Cognitive-behavioral therapy is arguably the most evidence-based of all counseling and psychotherapy approaches. With roots in Adlerian therapy and substantial influences from Albert Ellis, Aaron Beck, and others, the cognitive component of CBT involves therapists working with clients to help develop awareness of automatic thoughts — thoughts that have an adverse or maladaptive affect on client emotions and behaviors. Once clients have awareness of their automatic and maladaptive thinking, cognitive therapists work collaboratively with clients to question the usefulness of the thoughts, possibly even actively disputing them, and eventually revising or replacing them with more adaptive or helpful thoughts.
This past spring and summer, Rita and I produced a DVD with demonstrations of 11 different theory-based counseling and psychotherapy approaches. Our publisher, John Wiley & Sons, recently posted a clip (or teaser) of this cognitive therapy video. In the clip I’m demonstrating the five column technique popularized by Albert Ellis. What I think is most interesting about this clip is the how the five column technique is used as a platform for exploring the client’s anxiety . . . while at the same time, a unique, spontaneous, and collaborative relationship between therapist and client is developing.
I’m just writing a note here with a link to a news story with video about a new grant we just got in the Department of Counselor Education. Although it means more work, it also means more work for the good of the campus and for the good of women and men who suffer from assault. Yeah. I guess I’m saying this is a difficult topic, but it’s a place where there’s room to do lots of good stuff.
In theories class this past Monday Adler kicked Freud’s ass. This was, of course, metaphorical because Adler was radically anti-violent. Nevertheless, my Freud action figure ended up on the floor by the door where he had to lay there and listen to Adler’s repugnant (to Freud) ideas about how clients are affected by real (not fantasized) social dynamics or forces.
Below you can read a version of the Emotional Change Technique adapted from Tough Kids, Cool Counseling:
The Three-Step, Push-Button Emotional Change Technique
An early and prominent Adlerian therapist, Harold Mosak, originally developed and tested the push-button technique as a method for demonstrating to clients that thinking different thoughts can effectively change mood states (Mosak, 1985). The purpose of Mosak’s technique was to help clients experience an increased sense of control over their emotions, thereby facilitating a sense of encouragement or empowerment (Mosak, 2000, personal communication).
Mosak’s push-button technique can be easily adapted to work with young clients. When we implement this technique with younger clients, we are playful and call it an emotional change trick. When using this technique with teenagers, we describe it as a strategy for gaining more personal control over less desirable emotions. In essence, the three-step, push-button, emotional change technique is an emotional education technique; the primary goal is to teach clients that, rather than being at the mercy of their feelings, they may learn some strategies and techniques that provide them with increased personal control over their feelings.
The following example illustrates Adlerian emotional education principles and Mosak’s push-button technique expanded to three distinct steps.
Case example. Sam, a 13-year-old European American boy, was referred because of his tendency to become suddenly stubborn, rigid, and disagreeable when interacting with authority figures. Sam arrived for his appointment accompanied by his mother. It quickly became obvious that Sam and his mother were in conflict. Sam was sullen, antagonistic, and difficult to talk with for several minutes at the outset of the session. Consequently, the Three-Step, Push-Button Emotional Change Technique (TSPB) was initiated:
Preparation/Explanation.
JSF: I see you’re in a bad mood today. I have this . . . well, it’s kind of a magic trick and I thought maybe you’d be interested. Want to hear about it?
S: (Shrugs).
JSF: It’s a trick that helps people get themselves out of a bad mood if they want to. First, I need to tell you what I know about bad moods. Bad moods are weird because even though they don’t really feel good, lots of times people don’t want to get out of their bad mood and into a better mood. Do you know what I mean? It’s like you kind of want to stay in a bad mood; you don’t want anybody forcing you to change out of a bad mood.
S: (Nods in agreement.)
JSF: And you know what, I’ve noticed when I’m in a bad mood, I really hate it when someone comes up to me and says: “Cheer up!” or “Smile!”
S: Yeah, I hate that too.
JSF: And so you can be sure I’m not going to say that to you. In fact, sometimes the best thing to do is just really be in that bad mood—be those bad feelings. Sometimes it feels great to get right into the middle of those feelings and be them.
S: Uh, I’m not sure what you’re talking about.
JSF: Well, to get in control of your own feelings, it’s important to admit they’re there, to get to know them better. So, the first step of this emotional change trick is to express your bad feelings. See, by getting them out and expressing them, you’re in control. If you don’t express your feelings, especially icky ones, you could get stuck in a bad mood even longer than you want.
As you can see, preparation for the TSPB technique involves emotional validation of how it feels to be in a bad mood, information about bad moods and how people can resist changing their moods or even get stuck in them, hopeful information about how people can learn to change their moods, and more emotional validation about how it feels when people prematurely try to cheer someone up.
Step 1: Feel the feeling. Before moving clients away from their negative feelings, it’s appropriate—out of respect for the presence and meaning of emotions—to help them feel their feelings. This can be challenging because most young people have only very simplistic ideas about how to express negative feelings. Consequently, Step 1 of the TSPB technique involves helping youth identify various emotional expression techniques and then helping them to try these out. We recommend brainstorming with young clients about specific methods for expressing feelings. The client and counselor should work together (perhaps with a chalk/grease board or large drawing pad), generating a list of expressive strategies that might include:
scribbling on a note pad with a black marker
drawing an angry, ugly picture
punching or kicking a large pillow
jumping up and down really hard
writing a nasty note to someone (but not delivering it)
grimacing and making various angry faces into a mirror
using words, perhaps even yelling if appropriate, to express specific feelings.
The expressive procedures listed above are easier for young clients to learn and understand when counselors actively model affective expression or assist clients in their affective expression. It’s especially important to model emotional expression when clients are inhibited or unsure about how to express themselves. Again, we recommend engaging in affective expression jointly with clients. We’ve had particular success making facial grimaces into a mirror. (Young clients often become entertained when engaging in this task with their counselor.) The optimal time for shifting to Step 2 in the TSPB technique is when clients have just begun to show a slight change in affect. (Often this occurs as a result of the counselor joining the client in expressing anger or sadness or general nastiness.)
Note: If a young client is unresponsive to Step 1 of the TSPB technique, don’t move to Step 2. Instead, an alternative mood-changing strategy should be considered (e.g., perhaps food and mood or the personal note). Be careful to simply reflect what you see. “Seems like you aren’t feeling like expressing those yucky feelings right now. Hey, that’s okay. I can show you this trick some other day. Want some gum?”
Step 2: Think a new thought (or engage in a new behavior). This step focuses on Mosak’s pushbutton approach (Mosak, 1985). It’s designed to demonstrate to the client that emotions are linked to thoughts. Step 2 is illustrated in the following dialogue (an extension of the previous case example with John and Sam):
JSF: Did you know you can change your mood just by thinking different thoughts? When you think certain things it’s like pushing a button in your brain and the things you think start making you feel certain ways. Let’s try it. Tell me the funniest thing that happened to you this week.
S: Yesterday in math, my friend Todd farted (client smiles and laughs).
JSF: (Smiles and laughs back) Really! I bet people really laughed. In fact, I can see it makes you laugh just thinking about it. Way back when I was in school I had a friend who did that all the time.
The content of what young people consider funny may not seem particularly funny to adults. Nonetheless, it’s crucial to be interested and entertained—welcoming the challenge to empathically see the situation from the 13-year-old perspective. It’s also important to stay with and build on the mood shift, asking for additional humorous thoughts, favorite jokes, or recent events. With clients who respond well, counselors can pursue further experimentation with various affective states (e.g., “Tell me about a sad [or scary, or surprising] experience”).
In some cases, young clients may be unable to generate a funny story or a funny memory. This may be an indicator of depression, as depressed clients often report greater difficulty recalling positive or happy events (Weerasekera, Linder, Greenberg, & Watson, 2001). Consequently, it may be necessary for the counselor to generate a funny statement.
S: I can’t think of anything funny.
JSF: Really? Well, keep trying . . . I’ll try too (therapist and client sit together in silence for about 20 seconds, trying to come up with a positive thought or memory).
JSF: Got anything yet?
S: Nope.
JSF: Okay, I think I’ve got one. Actually, this is a joke. What do you call it when 100 rabbits standing in a row all take one step backwards?
S: Huh?
JSF: (repeats the question)
S: I don’t know. I hate rabbits.
JSF: Yeah. Well, you call it a receding hare line. Get it?
S: Like rabbits are called hares?
JSF: Yup. It’s mostly funny to old guys like me. (JSF holds up his own “hare line”)
S: That’s totally stupid, man (smiling despite himself). I’m gonna get a buzz cut pretty soon.
When you tell a joke or a funny story, it can help clients reciprocate with their own stories. You can also use teasing riddles, puns, and word games if you’re comfortable with them.
We have two additional comments for counselors who might choose to use a teasing riddle which the client may get wrong. First, you should use teasing riddles only when a strong therapeutic relationship is established; otherwise, your client may interpret teasing negatively. Second, because preteen and teen clients often love to tease, you must be prepared to be teased back (i.e., young clients may generate a teasing riddle in response to a your teasing riddle).
Finally, counselors need to be sensitive to young clients who are unable to generate a positive thought or story, even after having heard an example or two. If a young client is unable to generate a funny thought, it’s important for you to remain positive and encouraging. For example:
JSF: You know what. There are some days when I can’t think of any funny stories either. I’m sure you’ll be able to tell me something funny next time. Today I was able to think of some funny stuff . . . next time we can both give it a try again if you want.
Occasionally, young clients won’t be able to generate alternative thoughts or they won’t understand how the pushbutton technique works. In such cases, the counselor can focus more explicitly on changing mood through changing behaviors. This involves getting out a sheet of paper and mutually generating a list of actions that the client can take—when he or she feels like it—to improve mood.
Sometimes depressed young clients will need to borrow from your positive thoughts, affect, and ideas because they aren’t able to generate their own positive thoughts and feelings. If so, the TSPB technique should be discontinued for that particular session. The process of TSPB requires completion of each step before continuing on to the next step.
Step 3: Spread the good mood. Step 3 of this procedure involves teaching about the contagion quality of mood states. Teaching clients about contagious moods accomplishes two goals. First, it provides them with further general education about their emotional life. Second, if they complete the assignment associated with this activity, they may be able to have a positive effect on another person’s mood:
JSF: I want to tell you another interesting thing about moods. They’re contagious. Do you know what contagious means? It means that you can catch them from being around other people who are in bad moods or good moods. Like when you got here. I noticed your mom was in a pretty bad mood too. It made me wonder, did you catch the bad mood from her or did she catch it from you? Anyway, now you seem to be in a much better mood. And so I was wondering, do you think you can make your mom “catch” your good mood?
S: Oh yeah. I know my mom pretty well. All I have to do is tell her I love her and she’ll get all mushy and stuff.
JSF: So, do you love her?
S: Yeah, I guess so. She really bugs me sometimes though, you know what I mean?
JSF: I think so. Sometimes it’s especially easy for people who love each other to bug each other. And parents can be especially good at bugging their kids. Not on purpose, but they bug you anyway.
S: You can say that again. She’s a total bugging expert.
JSF: But you did say you love her, right?
S: Yeah.
JSF: So if you told her “I love you, Mom,” it would be the truth, right?
S: Yeah.
JSF: And you think that would put her in a better mood too, right?
S: No duh, man. She’d love it.
JSF: So, now that you’re in a better mood, maybe you should just tell her you love her and spread the good mood. You could even tell her something like: “Dude, Mom, you really bug me sometimes, but I love you.”
S: Okay. I could do that.
It’s obvious that Sam knows at least one way to have a positive influence on his mother’s mood, but he’s reluctant to use the “I love you” approach. In this situation it would be useful for Sam to explore alternative methods for having a positive effect on his mother’s mood.
Although some observers of this therapy interaction may think the counselor is just teaching Sam emotional manipulation techniques, we believe that viewpoint makes a strong negative assumption about Sam and his family. Our position is that successful families (and successful marriages) include liberal doses of positive interaction (Gottman et al., 1995). Consequently, unless we believe Sam is an exceptionally manipulative boy (i.e., he has a conduct disorder diagnosis), we feel fine about reminding him of ways to share positive (and truthful) feelings with his mother.
To spread a good mood requires a certain amount of empathic perspective taking. Often, youth are more able to generate empathic responses and to initiate positive interactions with their parents (or siblings, teachers, etc.) after they’ve achieved an improved mood state and a concomitant increased sense of self-control. This is consistent with social–psychological literature suggesting that positive moods increase the likelihood of prosocial or altruistic behavior (Isen, 1987). Because of developmental issues associated with being young, it’s sometimes helpful to introduce the idea of changing other people’s moods as a challenge (Church, 1994). “I wonder if you have the idea down well enough to actually try and change your mom’s mood.”
Once in a while, when using this technique, we’ve had the pleasure of witnessing some very surprised parents. One 12-year-old girl asked to go out in the waiting room to tell her grandmother that she was going to rake the lawn when they got home (something Grandma very much wanted and needed). Grandma looked positively stunned for minute, but then a huge smile spread across her face. The girl skipped around the office saying, “See. I can do it. I can change her mood.”
One 14-year-old boy thought a few minutes, then brought his mom into the office and said “Now Mom, I want you to think of how you would feel if I agree to clear the table and wash the dishes without you reminding me for a week.” Mom looked a bit surprised, but admitted she felt good at the thought, whereupon I (John) gave the boy a thumbs up signal and said, “Well done.”
Step 4.
At this point, readers should beware that although we’re describing a Three-Step technique, we’ve now moved to Step 4. We do this intentionally with young clients to make the point that whenever we’re working with or talking about emotions, surprising things can happen.
In keeping with the learn-do-teach model, we ask our young clients to teach the TSPB procedure to another person after they learn it in therapy. One girl successfully taught her younger brother the method when he was in a negative mood during a family hike. By teaching the technique to her brother, she achieved an especially empowering experience; she began to view herself as having increased control over her and her family’s emotional states.
The past two days (9/19 & 9/20) the Missoulian has run articles about an organization named Stop Abusive and Violent Environments (SAVE) and their criticism of the University of Montana required Personal Empowerment Through Self-Awareness (PETSA) video series designed to reduce and prevent the incidence of sexual assault. In particular, SAVE has complained that the U of M PETSA video series is not evidence-based. Being a scientist, this was of concern and so I immediately checked the SAVE website and discovered that SAVE is an organization that is not even REMOTELY related to evidence-based programming for sexual assault prevention or anything else. Their entire raison d’etre is to protect men from being falsely accused of intimate partner violence and sexual assault. Their website includes internal inconsistencies and videos that (unlike the PETSA series) have not been vetted by anyone other than the organization itself or other “believers” that men are somehow unfairly targeted.
SAVE claims to only be interested in the truth and scientific evidence. And they say U.S. law have evolved to the point that ANYONE can be convicted of sexual assault or intimate partner violence? Now, being male myself, I’m all about fair treatment for men and so this places me in a precarious position. If I oppose SAVE, am I opposing my own best interests?
Well . . . I’m going out on a limb here to say the SAVE folks are just plain wacky. They say they are only after the truth and that they support evidence-based approaches, but there is ABSOLUTELY NO EVIDENCE that changing laws to make it harder to prove sexual assault would result in a safer and less abusive environment in the U.S.
Although I think it’s important to acknowledge that false allegations happen and it’s important to address these false allegations through legal means, instead of sticking to the facts, SAVE relies on rhetoric and sensationalist debunking of a few incorrect statistics to lead people to believe that false reporting is the rule and not the exception. This phenomenon—when someone accuses someone else of perpetrating something they’re doing themselves—is referred to as projection.
My first big concern is that the Missoulian, in reporting this as news, has given SAVE a semblance of validity that it doesn’t deserve.
My second big concern is that the hard working creators of the PETSA videos will be criticized based on hysterical accusations from an organization using political rhetoric framed as science. Based on viewing 2 SAVE videos online and comparing them to the PETSA production it’s obvious that PETSA is vastly more evidence-based than SAVE – Talk about blatantly false allegations
I’m a white male writing about white privilege. This irony makes the task all the more challenging.
Gyda Swaney asked if I would write this piece. This brings me mixed feelings. I am honored. I met Gyda in 1981 and I like and respect her as a person and as a Native American leader in Montana. But the fact that she thinks I might have something useful to say to psychologists about white privilege is humbling. Rarely have I been asked to write about something I know so well and understand so little.
On Invisibility
The challenge begins with the definition. White privilege is defined as an “invisible package of unearned assets” (see McIntosh, 1988 or 2001 for more on this).
As a white, male, psychologist, and university professor, I’m pretty much a white privilege poster boy. Consequently, white privilege, by definition, is generally invisible to me . . . although I do occasionally glimpse it from the corner of my eye or notice its shadow if I sneak up on it when it’s not looking. In fact I think I just saw it – as evidenced by my certainty that I can write a sentence as silly as this last one and get it published in the Montana Psych Association Newsletter.
Like most things invisible (think UFOs, Harry Potter with his invisibility cloak on, ghosts) white privilege is problematic and controversial. This is because white privilege is not always invisible; it’s selectively invisible. It’s obvious to many (e.g., oppressed minorities), but beyond the awareness of those who are busily experiencing the luxury of their unearned assets.
Common Responses to White Privilege
This brings up what may be the most fascinating and disturbing component of white privilege: When the idea of white privilege is brought to the attention of those to whom it’s invisible, it typically evokes a response of defensiveness combined with anger, hostility, outrage, and occasionally guilt. And as we know from our work in psychology, dealing with people who are feeling angry, hostile, outraged, and guilty is very difficult.
There’s something about white privilege that has the potential to make everyone angry.
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.
Solutions
There are no easy ways to make white privilege quickly materialize and become visible. The resistance and pain associated with being told: “You’ve got unearned assets” is natural, partly because most people hold the perception that they’ve worked very hard to get what they deserve. Here’s a short list of ideas:
Teaching and learning about Peggy McIntosh’s Invisible Knapsack is a good place to start. One of the items from her knapsack is:
“I can swear, or dress in secondhand clothes, or not answer letters, without having people attribute these choices to the bad morals, poverty, or illiteracy of my race.”
Damn. That’s a nice privilege.
Teaching and learning about white privilege can be dangerous and so courage is another important factor in dealing with white privilege. Boatright-Horowitz and Soeung (2009) titled their commentary in the American Psychologist, “Teaching White Privilege to White Students Can Mean Saying Good-bye to Positive Student Evaluations.” When I recently posted about white privilege on my blog, I received one response that was so rabidly irrational it was frightening. Speaking out against the status quo always risks blowback.
A big part of the solution is to stop clinging to ideas about white superiority and instead, openly embrace and value the lessons we learn from other cultures. We should actively seek out other cultural perspectives. That isn’t about making the other culture better than ours . . . it just places it on the same, equal cultural footing where it belongs.
It’s also important to work on calming our anxiety over displacement from the top of the economic and power pyramid. We all get displaced someday; denying reality is dysfunctional. Actively sharing power along with values of egalitarian personal and community relationships is functional. This is part of the very important personal and communal work we need to do.
In closing, I’m painfully aware that I write this short column from a position of unearned privilege in a cabin on former Crow country on the beautiful Stillwater River; thank you Gyda Swaney, for handing me this challenge and opportunity.
This essay was published in the Montana Psychologist Newsletter in September, 2012.
Michael Smerconish did a feature on White Privilege today on CNN. It was excellent and reminded me of this piece I’d written on White Privilege about 4 years ago. Check it out if you like this sort of thing.
A White, Male Psychologist Reflects on White Privilege
I’m a white male writing about white privilege. This irony makes the task all the more challenging.
Gyda Swaney asked if I would write this piece. This brings me mixed feelings. I am honored. I met Gyda in 1981 and I like and respect her as a person and as a Native American leader in Montana. But the fact that she thinks I might have something useful to say to psychologists about white privilege is humbling. Rarely have I been asked to write about something I know so well and understand so little.
On Invisibility
The challenge begins with the definition. White privilege is defined as an “invisible package of unearned assets” (see McIntosh, 1988 or 2001 for more on this).
As a white, male, psychologist, and university professor, I’m pretty much a white privilege poster boy. Consequently, white privilege, by definition, is generally invisible to me . . . although I do occasionally glimpse it from the corner of my eye or notice its shadow if I sneak up on it when it’s not looking. In fact I think I just saw it – as evidenced by my certainty that I can write a sentence as silly as this last one and get it published in the Montana Psych Association Newsletter.
Like most things invisible (think UFOs, Harry Potter with his invisibility cloak on, ghosts) white privilege is problematic and controversial. This is because white privilege is not always invisible; it’s selectively invisible. It’s obvious to many (e.g., oppressed minorities), but beyond the awareness of those who are busily experiencing the luxury of their unearned assets.
Common Responses to White Privilege
This brings up what may be the most fascinating and disturbing component of white privilege: When the idea of white privilege is brought to the attention of those to whom it’s invisible, it typically evokes a response of defensiveness combined with anger, hostility, outrage, and occasionally guilt. And as we know from our work in psychology, dealing with people who are feeling angry, hostile, outraged, and guilty is very difficult.
There’s something about white privilege that has the potential to make everyone angry.
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.
Solutions
There are no easy ways to make white privilege quickly materialize and become visible. The resistance and pain associated with being told: “You’ve got unearned assets” is natural, partly because most people hold the perception that they’ve worked very hard to get what they deserve. Here’s a short list of ideas:
Teaching and learning about Peggy McIntosh’s Invisible Knapsack is a good place to start. One of the items from her knapsack is:
“I can swear, or dress in secondhand clothes, or not answer letters, without having people attribute these choices to the bad morals, poverty, or illiteracy of my race.”
Damn. That’s a nice privilege.
Teaching and learning about white privilege can be dangerous and so courage is another important factor in dealing with white privilege. Boatright-Horowitz and Soeung (2009) titled their commentary in the American Psychologist, “Teaching White Privilege to White Students Can Mean Saying Good-bye to Positive Student Evaluations.” When I recently posted about white privilege on my blog, I received one response that was so rabidly irrational it was frightening. Speaking out against the status quo always risks blowback.
A big part of the solution is to stop clinging to ideas about white superiority and instead, openly embrace and value the lessons we learn from other cultures. We should actively seek out other cultural perspectives. That isn’t about making the other culture better than ours . . . it just places it on the same, equal cultural footing where it belongs.
It’s also important to work on calming our anxiety over displacement from the top of the economic and power pyramid. We all get displaced someday; denying reality is dysfunctional. Actively sharing power along with values of egalitarian personal and community relationships is functional. This is part of the very important personal and communal work we need to do.
In closing, I’m painfully aware that I write this short column from a position of unearned privilege in a cabin on former Crow country on the beautiful Stillwater River; thank you Gyda Swaney, for handing me this challenge and opportunity.
John Sommers-Flanagan (Ph.D., 1986, University of Montana) is a clinical psychologist and counselor educator at the University of Montana. His blogsite, featuring material on counseling, psychotherapy, and parenting is at: johnsommersflanagan.com.
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.
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
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).
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.
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)?
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).
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?
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.
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.
The place to click if you want to learn about psychotherapy, counseling, or whatever John SF is thinking about.
John Sommers-Flanagan 