It can be good to have an IOU. I knew I owed my former student and current colleague, Maegan Rides At The Door, a chance to publish something together. We had started working on a project several years ago, but I got busy and dropped the ball. For years, that has nagged away at me. And so, when I read an article in the American Psychologist about suicide assessment with youth of color, I remembered my IOU, and reached out to Maegan.
The article, written by a very large team of fancy researchers and academics, was really quite good. But, IMHO, they neglected to humanize the assessment process. As a consequence, Maegan and I prepared a commentary on their article that would emphasize the relational pieces of the assessment process that the authors had missed. Much to our good fortune, after one revision, the manuscript was accepted.
I saw Maegan yesterday as she was getting the President Royce Engstrom Endowed Prize in University Citizenship award (yes, she’s just getting awards all the time). She said, with her usual infectious smile, “You know, I re-read our article this morning and it’s really good!”
I am incredibly happy that Maegan felt good about our published article. I also re-read the article, and felt similar waves of good feelings—good feelings about the fact that we were able to push forward an important message about working with youth of color. Because I know I now have your curiosity at a feverish pitch, here’s our closing paragraph:
In conclusion, to improve suicide assessment protocols for youth of color, providers should embrace anti-racist practices, behave with cultural humility, value transparency, and integrate relational skills into the assessment process. This includes awareness, knowledge, and skills related to cultural attitudes consistent with local, communal, tribal, and familial values. Molock and colleagues (2023) addressed most of these issues very well. Our main point is that when psychologists conduct suicide assessments, relational factors and empathic attunement should be central. Overreliance on standardized assessments—even instruments that have been culturally adapted—will not suffice.
And here’s the Abstract:
Molock and colleagues (2023) offered an excellent scholarly review and critique of suicide assessment tools with youth of color. Although providing useful information, their article neglected essential relational components of suicide assessment, implied that contemporary suicide assessment practices are effective with White youth, and did not acknowledge the racist origins of acculturation. To improve suicide assessment process, psychologists and other mental health providers should emphasize respect and empathy, show cultural humility, and seek to establish trust before expecting openness and honesty from youth of color. Additionally, the fact that suicide assessment with youth who identify as White is also generally unhelpful, makes emphasizing relationship and development of a working alliance with all youth even more important. Finally, acculturation has racist origins and is a one-directional concept based on prevailing cultural standards; relying on acculturation during assessments with youth of color should be avoided.
And finally, if you’re feeling inspired for even more, here’s the whole Damn commentary:
Uncommon Courses is an occasional series from The Conversation U.S. highlighting unconventional approaches to teaching.
Title of Course
Evidence-Based Happiness for Teachers
What prompted the idea for the course?
I was discouraged. For nearly three decades, as a clinical psychologist, I trained mental health professionals on suicide assessment. The work was good but difficult.
I consulted my wife, Rita, who also happens to be my favorite clinical psychologist. We decided to explore the science of happiness. Together, we established the Montana Happiness Project and began offering evidence-based happiness workshops to complement our suicide prevention work.
In 2021, the Arthur M. Blank Family Foundation, through the University of Montana, awarded us a US$150,000 grant to support the state’s K-12 public school teachers, counselors and staff. We’re using the funds to offer these educators low-cost, online graduate courses on happiness. In spring 2023, the foundation awarded us another $150,000 so we could extend the program through December 2025.
What does the course explore?
Using the word “happiness” can be off-putting. Sometimes, people associate happiness with recommendations to just smile, cheer up and suppress negative emotions – which can lead to toxic positivity.
As mental health professionals, my wife and I reject that definition. Instead, we embrace Aristotle’s concept of “eudaimonic happiness”: the daily pursuit of meaning, mutually supportive relationships and becoming the best possible version of yourself.
The heart of the course is an academic, personal and experiential exploration of evidence-based positive psychology interventions. These are intentional practices that can improve mood, optimism, relationships and physical wellness and offer a sense of purpose. Examples include gratitude, acts of kindness, savoring, mindfulness, mood music, practicing forgiveness and journaling about your best possible future self.
Students are required to implement at least 10 of 14 positive psychology interventions, and then to talk and write about their experiences on implementing them.
The lesson on sleep is especially powerful for educators. A review of 33 studies from 15 countries reported that 36% to 61% of K-12 teachers suffered from insomnia. Although the rates varied across studies, sleep problems were generally worse when teachers were exposed to classroom violence, had low job satisfaction and were experiencing depressive symptoms.
The sleep lesson includes, along with sleep hygiene strategies, a happiness practice and insomnia intervention called Three Good Things, developed by the renowned positive psychologist Martin Seligman.
I describe the technique, in Seligman’s words: “Write down, for one week, before you go to sleep, three things that went well for you during the day, and then reflect on why they went well.”
Next, I make light of the concept: “I’ve always thought Three Good Things was hokey, simplistic and silly.” I show a video of Seligman saying, “I don’t need to recommend beyond a week, typically … because when you do this, you find you like it so much, most people just keep doing it.” At that point, I roll my eyes and say, “Maybe.”
Then I share that I often awakened for years at 4 a.m. with terribly dark thoughts. Then – funny thing – I tried using Three Good Things in the middle of the night. It wasn’t a perfect solution, but it was a vast improvement over lying helplessly in bed while negative thoughts pummeled me.
The Three Good Things lesson is emblematic of how we encourage teachers in our course – using science, playful cynicism and an open and experimental mindset to apply the evidence-based happiness practices in ways that work for them.
I also encourage students to understand that the strategies I offer are not universally effective. What works for others may not work for them, which is why they should experiment with many different approaches.
What will the course prepare students to do?
The educators leave the course with a written lesson plan they can implement at their school, if they wish. As they deepen their happiness practice, they can also share it with other teachers, their students and their families.
Over the past 16 months, we’ve taught this course to 156 K-12 educators and other school personnel. In a not-yet-published survey that we carried out, more than 30% of the participants scored as clinically depressed prior to starting the class, compared with just under 13% immediately after the class.
The educators also reported overall better health after taking the class. Along with improved sleep, they took fewer sick days, experienced fewer headaches and reported reductions in cold, flu and stomach symptoms.
As resources allow, we plan to tailor these courses to other people with high-stress jobs. Already, we are receiving requests from police officers, health care providers, veterinarians and construction workers.
Parenting books are ubiquitous; they vary greatly by population (e.g., teens, toddlers, LGBTQ+, culture), problem (e.g., ADHD, autism, sleep, etc.) and approach. This is a field where nearly everyone has very strong (and often opposing) opinions and feelings and very much believe THEY ARE RIGHT. Think of Tiger Parenting vs. Free Range Parenting and the fights that might start between adherents to those approaches. You’ll notice I don’t include books on Tiger or Free Range parenting (which may or may not be a statement), but I do capture some of the extremes and nuances of the different approaches to helping babies and children sleep.
I’m not necessarily advocating the books on this list. In fact, I think some of them are pretty silly. For those of you who know me, you know that I dislike hype, and I dislike it when authors write and act like they’re the ones who have suddenly developed a new and revolutionary paradigm shift. Many contemporary parenting book authors are de-emphasizing compliance and behavioral control, and focusing instead on the underlying neurological states that are contributing to disruptive or undesirable behaviors. Although I don’t dispute the value of these approaches, they sound very Adlerian—other than the use of fancy pseudo-neuroscience terminology. They also sound like my mentor, Linda Braun, of Families First Boston, who always taught parents to “Get Curious, Not Furious.” Yes, I am now officially an old crank.
Many of these newer so-called “paradigm-shifting” approaches are very anti-behaviorism. That’s perfectly okay; after all, John Watson began the behavioral movement in parenting by advising parents not to hug or show too much affection to their children. His children suffered. Watson was a whack (and a genius); his form of behavioral parenting belongs only in the history books. On the other hand, parents need to pay attention to the repeating contingency patterns happening in their homes. Whether or not you buy into behaviorism, ignoring environmental contingencies happening in your home is a recipe for repeated parenting disasters. We need the knowledge of behavioral approaches, if only to make sure we’re not engaging in backward behavior modification. [for more on backward behavior modification, see: https://johnsommersflanagan.com/2012/12/02/backward-behavior-modification/ or https://johnsommersflanagan.com/2018/02/02/doing-behavior-modification-right/]
Many years ago, Sigmund Freud said something like, “There are many ways and means of conducting psychotherapy, all that lead to recovery are good.” The same might be said about parenting books. There are—truly—many ways and means of parenting. As you explore this field, you may want to focus your search on your particular interest. There’s great (and not so great) stuff out there on LGBTQ+ parenting, Indigenous parenting, and many other foci. You may want to find curated lists (like mine). For example,Maryam Abdullah and Megan Bander’s (of Berkeley’s Greater Good Magazine) favorite parenting books of 2023, see: https://greatergood.berkeley.edu/article/item/our_favorite_parenting_books_of_2023
My own list, which I’m sharing with my parenting consultation workshop participants is below.
Bryson, T. P., & Siegel, D. J. (2015). No-drama discipline: The whole-brain way to calm the chaos and nurture your child’s developing mind. Bantam.
Chiaramonte, N., & Chiaramonte, K. J. (2024). Embracing queer family: Learning to live authentically in our families and communities. Broadleaf Books.
Clarke-Fields, H. (2020). Raising good humans: A mindful guide to breaking the cycle of reactive parenting and raising kind, confident kids. New Harbinger.
Delahooke, M. (2019). Beyond behaviors: Using brain science and compassion to understand and solve children’s behavioral challenges. PESI Publishing.
Eriksen, T. (2022). Unconditional: A guide to loving and supporting your LGBTQ child. Mango.
Healy, G. (2023). Regulation and co-regulation: Accessible neuroscience and connection strategies that bring calm into the classroom. National Center for Youth Issues.
Lansford, J. E., Rothenberg, W. A., & Bornstein, M. H. (2021). Parenting across cultures from childhood to adolescence development in nine countries. Routledge.
Tyler, S., & Makokis, L. (2021). Ohpikinâwasowin/Growing a child: Implementing Indigenous ways of knowing with indigenous families. Fernwood Publishing.
Weissbluth, M. (2022). Healthy sleep habits, happy child: A new step-by-step guide for a good night’s sleep (5th ed.). Ballantine Books.
West, K., & Kenen, J. (2020). The sleep lady’s good night, sleep tight: Gentle proven solutions to help your child sleep without leaving them to cry it out (rev. ed.). Hatchet
FYI: Below is an annotated list of older parenting classics.
Ackerman, M. (1998). Does Wednesday mean Mom’s house or Dad’s? Wiley.
This book is written by a nationally renowned expert on child custody evaluations. It includes broad coverage of how parents can co-parent in a manner that is less confusing and more healthy for children. One of the book’s strengths is a chapter on developing parenting and custodial schedules, which is a practical problem often plaguing parents who are divorced or divorcing.
Brazelton, T. B., & Sparrow, J. D. (2006). Touchpoints: Birth to 3(2nd ed.). MA: Da Capo Press.
T. Berry Brazelton is one of the most renowned parenting experts in the world. His Touchpoints books (there is also a Touchpoints: 3–6 years) are packed with critical information about how to deal with parenting challenges. Although you may not agree with every recommendation in the book, it’s difficult to find a more comprehensive, balanced, and gentle approach to parenting. The book includes three main sections: Touchpoints of Development; Challenges to Development; and Allies in Development. The breadth and depth of these books are very impressive.
Cline, F., & Fay, J. (2006). Parenting with love and logic(rev. ed.). NavPress.
The love-and-logic model for parenting and teaching is extremely popular, particularly among educators. Cline and Fay are master storytellers and they bring home the lesson that parents need to give children increasing responsibility and stand by them (but not in for them) with empathy when they make mistakes or fail. The underlying premise of this model is that children learn best from their own mistakes and natural consequences and that we should all avoid being “helicopter” parents who rescue our children from real-world learning.
Coloroso, B. (2009). The bully, the bullied, and the bystander: From preschool to high school—How parents and teachers can help break the cycle (rev. ed.). Harper.
Barbara Coloroso is a popular parent educator from the Pacific Northwest. She has written several well-received books and this is her latest. It focuses on how parents and teachers can help children cope with bullying. Coloroso paints the bully, the bullied, and the bystander as “three characters in a tragic play.” Her focus on the bystander is especially important because of its consistency with research suggesting that the best bullying interventions focus not only on the bully and victim, but also on bystanders, parents, and teachers.
Dreikurs, R., & Soltz, V. (1991). Children: The challenge. Plume.
This is an early parenting classic, originally published in 1964. It’s based on Adlerian theory and emphasizes natural consequences and other methods through which parents can encourage, but not spoil, their children. The book provided foundational concepts for many parenting books that followed. For example, it discussed the goals of misbehavior, the family council, and natural consequences—all of which have been used as basic principles and strategies in many different contemporary parenting books.
Faber, A., & Mazlish, E. (1999). How to talk so kids will listen and listen so kids will talk. Harper.
This classic book, originally published in 1980, focuses on enhancing parent–child communication and remains immensely popular. As of this writing it was ranked #149 overall and #5 in the parenting book category on Amazon.com. The book includes communication strategies for helping children deal with their feelings, engaging cooperation, and dealing with misbehavior without punishment. It includes cartoons illustrating positive and negative communication strategies.
Faber, A., & Mazlish, E. (2005). Siblings without rivalry. New York: Harper.
Originally published in 1988, the latest edition of Faber and Mazlish’s second parenting classic begins with an excellent story that helps parents see that sibling rivalry can stem from jealousy similar to the jealousy a spouse might feel if asked to welcome another husband or wife into the home. The book provides clear ideas about how to avoid comparing, assigning roles, or taking sides and suggests specific alternative strategies to avoid conflict and promote more peaceful interactions.
Ferber, R. (1985). Solve your child’s sleep problems. Simon & Schuster.
This is a very distinct approach to helping very young children sleep better. It has been called the “Ferber approach” or the “cry-it-out solution.” About a two decades ago it was featured on the comedy series, Mad About You. Many parents swear by this approach while other parents believe it could be emotionally damaging. Research indicates it is effective in improving sleep onset, but there is no clear evidence about whether “crying it out” causes emotional damage. Sleep is such a common issue that we also recommend you be familiar with the extreme opposite approach (Tine Thevenin’s The family bed), and a more moderate approach (Pantley & Sears, The no-cry sleep solution).
Fields, D., & Brown, A. (2009). Baby 411: Clear answers & smart advice for your baby’s first year (4th ed.). Windsor Peak Press.
This book was recommended to us by a colleague who swears by its authoritative guidance. She raved about the precision of the authors’ advice . . . ranging from sleep to teething to illness to feeding. Not surprisingly, we also found it helpful both in terms of comprehensiveness and clarity. It’s a practical book designed as a much needed instruction manual for new parents. There are also additional 411 books by the same authors focused on handling pregnancy and parenting your toddler.
Fisher, B., & Alberti, R. E. (1999). Rebuilding: When your relationship ends. Impact Publishers.
This book is designed to help adults deal with the emotional side of divorce. It is highly acclaimed as a self-help book for parents and a good recommendation for parents who are suffering emotionally from divorce. As discussed in Chapter 11, many parents struggle deeply with divorce and knowing about a book that can help navigate this process is important.
Ginott, H. G., Ginott, A., Goddard, H. W. (2003). Between parent and child: The bestselling classic that revolutionized parent-child communication (rev ed.). Three Rivers Press.
This is another classic book focusing on parent–child communication. The main emphasis is on respecting and understanding children’s emotional states. Like Adler and Dreikurs, Haim Ginott’s work was a foundation for many to follow. For example, Faber and Mazlich attribute their approach to their experiences in workshops with Ginott.
Glasser, W. (2002). Unhappy teenagers. HarperCollins.
Glasser developed choice theory and in this book he applies it to raising teenagers. Similar to Dreikurs (and Adler), he believes all children (and teens) strive for love and belonging, but that if they feel excessively controlled or criticized they will rebel and begin seeking freedom and fun and their primary goals. Glasser’s approach in this book is very liberal and it may make some parents and consultants uncomfortable, but he provides a worthwhile and stimulating perspective.
Gordon, T. (2000). Parent Effectiveness Training: The proven program for raising responsible children. Three Rivers Press.
Thomas Gordon’s Parent Effectiveness Training (PET) was originally published in 1970. You can find many copies of these original editions on used-book shelves. PET quickly became very popular and still has a substantial following. Gordon’s PET is a very non-authoritarian approach that emphasizes listening and communication. Gordon is strongly opposed to using force, coercion, or power when parenting children. Instead, he emphasizes using active listening and interactive problem-solving when conflicts arise.
Gottman, J. & DeClaire, J. (1998). The heart of parenting: Raising an emotionally intelligent child. Simon & Schuster.
John Gottman is a renowned marriage researcher at the University of Washington. Apparently, in his spare time, he produced an excellent book on helping parents deal with their children’s emotions. This book emphasizes emotion-coaching, which is a procedure through which parents can teach their children how to cope with challenging and uncomfortable emotions. Gottman and DeClaire encourage parents to view their children’s meltdowns and tantrums as opportunities for positive and educational interactions. This book uses Daniel Goleman’s concept of emotional intelligence as a founding principle.
Kazdin, A. E. (2008). The Kazdin method for parenting the defiant child. Mariner Books.
Alan Kazdin is a past-president of the American Psychological Association and a highly respected researcher in the area of behavior therapy for teenagers and families. Not surprisingly, his approach to parenting the defiant child is strongly behavioral. Although behavioral approaches can be overly tedious and impersonal, Kazdin’s approach is relatively user-friendly (and perhaps more importantly, child-friendly). His substantial hands-on experience with children and families make this book a reasonable choice for parents and consultants. In particular, he does a fabulous job discussing challenging issues like punishment and provides immensely clarifying comments about timeout.
Kohn, A. (2006). Unconditional parenting. Atria Books.
Alfie Kohn is a well-known and controversial writer who is strongly against using behavioral psychology to control children’s behavior. Author of Punished by rewards, he emphasizes that children do best with unconditional love, respect, and the opportunity to make their own choices. He also emphasizes that most parents don’t really want compliance and obedience from their children in the long run and so they should work more on establishing positive relationships than on controlling their children. He believes controlling and authoritarian parenting methods communicate a destructive message of conditional love.
Kurcinka, M. S. (2001). Kids, parents, and power struggles. Harper.
Kurcinka’s book gives a concise, practical, and engaging account of how to use non-authoritarian approaches to attain children’s compliance and cooperation. The focus is on parents as emotion coaches (see Gottman for another resource) and does not offer immediate or magical solutions. Instead, it covers a range of creative techniques for using power struggles as pathways to better parent–child relationships and mutual understanding. There is a strong emphasis on firm guidelines and mutual respect.
Kurcinka, M. S. (2016). Raising your spirited child: A guide for parents whose child is more intense, sensitive, perceptive, persistent, and energetic(3rd ed.). William Morrow.
When we get feedback on books especially designed for parents of children who have very active and challenging temperaments, parents generally rate this as their favorite. Of course, spirited children have been called a variety of less positive names in the literature, including but not limited to: active alert, challenging, difficult, explosive, and strong-willed. These are also children who might be labeled as having attention-deficit/hyperactivity disorder. Kurcinka takes a masterful approach to relabeling and accommodating spirited children in a way that focuses on their personal strengths and avoids unnecessary power struggles.
Mack, A. (1989). Dry all night: The picture book technique that stops bedwetting. New York: Little, Brown.
There are several different approaches to address bedwetting in children. This is our favorite. The author takes a gentle approach to helping parents work through their own bedwetting reactions (which she refers to as sleepwetting). The book includes two main sections: (1)stet ten steps that will help your child become dry all night, and (2)stet a picture book with a story to read to your child. In contrast to more behavioral and medical approaches, this book offers reasonable guidance that parents are likely to understand and implement without much ambivalence.
McKenzie, R. G. (2001). Setting limits with your strong-willed child: Eliminating conflict by establishing clear, firm, and respectful boundaries. Three Rivers Press.
This book is hailed by many parents as a kinder and gentler approach to being a firm parent and limit-setter. Parents are educated about how they partake in the “dance” of noncompliance, and taking disciplinary action rather than using repeated warnings is emphasized. McKenzie helps parents move beyond using the constant reminders that erode parental authority and teach children to ignore their parents.
The lead author of this book, Jane Nelsen, is the author of the original, and very popular, ‘positive discipline’ book, published in the 1980s. Like many other parenting authorities, Nelsen bases much of her advice for parents on the theoretical perspective of Alfred Adler and Rudolf Dreikurs. The main emphasis is on mutual respect and helping children learn from the natural consequences of their behaviors.
Pantley, E., & Sears, W. (2002). The no-cry sleep solution: Gentle ways to help your baby sleep through the night. McGraw Hill.
This is the middle-of-the-road book for helping parents cope with their young child’s sleeping difficulties. Pantley and Sears help parents study their child’s sleep patterns and discover how to work with the baby’s biological sleep rhythms. They also articulate a “Persistent Gentle Removal System” that teaches babies to fall asleep without the breast, bottle, or pacifier.
Phelan, T. (2004). 1-2-3 magic: Effective discipline for children 2 through 12 (3rd ed.). Parentmagic.
This book and its accompanying video describes and advocates a simple approach for parents to set limits and take back control from children. Phelan coaches parents on avoiding the endless arguments with children. He also does a great job pointing out that one of the best ways to get your child to continue misbehaving is to have an extreme emotional reaction to the misbehavior.
Popkin, M. (2005). Doc Pop’s 52 weeks of Active Parenting. Active Parenting.
Michael Popkin is a popular contemporary parenting expert who has authored most books in the “Active Parenting” series. His approach is highly democratic and, like many parenting authorities, he follows the work of Adler and Dreikurs. In this book (there are many other Active Parenting books you could become familiar with), Popkin provides 52 weekly family activities designed to promote parenting skill development and family bonds. Sample activities include actively listening to children, methods for monitoring and limiting television/computer time, sharing stories from family history, as well as playful activities.
Reichlin, G., & Winkler, C. (2001). The pocket parent. Workman Publishing.
This is a handy, pocket-sized book filled with tips on how to deal with challenging parenting situations. It’s organized in an A–Z format and includes quick, bulleted suggestions on what to try when facing specific behaviors and situations (e.g., anger, bad words, lying, morning crazies, etc.). This book provides direct advice in ways that can help expand the repertoire of parenting consultants.
Ricci, I. (1997). Mom’s house, Dad’s house (2nd ed.). Fireside
Originally published in 1980, this is the classic book for establishing a joint custodial or shared parenting arrangement. Generally, if we recommend only one book for divorcing parents, this is it. The author clearly addresses many biases that our society and individual parents have about divorce and shared parenting. She articulates clear ways parents can modify their thinking and develop more healthy and adaptive post-divorce attitudes. She also includes a sample parenting plan and excellent chapters on how ex-spouses can work to establish a productive business relationship for managing their joint parenting interests more effectively. In 2006, Ricci published a second book, titled Mom’s house, Dad’s house for kids.
Samalin, N., & Whitney, C. (2003). Loving without spoiling: And 100 other timeless tips for raising terrific kids. McGraw-Hill.
Nancy Samalin, a well-known parenting expert, includes 100 mini-chapters in this book of tips. Similar to the Pocket parent, she covers a wide range of parenting challenges. Her focus often acknowledges the intense love and concern that parents have for their children, which can make it easy for parents to become too lenient, spoil their children, and then end up dealing with repeated bratty behavior. Samalin help parents recognize how they can give their children responsibility, maintain their authority, and raise well-mannered children.
Sears, W., Sears, M., Sears, R., & Sears, J. (2003). The baby book: Everything you need to know about your baby from birth to age two(revised and updated edition). Little, Brown.
This is a great resource for parents of very young children. The focus is on developing a strong attachment and raising a healthy baby. It’s written by the Sears family, three of whom are physicians and one a registered nurse. William and Martha Sears (the parents) are strong advocates of attachment parenting, a style that emphasizes touch and connection.
Siegel, D., & Hartzell, M. (2014). Parenting from the inside out. Tarcher
Daniel Siegel is a child psychiatrist and Mary Hartzell is an early childhood expert. In this book they explore recent developments in neurobiology and attachment research and discuss how interpersonal relationship patterns can affect brain development. They also address the interesting phenomenon of parents suddenly noticing that they’re unintentionally repeating their parents’ parenting patterns. This book helps parents look at their own lives in an effort to become parents who provide more optimal levels of love and security for their children.
Thevenin, T. (1987). The family bed. Avery Publishing Group.
Getting babies to sleep well can be challenging. This approach emphasizes that it’s natural and nurturing for babies/children and their parents to sleep together. The family bed is viewed as a very helpful solution to children’s sleeping problems. As you may recognize, this approach is the polar opposite to the Ferber or “cry-it-out” approach described previously (see Ferber). We don’t endorse either the cry-it-out or the family bed approach (both of which will raise heated emotions from some parents), but believe it’s very important for parenting consultants to know the ends of the spectrum when it comes to dealing with sleep problems.
And if you want a pdf of this to print, it’s here:
Recently, I had the honor of presenting to Camp Mak-A-Dream residents (13-20 year-olds) on “Happiness and You.” To empower the residents—all of whom have experienced brain tumors—and resonate with the challenges of being human and having emotions, I shared the Three Step Emotional Change Technique. Then, I invited a volunteer to help me demonstrate how sometimes our brains can trick us by immediately providing the wrong answer to a question. A marvelous young man named Brandon stepped up and volunteered.
Here’s the video link, as recorded by Alli Bristow, last year’s Montana School Counselor of the Year (you can hear her reactions, which are pretty fun too):
You can watch the video, but I’m also sharing a description and rationale for the activities below.
The Riddle Activity
You’ll see me asking Brandon to respond to three riddles. I manage to trick him with the first one. For the second one, he’s briefly fooled, and then catches himself and gives the right answer. On the third, he pauses and gets the right answer the first time.
Why This Activity
I’ve used riddles like these in individual counseling with youth and in group presentations (as illustrated in the video). The riddle activity is all about a basic cognitive therapy message: If we go with our automatic thoughts, without pausing and evaluating them, we can be wrong. However, if we pause to evaluate the situational context and our reactive thoughts, sometimes we can override our automatic and possibly maladaptive impulses (Aaron and Judy Beck would be proud).
The Next Lesson
In the video, you only see Brandon and me doing the riddles. He’s great. When I’m doing this presentation (or using it in counseling) after the riddles, I immediately give the youth a situational example. I say something like, “Okay. Now let’s say I go to the same high school as Brandon, and I know him, and I’m walking by him in the hall at school. When I see him, I say ‘Hi Brandon!” But he just keeps on walking. What are my first thoughts?”
Whether I’m working with a group or with individuals, the young people are usually very good at suggesting possible immediate thoughts. They say things like: “You’re probably thinking he doesn’t like you.” Or, “Maybe you think he’s mad at you.”
At some point, I ask, “Have you ever said hello to someone and have them say nothing back?” There are always head nods and affirming responses.
Way back in our “Tough Kids, Cool Counseling” book, Rita and I wrote about the typical internalizing and externalizing responses that people tend to have in reaction to a possible social rejection. The internalizing response is depressed, anxious, and self-blaming. Internalizing thoughts usually take people down the track of “What did I do wrong” or “What’s wrong with me?” Alternatively, some youth have externalizing thoughts. Externalizing thoughts push the explanation outward, onto the other person. If you’re thinking externalizing thoughts, you’re thinking, “What’s wrong with him?” or “That jerk!” or “Next time, I’m not saying hi to him.” Back in the day, Kenneth Dodge wrote about externalizing thoughts in adolescents as contributing to aggression; he labeled this cognitive error “the misattribution of hostility.”
In counseling and in group presentations, the next step is to ask for neutral and non-blaming explanations for why Brandon didn’t say hello. The youth at Camp Mak-A-Dream were quick and efficient: “He probably didn’t hear you.” “Maybe he was having a bad day.” “He could have had his earbuds in.” “Maybe he was feeling shy?”
What’s the Point?
One goal of these activities is to help young people become more reflective and thoughtful. My neuroscience enthralled friends might say I’m working their frontal lobe muscles. I basically agree that whenever we can engage teens with thoughtful and reflective processes, they may benefit.
But the other goal may be even more important. Although I want to teach young people to be thoughtful, I also want to do that in the context of an engaging, sometimes fun, and interesting relationship. For me. . . it’s not just teaching and it’s not just learning. It’s teaching and learning in the crucible of a therapeutic relationship. As one of my former teen clients once said, “That’s golden.”
Tomorrow, I’ll be online again with PacificSource, doing Part 2 of a three-part webinar series titled, “Caring for People Who are Suicidal.” Last week we focused on how to talk with people in general about this challenging topic. This week, the focus is on: “Blending Traditional and Strengths-Based Approaches to Suicide Assessment“
I’ll be talking for about an hour, which means we’ll really only quickly graze the topic. Below, for webinar viewers and other interested readers, I’ve posted the ppts, and excerpted the section in our Clinical Interviewing text that focuses on assessing suicide plans, patient impulsivity, suicidal intent, and a bit of information on talking with patients about previous attempts.
Once rapport is established and the client has talked about suicidal ideation, it’s appropriate to explore suicide plans. You can begin with a paraphrase and a question:
You said sometimes you think it would be better for everyone if you were dead. Some people who have similar thoughts also have a suicide plan. Do you have a plan for how you would kill yourself if you decided to follow through on your thoughts?”
Many clients respond to questions about suicide plans with reassurance that they’re not really thinking about acting on their suicidal thoughts; they may cite religion, fear, children, or other reasons for staying alive. Typically, clients say something like “Oh, yeah, I think about suicide sometimes, but I’d never do it. I don’t have a plan.” Of course, sometimes clients will deny having a plan even when they do. However, if clients admit to a plan, further exploration is crucial.
When exploring and evaluating a client’s suicide plan, assess four areas (M. Miller, 1985): (a) specificity of the plan; (b) lethality of the method; (c) availability of the proposed method; and (d) proximity of social or helping resources. These four areas of inquiry are easily recalled with the acronym SLAP.
Specificity
Specificity refers to the details. Has the person thought through details necessary to die by suicide? Some clients describe a clear suicide method, others avoid the question, and still others say something like “Oh, I think it would be easier if I were dead, but I don’t have a plan.”
If your client denies a suicide plan, you have two choices. First, if you believe your client is being honest, you can drop the topic. Alternatively, if you suspect your client has a plan but is reluctant to speak about it, you can use the normalizing frame discussed previously.
You know, most people who have thought about suicide have at least had passing thoughts about how they might do it. What kinds of thoughts have you had about how you would [die by suicide] if you decided to do so? (Wollersheim, 1974, p. 223)
Lethality
Lethality refers to how quickly a suicide plan could result in death. Greater lethality confers greater risk. If you believe your client is a very high suicide risk, you might inquire not simply about your client’s general method (e.g., firearms, toxic overdose, or razor blade), but also about the way the method will be employed. Does your client plan to use aspirin or cyanide? Is the plan to slash their wrists or throat with a razor blade? In both of these examples, the latter alternative is more lethal.
Availability
Availability refers to availability of the means. If clients plan to overdose with a particular medication, check on whether that medication is available. (Keep in mind this sobering thought: Most people keep enough substances in their home medicine cabinets to die by suicide.) To overstate the obvious, if the client is considering suicide by driving a car off a cliff and has neither car nor cliff available, the immediate risk is lower than if the person plans to use a firearm and keeps a loaded gun in an unlocked location.
Proximity
Proximity refers to proximity of social support. How nearby are helping resources? Are other individuals available to intervene and provide rescue if an attempt is made? Does the client live with family or roommates? Is the client’s day spent alone or around people? The further a client is from helping resources, the greater the suicide risk.
If you have an ongoing therapy relationship with clients, you should check in periodically regarding plans. One recommendation is for collaborative reassessment at every session until suicide thoughts, plans, and behaviors are absent in three consecutive sessions (Jobes, 2016).
Assessing Client Self-Control
Asking directly about self-control and observing for agitation, arousal, and impulsivity are the main methods for evaluating client self-control.
Asking Directly
If you want to focus on the positive while asking directly about self-control, you can ask something like this:
What helps you stay in control? Or, What stops you from killing yourself?
If you want to explore the less positive side, you could ask:
Do you ever feel worried that you might lose control and make a suicide attempt?
Exploring both sides of self-control (what helps maintaining self-control and what triggers a loss of self-control) can be therapeutic. This is done together with clients to understand their perception of self-control. Rudd (2014) recommended having clients rate their subjective sense of self control using a 1-10 scale (although we prefer 0-10). When clients are feeling or acting “out of control” hospitalization should be considered. Hospitalization can provide external controls and safety until clients feel more internal control.
Here’s an example of a discussion that shows (a) an interviewer focusing on the client’s fear of losing control and (b) an indirect question leading the client to talk about suicide prevention.
Client: I’m afraid of losing control late at night.
Therapist: Sounds like night is the roughest time.
Client: I hate when I’m awake and alone into the night.
Therapist: So, late at night, you’re sometimes afraid you’ll lose control and kill yourself. What has helped keep you from doing it.
Client: I think of how my kids would feel when they couldn’t get me to wake up. I can’t even think of that.
A brief verbal exchange, such as this, isn’t a final determination of safety or risk. However, this client’s children are a mitigating factor that may help with self-control.
Observing for Arousal/Agitation
Arousal and agitation are contemporary terms used to describe what Shneidman originally referred to as perturbation. Perturbation is the inner push that drives individuals toward suicidal acts. Arousal and agitation are underlying components of several other risk factors, such as akathisia associated with SSRI medications, psychomotor agitation in bipolar disorder, and command hallucinations in schizophrenia.
Arousal or agitation adversely affect self-control. Unfortunately, systematic methods for evaluating arousal are lacking. This leaves clinicians to rely on five approaches to assessing arousal, agitation, and impulsivity:
Subjective observation of client increased psychomotor activity (as in an MSE)
Client self-disclosure of feeling unsettled, unusually overactive, or impulse ridden (often accompanied by statements like, “I need to do something”)
Questionnaire responses or scale scores indicating agitation
A history of agitation-related suicide gestures or attempts
Clients report impulsivity around aggression and/or substance use
Assessing Suicide Intent
Suicide intent is defined as how much an individual wants to die by suicide. Suicide intent can be evaluated via clinical interview (Lindh et al., 2020), standardized questionnaire (e.g., the Beck Suicide Intent Scale, Beck et al., 1974), or after completed suicides. When evaluated after suicide deaths, higher suicide intent is linked to lethality of means, more extensive planning, and a negative reaction to surviving the act.
Assessing suicide intent prior to potential attempts is challenging. In an interview, the question can be placed on a scale and asked directly:
On a scale from 0 to 10, with 0 being you’re absolutely certain you want to die and 10 that you’re absolutely certain you want to live, how would you rate yourself right now?
Suicide intent is also related to suicide planning; that means when you’re evaluating suicide plans, you’re also evaluating suicide intent. More specificity and lethality in planning is linked to intent. Overall, standardized questionnaires and clinical interviews are equivalent in their predictive accuracy (Lindh et al., 2020).
Obtaining detailed information about previous attempts is important from a medical-diagnostic-predictive perspective, but less important from a constructive perspective, where the focus is on the present and future. Whether to explore past attempts or to stay focused on the positive is a dialectical problem in suicide assessment protocols. On the one hand, suicide scheduling, rehearsal, experimental action, and preoccupation indicate greater risk and, therefore, are valuable information (Rudd, 2014). On the other hand, to some extent, detailed questioning about intent, plans, and past attempts reinforces client preoccupation with suicide and suicide planning.
Balance and collaboration are recommended. As you inquire about intent, continue to integrate positively oriented questions into your protocol:
How do you distract yourself from your thoughts about suicide?
As you think about suicide, what other thoughts spontaneously come into your mind that make you want to live?
Now that we’ve talked about your plan for suicide, can we talk about a plan for life?
What strengths or inner resources do you tap into to fight back those suicidal thoughts?
Eventually you may reach the point where directly asking about and exploring previous attempts is needed.
Exploring Previous Attempts
Previous attempts are considered the strongest of all suicide predictors (Franklin et al., , 2017). Information about previous attempts is usually obtained through the client’s medical-psychological records or an intake form, or while discussing depressive symptoms during a clinical interview (see Case Example 10.2). It’s also possible that you won’t have information about previous attempts, but you decide to ask directly:
Have there been any times when you were so down and hopeless that you tried to kill yourself?
Once you have or obtain information about a previous attempt or attempts, you have a responsibility to acknowledge and explore it, even if only via a solution-focused question.
You’ve tried suicide before, but you’re here with me now . . . What has helped?
If you’re working with a client who’s severely depressed, it’s not unusual for your solution-focused question to elicit a response like this:
Nothing helped. Nothing ever helps.
One error clinicians often make at this point is to venture into a yes-no questioning process about what might help or what might have helped in the past. If you’re working with someone who is extremely depressed and experiencing the problem-solving deficit of mental constriction, your client will respond in the negative and insist that nothing ever has helped and that nothing ever will help. Encountering a negative response set requires a different assessment approach. Even severely depressed clients can, if given the opportunity, acknowledge that every attempt to address depression and suicidality isn’t equally bad. Using a continuum where severely depressed and mentally constricted clients can rank intervention strategies (instead of a series of yes-no questions) is a better approach:
Therapist: It sounds like you’ve tried many different things to help you through your depressed feelings and suicidal thoughts. Of all the things you’ve tried and all the ideas that professionals like me have recommended, which one has been the worst?
Client: The meds were the worst. They made me feel like I was already dead inside.
Therapist: Okay. Let’s put meds down as the worst option you’ve experienced so far. So, which one was a little less bad than the meds?
Instead of asking the client “What worked best?” and getting a bleak depressive response, the therapist asked which therapeutic recommendation had been “the worst?” Focusing on what’s worst resonates with the negative emotional state of depressed clients. Identifying the most worthless of all therapeutic strategies is more likely to produce a response and you can build from there to strategies that are “a little less bad.” Later in the interview process, you can add new ideas that you suggest or that the client suggests and put them in their appropriate place on the continuum. When this strategy works, it produces a list of ideas (some new and some old) for potential homework and experimentation (see also Sommers-Flanagan & Sommers-Flanagan, 2021).
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As I read through the preceding excerpt, I realize there’s so much more that could be covered. For more info, we also have our strengths-based suicide assessment book, which you can find online through different booksellers. Just search for our name and strengths-based suicide assessment to find a plethora of resources, many of which are free.
To continue with my plan to feature culturally diverse case examples from the latest edition of Clinical Interviewing, the following excerpt is from Chapter One and focuses on cultural self-awareness. In particular, I LOVE the quotation on intersectionality from Kimberlé Crenshaw.
Cultural Self-Awareness
Those who have power appear to have no culture, whereas those without power are seen as cultural beings, or “ethnic.” (Fontes, 2008, p. 25)
Culture and self-awareness interface in many ways. As Fontes (2008) implied, individuals from dominant cultures tend to be unaware of and often resistant to becoming aware of their invisible and unearned culturally-based advantages (Sue et al., 2020). In the U.S., these “unearned assets” are often referred to as privilege in general, and White privilege in particular (McIntosh, 1998).
Privilege and oppression are best understood in the context of intersectionality. Intersectionality is the idea that overlapping or intersecting social identities within individuals create whole persons that are different from the sum of their parts (Crenshaw, 1989). Social identities that intersect include, but are not limited to: Gender, sexual orientation, sexual identity, race, ethnicity, religion, nationality, mental disorder, physical disability/illness, citizenship, and social class (Hays, 2022). Understanding multiple social identities helps clinicians understand how feelings of oppression can multiply, be activated under distinct circumstances, and be moderated under other circumstances.
Kimberlé Crenshaw (1989, 1991) introduced intersectionality as a lens to facilitate cultural awareness and understanding, but ideas about intersectionality date back at least to Black female abolitionists. In the 1860s, Sojourner Truth articulated Black women’s simultaneous oppression through classism, racism, and sexism (aka “Triple oppression”; Boyce Davies, 2008). Thirty years after she defined intersectionality, Time Magazine asked Crenshaw, “You introduced intersectionality more than 30 years ago. How do you explain what it means today?” (Steinmetz, 2020). She said,
These days, I start with what it’s not, because there has been distortion. It’s not identity politics on steroids. It is not a mechanism to turn white men into the new pariahs. It’s basically a lens, a prism, for seeing the way in which various forms of inequality often operate together and exacerbate each other. We tend to talk about race inequality as separate from inequality based on gender, class, sexuality or immigrant status. What’s often missing is how some people are subject to all of these, and the experience is not just the sum of its parts.
Through the lens of intersectionality, we can develop nuanced ways to have empathy for clients. For example, sometimes clients simultaneously feel privilege and oppression. Thinking and feeling from an intersectional frame can help clinicians be more prepared to view the world from clients’ perspectives (see Case Example 1.2).
CASE EXAMPLE 1.2: EMPATHY FIRST
Maya, an international student of color was in her first practicum. As was her routine, when introducing herself, she acknowledged her accent, her country of origin, along with her eagerness to be of assistance. Her client, a cisgender male university student, was initially polite, but quickly shifted the conversation to his feelings about White privilege, becoming somewhat agitated in the process. He said, “One thing I think you should know that I don’t believe in that White privilege thing. I just came from a class where that’s all everyone was talking about. I know I’m white, but I didn’t get any privilege. I grew up in a trailer park in West Texas. We were what they call ‘White trash.’ Nobody I grew up with had any privilege. We had poverty, abuse, alcoholism, meth, and government bullshit.”
Maya stayed calm. Even though she was activated by her client’s disclosure and was taking some of what he said personally, she focused on empathy first. She also remembered intersectionality and how common it could be for people to have multiple social identities. She said, “I hear you saying that the White privilege concept really doesn’t fit for you. Being in your very last class before coming here made you realize even more that it doesn’t fit. The idea of trying to make it fit feels annoying.”
Maya’s client simply said, “Damn right,” and continued ranting about White privilege, White fragility, and what he viewed as the politically correct environment at the university. As she continued listening and tried feeling along with him, she was able to see glimpses of his personal perspective. Not surprisingly, Maya’s client had social problems related to his tendency to be angry and abrasive. Eventually, after several sessions, they were able to begin talking about what was underneath his agitated emotional response to multicultural ideas and how his tendency to lead with his anger when in conversations with others might be contributing to him feeling even more isolated and different than everyone else. In the end, the client thanked Maya for “being patient with this dumb ass White boy” and helping him learn to be more aware, softer, and less reactive to triggering cultural conversations.
This case illustrates the importance of intersectionality as a concept that can facilitate counselor and client awareness, while also enhancing empathy. Although Maya’s client may have had even worse oppressive experiences had he been a person of color, he was neither interested nor ready to hear that message (Quarles & Bozarth, 2022). Instead, Maya used her knowledge of intersectionality to have empathy with the part of her client’s social identity that had experienced oppression.
Developing cultural self-awareness is difficult. One way of expressing this is to note, “We don’t know what we don’t know.” When someone tries to help us see and understand something about ourselves that’s outside our awareness, it’s easy to feel defensive. Despite the challenges, we encourage you to be as eager for change and growth as possible, and offer three recommendations:
Be open to exploring your own cultural identity. Gaining greater awareness of your ethnicity is useful.
If you’re from the dominant culture, be open to exploring your privilege (e.g., White privilege, wealth privilege, health privilege) as well as hidden ways that you might judge or have bias toward diverse groups and individuals (e.g., transgender, disabled).
If you’re outside the dominant culture, be open to discovering ways to have empathy not only for members within your group, but also for other diversities and for the struggles that dominant cultural group members might have as they navigate challenges of increasing cultural awareness. Engaging in mutual empathy is a cornerstone of relational cultural psychotherapy (Gómez, 2020).
For the next several weeks I’ll be sharing from our almost new 7th edition of Clinical Interviewing.
One of our goals for the 7th edition of Clinical Interviewing is to move toward greater representation of different ethnic/cultural/sexual identities. We want all potential counseling, psychology, and social work students to be able to identify with counseling, psychology, and social work professionals. To accomplish this goal, we added greater representation by broadening our usual chapter content, as well as including case examples contributed by professionals with diverse identities.
Here’s an excerpt from Chapter 1 on culture-specific expertise
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Culture-Specific Expertise
Culture-specific expertise speaks to the need for clinicians to learn skills for working effectively with diverse populations. For example, learning the attitudes and skills associated with affirmative therapy is important for clinicians working with diverse sexualities, including lesbian, gay, bisexual, transgender, queer/questioning (sexual or gender identity), intersex, and asexual/aromantic/agender (LGBTQIA+) clients (Heck et al., 2013). Similarly, integrating skills for talking about spiritual constructs into your work with African American, Latinx, Indigenous, and traditionally religious clients is often essential (Mandelkow et al., 2021; Sandage & Strawn, 2022).
Stanley Sue (1998, 2006) described two general skills for working with diverse cultures: (a) scientific mindedness and (b) dynamic sizing.
Scientific mindedness involves forming and testing hypotheses about client culture, rather than coming to premature conclusions. Although many human experiences are universal, it’s risky to assume you know the underlying meaning of your clients’ behavior, especially minoritized clients. As Case Example 1.3 illustrates, culturally sensitive clinicians avoid stereotypic generalizations.
Dynamic sizing is a complex multicultural concept that guides clinicians on when they should and should not generalize based on an individual client’s belonging to a specific cultural group. For example, filial piety is a value associated with certain Asian families and cultures (Ge, 2021). Filial piety involves the honoring and caring for one’s parents and ancestors. However, it would be naïve to assume that all Asian people believe in or have their lives affected by this particular value; making such an assumption can inaccurately influence your expectations of client behavior. At the same time, you would be remiss if you were uninformed about the power of filial piety in some families and the possibility that it might play a large role in relationship and career decisions in many Asians’ lives. When clinicians use dynamic sizing appropriately, they remain open to significant cultural influences, but they minimize the pitfalls of stereotyping clients.
Another facet of dynamic sizing involves therapists’ knowing when to generalize their own experiences to their clients. S. Sue (2006) explained that it’s possible for clinicians who have experienced discrimination and prejudice to use their experiences to more fully understand the discrimination-related struggles of clients. However, having had experiences similar to a client may cause you to project your own thoughts and feelings onto that client—instead of drawing out the client’s emotions and showing empathy. Dynamic sizing requires that you know and understand and not know and not understand at the same time. Not knowing—or at least not presuming you know—is essential to interviewer-client collaboration.
CASE EXAMPLE 1.3: NOT AT HOME ANYWHERE
In this case, Devika Dibya Choudhuri, Ph.D., LPC (CT/MI), a self-described Buddhist, South Asian, cisfemale, middle-aged, middle-class, Queer, disabled counselor and professor at Eastern Michigan University, illustrates sophisticated cultural-specific expertise in cross-cultural work with a bi-cultural college student. Dr. Choudhuri uses self-disclosure, researches her client’s culture, and integrates culturally meaningful symbols into her sessions. Imagine how you can aspire to be like Dr. Choudhuri.
Darla, a 19-year-old Ghanian-American cisfemale college student, felt something was wrong with her. Her mother was from Ghana, while her father, with whom she had little contact, was generationally African American. She was halting in the first session, trying to decide whether she could trust me, and talking about her recent visit to Accra where her mother’s family lived. I said, “I know when I go to India, I’m American, and when I’m here, I’m Indian. Is it a bit like that for you?” She emphatically replied, “Yes! I’m not at home anywhere!” “Or,” I returned, “almost at home everywhere, like the rest of us global nomads.” She laughed, then spoke far more comfortably about her friends and boyfriend. I had, in that brief exchange, told Darla very important things about me. I self-disclosed casually about my ethnicity and international navigation, normalized her sense of homelessness, while reframing it to join a new group identity.
After having done some research, I asked Darla if her Ghanian kin were the majority Akan or a minority group. She said they were minority. I reflected on whether she might have picked up a sense of marginalization, not just from being Black in America, but also from being minority in Ghana. This became a deep and intense conversation. She reflected on how her American status in Ghana protected her from discrimination, but also alienated her from her cousins.
Another use of culture as intervention came when I brought in Adinkra (visual pictograph meaning saturated symbols originating in Ghana) for her use. Darla chose four to represent her aspirations, and then designed ways to use them in her daily life, incorporating her cultural roots into her present. One of them, Sankofa, is a symbol of the wisdom of learning from the past to build for the future; expressed in the proverb, “it is not taboo to go back for what you left behind.” Feeling grounded in multiple cultures, and being able to navigate from one context to another with her whole and complex self, rather than fragmenting, led her to see she wasn’t “wrong.” Sometimes the spaces were too limited; it was ok to fit and not fit, just as leftover food on a Ghanian table represented abundance.
[End of Case Example 1.3]
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As always, feel free to share your thoughts on and reactions to this content. We’re always looking for practical feedback that will help us continue to become better learners and teachers.
While doing supervision today, I found myself encouraging my supervisee to be more direct, to embrace his knowledge and his good judgment, and to share his knowledge and judgment with his client. This is an interesting (and perhaps surprising) stance for me to take, because, as some of you know very well, I lean hard toward Rogerian theory. I’m a fan of honoring clients’ expertise and of Carl Rogers’s words that it is “the client who knows what hurts and where to go.”
As I age (more like fine wine, and not like moldy bananas, I hope), one truth I keep feeling is that nearly everything is both-and—not either-or. Yes, I believe deeply in the naturally therapeutic process of person-centered theory and therapy; providing clients with that “certain type of environment” will facilitate self-discovery and personal growth. On the other hand, sometimes clients need guidance. In my supervision case earlier today, my point was that the client was a very long way away from deeper personal insights. That meant my supervisee needed to loan the client his good judgment and decision-making skills. As you may recognize, “loaning clients our healthy egos” is psychoanalytic language. Nevertheless, the guidance I offered my supervisee was to engage in some CBT coaching
All this reminded me of a section I updated in the 7th edition of Clinical Interviewing. The section is titled, “Client as Expert” and I’ve excerpted it below. It captures the essence of honoring client wisdom, which, IMHO, should always precede more directive interventions.
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Client as Expert
Clients are the best experts on themselves and their experiences. This is so obvious that it seems odd to mention, but sometimes therapists can get wrapped up in their expertness and usurp the client’s personal authority. Although idiosyncratic and sometimes factually inaccurate, clients’ stories and explanations about themselves and their lives are internally valid and should be respected.
CASE EXAMPLE 1.1: GOOD INTENTIONS
In one case, I (John) became preoccupied about convincing a 19-year-old client—who had been diagnosed years ago with bipolar disorder—that she wasn’t really “bipolar” anymore. Despite my good intentions (I thought the young woman would be better off without a bipolar label), there was something important for her about holding on to a bipolar identity. As a “psychological expert,” I believed it obscured her many strengths with a label that diminished her personhood. Therefore, I encouraged her to change her belief system. I told her that she didn’t meet the diagnostic criteria for bipolar disorder, but I was unsuccessful in convincing her to give up the label.
What’s clear about this case is that, although I was the diagnostic authority in the room, I couldn’t change the client’s viewpoint. She wanted to keep calling herself bipolar. Maybe that was a good thing for her. Maybe that label offered her solace? Perhaps she felt comfort in a label that helped her explain her behavior to herself. Perhaps she never will let go of the bipolar label. Perhaps I’m the one who needed to accept that as a helpful outcome.
[End of Case Example 1.1]
In recent years, practitioners from many theoretical perspectives have become outspoken about the need for expert therapists to take a backseat to their clients’ lived experiences. Whether you’re working online or face-to-face, several evidence-based approaches emphasize respect for the clients’ perspective and collaboration (David et al., 2022). These include progress monitoring, client-informed outcomes, and therapeutic assessment (Martin, 2020; Meier, 2015).
When your expert opinion conflicts with your client’s perspective, it’s good practice to defer to your client, at least initially. Over time, you’ll need your client’s expertise in the room as much as your own. If clients are unwilling to share their expertise and experiences, you’ll lose some of your potency as a helper.
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So, what’s today’s big takeaway? We start with and maintain great respect for the client’s expertise. . . and then we either stay more person-centered (or psychoanalytic) or collaboratively shift toward providing more direction and guidance. And the big question is: How do we determine whether to stay less directive or become more directive?
If you feel so inclined, let me know your thoughts on that big question.
Over and over—probably because I have a friend who once told me “Redundancy works!”—I told my group class that ending groups is about “learning consolidation.” In other words, we want group members to learn something from group. At the end of each session, and especially during the final session, we want to facilitate experiences that will help group members take their key learning beyond group, and into their lives.
Because role-modeling is a central part of being a group leader, to close our group class, I gave my students a learning consolidation assignment. Although we had been in a group (of 34) together all semester, the “final paper” was, idiographic (like Adlerian theory); students got to do their final paper in their own way. I mentioned poetry as an option, and then told the story of my own risky graduate school strategy of responding to my Advanced Learning professor’s weekly homework prompts with limericks. Turned out, my professor loved the limericks, shared them with his wife who was a writer-aficionado, and I got an “A” in Advanced Learning, while polishing my limerick skills.
Several students took me seriously and sent me fun and creative final papers. But the very last paper I read, by Astrid Santana, was BEYOND MY WILDEST DREAMS! She incorporated Haiku, knock-knock jokes, and a few limericks into her reflections on our group counseling course. I was gobsmacked, and I think you will be too. Happily, I’m here to report that I have her permission to share the paper.
Because WordPress has some difficulty in handling Haiku, I’m excerpting a sampling of Astrid’s work: First, some Haiku; second, a knock-knock joke; third, a limerick. Thanks Astrid!!
Her whole paper is available in a pdf at the bottom of this post.
My Attempt at Brevity:
Reflections on My Reflections
By Astrid Santana
Universality
Even if it sinks,
we’re in this boat together.
I’m grateful for that.
Development of Socializing Techniques
Finally realizing
I was the asshole, and not
everybody else.
Imitative Behavior
They’re so curious,
insightful, calm, and funny.
Could I do this, too?
Phases of Group Therapy
Forming
Knock knock.
Who’s there?
Hugo.
Hugo who?
Hugo first. I feel uncomfortable sitting in this circle and I don’t know if I want to be here
Good news. Yesterday, I got a mysterious email from ORCID–which stands for: Open Researcher and Contributor ID. ORCID is a global, non-profit organization. Their vision is: “a world where all who participate in research, scholarship, and innovation are uniquely identified and connected to their contributions across disciplines, borders, and time.”
Cool.
Anyway, ORCID was notifying me of a change to my ORCID record. A few minutes later, I received an email from Wiley telling me that our Happy Workshop for Grad Students article was now officially published online.
As some of you know, I’ve complained about the journal publishing process, and, although I still think it’s a pretty broken and disturbing process, working with the editors and reviewers from the Journal of Humanistic Counseling was pretty smooth and pretty fabulous. Check them out: https://onlinelibrary.wiley.com/journal/21611939
And so, without further ado, here’s the Abstract, followed by methods to access the article. . .
Effects of a Single-Session, Online, Experiential Happiness Workshop on
Graduate Student Mental Health and Wellness
John Sommers-Flanagan
Jayna Mumbauer-Pisano
Daniel Salois
Kristen Byrne
Abstract
Graduate students regularly experience anxiety, sleep disturbances, and depression, but little research exists on how to support their mental health. We evaluated the effects of a single-session, online, synchronous, happiness workshop on graduate student well-being, mental health, and physical health. Forty-five students participated in a quasi-experimental study. Students attended a synchronous 2.5-h online happiness workshop, or a no-workshop control condition. After workshop completion and as compared with no-treatment controls, participants reported significant reductions in depression symptoms but no significant changes on seven other measures. At 6 months, participants reported further reductions in depression symptoms. Moreover, across four open-ended questions, 37.0%–48.1% of workshop participants (a) recalled workshop tools, (b) found them useful, (c) had been practicing them regularly, and (d) used them in sessions with clients. Despite study limitations, single-session, synchronous, online, happiness workshops may have salutatory effects on graduate student mental health. Additional research is needed.
K E Y W O R D S: depression, graduate students, mental health, single-session, wellness
John Sommers-Flanagan 