantly worried that we hadn’t handled the final chapter very well. Turns out, he was referring to the binding.

After Allyn & Bacon let go of the copyright in 1996, we shopped the book and got great offers from Norton, Guilford, and Wiley. We went with Wiley, received excellent editorial guidance, and Clinical Interviewing was born; the text has been very popular in the graduate textbook market in psychology, counseling, and social work.

Along with the great news that we’re headed for another edition comes a rather large chunk of planning and work.

First, the planning . . .

Clinical Interviewing became popular and has remained popular because it’s a practical and accessible text that focuses on clinician competencies. We will continue that focus—we want students to not only read the text, but to return to it, keep it, and use it to remind themselves of the foundations that underlie the clinical encounter.

Another reason the book has been popular is because of the fabulous feedback and ideas we’ve gotten from people like you. We want to continue that emphasis too. If you’re familiar with Clinical Interviewing—as a professor or as a student—I’d love to hear your ideas about what we should change or add. Please, email me with any and all your ideas: john.sf@mso.umt.edu. We’ve already have some feedback, including:

  • Update the text to sync with DSM-5-TR
  • Add more content, and a video demonstration, of online (remote) interviewing (tele-mental health)
  • Add more specific content pertaining to interviewing special populations in general, and working across cultures and sexualities in particular
  • Add more (and updated) video demonstrations
  • Consider stronger and more traditional diagnostic assessment content (I’m mixed on this)

Second, the work . . .

During the past two revisions, I asked people to volunteer to read and review specific chapters. This is extra work for you, but it’s also a good academic process. Everyone who provides a chapter review will be listed in the acknowledgements. And so, if any of you would like to review a chapter (or more) and provide us with feedback and guidance for the 7th edition, please email me at john.sf@mso.umt.edu

As always, thanks for reading this and thanks for considering the opportunity to share your clinical interviewing expertise.

Helping Children Deal with Anxiety . . . and the Best Ever Children’s Anxiety Tip Sheet

Last week I got a press query to answer a few questions for an upcoming article in Parents magazine. The questions were sent to a broad spectrum of media reps and professionals. There was understandably no guarantee I would be quoted in the magazine.

No surprise, I wasn’t quoted. But my media connection was thoughtful enough to send me the article (it came out a couple days ago). IMHO commentary in the article was really good, and so I’m including a link to the article below.

Although I like the article, I have one objection. The authors immediately pathologize children’s anxiety. In the second sentence of the article, they write, “Both conditions (separation anxiety and social anxiety) are treatable with the proper diagnosis.” Using words like “conditions” and “treatable” and “diagnosis” deeply medicalizes children’s anxiety and is a bad idea. Separation anxiety and social anxiety are NOT necessarily mental disorders. It would have been better to start the article by noting that given our current global situation of uncertainty–with COVID, and other sources of angst all around us–it’s normal and natural for children to feel anxiety.

This blog post has three parts. First, I’m including a link to the article. Second, I’m including my responses to the media query. Third—and I think the best part—is a old handout I wrote for helping parents deal with children’s anxiety and fear.

Here’s the article link: https://www.parents.com/toddlers-preschoolers/how-to-help-your-kids-adjust-when-they-go-back-to-daycare-and-school-after-covid-19/

Here are my responses to the magazine’s questions:

  • What is anxiety, in a nutshell?

Anxiety is a natural human emotional response to stress, danger, or threat. One thing that makes anxiety especially distinctive and problematic is that it comes with strong physiological components. Other words used to describe anxiety states include, nervous, worried, jittery, jumpy, scared, and afraid.

Anxiety usually has a trigger or is linked to an activating situation, thought, or physical sensation. Hearing about COVID in the news or seeing someone fall ill can activate anxiety in children (and adults too!).

Anxiety is often, but not always, about the future because people tend to worry about what will happen or what is unfolding in the present. Even when children feel anxious about the past, they tend to worry about how the past will play out in the future.

  • How has COVID-19 affected children mentally? Has there been an uptick in anxiety-related conditions?

COVID-19 is a stressor or threat because of its implications (it can kill you and your loved ones) and because of how it affects children situationally. During my 30+ years as a professional psychologist, anxiety in children, teens, and adults has done nothing but increase. COVID-19 is another factor in contemporary life that has increased anxiety.

In some ways, the fact that more children are feeling anxious can be a positive thing. I know that sounds weird, but anxiety is mostly normal. A professor of mine used to say that the old saying “Misery loves company” isn’t quite true. What is true (and supported by data) is that misery loves miserable company. In other word, people feel a little better when their problems are more universal. When it comes to COVID-related anxiety, we should all recognize we’re in good company.

  • What are the symptoms of social anxiety in kids?

Social anxiety is defined as fear of being scrutinized or negatively evaluated by others. Symptoms can be physical (headaches, stomach aches, shaking, etc.), emotional (feeling scared), mental (thinking something terrible will happen), and behavioral (running away). Social anxiety is usually most intense in anticipation and during exposure to potential social evaluation. Of course, almost always, anxiety will make us imagine that everyone is staring at us—even though many other kids are also feeling anxious and as if everyone is staring at them.

  • What are the symptoms of separation anxiety in kids?

Separation anxiety occurs when children leave or part from a safe person or a safe place. Leaving the home or leaving mom or dad or grandma or grandpa will often trigger anxiety. The symptoms—because it’s anxiety—are the same as above (physical, emotional, mental, behavioral); they’re just triggered by a different situation.

  • How can you help children cope with anxiety–both in general and specific to each condition?

Children should be assured that anxiety is a message from your brain and your body. When anxiety spikes, there may be a good reason for it, just like when a fire alarm goes off and there’s really a fire and there’s physical danger and getting to a safe place is important. Children should be encouraged to identify their safe places and their safe people.

However, sometimes anxiety spikes and instead of a real fire alarm, the body and the brain are experiencing a false alarm. When there’s no immediate danger and the anxiety builds up anyway, it’s crucial for children to have a plan for how they’ll handle the anxiety. Having a plan to approach and deal with anxiety is nearly always preferable to letting the anxiety be the boss. Leaning into, facing, and embracing anxiety as a normal part of life is very important. We should all avoid taking actions designed to run away from or avoid anxiety. Developing a personal plan (along with parents, teachers, and counselors) for dealing with anxiety is the best strategy.

And, finally, here’s my tip sheet for helping with children’s anxiety

How to Help Children Deal with Fears and Anxiety

  1. Manage Your Own Anxiety and Negative Expectations: If you don’t have and display confidence in your own preparation and skills, YOUR WORRIES and negative expectations will leak into the child. Additionally, if you don’t show confidence in your child’s coping abilities, that lack of confidence will leak into them too! 
  2. Use Storytelling for Preparation and to Teach Coping Strategies: “Let’s read, Where the Wild Things Are.” Afterwards, launch into a discussion of how people deal with fears.
  3. Focus on Problem-Solving and Coping (especially as preparation): “How do you suppose people manage or get over their fears?”
  4. Instead of Dismissing Feelings, Use Soothing Empathy: “It’s no fun to be feeling so scared.”
  5. Show Gentle Curiosity:  “You seem scared.  Want to talk about it?”
  6. Provide Comforting Reassurance or Universality (after using empathy and listening with interest):  “Lots of people get afraid of things.  I remember being really afraid of dogs.”
  7. Offer Positive (Optimistic) Encouragement:  “I know it’s hard to be brave, but I know you can do it.”
  8. Have and Show Enormous Patience (connection—and holding hands—reduces anxiety):  “Yes, I’ll help you walk by Mr. Johnson’s dog again.  I think we’re both getting better at it, though.”
  9. Set Reasonable Limits:  “Even though you’re scared of monsters sometimes, you still have to be brave and go to bed.”
  10. Model how to Sit with and through Fear (No negative reinforcement!): One thing that’s always true is when fear is big, it always gets smaller, eventually. “Hey. Let’s sit here together and watch our fear go away. Let’s pay attention to what makes it get smaller.” (This might include direct coping skill work . . . or simple distraction and funny stories).
  11. Plan and Model Anxiety Management Skills: Specific skills, like deep breathing, aid with coping. Once you find some techniques or skills that are better than nothing, start to practice and rehearse using them. This can be for preparation, coping during the anxiety, or afterwards. “Let’s sit together and count our breaths. Just count one and then another. And we’ll try to find our sweet spot.”

What’s Happening with Montana Happiness?

Even a happy life cannot be without a measure of darkness, and the word happy would lose its meaning if it were not balanced by sadness. — Carl G. Jung                      

This opening quotation from Jung is a good start to a discussion of happiness. As many others have said, a “happy” life is a process and it includes the ability to embrace and experience darkness and sadness. I like the quote because it reminds us to not take happiness in the direction of toxic positivity. We don’t need that. At the same time, we need skills and attitudes to extend and prolong positive experiences and cope with our emotional challenges.

I’ve shared a bit about the Montana Happiness Project before, but it’s time for an update.

The Montana Happiness Project has four BIG initiatives.

  • Happy Schools
  • Happy Families
  • Happy Colleges
  • Happy Media

We’ve gotten started on all these initiatives, but in particular, Dylan Wright and Lillian Martz have us rolling forward on the Happy Schools initiative. This past Friday, Dylan and Lillian presented their work in Frenchtown School at the “GradCon” event at the University of Montana. They didn’t win the grand prize, but they were in the running. Their work is amazing and I’m proud to have them as a part of the Montana Happiness Project. Given their hard and smart work, it’s only a matter of time until they win some sort of grand prize. To give you a taste of their work and all that’s going on with the project, here are a couple of video clips.

A “Three Good Things” Tik Tok video produced by a high school student: https://www.youtube.com/channel/UCDXoFkQdE9ofT-WZCd7loEg

And here’s a link to the Dylan and Lillian’s presentation at GradCon. It’s under 15 minutes and will give you a great taste of the potential of integrating happiness into the lives of high school students: https://www.youtube.com/watch?v=cZvHqIMQNGg

Just in case you’re as inspired as I am, after you watch those videos, you’ll want to follow the new Montana Happiness Project YouTube site . . . and then you’ll probably want to go to Facebook where you can follow our new Facebook page: https://www.facebook.com/profile.php?id=100073966896370

Thanks, in advance, for your interest in and support of infusing happiness skills into Montana and beyond.

John SF