Introductions and Full Disclosure (at least in part)

When people ask me what I do for work, I often tell them I have the best job in the world; then I describe it to them: “Every spring our faculty intensely screens a group of about 50 applicants to our graduate programs in counseling down to about 20 students who are admitted. And then I have the summer off. And then the new group of students show up in the fall and they’re all smart and kind and compassionate and because they’re graduate students, they’re motivated and focused and they want to attend class and become the best darn counselors they can become. And then, when I have them in class I’m with this group of incredibly socially skilled and sensitive, nice people and they make eye contact, nod their heads, act like they’re listening to me, and laugh at my jokes and stories.” Pretty much after I describe this scenario whoever asked me the question has either walked away or has crumpled into a heap on the floor racked with pain and jealousy.

This past Friday I got to teach my first full-day class with our new students. And just like Mary Poppins, they were practically perfect in every way.

Students in our graduate programs school and mental health counseling have a plethora of opportunities to engage in role-plays. As you may guess, these opportunities may or may not be met with great enthusiasm. More often than not we suggest to our students that they think of a minor problem in their lives, exercise censorship, and actually play themselves in these role-play encounters. This is totally fun . . . at least for the faculty.

Because we ask so much from our students—we expect them to “bring it” every hour of every class—at the beginning we offer our first year graduate students an activity where they can come to the front of the room as ask faculty members any question they’d like. This is totally fun . . . at least for the students.

On Friday, I had the added joy of listening as our two newest faculty members, Dr. Kirsten Murray and Dr. Lindsey Nichols, got quizzed by the new students. It was fabulous. I was filled with pride and happiness over having colleagues who are amazing and cool. Then it was my turn.

Somehow, the very first question turned into an awkward explanation of my professional status. I’m pretty old and I’ve answered a gazillion student questions about myself over the years, but I still felt the inner warmth, the sudden presence of sweat on my skin, and that funny feeling of hearing my own voice from a distance (totally fun!).

The problem is that I’m trained as a clinical psychologist and I teach in a counselor education program. To some people, this is like blasphemy. It’s like I was born in the country of clinical psychology and immigrated to the country of counselor education. At some tiny level, I sense how it might feel to be in the marginalized category of acculturation. Sometimes, under stress, I start speaking the language of clinical psychology (one time at an editorial board meeting of the Journal of Counseling and Development I accidentally said “A-P-A” instead of “A-C-A” and thought for sure I might be stoned; but everyone acted like they didn’t notice; of course, they also acted like they didn’t notice me after the meeting—or maybe I was just imagining that and isolating myself?).

I love my country of origin—the country of clinical psychology. I could talk about Rorschach cards and what it means for me to have a spike 5 and subclinical 6-9 profile on my MMPI for days. Studying psychopathology was like the coolest thing ever.

But I also love the country I’ve immigrated to. I have pleasant flashbacks of my first ACA conference back in 1992 when I volunteered to participate in a group counseling demonstration with Jerry and Marianne Corey. They were fabulous and I was hooked. I still like going to APA conferences, but for me, ACA conferences are a little less anal and a little more fun. I mean like one time I got my photo taken with William Glasser and last year I got it taken with Robert Wubbolding. They’re starting to think of me like a Reality Therapy groupie. What’s not cool about that?

The problem is that some members of ACA and APA don’t really like each other all that well. And neither of them really like the NASW or that evil “other” APA. The turf issues around professional discipline strike me as silly and overdone. I’m pretty sure that at this point I’m completely unemployable as an academic anywhere but the University of Montana. Psychology departments wouldn’t touch me because of my counseling cooties and Counseling departments now have to abide by a rule where they can’t hire anyone who doesn’t have a doctorate in counselor education. This would be pretty funny stuff if it weren’t so ridiculous. Psychologists want prescription privileges, Counselors want to do psychological evaluations, Social Workers want to do everything and anything, and yet, in many ways, we’re all more alike than we are different. I’ve got no solutions here . . . just observations.

And so in the beginning I experienced only a mild dissociative episode as I squeezed out my full disclosure—admitting before God and the class and my fellow professors that I am, in fact, BOTH a clinical psychologist AND a counselor educator. And in the end, it felt good. We had more discussions and questions later and no one (at least while I was looking) made the sign of the cross and shrunk away. I was just part of an amazing group of people who want to help other people live happier and more fulfilling lives. It could have been a group of students studying psychology or social work or counseling or maybe even all three at once . . . . It was really very nice.

John Dancing at a Wedding Reception

 

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Teaching Counseling and Psychotherapy Theories: Reflections on Week 1

Teaching Counseling and Psychotherapy Theories – Week 1

This past Monday evening in Missoula, Montana I met with my 80+ counseling and psychotherapy theories students for our first 3-hour class of the semester. Some student might have thought they’d get out early on the first day of the semester . . . but such was not the case. We had a nice evening together (my opinion). Although it was smoky outside (too many forest fires nearby) in the classroom the air was clear and the thinking sharp. Every year it feels humbling when I meet a new group of students in the fall and recognize their dedication and intelligence, not to mention the compassion for and interest in helping others that’s an intrinsic requirement of taking a class that’s all about counseling and psychotherapy theories and practice.

This group was especially generous – laughing heartily at my stories and gently confronting me when I misspoke and suggested I might spontaneously lie to protect my client’s confidentiality. One of my favorite moments was when, as we were talking about strategies for protecting client confidentiality in a public situation where someone might ask, “How do you know ______?” Several students shared excellent strategies (far better than my ‘spontaneous lying’ idea). One in particular said, “I just don’t respond to the question and make some comment like ‘Oh yeah, you know she’s really good at soccer’ and then hardly anyone follows that up by asking me how I know that person a second time.” Somewhat surprisingly, I was able to use that particular line several times later in class whenever students asked me questions I couldn’t answer. You should try it. Here’s how it works: Somebody asks you something you can’t or don’t want to answer, just say, “Hey, you know she’s really good at soccer.” It’s pretty much guaranteed you won’t have to answer the question.

As a method of providing a little extra intellectual stimulation, below I’m including two activities that go along with the content of Counseling and Psychotherapy Theories in Context and Practice. Have fun and good luck in your personal quest for better understanding of yourself and others . . . a particular quest that never really ends.

Activity 1: Creating and Testing Personal Hypotheses

One of our graduate students told us his “personal theory” of why some people become good cooks and other people develop poor cooking skills. He said:

I’m a bad cook because my mom was a good cook. I never had any reason to learn to cook because my mom did it all for us. But my girlfriend is a really good cook. I think that’s because her mom was a bad cook and so she had more reason to learn to cook for herself.

Although you can probably see a number of flaws with the reasoning underlying this “theory,” most of us carry these sorts of ideas around with us all the time. Let’s briefly analyze and test our student’s theory and then move on to identifying some of yours.

First, we should ask: Is this student’s statement really a theory? The answer is “No.” The reason this isn’t a theory is because it’s too narrow and not very elaborate. Theories don’t just predict behavior, they also provide detailed explanations for why particular behaviors occur.

As described in the text, a theory involves a gathering together and organizing of knowledge about a particular object or phenomenon. Also, theories are used to generate hypotheses about human thinking, emotions, and behavior.  Although our student has developed an interesting hypothesis about one factor that contributed to why he and his girlfriend have poor and good cooking skills, he really doesn’t have an overarching theory for generating the hypothesis . . . but he could develop one. Perhaps his bigger theory is about how individuals compensate for their caregivers strengths and weaknesses. He would need to work on describing, explaining, and predicting how this process works, but his idea has potential.

Theorists work both deductively (from the theory to the hypothesis) and inductively (from the specific hypothesis or observation to the bigger theory). Our student appears to be operating inductively. He observed himself and he observed his girlfriend and he developed an interesting hypothesis.

It’s possible and reasonable for people to systematically test their personal theories or hypotheses. Most likely, if we asked our student to test his hypothesis, he would do so in a biased way. He would likely notice when his hypothesis is true and ignore or completely overlook evidence opposing his hypothesis. Social psychology has shown that humans just seem to operate that way . . . we look for evidence to support our ideas and ignore evidence that contradicts our ideas (see Snyder & Swann, 1978).

With all this in mind, take a few minutes to write down some of your personal hypotheses about human behavior. Pick anything that you tend to think is true about humans (e.g., women have greater pain tolerance than men; individuals from larger families have better social skills; pet owners have trouble relating to people) and describe it below.

Hypothesis 1:

 

Hypothesis 2:

 

Hypothesis 3:

 

After you’ve established a few hypotheses, think about whether they might fit together into an overarching theory—or are they just a few random and unconnected ideas about human behavior? Then, either way, think about how you might test the validity of your hypotheses. Also, think about how you could or would avoid being systematically biased toward validating your own hypotheses?

Activity #2: A Psychological Assessment Critique

Years ago, Rita had a cartoon on her office door that had two guys in their scientific lab coats in conversation. One of the guys was asking the other one something like: “Would you like me to come up with evidence to destroy this scientific argument or evidence to support it?”

The big point of the cartoon is that even science is subjective. Because science is subjective, it’s important to be able to criticize research in general and or own research in particular. For this activity, we’d like you to list five shortcomings or problems with measuring counseling and psychotherapy outcomes. For example, let’s pretend you’ve just conducted 10 sessions of therapy with a client. You’re interested in measuring your effectiveness and so you had your client complete a self-report questionnaire on depression at the beginning and again at the end of the therapy. Using a seven-point Likert scale, the client rated him/herself on 20 depression symptoms. If you used this scale or questionnaire, what might be the shortcomings or problems associated with this measurement system?

1.

 

2.

 

3.

 

4.

 

5.

 

At the end of this blog I’ve listed what I think are five of the most common problems with self-report outcomes measures. When you’re finished listing your five ideas, check out and compare your five ideas with my five ideas.

What are the Most Common Measurement Problems when Using Self-Report Measures in Therapy Outcomes Studies?

John’s Answers

  1. How do we know participants are giving us honest feedback about their feelings, beliefs, and response to the intervention? (Sometimes people lie, other times they deceive themselves, other times they automatically or intentionally respond in a socially desirable manner).
  2. How do we know participants are motivated to answer surveys, questionnaires, or interview questions with due diligence? (This variability in participant motivation can translate into a hasty response set or compulsive over-reflection on each item). It also results in a less than 100% response rate when surveys are administered.
  3. How do we know if participants are capable of defining or understanding what’s helpful for them? (Respondents may not have clear ways to distinguish whether what they received was helpful or they may not understand the question or they may misinterpret the question; even if they can make internal, individual distinctions of what’s helpful, how can we know how that compares with another person’s internal and individual standard for helpfulness)?
  4. How can we ever know if one person’s rating of a “5” on a 1-7 Likert (pronounced lick-ert) is ever really equivalent to someone else’s rating of a “5”? (For example, one of us has an issue with ever giving anyone or anything a perfect “7” or worthless “1” when completing seven-point Likert-type questionnaires and so his (or her) responses may not be comparable to people who don’t have such issues).
  5. Given that mood is highly variable and yet powerfully influential, how can we be sure that we’re not measuring, at least in part, something related to the respondent’s current mood, instead of current attitude or anything close to a behavioral inclination?

 

Making a Plan to Stop Yelling at the Kids

This is a case example from “How to Listen so Parents will Talk and Talk so Parents will Listen.” It focuses on working with a couple on yelling at the kids.

Case: “I Think She Likes Yelling”

In this case, the consultant is working with a couple to address parenting issues and the mother discloses that she finds herself yelling too often at her two young (ages 6 and 8 years) children.

Mother (Nan): I try very hard not to yell, but I can’t seem to stop myself.

Father (Ed): She does yell a lot. I think sometimes she likes to yell.

Nan: [Gives Ed a blistering glare]

Consultant: Hang on a second. Ed, I know you’re saying what it looks like to you, but I don’t think that captures what it feels like to Nan on the inside. Most parents tell me that yelling happens when they feel desperation. My guess is that Nan doesn’t enjoy yelling, but that sometimes she wants so badly to get the kids to listen that she yells out of desperation and tries to get them to cooperate. It probably doesn’t feel enjoyable. [This is a risky, but necessary, confrontation and reframe.]

Nan: That’s exactly right.

Ed: Okay. You’re probably right. It just looks that way to me sometimes.

Consultant: And as you’ve both said, Nan is with the kids more often, and the parent who’s with the kids more is often the biggest target for defiance. With all that in mind, I’ve got some ideas about how Nan might start feeling a little more control over her yelling and get a little more cooperation from the kids.

Nan: That would be great.

Ed: I agree.

Consultant: Another thing that’s important to remember is that it’s humanly impossible to never feel angry toward our children. Anger is normal and natural. Usually we feel anger when we care deeply about something. Nan, you’ll feel angry again and probably soon, so a big part of this involves making a plan for how to deal with it when it comes up, because it will.

In this case, it was obvious that Nan felt out of control and Ed was feeling a bit smug or superior. The glare that Nan directed toward him when he volunteered his theory about her yelling was blistering. However, rather than drifting into marital conflict, the consultant moved through the conflict using empathy, reframing, and universalization, and by giving both parents new words to describe why Nan was yelling. To do this, she pointed out that yelling is a natural behavior that emanates from desperation and anger, and not from personal enjoyment.

The second key part of this intervention involves helping parents make a new plan.

Consultant: It’s important to remember that you’ll be angry again. You can’t stuff your angry feelings and say and do nothing, so you need a new plan for exactly what you’ll do next time your children misbehave. You can’t just decide to stop yelling. Most of us tried that and it doesn’t work very well. You need to come up with something else to do instead. Does that make sense?

Parents: Yes.

Consultant: Nan, this new and improved plan is all about you and only a little about your children. It should be a plan you feel good about and have a chance of enacting successfully. Your child’s misbehavior may or may not continue. You just need to do something different. What possibilities come to mind for you?

The consultant is using a solution-focused “Do something different” task and, while doing so, can engage one or both parents in a problem-solving process. In particular, the consultant is thinking in the back of her mind about ways Ed might be supportive by being available when Nan calls for his help (like tag-team wrestling). Additionally, this is a time when the consultant might share a brief personal story about how she effectively dealt with yelling (as long as the story is compassionate and joining, not condescending, and offers hope for positive change; see online resources at http://www.familiesfirstmontana.org/ for John’s favorite yelling story).

The third part of this intervention involves making a plan to practice the new plan.

Consultant: Okay. Now you both came up with ideas about what Nan might do to deal with her anger instead of yelling. Having good ideas is important, but ideas won’t magically cause less yelling. It’s really hard to stop yelling. Sometimes that’s because your kids are so used to it that they’ll automatically keep misbehaving until you yell—because that’s the established pattern. Because of that, unless you think it through mentally by imagining exactly what you will do and practice the behavior physically (with a friend or with Ed), you may quickly return to yelling because that’s what you all know best. Which of these new alternatives to yelling could you two practice together?

In this case it will be critical for Ed to support Nan as she experiments with alternatives to yelling. Like many spouses, he will need to be coached on what to say and do. Most importantly, he’ll need to agree to refrain from criticism and to notice and comment on her progress (as long as that’s okay with Nan) because his current attitude is likely contributing to Nan’s anger and yelling. Getting a commitment from Ed should be conducted in a direct and positive manner.

Consultant: Ed, can I be completely straight with you?

Ed: Uh, yeah. Sure.

Consultant: For couples, it’s always easier if both people make changes. I know Nan’s yelling is completely her responsibility. But, at the same time, you have the power to make this situation better or worse. If you just stand back and let Nan sink or swim, in a way, you’ll be contributing to the yelling. If you support her, if you take your share of time with the kids when she needs you, if you tell her you love her and how great she’s doing, you’ll be contributing to the solution. It’s really up to you. Can you step up here?

As with all interventions, the exact wording needs to be your own. Our tone may seem too direct and confrontational.  However, if you do brief work with parents, you’ll need to find the right words for talking with parents in a way that engages them in the change process. In fact, we’ve found that parents, especially fathers, appreciate a brief, respectful, and direct approach that acknowledges their power within the family system and challenges them to contribute to a healthier and happier family.

In the end, Ed agreed to take complete responsibility for the kids three times a week so Nan could go to the gym and work out. They also agreed to sharing the bedtime ritual more equally, because being on her own to put the children to bed was annoying Nan. For her part, Nan agreed to develop a monitoring system for her anger and to take a break on her own (if Ed wasn’t home) or to ask Ed to step in and take over the parenting responsibilities. Ed agreed to step in when Nan made the request.

Reflections on White Privilege

As many readers already know, “White Privilege” is defined as an “invisible package of unearned assets” (see Peggy McIntosh’s work, 1988 or 2001 for more on this). White privilege is also a concept that often activates strong feelings–one of them being anger. Recently, Gyda Swaney, an American Indian psychology professor at the University of Montana asked me to write a piece on White Privilege for the Montana Psychological Association Newsletter. The newsletter isn’t out yet, but here is a short highlight from the essay.

Personal Reflections

Although White privilege precedes me and I hold no responsibility for its origins, I was born into it and have lived with it every day for nearly 55 years. Even my birth, characterized by greater-than-equal access to healthcare, is an example of my white privilege.

Maybe that’s a phrase that captures much of the white privilege experience—greater-than-equal. My whiteness and the whiteness of most Montana psychologists affords us greater-than-equal treatment, greater-than-equal power, greater-than-equal access, and greater-than-equal perceptions of ourselves. But privilege is complicated . . . and so it’s possible that we also have a greater-than-equal means of denying our privilege.

Privilege grows in complexity when we look at all the different factors that contribute to a more privileged status in one person and a less privileged status in others. My wife consistently reminds me of my male privileged status and although I’m inclined to deny this along with my white privilege, I know better. I was born male and being born male is like being dealt an ace as your first card in a round of Texas Hold-Em. In most cultures it’s clear that to be male is to be superior. That’s the case even though, as most males know, being handed an expectation of superiority isn’t always comfortable or easy. Paradoxically or dialectically, being a white male cuts both ways and isn’t only an unearned asset or gift, it’s also an unearned burden. It’s a burden like having to carry too many gold coins and diamonds to the bank. The weight of gold hurts your back and the diamonds cut your hands, but it’s ridiculous to complain about the fact that you have to carry a treasure to the bank.

More Than Praise — Other Ways Parents Can Be Positive With Their Children

Exploring the Differences between Praise, Mirroring,

Character Feedback, and Solution-Focused Questions

This is a homework assignment from “How to Talk so Parents will Listen and Listen so Parents will Talk.” More info on the book is at: http://www.wiley.com/WileyCDA/WileyTitle/productCd-1118012968.html

If you’ve been given this homework assignment, you’re probably already using many good parenting techniques with your child. This assignment will help you refine your parenting approach to intentionally include even more ways of being positive with your child.

Imagine that a father is busy taking care of household chores while he’s parenting his 5-year-old daughter. She’s creating some excellent 5-year-old crayon art and approaches her daddy with a finished product and a beaming smile. Dad looks up and takes a break from his chores to admire his daughter’s artwork. He returns her grin and says one of the following:

  • “This is beautiful!” (An example of praise—a form of direct power)
  • “Thanks for showing me your drawing. You look very happy with your picture.” (An example of emotional mirroring or encouragement—a form of indirect power)
  • “You love doing artwork!” (An example of character feedback—another form of indirect power)
  • “How did you manage to create this beautiful drawing?” (An example of a solution-focused question—a form of problem-solving power)

If you can increase your awareness of these different strategies, you’ll feel more capable of being intentional and positive when interacting with your children. The result usually includes fewer power struggles and more positive parent–child relationship dynamics.

Using Praise

Using praise is simple. For example, praise includes statements like: “Great work,”  “I’m proud of you,” and “Look at what a good job you’ve done cleaning the bathroom!” When you use praise, you are clearly communicating your expectations and your approval to your child.

Think about how much praise you use with your children. Are you being clear enough with them about what you want and are you letting them know when they’ve done well? As a part of this homework assignment, consider increasing how much you praise your child and then see how your child reacts.

Using Mirroring

Sometimes children don’t have a clear sense of how their behaviors look to others (which can also be true for adults). The purpose of mirroring is to help children see themselves through your eyes. After seeing (or hearing) their reflection, your child becomes more aware of his or her behavior and may choose to make changes.

For now, we recommend that you practice using mirroring only to reflect your child’s positive behaviors. For example, if your daughter has a play date and shares her toys with her friend, you could say, “I noticed you were sharing your toys.” Or if your son got home on time instead of breaking his curfew, you might say, “I noticed you were on time last night.” The hard part about using mirroring is to stay neutral, but staying neutral is important because mirroring allows your children to be the judge of their own behaviors. If you want to be the judge, you can use praise.

Using Character Feedback

Character feedback works well for helping your children see themselves as having positive character traits. For example, you might say, “You’re very honest with us,” or “You can really focus on and get your homework done quickly when you want to,” or “You’re very smart.”

Usually, as parents, instead of using character feedback to focus on our children’s positive qualities, we use it in a very negative way. Examples include: “Can’t you keep your hands to yourself?” “You’re always such a big baby,” and “You never do your homework.”

For your homework assignment, try using character feedback to comment on your children’s positive behaviors, while ignoring the negative. You can even use character feedback to encourage a new behavior—all you have to do is wait for a tiny sign of the new behavior to occur and then make a positive character feedback statement: “You’re really starting to pay attention to keeping your room clean.”

Using Solution-Focused Questions

Problem-focused questions include: “What’s wrong with you?” and “What were you thinking when you hit that other boy at school?” In contrast, solution-focused questions encourage children to focus on what they’re doing well. For example, “How did you manage to get that puzzle together?” “What were you thinking when you decided to share your toy with your friend?” and “What did you do to get yourself home on time?”

Solution-focused questions require us to look for the positive. For practice, try asking your child questions designed to get him or her to think about successes instead of failures. After all, it’s the successes that you want to see repeated. Of course, when you ask these questions, don’t expect your child to answer them well. Instead, your child will most likely say, “Huh? I don’t know.” The point is that you’re focusing on the positive and eventually these questions get your children to focus on the positive as well.

Four Roads to Helping Your Children Develop Positive Self-Esteem

Four Roads to Healthier Self-Esteem

This case and the discussion that follows is excerpted from “How to Listen so Parents will Talk.”

Father: I’m a single dad and so I have the job of two parents. It’s hard, but it’s especially hard because I’m a worrier. My girls don’t have a mom around and so I get obsessed about their self-esteem. What can I do to boost their self-esteem?

Consultant: That’s a great question . . . and a big question. But before we talk about the answer, tell me, what sorts of things are you doing now to build their self-esteem?

Father: I compliment them as much as I can. I praise them. I constantly say “I love you.”

Consultant: Can you give me an example of how you compliment them?

Father: Like last night. The girls were coloring and they kept showing me their pictures and I would say, “That’s beautiful!” and “That’s wonderful!” and “You two are great artists.” Stuff like that.

Consultant: I should say first that I think it’s wonderful that you’re so positive with your daughters. I wish more parents were positive like you.

Father: Thanks, but, uh, what else can I do?

Consultant: You’re great at using praise and compliments and that’s really important, but I’ve got other ideas about how to expand your self-esteem-building repertoire.  Can I share a few?

Father: Go for it.

Consultant:  Let’s take the coloring and picture-drawing example. You’re giving out praise and compliments, which is very important. But praise and compliments are what we call “external” or “outside-in” strategies. They build your daughters’ self-esteem from the outside in. You’re the outside expert and you tell them they’re great. There are three other things you could add to that. I’ll describe these three options now, but I have a tip sheet that describes them, too.

First, instead of praising and complimenting, sometimes you could use a technique called “mirroring.” Mirroring is more of an “inside-out” technique for building self-esteem. To use mirroring, you should watch your children and mirror their positive feelings back to them. For example, you could say, “You look really happy about your drawing,” or you could ask a question: “What do you like best about your drawing?” By using these mirroring responses, you’re encouraging your children to judge their own drawings. That’s why we call it an inside-out approach, because it draws out your children’s internal feelings and judgments.

Father: Okay. I think I get that, but what if one of my daughters doesn’t like her drawing—or, even worse, what if she says ‘I hate my drawing’?

Consultant: Good questions. You’re so good at praise, your daughters may be depending on you for their compliments. If one daughter can’t think of anything positive, that’s okay. No need to get worried. We all sometimes produce things we don’t like. But you might try several things. You could just reflect back her feelings and see what happens by saying, “I guess you don’t like this drawing so much.” Or you could push her to identify to positives and negatives with a comment like, “Well, I see something about it I like, but I don’t want to go first. So, first you tell me what you like and then I’ll say what I like.” Or, you could help her focus on her next drawing with empathy and encouragement by saying, “Hmmm. You don’t seem too happy with this drawing. Maybe you’ll like your next one better.” The thing that’s important to remember is that false praise or too much praise doesn’t help your children build self-esteem from the inside out. Pretty soon, they’ll recognize that you always say something positive and they might start wondering if you really mean it.

Father: Okay. I get it.

Consultant: That’s mirroring. The key is to draw out or reflect your child’s judgments. It’s even okay to mirror back if she doesn’t like her drawing. This is part of respecting her judgment. If she doesn’t like the drawing, that’s okay, just reflect that back. You can even move a little bit away from mirroring and if you really like her drawing you can disagree with her and say something like, “I see you don’t like your drawing, but here’s what I like about it.”

Father: All right.

Consultant: The next method after praise and mirroring is character feedback. Character feedback is when you say something like, “You’re the kind of girl who loves to draw.” What you’re doing with this method is you’re making a positive behavior into a character trait. Try that out. Think of a character trait that one of your daughters has and put it into the sentence, “You’re the kind of girl who . . .”

Father: My older daughter likes to keep all her school stuff organized. So would I say, “You’re a girl who’s organized”?

Consultant: Sure. Almost anyway you say it is fine. What you’re doing is helping her build positive character traits so she begins seeing herself as an organized person.

Father: How about my other daughter? She’s very disorganized. Do I tell her, “You’re a disorganized girl”? That doesn’t seem like a good idea.

Consultant: Exactly. When we use character feedback, we almost always use it for positive character traits. With your less organized daughter, you might wait for a time when she displays even a tiny bit of organizational skill and then say, “I notice you can really get organized when you want to.” For character feedback, just think of yourself as a mirror that reflects positive behaviors and forms them into character traits. What’s interesting about this is that most parents, including me, tend to watch for our children’s weaknesses and negative qualities and comment on them. For example, lots of parents and teachers see children misbehaving and can’t resist making comments like, “What’s wrong with you? Can’t you keep your hands to yourself?” or “You’re lying again, aren’t you? You need to get over that lying problem.” Basically, when we repeatedly comment on our children’s negative behaviors we help them construct a more negative character. They end up thinking, “I’m the kind of kid who just keeps getting into trouble.” The magic of character feedback is that we can use it to intentionally construct positive character traits. I know it’s manipulative, but it’s being manipulative in a positive way.

Father: That’s interesting. I do have trouble not commenting when my daughters misbehave. Should I  ignore misbehavior?

Consultant: Not always. We should just focus most of our attention on our children’s positive behaviors and only a little of our attention on the negative behaviors. Sometimes our children need corrective feedback or input. But if we focus too much on the negative, the negative will tend to grow, because it’s getting so much attention.

Father: Okay. I think I get that. You said you have a handout on this, right?

Consultant: Right. And there’s one last method. The last method is called solution-focused questioning. Here’s an example with your less organized daughter. Let’s say she shows a flash of organizational skill. Then, you could ask something like, “Wow. How did you manage to get your school work all organized?” Be careful to be curious and impressed, but not too surprised. You know how some parents will say things like, “Who are you and what have you done with my child?” as a joke. Well, that’s a funny joke, but it plays on the fact that the child is acting in an unusual way. What we want to communicate is that it’s normal for your daughter to be organized when she wants to and so you’re showing curiosity about how she manages to get organized. Solution-focused questions with children almost always ask them to reflect on how they accomplished something positive. For example, you could say: “How did you manage to be honest and tell the truth in that hard situation?” or “How did you figure out how to get that puzzle together?”

Father: Okay. This one is about focusing on solutions.

Consultant: Right. Let’s try one. What’s something one of your daughters did well this past week?

Father: My organized daughter had a terrible tantrum and then apologized to me.

Consultant: That’s great. What would be a solution-focused question?

Father: Um, how about this? “What were you thinking when you decided to apologize?”

Consultant: Yeah. That’s pretty good. But that might feel like you’re investigating or analyzing her thoughts. I might change it a little and throw in a positive character trait, like, “How did you find the courage to come and apologize to me?” That sends her a message that it takes courage to apologize and as long as you agree with that, it might be a nice way to combine a solution-focused question and a little character feedback.

Father: I like that.

Consultant: I should also say that often when we ask solution-focused questions of children they just shrug their shoulders and say, “I don’t know,” which is perfectly fine. The point is that hopefully we’re building into them a tendency to reflect on how they managed to do something that was positive or successful.

Father: Right. I can imagine my daughter saying “I don’t know.”

Consultant: Now, I know we’ve covered a whole lot of ground in the last few minutes, but parenting can be complicated sometimes.

Father: You’re telling me? I’ve got two daughters and pretty soon they’ll be attracting boys and that will be even worse.

Consultant: Yeah. I guess I don’t need to tell you that parenting is complicated, but what I want to say is that I’ve got this tip sheet for you on praise, mirroring, character feedback, and solution-focused questions and you can take it and just try out the ideas we talked about today that are in this tip sheet. Just practice away and see what happens and we can talk about it more next week.

In this case we see the consultant squeezing lots of nuanced parenting information into a brief time period. This is a very educational approach and most likely to work after the practitioner has established a positive working relationship with parents who are in the action stage of Prochaska and DiClemente’s (2005) transtheoretical model. Even in the action stage, most parents can’t absorb all this information at once, which is why tip sheets and homework assignments can be so important.

Although the methods illustrated (praise, mirroring, character feedback, and solution-focused questions) are fairly complex, most parents intuitively understand the differences. These methods are only partly designed to improve parent–child relationships; they’re also good behavior management and self-efficacy-building techniques and so they can be used with parents who are being either too negative or too positive with their children.

You can find the “How to Listen . . .” book at: http://www.amazon.com/How-Listen-Parents-Will-Talk/dp/1118012968/ref=sr_1_1?ie=UTF8&qid=1345003465&sr=8-1&keywords=how+to+listen+so+parents+will+talk

 

Two Sample Mental Status Examination Reports

The following two fictional reports are samples for those individuals learning to conduct Mental Status Examinations and write MSE reports. They’re from the forthcoming 5th edition of Clinical Interviewing.

If you’d like to see a short video-clip MSE example, you can go to: http://www.youtube.com/watch?v=1lu50uciF5Y

Mental Status Examination Reports

A good report is brief, clear, concise, and addresses the areas below:

1.  Appearance

2.  Behavior/psychomotor activity

3.  Attitude toward examiner (interviewer)

4.  Affect and mood

5.  Speech and thought

6.  Perceptual disturbances

7.  Orientation and consciousness

8.  Memory and intelligence

9.  Reliability, judgment, and insight

The following reports are provided as samples.

Mental Status Report 1

Gary Sparrow, a 48-year-old white male, was disheveled and unkempt on presentation to the hospital emergency room. He was wearing dirty khaki pants, an unbuttoned golf shirt, and white shoes and appeared slightly younger than his stated age. During the interview, he was agitated and restless, frequently changing seats. He was impatient and sometimes rude in his interactions with this examiner. Mr. Sparrow reported that today was the best day of his life, because he had decided to join the professional golf circuit. His affect was labile, but appropriate to the content of his speech (i.e., he became tearful when reporting he had “bogeyed number 15”). His speech was loud, pressured, and overelaborative. He exhibited loosening of associations and flight of ideas; he intermittently and unpredictably shifted the topic of conversation from golf, to the mating habits of geese, to the likelihood of extraterrestrial life. Mr. Sparrow described grandiose delusions regarding his sexual and athletic performance. He reported auditory hallucinations (God had told him to quit his job and become a professional golfer) and was preoccupied with his athletic and sexual accomplishments. He was oriented to time and place, but claimed he was the illegitimate son of Jack Nicklaus. He denied suicidal and homicidal ideation. He refused to participate in intellectual- or memory-related portions of the examination. Mr. Sparrow was unreliable and exhibited poor judgment. Insight was absent.

Mental Status Report 2

Ms. Rosa Jackson, a 67-year-old African American female, was evaluated during routine rounds at the Cedar Springs Nursing Home. She was about 5’ tall, wore a floral print summer dress, held tight to a matching purse, and appeared approximately her stated age. Her grooming was adequate and she was cooperative with the examination. She reported her mood as “desperate” because she had recently misplaced her glasses. Her affect was characterized by intermittent anxiety, generally associated with having misplaced items or with difficulty answering the examiner’s questions. Her speech was slow, halting, and soft. She repeatedly became concerned with her personal items, clothing, and general appearance, wondering where her scarf “ran off to” and occasionally inquiring as to whether her appearance was acceptable (e.g., “Do I look okay? You know, I have lots of visitors coming by later.”). Ms. Jackson was oriented to person and place, but indicated the date as January 9, 1981 (today is July 8, 2009). She was unable to calculate serial sevens and after recalling zero of three items, became briefly anxious and concerned, stating “Oh my, I guess you pulled another one over me, didn’t you, sonny?” She quickly recovered her pleasant style, stating “And you’re such a gem for coming to visit me again.” Her proverb interpretations were concrete. Judgment, reliability, and insight were significantly impaired.

The latest edition (4th edition, updated) of Clinical Interviewing also includes a DVD with me (John) demonstrating a mental status examination. You can check our and/or purchase the whole DVD at: http://www.wiley.com/WileyCDA/Section/id-302475.html?query=John+Sommers-Flanagan

If you’re interested in having me come to your organization to provide a workshop or keynote on this or on a related topic, please email me at johnsf44@gmail.com.

Author, Speaker, University of Montana Professor