Counseling and Psychotherapy Theory and Practice, Parenting

Building a Therapeutic Relationship with Parents: Part II – Using Radical Acceptance

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Building a Therapeutic Relationship with Parents: Part II – Using Radical Acceptance

Radical acceptance is a central therapeutic attitude held by practitioners who work effectively with parents. Radical acceptance is both an attitude and a clinical technique. This concept was originally articulated by Marsha Linehan (1993) and is a foundational component of dialectical behavior therapy. It involves a particular attitude that builds on Carl Rogers’s core therapeutic condition of unconditional positive regard as well as Eastern (Buddhist) philosophy.

Radical acceptance enables helping professionals to approach each client or parent with an overarching, pervasive dialectic belief, which we translate as, “I completely accept you just as you are and I am committed to helping you change for the better.” When working with parents, consultants strive to simultaneously hold both of these beliefs or attitudes. On the surface, these attitudes may seem contradictory, thus the term dialectic. At a deeper level, in a helping relationship, each attitude is necessary to complete the other.

As a technique, radical acceptance serves two main functions. First, it can help you refrain from expressing negative personal reactions to statements by parents that inadvertently push your buttons (we’ll focus more on button-pushing in Chapter 2). If you hear a statement that pushes an emotional button for you, having a radical acceptance attitude would help remind you that your job is to fully accept the person in the room with you—as is. In this situation, you don’t have to say anything as you simply quiet your roiling reactions. You can just be present and nonreactive.

Second, beyond momentary silence, radical acceptance allows parenting professionals to actively embrace whatever attitudes or beliefs parents bring into the consulting room. As we’ve stated previously (J. Sommers-Flanagan & Sommers-Flanagan, 2007):

The generic version or statement of radical acceptance is to graciously welcome even the most absurd or offensive . . . [parent] . . . statements with a response like, “I’m very glad you brought that [topic] up.” (p. 275)

Radical acceptance is especially warranted when parents say something you find disagreeable. This may include racist, sexist, or insensitive comments. For example:

Parent: I believe in limiting my children’s exposure to gay people. Parents need to keep children away from evil influences.

Consultant: Thanks for sharing your perspective with me. I’m glad you brought up your worries about this. Some parents have similar beliefs but won’t say them in here. So I especially appreciate you being honest with me about your beliefs. [Adapted from Sommers-Flanagan & Sommers-Flanagan, 2007, p. 276.]

Rest assured, radical acceptance does not mean agreeing with the content of whatever parents say. Instead, it means moving beyond feeling threatened, angry, or judgmental about parents’ comments and authentically welcoming whatever comes up during the session. The main purpose of welcoming disagreeable or challenging parent comments is to communicate your commitment to openness. If you don’t communicate and value openness by welcoming all remarks, parents or caregivers may never admit their core underlying beliefs. And if parents cover up their true beliefs—especially disagreeable or embarrassing beliefs—there will be no opportunity for insight or change because the underlying beliefs will never be exposed to the light of personal and professional inspection.

Similar to person-centered therapy, one key to using radical acceptance effectively is genuineness or congruence. This means you should never falsely welcome parents’ racist, sexist, insensitive, or outrageous comments. Instead, you should welcome such comments only if you really believe that hearing them is a good thing that can benefit the counseling or consultation process.

Radical acceptance also involves letting go of the immediate need to teach parents a new and better way. We must confess that we haven’t always maintained an attitude of radical acceptance ourselves. During one memorable session, upon hearing the classic line, “I got spanked and I turned out just fine!” John, being in an impatient and surly mood, barely managed to suppress an extremely destructive impulse (he wanted to say, “Are you really so sure you turned out fine?”). Nevertheless, a judgmental and dismissive comment still slipped out and he said: “I can’t tell you how many times I’ve heard parents say what you just said.” Not surprisingly, that particular session didn’t proceed with the spirit of empathy, acceptance, and collaboration we generally recommend.

This leads us to some obvious advice: Although you cannot be radically accepting all the time, you should always avoid radical judgment. There’s no need to test the “How about I treat parents in a judgmental, dismissive manner?” technique. Outcomes associated with judgmental and disrespectful counselor behavior are quite undesirable.

Stay Tuned for Part III on Building a Therapeutic Relationship with Parents tomorrow.

Counseling and Psychotherapy Theory and Practice, Parenting

Building a Therapeutic Relationship with Parents: Part I

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Every parent is unique. But as a group, most parents have similar interests and goals. What this means for consultants and counselors and psychotherapists is that parents constitutea unique population and therefore to work effectively with parents requires a specifically tailored treatment approach and training in how to provide educational and therapeutic services for parents.

The following is an adapted excerpt from the book, “How to Listen so Parents will Talk and Talk so Parents will listen. For more info, go to: http://www.amazon.com/How-Listen-Parents-Will-Talk/dp/1118012968/ref=la_B0030LK6NM_1_4?ie=UTF8&qid=1366501670&sr=1-4

To work effectively with parents, consultants or practitioners should use an approach that, similar to person-centered therapy, is characterized by three core attitudes: (1) empathic understanding; (2) radical acceptance; and (3) collaboration.

Empathy for Parents and Parenting

As is well-known, empathic understanding is one of the three core conditions for psychotherapy originally identified by Carl Rogers (1942; 1961; 1980). Over the years, research has left no doubt that therapist empathy facilitates positive therapy outcomes (Goldfried, 2007; Greenberg, Watson, Elliot, & Bohart, 2001; Mullis & Edwards, 2001). As applied to parents, empathy involves:

The therapist’s ability and willingness to understand the parent’s thoughts, feelings, and struggles from the parent’s point of view and an ability to see, more or less completely, through the parent’s eyes and adopt the parent’s frame of reference . . . . It means entering the private perceptual world of a parent. (adapted from Rogers, 1980, pp. 85, 142)

When working with parents, counselors, psychologists, and other human services professionals must learn to sensitively enter into the parent’s unique perceptual world. The practitioner needs to demonstrate empathy and sensitivity for specific parenting challenges. A person-centered perspective also implies that professionals who work with parents show empathy for the barrage of criticism, scrutiny, and associated insecurity that parents experience due to their exposure to social and media sources. Brazelton and Sparrow (2006) capture one way in which socially driven parental insecurity can manifest itself:

When Mrs. McCormick held Tim in her lap at the playground, she sat alone on a bench across from the other mothers as if she were ashamed of Tim’s clinging. She knew that if she sat by other mothers, they would all give her advice: “Just put him down and let him cry—he’ll get over it.” “MY little girl was just like that before she finally got used to other kids.” “Get him a play date. He can learn about other children that way.” (p. 8)

This example illustrates how parents anticipate criticism and work hard to avoid it. If you’ve been a parent or you work with parents, you know how easy it is for them to feel defensive about their children’s behaviors and their parenting choices. This is partly because, like Mrs. McCormick, they’re unable to measure up to narrowly defined parenting standards and cannot face the cascade of criticism or advice they’re likely to receive when their child doesn’t behave perfectly in social settings. To provide an optimally empathic environment, practitioners should have and show empathy or attunement with parents’ sensitivity to perceived or actual criticism and counter this sensitivity by amplifying their support and acceptance (we’ll cover therapeutic methods for amplifying support and acceptance in greater detail in Chapter 4).

Similar to the empathic attitude associated with person-centered therapy, it’s crucial for professionals who work with parents to hold the attitude that parenting is naturally difficult and that making mistakes or having a child who publicly misbehaves is nothing to feel shameful about. By maintaining this attitude, practitioners provide a nonjudgmental and empathic space for parents to explore their personal doubts and fears. This is the way the theory works: By being nonjudgmental, compassionate, and openly supportive, parenting professionals provide an environment free from societal conditions of worth, which then stimulates parents to become more open and collaborative when examining their weaknesses with a trusted professional.

Part II of this three part blog post continues tomorrow.

Counseling and Psychotherapy Theory and Practice, Parenting, Personal Reflections

The Return of Mother’s Little Helper . . .

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This week Allen E. Ivey (the creator of the microcounseling approach) sent me a link to an article claiming that exercise is better for long-term brain functioning than medications. He was “venting” because he thinks this is not “new” information and instead constitutes basic common sense that everyone should embrace. The fact that exercise is good for neurological development and functioning is obvious and it can be frustrating to see the media acting surprised over and over again that life experiences—including counseling and psychotherapy—improves health, life satisfaction, and brain functioning.

Dr. Ivey’s comments and the article he sent reminded me of an unpublished piece I wrote a few years ago. It was a sarcastic commentary on a recent (at the time) publication touting the efficacy of antidepressants in treating depressive symptoms in mothers.

Here’s the piece. Sarcasm included.

The Return of Mother’s Little Helper

            Mother’s little helper is back.

            In a recent landmark study published in the Journal of the American Medical Association, a prestigious group of researchers reported that children with depression improved or recovered when their depressed mothers became less depressed. The researchers were surprised and optimistic that an environmental change—mothers becoming less depressed—could directly help children whom they thought had biological depression. This is an important finding, especially given concerns about prescribing psychotropic medicines directly to children.

            Having closely followed pharmaceutical research in child psychiatry, I’m always skeptical about landmark studies and promising new drugs, but try to stay balanced and hopeful. When I mentioned the research results to my graduate students in counseling and social work, all of whom happened to be women, they felt no need for balance or hope. They responded in unison.

            “No duh. Obviously children will do better if their mothers aren’t depressed. Who needs a study to tell you that?”

            I felt instantly defensive for pharmaceutical researchers everywhere. Okay, maybe the study demonstrated the obvious, but helping children be less depressed is clearly a good thing.

            My students weren’t convinced. They asked, “What treatment did the mothers’ get?”

            “Mostly they got Celexa.” Celexa is very similar to Prozac. They’re both classified as ‘SSRIs,’ meaning they selectively focus on making serotonin more plentiful in crucial brain regions.

            My cynical students pressed on: “Did the makers of Celexa fund the study?”

            “No,” I responded. “Forest Laboratories makes Celexa, but the study was funded by the National Institute of Mental Health.” I felt redeemed; the study was objective.

            “How many of the authors were paid by Forest Laboratories?”

            I happened to have the article with me, so I looked at the back page where financial disclosures are conveniently listed—in very small print. I squinted my way through: “Only 3 authors name Forest Laboratories as giving them money. And Forest Laboratories is thanked in the fine print for supplying all the medication for free.”

            Actually, that wasn’t too bad. There were 15 coauthors on the study; only 20% were linked to Forest Laboratories.

            But my picky students wanted to know about the numbers, so I explained that 151 mothers started the study, but 37 (24.5%) dropped out before three months. Overall, 38 of the 114 remaining mothers recovered from their depressive condition and another 16 improved somewhat. The authors report an overall response rate of 47%.

            A student pecked at her calculator and declared. “No way! Fifty-four of 151 isn’t 47%, it’s 36%; they’re either lying, cheating, or very bad at arithmetic.”

            “How about the kids,” another asked.  “How many of them got better?”

            “Well, it’s complex and hard to say, but overall the researchers report that, of 105 kids, 9 were significantly affected during the study, 4 in a positive direction and 5 in a negative direction.”

            The students mumbled and grumbled. “Are you kidding? That’s not much improvement.” They went on to rant a bit about never knowing a depressed, sleep-deprived mother—including themselves—who looked forward to 18 hours of screeching children and smelly diapers? One student, now a grandmother, noted that Valium (the original mother’s little helper) was the most prescribed drug in the U.S. from 1969-1982 and such a big pharmaceutical success that it inspired a Rolling Stones song. Unfortunately, Valium turned out to be terribly addictive, but now apparently, there’s Celexa, Prozac, and other options for overwhelmed mothers.

            After a few more stories, my students asked, “What were the study’s conclusions?”

            I read aloud: “. . . these findings suggest that it is important to provide vigorous treatment to mothers if they are depressed.”

            Throughout the room, eyes began to roll.

            “That’s a big surprise. They want depressed moms to feel guilty if they don’t take antidepressants. That’s what they mean by ‘vigorous treatment.’ As if a hard life is made better by serotonin? How much did they spend on that study anyway?”

            “I really don’t know,” I answered.  “Maybe half a million?”

            The student with the calculator pecked away again: “They should use that money to do a study on something that might really help depressed mothers.”

            “Like what?” I asked.

            “Like maybe a study on the effectiveness of splitting half a million among 114 moms—that’s over $4,300 each. They could just give them the money, or pay for some counseling and parenting consultations, or health club memberships, or childcare, or massages, or vocational training. Better yet, the researchers could use the money to train fathers to hang around the house and be helpful, rather than lying around watching sports and reading Penthouse.”

            At that point I decided class was over. I’d learned about as much as I could handle for one day.

Counseling and Psychotherapy Theory and Practice, Divorce, Group therapy, Parenting, Uncategorized

The Love Reframe

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Years ago I had the privilege and challenge of teaching a class for divorced parents through Families First in Missoula. About half of the dozen or so participants were mandated to attend. This made for an initially less-than-pleasant opening mood. As I went around the room doing introductions, I came to a man who looked a bit snarly. He announced his name and then said, “But I don’t need no stupid-ass parenting class. The only reason I’m here is because the Judge told me that if I didn’t come, I’d be forced to have supervised visits with my 12 year-old daughter. I’m here, but I don’t need this stupid-ass class.”

 

This was a difficult moment and perhaps because I’m a man, complete with a pesky “Y” chromosome, I was tempted to get into an instant pissing match right there. I felt an urge to say something like, “Well, you may not think you need this class, but apparently the Judge does and so you’d better watch how you talk in here!” Instead, somewhat to my surprise, the following words came into my mind and then out of my mouth, “Well, let me especially thank you for coming because you must really love your daughter to be willing to attend this class.”

 

As the 6 hour marathon class progressed, the snarly man settled in. He was never really pleasant, but he contributed to discussions and politely got in line at the end of class to receive his signed certificate. When I handed him the certificate, I said something like, “Hey, you know you should frame this certificate and put it on your wall at home.”

 

A few weeks after the class I got a call from the guy who didn’t need a stupid-ass parenting class. He sounded different and immediately apologized for “being a jerk in class.” Then he told me in a cracking voice that he’d taken my advice and hung the class certificate on his wall. And then it was clear he was crying when he said, “My daughter came over for an unsupervised visit and when she saw that certificate on the wall, she turned around and gave me this big old hug and said, Daddy, I am so proud of you!”

 

This experience and others like it taught me an important lesson about parents in general and fathers in particular. I’ve learned that underneath the bluster of some irritable and difficult dads there are men who desperately love their children. If we tap this potential, good things can happen.

Parenting

Who Needs Parenting Education Anyway?

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Today and tomorrow I’m in Minneapolis at the annual work meeting for the National Parenting Education Network (NPEN). The room at the Search Institute (our host for the two days) is filled with very nice and very intelligent people—all of whom are deeply dedicated to making high quality parenting education a norm in the United States. Being with these fabulous people gave me a 15-year-old flashback.

I transported back in time and saw myself as the executive director of Families First Missoula, making a routine appearance on a local television news show. The vintage female newscaster was interviewing me about the upcoming Missoula “Parents’ Convention.” The Parents’ Convention was a full-day—including  a keynote speaker and 75 minute break-out sessions—all designed specifically for parents. It was pretty darn cool.

The newscaster nodded attentively. I explained how the event was created for parents because parents often didn’t get respect for all the knowledge required to fulfill their parenting commitments. This Parents’ Convention was about treating parents as professionals. As I finished talking, the newscaster turned to the camera, exclaiming, “Do go!”

I was pretty happy.

But moments later she scrunched up her face and muttered: “If you need that sort of thing.”

I wish I’d been ready for this negation of my message. But I wasn’t and so I just ignored her. Instead, I wish I’d explained that good, competent, and effective parenting is NOT NATURAL. I wish I’d emphasized that everyone needs parenting education and that everyone should want the sort of knowledge that just might make them a little better parent.

And this flashback takes me to another one.

This time I’m doing a short stint of in-home family therapy. There’s a mom with her 8-month pregnant teenage daughter and the room is filled with worries—worries about whether this teen mom is ready for what she’s facing. In a massive effort at denial, the soon-to-be grandmother turns to me with a strange and strained grin, stating, “Once she holds that new baby in her arms, she’ll know what to do . . . don’t you think?”

The answer then—and now—is the same. “No. She will not naturally and automatically know what to do. Parents need education. Parents need support. And parents need to know they need education and support. Rarely are parents really ready to face the enormity of their task. It’s hard to competently cope with sleep deprivation, mood swings, a wailing baby with poop somehow defying gravity and making its way up your child’s back, as well as the many other emotional, physical, and psychological demands of parenting.

And so this is why I invite you all to go to the National Parent Education Network’s website. For a mere $25 a year, you can join the movement to make high quality parenting education more accessible for to all parents. Somewhere inside, behind our strange and strained grins, we all know that parents need our help and that it’s the children who will benefit.

NPEN’s website: http://npen.org/

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice, Multicultural

Talking About White Privilege with Tommy Flanagan

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Tonight I’m in Absarokee, MT and had a chance to talk awhile with my very cool nephew, Tommy Flanagan. Tommy attends Pacific Lutheran University in Tacoma, WA. He shared with me this evening that he’s currently enrolled in several courses focusing on gender, feminist, and cultural issues. We talked about our respective invisible knapsacks and he even asked me how a White guy like me would approach counseling with a Black Lesbian woman. In response, I said, “Well, I just wrote something about that in the Clinical Interviewing text and I had a Black Lesbian woman review it so I would be sure to get some feedback.”

And so here’s the piece:

Working with Gay and Lesbian couples or couples and families from different cultural backgrounds can present clinicians with unique challenges (Bigner & Wetchler, 2004). As discussed in Chapter 11, when a clinician and client have clear and unmistakable differences, the client may initially scrutinize the clinician more closely than if the client and clinician are culturally similar or of the same sexual orientation. These circumstances call for sensitivity, tact, and a discussion of the obvious. Imagine the following scenario:

You’re a white, heterosexual, Christian male. You have a new appointment at 3pm with Sandy Davis and Latisha Johnson for couple counseling. When you get to the waiting room, you see two African American females sitting side by side. You introduce yourself and on the short walk back to your office you mentally process the situation and come to several conclusions: (a) You’re about to meet with an African American Lesbian couple; (b) you’ve never done therapy with this particular cultural minority group; (c) you’re aware of your uncertainty and your concerns about your lack of knowledge makes you feel uncomfortable . . . but also recognize that you want the couple to be comfortable with you . . . and realize they may be feeling similar discomfort about your cultural differences; (d) you are clear that it’s your ethical mandate to provide services to the best of your ability; and (d) although you don’t feel competent to work with this couple, this is a low-income clinic and so the couple may not have many alternatives. How do you proceed?

Below is a brief list of how a clinician might specifically handle this situation. After this list, we provide a description of the underlying principles:

  1. Welcome the couple to your office with the warmth and engagement you offer to all clients (e.g., “I’m glad you could come to the clinic today for your appointment and am happy to meet you. . .”).
  2. Explain confidentiality and the limits of confidentiality. Also, review relevant agency policies that you routinely review with new clients.
  3. If you know the purpose of their visit (e.g., couple counseling) because of the registration form, explain how you usually work with couples.
  4. Let the couple know you’d like them to ask any questions of you they may have . . . but before they ask the questions, explain: “My usual approach with couples is primarily based on work with heterosexual couples. I don’t have experience working with African American Lesbian couples. I’d like to work with you as long as you’re comfortable working with me and it seems like the work is helpful. I know there aren’t lots of couple’s counseling options available. What I propose—if it’s okay with the two of you—is that we start working together today. Today I’ll be asking you directly about your goals for counseling, but also about your interests, values, spirituality and other things that will help me know you better as individuals and as a couple. And toward the end of our session I’ll ask you for feedback about how you think our work together is going and I’ll try to honor that feedback and make adjustments so we can work well together. If, for whatever reason, it looks like we can’t work together effectively, I’ll offer you a good referral to another therapist. What do you think of that plan?”

As described in Chapter 11, the general multicultural competencies include: (a) Awareness (e.g., knowing your biases and limitations); (b) knowledge (e.g., gathering information pertaining to specific cultural groups); and (c) skills (e.g., applying culturally-specific interventions in a culturally sensitive manner). In addition to these competencies, the preceding case illustrates the need for clinicians to explicitly address cultural differences using the following strategies:

  • Cultural universality (treating culturally different clients with same respect you offer to culturally similar clients)
  • Collaboration (working with the clients to understand the particulars of their culture and situation)
  • Feedback (soliciting ongoing feedback regarding client perceptions of how the interview is proceeding and make adjustments based on that feedback).

No clinician can be expected to have awareness, knowledge, and skills for working with every possible diverse client. That being the case, if you also rely on cultural universality, collaboration, and feedback to help strengthen the therapeutic alliance, you’ll have a better chance for therapy to proceed in an ethically and professionally acceptable manner.

 

Therapy with Adolescents

Information on Suicide Interventions for Counselors

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The following information is excerpted from the soon-to-be-forthcoming 5th edition of Clinical Interviewing, published by John Wiley & Sons. This includes information that I didn’t get a chance to cover during my ACA pre-conference Learning Institute yesterday. For information on the Clinical Interviewing text, see:  http://www.amazon.com/Clinical-Interviewing-John-Sommers-Flanagan/dp/1118270045/ref=dp_ob_title_bk

Safety Planning

The primary thought disorder in suicide is that of a pathological narrowing of the mind’s focus, called constriction, which takes the form of seeing only two choices; either something painfully unsatisfactory or cessation of life. (Shneidman, 1984, pp. 320–321)

Helping clients develop a thoughtful and practical plan for coping with and reducing psychological pain is a central component in suicide interventions. This plan can include relaxation, mindfulness, traditional meditation practices, cognitive restructuring, social outreach, and other strategies that increase self-soothing, decrease social isolation, and decrease the sense of being a social burden (Joiner, 2005).

Instead of the traditional approach of implementing no-suicide contracts, contemporary approaches emphasize obtaining a commitment to treatment statement from the client (Rudd et al., 2006). These treatment statements or plans go by various names including, “Commitment to Intervention,” “Crisis Response Plan,” “Safety Plan,” and “Safety Planning Intervention” (Jobes et al., 2008; Stanley & Brown, 2012); they’re more comprehensive and positive in that they describe activities that clients will do to address their depressive and suicidal symptoms, rather than focusing narrowly on what the client will not do (i.e., commit suicide). These plans also include ways for clients to access emergency support after hours (such as the national suicide prevention lifeline 1(800) 273-TALK or a similar emergency crisis number; Doreen Marshall, personal communication, September 30, 2012).

As a specific safety planning example, Stanley and Brown (2005) developed a brief treatment for suicidal clients, called the Safety Planning Intervention (SPI). This intervention was developed from evidence-based cognitive therapy principles and can be used in hospital emergency rooms as well as inpatient and outpatient settings (Brown et al., 2005). The SPI includes six treatment components:

  1. Recognizing  warning  signs of an  impending suicidal crisis
  2. Employing  internal coping  strategies
  3. Utilizing social contacts as a means of distraction  from suicidal  thoughts
  4. Contacting  family   members   or friends who may help to resolve the crisis
  5. Contacting mental health  professionals or agencies
  6. Reducing the  potential use of lethal  means (Stanley & Brown, 2012, p. 257)

Stanley and Brown (2012) noted that the sixth treatment component, reducing lethal means, isn’t addressed until the other five safety plan components have been completed. Component six also may require assistance from family members or a friend, depending on the situation.

Identifying Alternatives to Suicide

Suicide is a possible alternative to life. Engaging in a debate about the acceptability of suicide or whether with clients with suicidal impulses “should” seek death by suicide can backfire. Sometimes suicidal individuals feel so disempowered that the threat or possibility to take their own life is perceived as one of their few sources of control. Consequently, our main job is to help identify methods for coping with suicidal impulses and to identify life alternatives that are more desirable than death by suicide—rather than taking away clients’ rights to consider death by suicide.

Suicidal clients often suffer from mental constriction and problem-solving deficits; they’re unable to identify options to suicide. As Shneidman (1980) suggested, clients need help to improve their mood, regain hope, take off their constricting mental blinders, and “widen” their view of life’s options.

Shneidman (1980) wrote of a situation where a pregnant suicidal teenager came to see him in a suicidal crisis. She said she had a gun in her purse. He conceded to her that suicide was an option, while pulling out paper and a pen to write down other life options. Together, they generated 8-10 alternatives to suicide. Even though Shneidman generated most of the options and she rejected them, he continued writing them down, noting they were only options. Eventually, he handed the list over to her and asked her to rank order her preferences. It was surprising to both of them that she selected death by suicide as her third preferred option. As a consequence, together they worked to implement options one and two and happily, she never needed to choose option three.

This is a practical approach that you can practice with your peers and implement with suicidal clients. Of course, there’s always the possibility that clients will decide suicide is the best choice (at which point you’ve obtained important assessment information). However, it is surprising how often suicidal clients, once they’ve experienced this intervention designed to address their mental constriction symptoms, discover other, more preferable options that involve embracing life.

Separating the Psychic Pain From the Self

Rosenberg (1999; 2000) described a helpful cognitive reframe intervention for use with suicidal clients. She wrote, “The therapist can help the client understand that what she or he really desires is to eradicate the feelings of intolerable pain rather than to eradicate the self” (p. 86). This technique can help suicidal clients because it provides much needed empathy for the clients’ psychic pain, while at the same time helping them see that their wish is for the pain to stop existing, not for the self to stop existing.

Similarly, Rosenberg (1999) recommended that therapists help clients reframe what’s usually meant by the phrase “feeling suicidal.” She noted that clients benefit from seeing their suicidal thoughts and impulses as a communication about their depth of feeling, rather than an “actual intent to take action” (p. 86). Once again, this approach to intervening with suicidal clients can decrease clients’ needs to act, partly because of the elegant cognitive reframe and partly because of the therapist’s empathic message.

And here’s a photo of the cover of the Tough Kids, Cool Counseling book. You can get this through ACA or on Amazon: http://www.amazon.com/Tough-Kids-Cool-Counseling-User-Friendly/dp/1556202741/ref=la_B0030LK6NM_1_3?ie=UTF8&qid=1363881381&sr=1-3

Tough Kids Image

Personal Reflections, Therapy with Adolescents

ACA Conference in Cincinnati: Day One

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Yesterday was Day One of my American Counseling Association conference experience and it has led me to notice that whenever I dish up my plate, it always seems there’s a little food that falls off the edges. My grandmother used to say my eyes were bigger than my stomach, but that’s silly because I’ve looked at my stomach; if my eyes really were bigger, I’d look like a brother from another planet. Obviously, this is a metaphor.

The point is that I always try to fit too much material into my presentations. Yesterday I presented a 6 hour “Learning Institute” titled, “Counseling Challenging Teenagers.” It was a very nice experience with about 20 participants who care enough about working with teenagers to show up in Cincinnati 2 days before the conference actually starts for a spendy workshop. I was impressed with the participants and the questions and the dedication to learning and serving teenagers. Very cool.

However, not surprisingly, because as Robert Frost would undoubtedly contend, my reach consistently exceeds my grasp, I didn’t quite fit every part of the workshop content into the workshop . . . which brings me to the purpose of this post . . . which is to describe my next two postings . . . which will be on alternative to suicide and neodissociation as a suicide intervention . . . which were the two parts of the workshop that exceeded my grasp.

Highlights of Day One: The man who drove 18 hours from Maryland to attend (and managed to mostly stay awake); the woman who helped with the workshop as a volunteer and then was super-giddy about getting me to take a photo of her with Bob Wubbolding (and then, I think to humor me, acted excited to include me in an additional photo with the two of them); finding a Starbucks, Panera Bread, and Chipotle within blocks of the Convention Center.

More soon.

 

Parenting, Therapy with Adolescents

Why Big Boys Should Cry

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As I sit stranded in the Minneapolis airport on my way to the ACA conference in Cincinnati, I remembered that although this blog was posted on the ACA blogsite, I haven’t posted it here yet . . . and so here it is. Feels like it’s about time for a nap.

Why Big Boys Should Cry

By John Sommers-Flanagan

Aaron was asleep on the couch in my office. I decided not to wake him, even though I don’t advocate napping during counseling. But Aaron had just spent several minutes intensely sobbing and unable to speak and so a short nap seemed reasonable.

Experiencing calmness after an emotional storm can be therapeutic. This is partly because holding back strong emotions requires physical effort. When strong sad or painful feelings are present, the body seems to want to naturally express those feelings, as if to unload an extra burden. Holding onto emotions may cause a lump to form in your throat or stinging in your eyes. Letting sad or painful feelings come out can be a great relief.

Research shows that identifying and expressing feelings of sadness, fear, or emotional pain promotes health. This is true whether people write, talk, or nonverbally express emotional pain. The body, unburdened by the need to inhibit or suppress feelings, responds with improved immune functioning.

Generally, boys and men have more trouble acknowledging and expressing painful emotions than girls and women. Some people believe this difference partially explains why males are more violent than females. Others have suggested that inhibiting sad feelings contributes to the fact that, on average, males die younger than females. Most researchers and theorists agree that inhibiting sad, hurt, or fearful feelings is a health liability for boys and men.

It could be argued that biological differences cause males to have more trouble expressing painful feelings (perhaps higher testosterone levels interfere with emotional expression). However, it’s also obvious that boys are systematically taught to inhibit certain feelings. For example, one study showed that mothers—yes, even mothers—were less emotionally responsive to baby boys than baby girls. There also are many gender-based emotionally hardening edicts present in our society, summed up in the old expression: “Big boys don’t cry.” The message to boys is loud and clear: To be accepted, you need to walk, talk, and act like a man (which does NOT include crying because you’ve gotten your feelings hurt).

For boys and men, it’s socially acceptable to experience and express anger, instead of sadness, fear, or hurt feelings. Male teens I work with often brag that they DON’T cry—they just get angry or seek revenge. They’re thoroughly socialized and proud of it. In an interesting contrast, I’ve talked with men who tell me—with regret and not pride—that they haven’t cried for 20 (or more) years. They worry about their inability to cry and speak of it as a loss. The spigot, having been closed so many years ago, feels rusted shut. They want to cry, but don’t know how.

It’s sad that society does this to boys. But it’s especially sad when parents, sometimes inadvertently, other times intentionally, discourage boys from experiencing and expressing emotional pain. It’s also sad when boys are encouraged to be aggressive—instead of sensitive (because, as you know, boys not only will be boys, they must be real boys). Instead, parents need to be a safe haven for the full range of their son’s emotions.

The following suggestions may be helpful to parents who want their boys to learn that big boys should cry.

  • Don’t be afraid that if your son cries, he will turn out to be a sissy.
  • Let your sons cling to you—to both mother and father—for comfort and security. They’ll grow up and distance themselves from you on their own. There’s no need to push them away.
  • When your son looks distressed and you ask him how he’s doing, he’ll often respond by saying: “Fine.” If so, continue to be gently curious. Keep listening. Let him know you’re interested. For boys, the first few “Fine” responses are often a defense against their emotions.
  • Spend time with your sons. Do active things together. Boys often talk best when they’re hiking, biking, hunting, fishing . . . or cleaning the kitchen.
  • Never let there be any doubt in your son’s mind that you love him.

Because of society’s harsh condemnation, when boys or men cry, it can be a harrowing experience. Years ago, I worked with Michael, a Vietnam veteran. He was macho and angry. He told me of a 60 Minutes episode about how Vietnam vets were never welcomed home by American citizens. He was pissed about how his country had treated him.

At the end of the hour, I stood up, reached out, shook his hand, looked him in the eye, and said, “Welcome home Michael.” In response, his anger melted away, his eyes filled with tears, and he fell forward and gave me a short hug. Later, he told me he was ashamed of this embarrassing emotional outburst.

Everyone in our society needs to be open to loving and hugging our boys. We need to let them cry openly and without shame. No one should feel ashamed to experience natural feelings of hurt or sadness. Boys should be helped to accept and experience their feelings. They shouldn’t have to go to counseling to learn to cry again.

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John Sommers-Flanagan, Ph.D. is a counselor educator at The University of Montana. You can follow his personal blog at johnsommersflanagan.com

Counseling and Psychotherapy Theory and Practice

Through the Anger Looking Glass

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This blog was originally posted on the psychotherapy.net website this past week. Psychotherapy.net is a great resource for counselors and psychotherapists . . . http://www.psychotherapy.net/blog/title/through-the-anger-looking-glass

Through the Anger Looking Glass

By John Sommers-Flanagan

A couple weeks ago on NPR’s “Weekend Edition,” the focus was on the 50th anniversary of Betty Freidan’s The Feminine Mystique. In this book Friedan raged against the status of women in the 1960s. Although millions of people have read this feminist manifesto, it seems very few presently understand how anger in general and Friedan’s anger in particular could be a source of insight, motivation, and personal and social transformation.

Anger is an emotional state that has a bad rap. There’s far more written about anger control (“anger management”) than about how anger, when nurtured and examined, can transform. As most mental health professionals already know, anger is an emotion, not a behavior. And emotions are acceptable and desirable. When anger fuels aggressive or destructive behavior is when it becomes problematic.

But since everyone already knows about and talks about the destructive capability of anger—let’s talk about the constructive side of this emotion instead. Hardly anyone articulates anger’s positive qualities as clearly as the feminists. Feminist therapists consider “encouraging anger expression” as a meaningful process goal in psychotherapy for at least five reasons:

  1. Girls and women are typically discouraged from expressing anger directly. Experiencing and expressing anger without repressive cultural consequences can be an exhilarating freedom for females. Similarly, experiencing anger, but not letting it become aggression, is a new and productive process for males.
  2. Anger illuminates. There’s nothing quite like the rush of anger as a signal that something is not quite right. Examined anger can stimulate insight.
  3. Alfred Adler suggested that the purpose of insight in psychotherapy was to enhance motivation. Anger is helpful for both identifying psychotherapy goals AND for mobilizing client motivation.
  4. During psychotherapy anger may occur in-session towards the psychotherapist. Skillful therapists accept this anger without defensiveness and then collaboratively explore the meaning of in-session anger.
  5. Anger is a natural emotional response to oppression and abuse. If clients consistently suppress anger, it inhibits them from experiencing their full range of humanity.

For feminists, one goal of nurturing and exploring client anger is to facilitate feminist consciousness. Feminist consciousness involves females (and males) developing greater awareness of equality and balance in relationships. However, using anger to stimulate insight and motivation is useful in all forms of therapy, not just feminist therapy.

But working with (and not against) anger in psychotherapy is complex. The problem is that anger pulls so strongly for a behavioral response. Reactive anger is destructive. Clients want to let it out. Experiencing and expressing anger feels so intoxicatingly right. Clients want to punch walls. They want to formulate piercing insults. They want to counterattack. Unexamined anger is reactive and vengeful.

Imagine a male client. He’s uncomfortable with how his romantic partner has been treating him. You help him explore these feelings and identify the source; he recognizes that his partner has been treating him disrespectfully. But good psychotherapy doesn’t settle for simple answers. His new insight without further exploration could stimulate retaliatory impulses. Good psychotherapy stays with the process and examines aggressive outcomes. It helps clients explore alternatives. Could he be overreacting? Perhaps the anger is triggering an old wound and it’s not just the partner’s behavior that’s triggering the anger?

Relationships are nearly always a complex mix of past, present, and future impulses and transactions. When anger is respected as a signal and clients take ownership of their anger, good things can happen. It can be used to help clients become more skilled at identifying and articulating underlying sadness, hurt, and disappointment. Clients can emerge from psychotherapy with not only new insights, but increased responsibility for their behavior and more refined skills for communicating feelings and thoughts without blaming anger, but in a way that serves as an invitation for greater intimacy and deeper partnership.

None of this would be possible without the clarifying stimulation of anger and a collaborative psychotherapist who’s able to help clients face, embrace, and understand the many layers of meaning underneath your anger. And it’s about time we learned a lesson from the feminists and started giving anger the respect it deserves.

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