Category Archives: Writing

Personal Reflections, Research, Writing

Concerns about Science

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As many of you know, over the past year or so I’ve been frustrated in my efforts to publish a couple of journal articles. I know I’m not the only one who has experienced this, but this morning we got another rejection (the third for this manuscript) that triggered me in a way that, as the feminists might say, raised my consciousness.

Three colleagues and I are trying to publish the outcomes from a short online “happiness workshop” I did a couple years ago for counseling students. Mostly the results were nonsignificant, except for the depression scale we used, which showed our workshop participants were less depressed than a non-random control group. Also, based on open-ended responses, participants seemed to find the workshop experience helpful and relevant to them in their lives.

Problems with the methodology in this study are obvious. In this most recent rejection, one reviewer noted the lack of “generalizability” of our data. I totally agree. The study has a relatively small n, nonrandom group assignment, yada, yada, yada. We acknowledge all this in the manuscript. Having a reviewer point out to us what we have readily acknowledged is annoying, but accurate. In fact, this rejection was accompanied by the most informed and reasonable reviews we’ve gotten yet.

Nevertheless, I immediately sent out a response email to the editor . . . which, because I’m partially all about entertainment, I’m sharing below. As you’ll see, for this rejection, my concerns are less with the reviews, and more about WHAT IS BEING PUBLISHED IN SO-CALLED SCIENTIFIC JOURNALS. Although I don’t think it’s necessary, I’ve anonymized my email so as to not incriminate anyone.

Dear Editor,

Thanks for your timely processing of our manuscript.

Overall, I believe your reviewers did a nice job of reading the manuscript, noting problems, and providing feedback. Being very familiar with the journal submission and feedback process, I want to compliment you and your reviewers on your evaluation of our manuscript. Compared to the quality of feedback I’ve obtained from other journals, you and your team did well.

Now I’d like to apologize in advance for the rest of this email because it’s a critique not only of your journal, but of counseling research more generally.

Despite your professional review, I have concerns about the decision, and rather than sit on them, I’m going to share them.

Although the reviews were accurate, and, as Reviewer 1 noted, there are generalizability concerns (but aren’t there always), I looked at the most recent online articles published in [your journal], to get a feel for the journal’s standards for generalizability, among other issues. What I found was disturbing.

In the seven published 2023 articles from your most recent issue, none have data that are even close to generalizable, and yet all of the articles offer recommendations, as if there were generalizable data. In the [first] article there’s an n of 8; [the second article] has an n of 6 and use a made-up questionnaire. I know these are qualitative studies, but, oh my, they don’t shy away from widely offering recommendations (is that not generalizing?), based on minimal data. Four of the articles in the most recent issue have no data; that’s okay, they’re interesting and may be useful. The only “empirical” study is a survey with n = 165, using a correlational analysis. But no information is provided on the % response to the survey, and so any justification for generalization is absent. Overall, some of these articles are interesting, and written by people I know and like. But none of them have anything close to what might be considered “generalizability.”

What’s most concerning to me is that none of the published articles employ an experimental design. My impression is that “Counselor Education and Preparation” (not just the journal, but the whole profession) mostly avoids experimental or quasi-experimental designs, and privileges qualitative research, or correlational designs that, of course, are really just open inquiries about the relationships among 2 or more variables.

This is the third rejection of this manuscript from counseling journals that, to be frank, essentially have no scientific impact factor. Maybe the manuscript is unpublishable. I would be open to that possibility if I didn’t read any of the published articles from [your journal and other journals]. My best guess (hypothesis) is that counseling journals have double standards; they allow generalizing statements from qualitative studies, but they hold experimental designs to inappropriately high standards. I say inappropriate here because all experimental designs are flawed in one way or another, and finding those flaws is easier than understanding them.

I know I’m biased, but my last problem with the rejection of this manuscript has to do with relevance. We tried to offer counseling students a short workshop intervention to help them cope with their COVID-related distress and distress in general–something that I think more counseling programs should do, and something that I think is innately relevant and potentially very meaningful to counseling students and practitioners.

Sorry again, for this email and it’s length, but I hope some of what I’ve shared is food for thought for you in your role as journal editor.

Thanks again for the timely review and feedback. I do appreciate the professionalism.

Sincerely,

John SF

If you’re still reading and following my incessant complaining, for your continued pleasure, now I’m pasting my email response to my coauthors, one of whom wrote us all this morning beginning with the word “Bummer.”

Hi There,

Yes! Another bummer.

For entertainment purposes, I kept you all on my email to the editor.

Although I’m clearly triggered, because I just read some articles in the [Journal], I now know, more about self-care, because in their [most recent lead published article], the authors wrote:

“Most participants also offered some recommendations for self-care practices to process crisis counseling. One participant (R2) indicated, “I keep a journal with prayers, thoughts and feelings, complaints and poetry.”

Now that I’ve done my complaining, I need to take time off to pray and write a poem or two, but then, yes . . .  I will continue to send this out into the world in hopes of eventual validation.

Happy Friday to you all,

John

I hope you all caught my clever utilization of recommendations from the offending journal to cope with this latest rejection. The good news is, like most rejections, this one was clarifying and inspired me with even more snark energy than I usually have.

Have a great weekend.

Counseling and Psychotherapy Theory and Practice, Happiness, Personal Reflections, Writing

Anger Management — Revisited

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What’s new about anger? Everything and nothing. You will feel angry over and over in your life. Each time it will be your familiar anger, which may come to feel old, tired, and boring. But each time it also will be new and compelling—as if you’ve been charged with energy to change the world.

Here’s one big truth about anger; it will come around again.

Here’s another: when doing anger management, it’s helpful to develop awareness of your usual triggers because if you see it coming, you may have a better chance to handle your anger in ways that are less embarrassing or destructive.

Here’s a third. This one I like to tell my clients and students: One good thing about having anger problems is that—and you can count on this—you will get many opportunities to work on your anger in the future, because it won’t be long until your anger visits you again (and again).

To summarize: Anger is repetitive; it’s good to develop self-awareness of your personal triggers; you will be presented with many opportunities to deal with your anger differently.

What follows is a slight revision of a post from seven years ago.

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

In my rear-view mirror, I notice a car slowly creeping up on me from behind. He gets a little to close to my rear bumper, and then slowly drifts into the left lane past me, lingering beside me and edging ahead. Then, with only three car lengths between us, he puts on his blinker and drifts in front of me. Now, with no other cars in sight, there’s just me and Mr. 83 mph on I-90, three car lengths apart.

An emotion rises into awareness. It’s anger, from a distance. I see it coming slowly, as if it’s in the rear-view mirror of my brain. At this distance, it’s only annoyance. I feel it and see it coming and immediately know it can go in one of three directions: My annoyance could sit there and remain unpleasant, until I tire of it. If I provide it with oxygen, could rise up and blossom into full-blown anger. Or, I can send it away, leaving room for other—more pleasant—thoughts and actions.

That’s not to say annoyance and anger is wholly unpleasant. Part of me likes it; part of me feels so damn aggrieved and indignant and justified.

All this self-awareness is fabulous. This is the Sweet Spot of Self-Control.

Without moving or speaking, “Hello anger,” I say, to myself, in my brain.

In this sweet spot, I experience expanding awareness, a pinch of energy, along with unfolding possibilities. I love this place. I love the strength and power. I also recognize anger’s best buddy, the behavioral impulse. This particular impulse (they vary of course), is itching for me to reset my cruise control to 84 mph.  It’s coming to me in the shape of a desire—a desire to send the driver in front of me a clear message. Isn’t that what anger, in its behavioral manifestation, aggression, is all about—sending a message?

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

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

Now I’m listening to a different voice in my head. It’s smaller, softer, steadier. “It doesn’t matter” the voice whispers. “Let him move on ahead. Revenge is only briefly sweet. Those who seek revenge should dig two graves.”

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

One participant said, “Lust. Lust is like anger. One second you want something more than anything, but the next second you might wish you hadn’t.”

“Maybe so,” I said.

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

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

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

The other driver is now far ahead. I recognize that I could resurrect my anger. I choose to let it go instead.

I haven’t always let go of my anger. In my teen years I developed a temper. I had many sport-related fits of embarrassing anger. I went to psychotherapy. My therapist listened, and helped me grow my better judgment. He said, “I don’t believe in the bowel movement theory of anger control.” That was a little indirect, and interesting. We don’t have to expel it. We can sit with it. We can reflect on it. We can watch it go away. We can put it in the rear-view mirror, or let it pass us by. Using our functional frontal lobes, we can experience the joy of the Sweet Spot of Self-Control.

My anger is like an old, greedy, needy, and fickle friend. It has an all-or-nothing mentality. My anger wants attention and power, because it values power over long-term happiness.

Anger is also a source of energy; it can fuel us to be assertive, to fight injustice, to be clear on our values. Anger has its place, and is sometimes a useful partner: a partner whom we should keep in the passenger seat, never letting it get behind the wheel and drive—even on a wide-open Montana highway.

Clinical Interviewing, Suicide Assessment and Intervention, Writing

A Strengths-Based Approach to Suicide Prevention with Marginalized Communities

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This morning I’m doing a one-hour webinar for Division 17 of the American Counseling Association. The focus is on how we can do suicide assessment, treatment, and prevention with people from historically and currently marginalized or oppressed communities. To deal with this immense issue, it would help if we had some superpowers.

Here are the ppts for this morning:

suicide-talk-for-d17Download

We know, from decades of sociological and psychological research that many different factors contribute to global and regional changes in suicide rates. We also know that, in general, suicide is at least in part driven by individual experiences and perceptions of high personal distress (Shneidman’s “psychache”). Researchers have also identified how poverty, racism, and factors like neighborhood safety/climate can contribute to suicidality. In our suicide book, we call these factors–factors that are typically outside of the self, but that can be internalized–as “contextual.” What follows is an excerpt on contextual factors from Suicide Assessment and Treatment Planning: A Strengths-Based Approach.

Externalizing the External          

At age 82, in an interview with the Los Angeles Times (Stein, 1986), B. F. Skinner said: “I have to tell people that they are not responsible for their behavior. They’re not creating it; they’re not initiating anything. It’s all found somewhere else.”

We find Skinner’s words reassuring. All humans are influenced—to some extent—by factors outside themselves. This is not to say people are helpless victims of their environments; there are methods for coping with external stressors. But the first step, even though the stressor is obviously external, is to re-externalize it, because all too often, it’s all too easy, to internalize the external.

Coping Strategies for Toxic or Malignant Stressors

When clients are exposed to larger sociological and uncontrollable stressors, they can experience frustration, helplessness, and hopelessness. As a counselor, mostly you’re unable to change the unchangeable for your clients. Within the counseling relationship, you can express both empathy for your client’s situation, and indignation that society can be so painful and difficult to change. Depending on the counseling goals, you can provide empathy, commiseration, assistance in discerning achievable goals, learning opportunities, and advocacy or support for activism.

Empathic Commiseration

News events pertaining to racism, climate change, global pandemics, and other topics activate and agitate some clients (and counselors). When this happens, empathic commiseration is a good first step. Empathy from you can universalize client emotional reactions and help clients feel more normal. Simple statements like, “I agree. It’s so hard to watch the news” can facilitate recognition that excessive media exposure heightens feelings of helplessness and depression.

Other scenarios where clients are exposed to environmental toxicity, but unable to extricate themselves from the situation, can be especially demoralizing. In such cases, brainstorming about how to mobilize community resources, how to gain access to safe spaces, and how to engage in self-advocacy can be important and empowering. As with goal-setting in other dimensions, helping clients evaluate their own behaviors and the factors over which they have control, may mitigate frustration. Having you to resonate with their frustration and show compassion is crucial.

Discernment and Goal-Setting

People associated with Alcoholics Anonymous are familiar with Richard Neibauer’s (1932) serenity prayer: God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference. Similar guidance comes from Shantideva, an 8th century Indian Buddhist Scholar, who put it this way: If there’s a remedy when trouble strikes, what reason is there for dejection? And if there is no help for it, what use is there in being glum? (Shantideva, The way of the Bodhisattva, p. 130). Clients who are religious or spiritually oriented may find particular comfort and insight in the words of Neibauer or Shantideva.

Yet another version of the Serenity Prayer comes from 20th century Philosopher W. W. Bartley. Bartley took a break from writing about philosophical rationalism, to put the message of the Serenity Prayer into a Mother Goose nursery rhyme format:

For every ailment under the sun

There is a remedy, or there is none;

If there be one, try to find it;

If there be none, never mind it.

When it comes to helping clients deal with complex contextual difficulties, these prayers or philosophies can be a good place to start, both for professionals, and for clients. Recognizing and accepting that some problems in life are unchangeable can bring solace. Trying to change that which is unchangeable generally fuels unhappiness.

The developers of mindfulness-based cognitive therapy (MBCT; Segal, Williams, & Teasdale, 2013) put their own brain-based 21st century spin on the Serenity Prayer. To summarize, they say the brain has two basic modes of functioning. The first mode is problem-solving. The brain is quite good at problem-solving. But some problems are unsolvable. When faced with insoluble problems, rather than letting go of the problem-solving process, the brain naturally persists, relentlessly continuing to problem-solve, ruminate, and chew on old ideas and failures. Anxiety and fear escalates. If the brain gets hooked on unsolvable problems, it can take clients down into bottomless rabbit-holes and exacerbate emotional discomfort.

What about that second basic brain modality? Mindfulness practitioners say that engaging the second mode can unhitch our brains from the out-of-control problem-solving train. The second brain modality operates on a less natural principle: The principle of acceptance. MBCT practitioners emphasize shifting into noticing, or nonjudgmental acceptance. Although the brain is capable of intermittent nonjudgmental acceptance, shifting into that modality is tough. Most clients can’t make that switch in the moment. That’s okay. Accepting failure to switch into nonjudgmental mindfulness is part of mindful acceptance. Coaching clients to make efforts at mindfulness and then to accept their failings and inadequacies might facilitate client self-acceptance and grow mindful parts of the brain, like the insula (Haase et al., 2016). Nonjudgmental acceptance requires regular practice. No one ever gets it right all the time.

Opportunity Ameliorates

James Garbarino (2001) wrote: “Stress accumulates; opportunity ameliorates” (p. 361). Within the trauma literature, it’s clear that toxic stress increases illness (Shern et al., 2016); it’s also clear that providing traumatized youth and adults with physical, social, and academic opportunities mitigates trauma and increases health. In part, your role with clients who have experienced trauma and who are chronically reactivated by socio-political events, is to assist them in finding and participating in local resources and opportunities.

Clients who are suicidal and in the midst of toxic and uncontrollable contextual factors, may feel they don’t have the time or energy for new opportunities. Like Katie from chapter 5, they may need support, assistance, and resources to step outside of their survival mode. Practical problems like childcare, transportation, and inaccessible community organizations can loom large. In such situations, you may need to engage in advocacy or activism to help your clients get connected to the resources and opportunities they need.

Personal Reflections, Politics, Writing

The Power of Words

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Long before Freud said “words were originally magic,” nearly everyone already knew that words, language, and gestures were emotionally powerful. Perhaps this is why someone eventually made up the famous (and not evidence-based) “Sticks and stones . . .” saying. Using words to deny or disempower other words is an age-old social and emotional strategy. But generally, if you have to use words to disempower other words, you’ve probably already felt the pain.

In Montana, some politicians are especially sensitive to words. We’ve seen efforts to eliminate particular words from the lexicon. Instead of—or in addition to—banning books, banning words is in vogue.  I’d give you a list, but I’d rather not waste my words on the efforts of others to limit my words.

Although efforts at prohibition have nearly always ended badly (no citations needed here), people who crave power still act on the idea that prohibiting others from using certain words or reading certain books or attending certain parties will achieve their ends.  

Words are also powerful in shaping identity. Identity labels are motivating, popular, and often limiting. When I worked as a mental health consultant at a Job Corps, most of the students had absorbed labels like bipolar, learning disabled, clinically depressed, suicidal, and attention-deficit for the better part of a decade. When I told them that we believed they were much more than any label, they would either look at me with confusion or elation. IMHO, when we free young people from limiting labels, we increase their chances of thriving. But letting go of negative labels can be difficult.

Another common label involves victimhood. Some people label others as victims—even though the so-called victims view being labelled as a victim as insulting and limiting. Ironically, other people like to play the victim, taking on the label for particular purposes. What seems especially puzzling about this is that some people who play the victim have plenty of justification for feeling like a victim, while others embrace victimhood, despite appearing more privileged than anything else.

The obvious and immediate example of a wealthy, white man playing victim is the former president, Donald Trump. He seems to see himself as a victim, and regularly complains about it. This is in contrast to many young adults with whom I’ve worked in counseling; they eschewed the victim label. In one way or another, they would tell me to stop feeling sorry for them. These young adults came from poverty, were members of underrepresented and generally oppressed groups, and had experienced suffering that Mr. Trump has likely never imagined.

The Trump phenomenon—we might call it “representational victimhood”—is the traditional enigma wrapped in a mystery. He brags about his accomplishments. He asserts that only he can save the country from its imminent demise. His fans idolize him as a sort of superhero. All the while, he whines and complains—and then hops into a golf cart to ride around golf courses—that he happens to own. That’s a pretty rough scene; it’s easy to see why he claims great oppression and victimhood (n.b., the preceding is complete sarcasm).

Trump’s song and dance was old and worn years ago. Rather than being cryptic, in this moment I hope you can feel my effort to use words to call Mr. Trump’s schtick boring and onerous. That he continues to be over-covered in the media is banal tedium (more words). This week on NPR they noted he was engaging in a media stunt—and then proceeded to thoroughly cover his media stunt, in depth, and repeatedly, all week (and it’s only Wednesday!). Jon Stewart described the Trump and media relationship back in 2015. Trump is like a train wreck in a dumpster fire; the media cannot look away.

Trump is unquestionably a sore loser, a liar, and willing to say anything to retain or regain power. He’s also probably a serial philanderer, sexual predator, Russian comrade, and card-carrying racist and sexist. To top it off, he’s become enchantingly boring. . . so much so that I can barely force myself to write 500 words about him. Although I hope he gets arrested, I’ve also stopped caring much. Mostly, I want him to slip quietly into the night. But since he’s completely unable to embrace his quieter self, I keep rooting for the press to start giving him the attention and number of words he deserves . . . which is none, zero, nada, zip, or nil. 

Parenting, Personal Reflections, Writing

Working Effectively with Parents: Powerpoints from the 1st Annual Missoula Education Summit

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I had an awesome day yesterday with many amazing Missoula educators. I always respect and admire educators for their willingness to enter classrooms with large groups of young people. I have many reasons upon which I base the belief–that educators deserve respect and admiration–not the least of which is my lived experience of having occasionally stepped into a classroom with young people. One of my memories is of hearing panic in my own voice, while asking the regular classroom teacher, “You’re not leaving me alone in here, are you?”

Sadly, now is a time in American society when teachers seem not to receive the respect and admiration I think they deserve. For multiple reasons (many of which strike me as misleading and political), it seems like there has been distrust sown between teachers and parents. Yesterday, I spent the day with over 400 teachers, counselors, psychologists, administrators, custodians, and other school personnel who attended sessions I offered. I was honored to be there. Being with them not only strengthened my trust in them, but also renewed my hope in the world.

Here are the powerpoints for my workshop on “Working Effectively with Parents”:

parenting-mcps-summit-jsf-2023Download

And here’s a one-page handout on de-escalation strategies:

de-escalation-handout-revDownload

FYI: My biggest takeaway from the Summit was that teachers and other school personnel who dedicate themselves to educating our future generations are simply amazing.

Pass it on.

Happiness, Love, Multicultural, Personal Reflections, Writing

Love One Another

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Last week I was dancing and singing in India at my nephew’s wedding. This week I’m jet-lagged in Missoula. But the afterglow continues.

Being at a wedding, it was hard not to think of my mother. She loved weddings and always wished for everyone to find love.

My sisters had similar thoughts. We reminisced and projected my mother into the scene of my nephew marrying an Asian Indian woman in a Hindu ceremony. We wished she could pop back into the world and join in.

Mostly, my mother was shy and insecure. She didn’t learn to drive until age 34. I often wished she had more confidence.

But there was one place where my mom found her voice, early and often. For mysterious and obvious reasons, she became anti-racist in the 1950s, before anti-racism was a thing. She delighted in visits from my father’s Japanese friend, Carl Tanaka. When a Black family moved onto our all-White dead-end suburban street, she was the first to greet them with welcome gifts. She then sat my sisters and I down, and told us with piercing clarity that we would ALWAYS treat every member of that family with nothing but respect and kindness. They quickly became our friends. I have great memories of hanging out with my friend Darrell, who was the closest to me in age and in school.

What I didn’t understand about my mom’s anti-racism—until last week—was that she also had a solution. My sisters told me that my mother’s favorite solution to all that ails the world was inter-racial, inter-cultural, and inter-religion marriage. Of course, I’m not naïve enough to think that any single strategy could solve racism, but last week, during a three-day Hindu marriage ceremony, I returned home transformed and preoccupied with the idea that we can and should love one another.

The internet tells me that love one another has Christian Biblical origins . . . and more. Here’s an excerpt from a site that discusses “love of neighbor” in Hinduism.

Love of the neighbor or the “other soul” is a fundamental requirement for a functioning Hindu who aspires for final liberation from this world. Any injury or insult inflicted upon the other soul is ultimately injury inflicted on oneself—or worse still, the higher being. Neighborly love is integral for one’s social existence in this world. The Anusana Parva (113:8) in Mahabharata encapsulates this wisdom and dictates that one should be unselfish and not behave toward others in a way that is disagreeable to oneself. [From: http://what-when-how.com/love-in-world-religions/love-of-neighbor-in-hinduism/]

The facts were that Stephen Klein married Sahana Kumar last week, in a beautiful coastal setting just south of Chennai, India.

In a marvelous stroke of luck, I happen to be Gayle Klein’s brother and Stephen’s Uncle John. Along with the dancing singing (which I may have overdone), I was completely taken by the intercultural love and acceptance. The Kumar family welcomed Stephen and all of us to be with them not only in the celebration, but in relationship. At the Sangeet, we were invited to dance a Bollywood and a Hollywood dance. We were terrible AND we were completely accepted. To be immersed in another culture, to learn about Hinduism, to experience glimpses of the Southern Indian cultural ways of being . . . was AMAZING.

In love and in relationship, we often fall short. It’s hard to love our politically different family members. It’s hard to love when we feel annoyed. Sometimes, as I heard the famous Julie and John Gottman say, it’s even hard to find the time and timing to love our romantic partners. But love is big and, thanks to my sisters and Stephen, Sahana, and the Kumars, I understand love a little better this week. The intent to love people who are different than us; the invitation to be in relationship across cultures and generations; the desire to be as loving as we can be . . . those are the ways of being my mom might be shouting from the heavens.   

Clinical Interviewing, Writing

Istanbul Tomorrow

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In 90-minutes, Rylee and I fly out of Seattle to Istanbul. Upon our arrival, the amazing Dr. Umit Arslan will pick us up from the airport, and then we’ll have three days of Umit, Turkish coffee, Turkish breakfasts, and tours of Istanbul with him (thank you, Umit!). As part of the trip, I’ll be offering a talk (translated live and in-person by Umit) at Yildiz Technical University (motto: “The ever-shining star”) in Istanbul. For those of you interested in such things, here are the ppts for the presentation, titled, Skills and Strategies for Conducting Excellent Clinical Interviews:

excellent-clinical-interviews-istanbul-no-vidsDownload

Peace, love, and virtual hugs,

John S-F

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice, Writing

Neurogenesis and Ideas for Training Your Brain to Listen with Empathy

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To start, I should say that I generally dislike pop-psych articles and promotional efforts that include cute sayings like, you can “Train (or re-wire) your Brain.” Most of you know this about me, partly because I like to make pithy comments about how, in fact, our brains actually don’t have any wires.

Despite overuse of the “wiring” analogy, I’m all-in on the principle that our behavior influences our brain structure, function, including a vast array of neurochemicals, hormones, and yada, yada, yada. In the following excerpt from our forthcoming Clinical Interviewing text, we provide a brief scientific commentary and recommendations for what we might oversimplify as “empathy training.”

*****

Neurogenesis refers to the birth of neurons and is one of the biggest revelations in brain research. Although neurogenesis primarily occurs during prenatal brain development, humans and other mammals generate new neurons (brain cells) throughout the life span (Jenkins et al., 1990). When adult neurogenesis occurs, new neurons are integrated into existing neurocircuitry.

Over 30 years ago, researchers demonstrated that repeated tactile experiences produced functional reorganization in the primary somatosensory cortex of adult owl monkeys (Jenkins et al., 1990). This finding and subsequent research supporting neurogenesis underscore a commonsense principle: Whatever behavior you practice or repeat is likely to stimulate neural growth and strengthen skills in that area. This is our explanation and prescription for how you can become more like Carl Rogers.

Multiple brain regions are activated during an empathic experience. Kim and colleagues (2020) summarized the complexity of what’s happening in the brain during empathic or compassionate responding, “Our analysis of sixteen fMRI studies revealed activation across seven broad regions, with the largest peaks localized to the Periaqueductal Grey, Anterior Insula, Anterior Cingulate, and Inferior Frontal Gyrus” (p. 112). In a similar review, Sezer and colleagues (2022) wrote:

Mindfulness-mediated functional connectivity changes include (1) increased connectivity between posterior cingulate cortex (DMN) and dorsolateral prefrontal cortex (FPN), which may relate to attention control; (2) decreased connectivity between cuneus and SN, which may relate to self-awareness; (3) increased connectivity between rostral anterior cingulate cortex region and dorsomedial prefrontal cortex (DMN) and decreased connectivity between rostral anterior cingulate cortex region and amygdala region, both of which may relate to emotion regulation; and lastly, (4) increased connectivity between dorsal anterior cingulate cortex (SN) and anterior insula (SN) which may relate to pain relief. (https://doi.org/10.1016/j.neubiorev.2022.104583)

If we focus in (somewhat inappropriately) on a particular brain structure, the anterior insula or insular cortex, a small structure residing deep within the fissure that separates the temporal lobe from the frontal and parietal lobes, seems particularly linked to empathy experiences, self-regulation, and other compassionate counseling-type responses (Chen et al., 2022).

Compassion meditation (aka lovingkindness meditation) is also associated with neural activity and structural development (or thickening) of the insula. Individuals who engage in regular compassion meditation have thicker insula, and when they view or hear someone in distress, they show more insula-related neural activity than individuals without compassion meditation experience (Hölzel et al., 2011). Other researchers have conducted meta-analyses and written reviews indicating that several brain structures are activated during cognitive-emotional perception, regulation, and response, and the relationships among them are highly complex (Kim et al., 2020; Pernet et al., 2021).

To oversimplify a complex neurological process, it appears generally safe to conclude that compassion meditation and other human activities related to empathy may contribute in some way to the thickening of the insula and development of other brain processes that enhance empathic responsiveness.

Although our knowledge about what’s actually happening in the brain is limited, these findings imply that you should engage in rigorous training to strengthen and grow your insula—as well as some of its empathic and self-regulating buddies like the posterior cingulate cortex, dorsolateral prefrontal cortex, rostral anterior cingulate cortex region, and dorsomedial prefrontal cortex (Sezer et al., 2022). This “training regimen” might contribute to you becoming more empathic and therefore, more therapeutic. In addition to practicing mindfulness or lovingkindness meditation, such a regimen could include:

  1. Committing to the intention of becoming a person who listens to others in ways that are accepting, empathic, and respectful.
  2. Developing an empathic listening practice. This would involve regular interpersonal experiences where you devote time to using active listening skills described in this chapter. As you practice, it’s important to have listening with compassion as your primary goal.
  3. Engaging in the active listening, multicultural, and empathy development activities sprinkled throughout this text, offered in your classes, and obtained from additional outside readings.
  4. When watching videos/television/movies, reading literature, and obtaining information via technology, lingering on and experiencing emotions that these normal daily activities trigger.
  5. Reflecting on these experiences and then… repeating… repeating… and repeating them over time and across situations

Rogers wrote in personal ways about his core conditions for counseling and psychotherapy. Contemplating his perspective is part of our prescription for developing an empathic orientation toward the variety of individuals with whom you will work.

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

As always, send me your thoughts on this content, as well as any ideas for improvement. Thanks and happy Friday!

Clinical Interviewing, Personal Reflections, Research, Writing

The Delight of Scientific Discovery

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Art historians point to images like John Henry Fuseli’s 1754 painting “The Nightmare” as early depictions of sleep paralysis.

Consensus among my family and friends is that I’m weird. I’m good with that. Being weird may explain why, on the Saturday morning of Thanksgiving weekend, I was delighted to be searching PsycINFO for citations to fit into the revised Mental Status Examination chapter of our Clinical Interviewing textbook.

One thing: I found a fantastic article on Foreign Accent Syndrome (FAS). If you’ve never heard of FAS, you’re certainly not alone. Here’s the excerpt from our chapter:   

Many other distinctive deviations from normal speech are possible, including a rare condition referred to as “foreign accent syndrome.” Individuals with this syndrome speak with a nonnative accent. Both neurological and psychogenic factors have been implicated in the development of foreign accent syndrome (Romö et al., 2021).

Romö’s article, cited above, described research indicating that some forms of FAS have clear neurological or brain-based etiologies, while others appear psychological in origin. Turns out they may be able to discriminate between the two based on “Schwa insertion and /r/ production.” How cool is that? To answer my own question: Very cool!.

Not to be outdone, a research team from Oxford (Isham et al., 2021) reported on qualitative interviews with 15 patients who had grandiose delusions. They wrote: “All patients described the grandiose belief as highly meaningful: it provided a sense of purpose, belonging, or self-identity, or it made sense of unusual or difficult events.” Ever since I worked about 1.5 years in a psychiatric hospital back in 1980-81, I’ve had affection for people with psychotic disorders, and felt their grandiose delusions held meaning. Wow.  

One last delight, and then I’ll get back to my obsessive PsycINFO search-aholism.

Having experienced sleep paralysis when I was a frosh/soph attending Mount Hood Community College in 1975-1976, I’ve always been super-delighted to discover old and new information about multi-sensory (and bizarre) experiences linked to sleep paralysis episodes. Today I found two articles stunningly relevant to my 1970s SP experiences. One looked at over 300 people and their sleep paralysis/out-of-body experiences. They found that having out-of-body experiences during sleep paralysis reduced the usual distress linked to sleep paralysis. The other study surveyed 185 people with sleep paralysis and found that most of them, as I did in the 1970s, experienced hallucinations of people in the room and many believed the “others” in the room to be supernatural. I find these results oddly confirming of my long-passed sleep insomnia experiences.

All this delight at scientific discovery leads me to conclude that (a) knowledge exists, (b) we should seek out that knowledge, and (c) gaining knowledge can help us better understand our own experiences, as well as the experiences of others.

And another conclusion: We should all offer a BIG THANKS to all the scientists out there grinding out research and contributing to society . . . one study at a time.

For more: Here’ a link to a cool NPR story on sleep paralysis: https://www.npr.org/2019/11/21/781724874/seeing-monsters-it-could-be-the-nightmare-of-sleep-paralysis

References

Isham, L., Griffith, L., Boylan, A., Hicks, A., Wilson, N., Byrne, R., . . . Freeman, D. (2021). Understanding, treating, and renaming grandiose delusions: A qualitative study. Psychology and Psychotherapy: Theory, Research and Practice, 94(1), 119-140. doi:https://doi.org/10.1111/papt.12260

Herrero, N. L., Gallo, F. T., Gasca‐Rolín, M., Gleiser, P. M., & Forcato, C. (2022). Spontaneous and induced out‐of‐body experiences during sleep paralysis: Emotions, “aura” recognition, and clinical implications. Journal of Sleep Research, 9. doi:https://doi.org/10.1111/jsr.13703

Romö, N., Miller, N., & Cardoso, A. (2021). Segmental diagnostics of neurogenic and functional foreign accent syndrome. Journal of Neurolinguistics, 58, 15. doi:https://doi.org/10.1016/j.jneuroling.2020.100983

Sharpless, B. A., & Kliková, M. (2019). Clinical features of isolated sleep paralysis. Sleep Medicine, 58, 102-106. doi:https://doi.org/10.1016/j.sleep.2019.03.007

Happiness, Personal Reflections, Politics, Writing

To Tweet or Not to Tweet: The Question of Quitting Twitter

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Photo, courtesy of @rksf2/twitter

Last week, I tweeted that I was quitting Twitter, “For obvious reasons.” In response, several of my Twitter friends (you know who you are AND I appreciate YOU) noted that staying on Twitter and having a positive voice might be a better option than retreating to a location under Zuckerman’s umbrella. Hmm. Point taken. And so instead of completely quitting Twitter, this past week I put myself in Twitter time-out.

Over the past couple years, I’ve come to mostly like Twitter. There’s lots of aversive stuff, but following selected news outlets, researchers, a few Twitter-friends, and various renowned individuals helps with cutting edge news and perspective; it also contributes to me feeling “in the loop.”

Problems with Twitter, however, are legion. There’s an odd plethora of so-called mindfulness practitioners engaging in self-promotion. That’s ironic, but my understanding (and experience) is that Twitter is very much about self-promotion. That’s probably why the former guy (TFG) used it so prolifically. But only so many voices can fit into a Twitter feed, which leads to INTERMITTENT YELLING IN HOPE THAT SOMEONE WILL HEAR YOUR TWITTER-VOICE. Even TFG did lots of ALL CAPS. There may be no better means for getting your perspective “out there.” Whether the perspective is worthy of public viewing, that’s harder to discern.

Part of my current conundrum stems from the fact that I have a small sense of a small “Twitter community.” I enjoy liking and being liked by them. I can find cutting edge suicide-related research straight from several academics. But, along with the benefits, two days prior to the Musk takeover, my Twitter feed became suspiciously littered with so-called republican politicians. I saw despicable Unamerican, divisive posts from Marsha Blackburn, Marco Rubio, Kevin McCarthy, Lauren Boebert, Jim Jordan, and others whose names I’m conveniently suppressing. It was a line-up of political partisan trash the likes of which couldn’t have been better designed to push my buttons.

Of course, as someone close to me accurately observed (I’m paraphrasing now), perhaps rather than living in my own partisan echo-chamber, I should be more open to hearing messages from the “other side.” Not surprisingly, my buttons were pushed, yet again.

Maybe it’s already obvious to everyone else, but MY biggest problem with Twitter (and mainstream media and other social media and political debates and any opinion other than my own) is more about me than anything else. My inability to self-regulate and manage my own emotional buttons make the best case for exiting Twitter. If I can’t read antivaxxer Twitter posts without feeling the need to slap them upside the head with a rolled-up copy of the latest edition of the New England Journal of Medicine or bash them in the face with David Quammen’s “Breathless,” then maybe it’s time to stop tweeting. On the other hand, if I can recognize that all Twitter disagreements end the same way—with elevated animosity and mutual disgust—and instead, focus on being the most positive voice I can be, then maybe Musk won’t dysregulate me into quitting something I enjoy.

This past week without Twitter has been fine. I found plenty of alternative ways to agitate myself (haha). But I didn’t feel any Tweet-generated-angst. I also was out of the news loop. My wife had to tell me Lula won the Brazilian election. Woot-woot! If I’d been Twittering, I’d have known right away. I also missed following my daughter’s non-profit, social justice Upper Seven Law firm. Her tweets are awesome and she—along with other people in the habit of consciousness-raising and justice give me hope.

Here’s my new plan. I’m returning to Twitter this week, with adjusted expectations, and will closely monitor myself. Can I be a positive voice? Can I accept the reality that some people (and Bots and Trolls) are purposely spreading misinformation (without feeling agitated and unhappy)? Can I accept that I’m mostly powerlessness and irrelevant in the fight against racist, sexist, ableist, and classist forces seeking to inhibit growth in the lower and middle class, while sowing fear and hate? Can I add my voice (and Tweets) to the social media soup and stay mostly positive, while managing my expectations and NOT FEELING THE URGE TO YELL?

We shall see.