Clinical Interviewing

What I’m Writing Today: CI5 Chapter 5

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With a February 1 deadline looming, I’m in all out writing and editing mode. Today’s topic: Congruence. Below is an excerpt from the draft of the upcoming 5th edition of Clinical Interviewing. I gotta say, Congruence and Carl Rogers—good stuff—way better than any NFL playoff games:). I know, Empathy would be a little better, but you can’t always get what you want.

Here’s a glimpse of the opening of chapter 5: Evidence-Based Relationships in the Clinical Interview

In 1957, Carl Rogers made a bold declaration that has profoundly shaped research and practice in counseling and psychotherapy. He hypothesized in a Journal of Consulting Psychology article that no techniques or methods were needed, that diagnostic knowledge was “for the most part, a colossal waste of time” (1957, p. 102), and that all that was necessary and sufficient for therapeutic change to occur was a certain type of relationship between therapist and client.

Although we could go back further in time and note that Freud (of course) had originally discussed the potential value of therapeutic relationships, Rogers’s revolutionary statements refocused the profession. Until Rogers, therapy was primarily about theoretically-based methods, techniques, and interventions. After Rogers {{365 Rogers 1961; 690 Rogers 1957; 363 Rogers 1942;}}, we began thinking and talking about the possibility that it might be the relationship between client and therapist—not necessarily the methods and techniques employed—that produced therapeutic change.

For years, a great debate has fulminated within the counseling and psychotherapy disciplines {{499 Wampold 2001;}}. Norcross and Lambert (2011) refer to this debate as “The culture wars in psychotherapy” (p. 3). They describe it as a polarization or dichotomy captured by the question: “Do treatments cure disorders or do relationships heal people?” (p. 3). As academics and professional organizations have engaged in this debate, typically there has been little room for moderation and common sense. There have been assertions about the “rape” of psychotherapy as well as strong criticisms of practitioners who blithely ignore important empirical research {{4453 Baker,Timothy B. 2008; 5969 Fox, Ronald E. 1995;}}. The heat of this controversy continues, in part, because we live in a world with limited health care dollars . . . and the fight to determine which forms of therapy are included as “valid” and therefore reimbursable will likely continue.

But the focus of this chapter is about a part of the controversy that’s really no longer a controversy at all. In the past two decades excellent research and research reviews have settled at least one dimension of the argument. Evidence now overwhelming shows that therapy relationships do contribute to positive outcomes across all forms of therapy and setting {{2241 Goldfried 2007; 285 Sommers-Flanagan 2007; 4074 Norcross 2011;}}. The question is no longer a matter of whether the relationship in counseling and psychotherapy matters, but how much it matters.

This chapter focuses on what has come to be known as “evidence-based therapy relationships” {{5958 Norcross 2011;}}. Although organized around specific theories and supporting research, the chapter also provides clinical examples for how the theories and evidence translate into specific evidence-based relationship facilitating behaviors that occur in the clinical interview.

Carl Rogers’s Core Conditions

Carl Rogers (1942) believed that the necessary and sufficient therapeutic relationship consisted of three core conditions: (a) congruence, (b) unconditional positive regard, and (c) empathic understanding. In his words:

Thus, the relationship which I have found helpful is characterized by a sort of transparency on my part, in which my real feelings are evident; by an acceptance of this other person as a separate person with value in his own right; and by a deep empathic understanding which enables me to see his private world through his eyes. When these conditions are achieved, I become a companion to my client, accompanying him in the frightening search for himself, which he now feels free to undertake. (Rogers, 1961, p. 34)

Congruence

Congruence means that a person’s thoughts, feelings, and behaviors match. Based on person-centered theory and therapy, congruence is less a skill and more an experience. Congruent therapists are described as genuine, authentic, and comfortable with themselves. Congruence includes spontaneity and honesty; it’s usually associated with the clinical skill of immediacy and involves some degree of self-disclosure (see Chapter 4).

Congruence is complex and has been described as “abstract and elusive” {{5961 Kolden, Gregory G. 2011;}} (p. 187). The ability to be congruent includes an internal dimension that involves clients being in touch with their inner feelings or real self plus an external or expressive dimension that involves therapists’ being able to articulate their internal experiences in ways that clients can understand. The following excerpt from Rogers’s work illustrates these internal and external dimensions of experiencing and expressing congruence:

We tend to express the outer edges of our feelings. That leaves us protected and makes the other person unsafe. We say, “This and this (which you did) hurt me.” We do not say, “This and this weakness of mine made me be hurt when you did this and this.”

To find this inward edge of my feelings, I need only ask myself, “Why?” When I find myself bored, angry, tense, hurt, at a loss, or worried, I ask myself, “Why?” Then, instead of “You bore me,” or “this makes me mad,” I find the “why” in me which makes it so. That is always more personal and positive, and much safer to express. Instead of “You bore me,” I find, “I want to hear more personally from you,” or, “You tell me what happened, but I want to hear also what it all meant to you.” (pp. 390-391)

Rogers also emphasized that congruent expression is important even if it consists of attitudes, thoughts, or feelings that don’t, on the surface, appear conducive to a good relationship. He’s suggesting that it’s acceptable—and even good—to speak about things that are difficult to talk about. However, as you can see from the preceding example, Rogers expected therapists to look inward and transform their negative feelings into more positive external expressions of congruence.

Guidelines for Using Congruence

When discussing congruence, students often wonder how this concept is manifest. Common questions include:

  • Does congruence mean I say what I’m really thinking in the session?
  • If I feel sexually attracted to a client, should I be “congruent” and share my feelings?
  • If I feel like touching a client, should I go ahead and touch?
  • What if I don’t like something a client does? Am I being incongruent if I don’t express my dislike?

These are important questions. Watson, Greenberg, & Lietaer {{4387 Greenberg,Leslie S. 1998;}} provided one way for determining the appropriateness of therapist transparency or congruence. They wrote: “. . . it is not necessary to share every aspect of [your] experience but only those that [you] feel would be facilitative of [your] clients’ work” (p. 9). This is a good initial guideline: Would the disclosure be facilitative? In fact, sometimes, too much self-disclosure—even in the service of congruence or authenticity—can muddy the assessment or therapeutic focus. Perhaps the key point is to maintain balance; the old psychoanalytic model of therapist as a blank screen can foster distrust, reluctance, and resistance, while too much self-disclosure can distort and degrade the therapeutic focus {{2454 Farber 2006;}}.

Rogers also suggested limits on congruence. He directly stated that therapy wasn’t a time for clinicians to talk about their own feelings:

Certainly the aim is not for the therapist to express or talk about his own feelings, but primarily that he should not be deceiving the client as to himself. At times he may need to talk about some of his own feelings (either to the client, or to a colleague or superior) if they are standing in the way. (pp. 133–134) {{760 Rogers 1958;}}

Let’s say you’re working with a client and you feel the impulse to congruently self-disclose in the moment. If you’re not sure your comment will be facilitative or whether it will keep the focus on the client (where the therapy focus belongs), then you shouldn’t disclose. Additionally, you should discuss ongoing struggles with self-disclosure with your peers or supervisors because by so doing, you’ll deepen your learning about how best to be congruent with clients.

Since the 1960s, feminist therapists have strongly advocated congruence or authenticity in interviewer-client relations. Brody {{331 Brody 1984;}} described the range of responses that an authentic therapist might use:

To be involved, to use myself as a variable in the process, entails using, from time to time, mimicry, provocation, joking, annoyance, analogies, or brief lectures. It also means utilizing my own and others’ physical behavior, sensations, emotional states, and reactions to me and others, and sharing a variety of intuitive responses. This is being authentic. (p. 17)

Brody is advocating many sophisticated and advanced therapeutic strategies; but keep in mind that she’s an experienced clinician. Authentic or congruent approaches to interviewing are best if combined with good clinical judgment, which is obtained, in part, through clinical experience.

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Excerpt from The Initial Psychotherapy Session with Adolescent Clients

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Adolescent clients are known for their tendency to push their psychotherapist’s emotional buttons. For example:

Therapist:     I want to welcome you to therapy with me and I hope we can work together in ways you find helpful.

Client:          You talk just like a shrink. I punched my last therapist in the nose (client glares at therapist and awaits a response).

If psychotherapists are not aware of how they are likely to react to emotionally provocative situations (such as the preceding) and prepared to respond with empathy, validation, and concession, they may not be well-suited to working with adolescent clients (Sommers-Flanagan & Richardson, 2011).

Nearly all adolescents have quick reactions to therapists and unfortunately these reactions are often negative, though some may be unrealistically positive (Bernstein, 1996). Adolescents may bristle at the thought of an intimate encounter with someone whom they see as an authority figure. Having been judged and reprimanded by adults previously, adolescents may anticipate the same relationship dynamics in psychotherapy. Therapists must be ready for this negative reaction (i.e., transference) and actively develop strategies to engage clients, lower resistance, and manage their own countertransference reactions (Sommers-Flanagan & Sommers-Flanagan, 2007).

And later in the article . . .

Based on clinical experience, we recommend opening statements or questions that are like invitations to work together. Adolescent clients may or may not reject the invitation, but because adolescent clients typically did not select their psychotherapist, offering an invitation is a reasonable opening. We recommend an invitation that emphasizes disclosure, collaboration, and interest and that initiates a process of exploring client goals. For example,

I’d like to start by telling you how I like to work with teenagers. I’m interested in helping you be successful. That’s my goal, to help you be successful in here or out in the world. My goal is to help you accomplish your goals. But there’s a limit on that. My goals are your goals just as long as your goals are legal and healthy.

The messages imbedded in that sample opening include: (a) this is what I am about; (b) I want to work with you; (c) I am interested in you and your success; (d) there are limits regarding what I will help you with. It is very possible for adolescent clients to oppose this opening in one way or another, but no matter how they respond, a message that includes disclosure, collaboration, interest, and limits is a good beginning.

And finally, photo that includes me and my professional coauthor.

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Rita’s Children’s Book for Adults

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In case you didn’t know, my wife Rita is an exceptionally creative person. She’s the source of many, if not most, of my good ideas, which I often steal from her in ways that couples do . . . in that she’ll say something and then because I spend time in my own mind thinking about it, later I’ll forget she was the source of the idea and unintentionally claim it as my own. For example, she had this great idea for a children’s book for adults about baby corporations that end up in a daycare with the rest of the human babies. In this case, I remember it was her idea, but it’s so good that occasionally, I slip into thinking that maybe we thought of it at the same time. . . or maybe I inspired her to think of it. . . or maybe I’d like a little credit even though I don’t deserve any.

All this is a way for me to say that Rita did the impressive thing of taking her idea and turning it into reality. Just 2 days ago she published an electronic version of her children’s book for adults online through Amazon. It’s only $0.99 and so feel free to check it out and “Like” it on Amazon or write a review on it (like I did:) or share it . . . Here’s the link:

 

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New Publications

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This past month I’ve had a few published pieces that may be of interest. First, thanks to Jim Overholser of Case Western University, I had the honor of being the editor of a special issue for the Journal of Contemporary Psychotherapy. Here’s a link to the “Intro to the Special Issue” written with Nick Heck, who’s currently in South Carolina doing his pre-doc internship in clinical psych.

 http://www.academia.edu/2012598/The_Initial_Interview_with_Diverse_Populations_Introduction_to_the_Special_Issue

 In this intro piece we also describe the several other very cool articles that take a look at how we can best connect with diverse clients during initial clinical interviews.

I also wrote part one of a “miracle question” blog for the ACA blogsite. Check it out at:  http://my.counseling.org/2012/12/04/secrets-of-the-miracle-question-in-counseling-part-i/

Here’s my grandson Davis in his Chicken Suit, providing writing inspiration.

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Office Clutter and Decor

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I’m in Connecticut hanging out with Rita, Chelsea, Seth, and my twin grandkids . . . and doing a little writing editing for the forthcoming 5th edition of Clinical Interviewing. Just edited the following section where I reveal a bit about my dream-life. The unconscious is a funny thing. (see http://www.amazon.com/Clinical-Interviewing-2012-2013-John-Sommers-Flanagan/dp/1118390113/ref=sr_1_1?s=books&ie=UTF8&qid=1357513945&sr=1-1&keywords=clinical+interviewing)

Office Clutter and Decor

We all have stuff that we drag around with us in our lives. Some of this stuff is disorganized, messy and unsightly. Other stuff is more interesting and pleasing to the psyche or the eye.

One of us (John) sometimes dreams that he’s preparing for a therapy session and just before it begins, he notices that his office is a complete mess. There are piles of dirty clothes, books, CDs, and papers strewn around the room. At the last minute, he dashes around the room stuffing papers and clothes under his desk in anticipation of his client’s arrival. Unfortunately, the cleaning never gets quite finished, and when the client comes into the room there’s an obvious and embarrassing mess to explain.

Those of you inclined toward dream interpretation may quickly assume that John has excessive psychological baggage that leaks out during therapy sessions and personal needs to be addressed and de-cluttered. Although this interpretation may well be true, John also has the more concrete problem of keeping his office neat and tidy (although he strongly denies keeping dirty clothes strewn about his office). The main point is, of course, to be intentional, disciplined, and tasteful in your office décor and clutter management.

To whatever degree you wish, your office can represent your personality and your values. You can consciously arrange your office more or less formally, more or less chic, and more or less self-revealing. It’s important to strive for an office that a wide and diverse range of individuals may find comforting. For example, therapists working with Native American clients may want tasteful Native American art or handicrafts in their office—although multiculturally sensitive art is no substitute for adequate multicultural awareness, exposure, study, training, and supervision.

Clinical Interviewing

Psychic Communications . . . and Cultural Differences in Mental Status

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You may or may not have noticed that I haven’t posted anything on this blog in the past 10 days or so. This is because I’ve been experimenting with my telepathic (psychic) communication abilities. As it turns out, my telepathy skills aren’t as refined as I wish they were and so instead of any specific communications from me, receivers have only experienced warm and fuzzy positive sensations. And so if you experienced anything positive like that over the past ten days, it probably means I was thinking of you and trying to psychically send you some pleasant holiday wishes.

Below please find another installment in my intermittent Mental Status Examination series. This posting includes an activity you can use yourself or with a class to facilitate a discussion (with yourself or among class members) about cultural differences in mental status.

Happy New Year! and Happy Mental Statusing!!

Cultural Differences in Mental Status

Part One: Cultural norms must be considered when evaluating mental status. In the following Table, read through the MSE category, the MSE observation, and then contemplate the “invalid conclusion” along with the “explanation.” The purpose of this activity is to illustrate how cultural background and context can affect the meaning of specific client symptoms.

Category Observation Invalid Conclusion Explanation
Appearance Numerous tattoos and piercings Antisocial tendencies Comes from region or area or subculture where tattoos and piercings are the norm
Behavior/psychomotor activity Eyes downcast Depressive symptom Culturally appropriate eye-contact
Attitude toward examiner Uncooperative and hostile Oppositional-defiant or personality disorder Has had abusive experiences from dominant culture
Affect and mood No affect linked to son’s death Inappropriately constricted affect Expression of emotion about death is unaccepted in client’s culture
Speech and thought Fragmented and nearly incoherent speech Possible psychosis Speaks English as third language and is under extreme stress
Perceptual disturbances Reports visions Psychotic symptom Visions are consistent with Native culture
Orientation and consciousness Inability to recall three objects or do serial sevens Attention deficit or intoxication Misunderstands questions due to language problem
Memory and intelligence Cannot recall past presidents Memory impairment Immigrant status
Reliability, judgment, and insight Lies about personal history Poor reliability Does not trust White interviewer from dominant culture

Part Two: For each category addressed in a traditional MSE, try to think of cultures that would behave very differently but still be within “normal” parameters for their cultural or racial group. Examples include differences in cultural manifestations of grief, stress, humiliation, or trauma. In addition, persons from minority cultures who have recently been displaced may display confusion, fear, distrust, or resistance that is entirely appropriate to their situation.

Work with a partner to generate possible MSE observations, in addition to those listed in Part One of this Multicultural Highlight and using the Table below, that might lead you to an inappropriate and invalid conclusion regarding client mental status.

Category Observation Invalid Conclusion Explanation
       
       
       

This Table is adapted from the text, Clinical Interviewing, by John and Rita Sommers-Flanagan: http://www.amazon.com/Clinical-Interviewing-2012-2013-John-Sommers-Flanagan/dp/1118390113/ref=la_B0030LK6NM_1_1?ie=UTF8&qid=1357167677&sr=1-1

 

Parenting, Therapy with Adolescents

The Seven Magic Words for Parents

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Children become adults by practicing. Some of this practicing involves having the right to make choices, even bad and painful choices. For parents who have not learned to back down, we offer the seven magic words. These are words derived from our study of choice theory (Glasser, 1998, 2002). The good news is that by using these words parents can share their thoughts, feelings, and wishes with their children in way that might help a rebellious child hear their viewpoint. The bad news is that after carefully expressing themselves, parents then acknowledge that ultimately, compliance is not mandatory. And there’s even more bad news:  These words aren’t really magic and parents will need more than seven of them to make them work at all.

The seven magic words are a frame for direct, powerful, and noncontrolling communication. They are: “I want you. . . but it’s your choice.” These framing words allow parents to express whatever they want (we encourage positive words) while at the same time acknowledging their child’s power and right to self-determination. By explicitly acknowledging their children’s right to self-determination, parents may reduce their children’s need to prove their independence. Examples of the seven magic words in action include:

  • I want you to stay clean and sober at the party tonight because I love you, and I know if you get caught, you might end up kicked off the basketball team, and also, your dad and I can’t trust you with the car if we know you drink, but of course I know I can’t control you, so it’s your choice.
  • I want you to graduate from high school, go to college, have a great job, and get rich, but whether or not that happens is really up to you.
  • You know I want you to be healthy, eat well, and exercise, but whether you do that is your business. I’ll help you any way I can, but it’s your choice.

As you can see, the magic words are a frame for parents to express their own beliefs and convictions. This technique allows parents to directly express heartfelt feelings, and even describe the consequences they fear, but to then turn the choice back over to the child.

Some parents will be disappointed with the seven magic words. They wish for true magic and true control. Instead, this frame merely offers an opportunity to briefly and succinctly communicate personal and family values directly to children. In many families, one of these values is to acknowledge and honor the children’s individual freedom and ultimate rights to choose how to live their lives.  Most parents want their children to learn how to make responsible, life-enhancing choices.

Go to http://www.wiley.com/WileyCDA/WileyTitle/productCd-1118012968.html to purchase a copy of “How to Listen so Parents will Talk and Talk so Parents will Listen as an excellent, but belated, holiday gift for someone you love:).

Counseling and Psychotherapy Theory and Practice, Parenting, Personal Reflections, Therapy with Adolescents

Talking with Kids about Trauma and Tragedy

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             All too often, very bad and traumatic things happen in the world. Many of these terrible things find their way into the news. This can be shocking and depressing not only for the people who were directly affected, but also for the general public. We are often repeatedly exposed to words and images that can trigger emotional and behavioral reactions in adults and children. Below is a short list with brief descriptions of how adults can help children deal effectively with traumatic information from the news and other media sources.

TALKING WITH CHILDREN: CONVERSATIONS ABOUT REALITY

The first step in talking with children is always the opposite of talking. LISTEN. Listen for how children have been affected. Listen for what they’ve seen and heard. Listen for their fears and fantasies. Listen for their personal coping strategies and solutions.

It’s important to listen closely, but if you listen too hard for children to talk about trauma, you run the risk of making them think they SHOULD be traumatized. If this happens, then children often will start giving you what they think you want . . . they’ll start talking about trauma. Therefore, a big challenge for adults is to listen in a balanced way.  Don’t spend too much time everyday encouraging children to talk about their deepest fears. If you do, it’s possible that everyone will get more and more scared — including you!

Perhaps the biggest deal when talking with kids about real tragic events, is being able to answer their questions. They may ask you terribly hard questions, like, “Will there be a plane crashing in our neighborhood?” or “Do you think a shooter might come to our school?” or “Will I be safe at home?” or “Teacher, are you scared?”

Children often ask very good and very hard questions. An important guideline for teachers, parents, and counselors is to stay balanced. This means you can admit to being scared — as long as you also admit to being strong. Some children can quickly pick up on false reassurance, which is one reason why I’m not in agreement with Dr. Joyce Brothers who suggested after 9/11 that it was a good time to lie to your children. Instead, I recommend acknowledgement that the world is not always a safe place, but that you’ll do everything you can to be strong and help keep the child or children safe.

With preschoolers, there are some conversational topics that are best to avoid. For example, there’s no need to go into graphic detail about specific injuries, etc.  This is similar to the fact that very young children don’t need to know all the details about sexuality. It’s better to speak generally about violence and destruction. It’s also very important to protect your children from too much exposure to media coverage of violent events.

It’s also important to never forget about focusing on children’s strengths. Listening first provides you with a foundation for giving children feedback about their strengths. Be sure to listen for children’s strengths . . . and then reflect them back. You can also encourage children to tell you about their strengths – including both ways they’ve handled hard things in the past and ways they might handle hard things in the future.

 PLAYING WITH CHILDREN: REENACTMENT, PRETEND PLAY, AND MASTERY

Younger children will typically play out or reenact their traumatic experiences. For preschoolers pretend play will be the dominant way they deal with the trauma of what they’ve seen and heard. Around 9/11 children were likely to build towers and have them knocked down. They also enacted play activities involving airplanes, police, terrorists (or other “evil/bad” people). If they’ve been exposed to images and heard about school shootings you might see some play activities involving guns and death and loss. For the most part, it’s best to just sit back and watch children as they enact these scenes. By allowing them un-directed play time and some nondirective commentary, you’ll be helping them take their first steps toward healing (more information on non-directive play is included on the “Special Time” tip sheet on this blogsite).

On the other hand, sometimes children get stuck in the same repeated play pattern. This more chronic form of play is referred to as post-traumatic play. When children seem genuinely stuck repeating pretend interactions through non-interactive play that provides no apparent gratification, you may need to interact with them in ways that help them get un-stuck. You might want to try these strategies: (a) have the child stand up and take some deep breaths before resuming play; or (b) interact with the child in a way that disrupts the pattern (for example, you might ask, “what would happen if . . . ?”).

Obviously, rigid post-traumatic play patterns indicate a need for professional assistance.

 DRAWING WITH CHILDREN:  CAPTURING THE FEAR ON PAPER

Children’s fears can seem big and intimidating. That’s true for people of any age. Maybe that’s why, for adults and older children, writing about specific fears and trauma can be so helpful. Somehow, writing things down on paper can help to put it in perspective.

Younger children aren’t able to use the written word effectively for personal journaling. That’s where drawing comes in. When children color, draw, paint, or sculpt their fears, the fears become more manageable.

 STORYTELLING STRATEGIES

Storytelling is a very powerful tradition and technique for dealing with many human problems and challenges. Stories can be designed or obtained through published materials. In response to tragedy, it can be helpful for children to hear stories of bravery under difficult or perilous conditions.

If you choose to invent your own stories, be sure to create a story with a main character and a clear beginning, middle, and ending. If you’re comfortable with it, you can even have the children help invent characters and their own stories.

There are many ways to encourage children to make up stories of their own. The advantage of this is that you get to listen for the dynamics of the children’s story and so it provides some assessment information. As a counseling technique, it’s possible to use a pretend radio or television show. You can invite children to be guests on your “show” and interview them about their experience or have them share a story.

 HELPING WITH TRANSITIONS:

Separation anxiety is a common reaction that children have to stressful news or situations. This means children may have trouble saying goodbye to their parents and being left at school or day care. In most cases, it’s best for parents, children, and staff to develop an individualized goodbye and hello routine for drop-offs and pick-ups. These routines will be less necessary as time goes by, but it’s good to have goodbye and hello rituals there when you need them. For example, having a hello and goodbye song, transitional objects, and other objects of comfort can ease the pain of separation.

 HAVING FUN: USING DISTRACTION, HUMOR, AND PLAY TO MOVE PAST TRAUMA

Don’t forget, it’s easy to pay way too much attention to the traumatic news and ignore regular daily play routines. Don’t fall into this trap. It’s good to keep kids active and keep them having fun. It’s good to be prepared with some games, songs, or activities that you can rely on to engage children and help them forget about the bad news for a while.

 LEARNING ACTIVITIES: MASTERY THROUGH EDUCATION, SAFETY, AND SERVICE

Not only does life go on after a trauma; it’s important for life to keep getting better. Ways to move forward include (a) continuing with educational, skill-building, and stress management activities, (b) promoting safety strategies and skills, and (c) involving children in basic service activities . . . possibly even service activities that include teaching other children strategies for coping with trauma or difficult situations.

 GET HELP AS NEEDED

It’s a sign of strength to get help when it’s needed. You may notice specific reactions or experiences in children or yourself that indicate it’s time to for professional assistance. Some of the primary symptoms of trauma and vicarious trauma that can develop in these situations include the following:

  • Repetitive and intrusive thoughts and images.
  • Sleep problems: Insomnia, nightmares, and night terrors.
  • Separation Anxiety and clingy-ness.
  • Specific fears/phobias.
  • Hypervigilence.
  • Regression.

 SELF CARE NOW AND INTO THE FUTURE

Remember to take good care of yourself so you can be of greater help for others. This could involve many different activities including vigorous exercise, maintaining healthy eating and sleeping routines, and scheduling time for social contact and social support.

This Tip Sheet was written by John Sommers-Flanagan, Ph.D., professor of Counselor Education at the University of Montana.

Counseling and Psychotherapy Theory and Practice, Group therapy, Personal Reflections

When Giving Gives Back

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For several years Rita has been having first year counseling students do at least five hours of “volunteer” work with our local day treatment center for clients (or consumers) who struggle with chronic mental disorders. This year Rita is on sabbatical and so the task fell to me. To be honest, I was ambivalent about the assignment, mostly because the logistics seemed challenging. I had to arrange two separate organizational visits to the mental health center for about 15 students with different schedules before the volunteering could start and I struggled to make these happen in a timely manner. I secretly wondered if arranging this experience would be worth the hassle.

On Monday, October 29, I finally met the first group at the Day Treatment program and was emotionally transported back to the early 1980s when I was worked in a Day Treatment program and then as a recreation therapist at a 23-bed private psychiatric hospital. I listened as a staff member gave us the most unstructured orientation ever. He eventually told us that he was a “client” at the center before becoming staff. He told the students they were free to just drop in and hang out whenever. I could feel the students’ anxiety rising at the thought of just hanging out and so I asked a few questions and told a couple stories to take up time and they asked questions of their own. In an odd mix of awkwardness and genuineness and anxiety, I felt the wish to just hang out with the day treatment clients myself.   

But instead of hanging out, the reality of other responsibilities started pressing forward and I left with unresolved emotions. I decided to deal with those emotions by writing a small check to support the River House Day Treatment Member Fund. I wrote the check and sent it off.

After completing their five volunteer hours, our students are required to write a short essay about their experience. Today, I’ve spent much of my day reading these essays. They are amazingly open and appreciative of the experience. Some samples:

“I am always humbled by the willingness of others to not only be open with me and to share with me their experiences but also by the ‘sameness’ of a lot of human experiences and suffering.”

“It felt good to share in the humanness of it all- bad days, favorite things, boyfriends, girlfriends, family, and trying to find meaning even when our stories are so different.”

“The clients were not only positive and loving toward the staff members, but also towards me as a volunteer. Every client I was able to talk to complimented something about me and they were constantly complimenting each other.”

“The clients I talked with accepted me in to their community and openly shared their experiences with me. This allowed me to see the world, in a small way, through their eyes.”

Every essay has emphasized the positive environment, the loving-kindness of staff and patients, and the surprise and joy of making deeply human connections. I also received an excellent formal thank-you note from the program director (for the small donation). In it she enclosed a short note from the clients or members of the Day Treatment Center. They wrote:

Thank you so much for the monetary gift. We appreciate it so much. Your students have blessed us with their presence and we have enjoyed them. I hope that we can give the students a fresh perspective on how a special place such as River House can do good and help its members. I hope you will always feel welcome here and thank you for all you do, mentoring the students and giving gifts to us.

This letter and the feelings I get when I read “Your students have blessed us with their presence . . .” was much bigger than what I gave. That’s the same message I keep getting from my students. They went with minimal expectations, a little angst, and to clock their required hours. But instead of just completing a simple assignment, they received an experience so meaningful that many of them have are extending their volunteer work far beyond the required five hours.

This is a fabulous example of how giving can give back much more than what was originally given. This is probably what Adler meant by Gemeinschaftsguful.

Thank-you to the River House staff and members for . . . BLESSING US with YOUR presence.

Counseling and Psychotherapy Theory and Practice

The Girl Code by Ashley Marallo

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In 1999, William Pollack published a book titled, Real Boys.This book, based on his interviews with adolescent boys, included a list of behaviors he referred to as the “Boy Code.” The Boy Code included boy-related norms like: (a) Stand on your own two feet, (b) never show emotion–except anger, and (c) separate from your mother and all things female ASAP.

When lecturing on feminist theory and therapy, I often include a short review of Pollack’s Boy Code and follow that with a discussion about what might be the American version of a Girl Code. Most years I offer students a few points if they’ll email me their personal rendition of a Girl Code.

The year, Ashley Marallo, M.S.W., who’s currently a doctoral student in our counselor education program sent me her amazing and poetic version of the Girl Code. With Ashley’s permission, here it is:

Be nurturing and passive and loyal. Above all else, sacrifice for others who need you to tend to them. Put your life on hold to be available at the moment they need you. Standby anxiously watching and waiting to be of use. It is why you are loved. Don’t forget you are nothing without me. But I will throw you a bone, the façade of real belonging, and you will be too scared to look for something better. Please me. Be desirable. Put on a show for me. Show me how much you care what I think. Don’t inhabit your body. Detach yourself so you see you through my eyes. Remove all your body hair. Look like a porn star. Be skinny, but still curvy. But eat! Take this and buy yourself something nice. By nice I mean Victoria’s Secret for you to parade around in later for me. Be sexual when I want you to be, anticipate my moods, take charge within the limits of the power I give you, make decisions. Make the right ones. You’re an idiot if you make the wrong one. Obviously you’re not paying attention. Be sorry. You’re so emotional. Crazy. Needy. Clingy. You need help. Need me. I’ll keep you safe. Then trust me and be vulnerable and I’ll make you feel weak and worthless. Be feminine but independent. Your ambition is so cute. So is your anger as long as it bends to mine. I’m not happy. Do something for me. Be responsible for my emotions. Feel bad about it. Come home. Read my mind. Control yourself. You’re like a child. Grow up. All you ever do is think about yourself. Prove yourself. Work harder than everyone else then I’ll approve. Be perfect. Look rested. Glow. Don’t wear too much makeup. You look like a slut. Why did you cut your hair that way? Be graceful. Be beautiful and make it look natural. Don’t cry. It makes your eyes puffy. No one wants to be around you when you are like this. Your job is to make men feel important and special. Your value depends on it. If they want you, go with them. That will give you power. You can make them lose control. Be mysterious and intriguing. Speak intellectually but not over their head. You don’t want them to feel inadequate. A specific level of smartness is sexy. Be fun. Be charming and alluring. Drink and show you can have a good time. But don’t get wasted or throw up. Maintain the precise amount of control over yourself at all times. Be sensitive. Absorb meanness. Forgive them. It’s nice of them to apologize. Don’t be too hard to handle, or too much work. They’ve had a hard day. Go be by yourself when you feel sad. Like the things I like. Look adorable in oversized football jerseys. Hang out with the guys. Let me show you off. Who’s that guy you were talking to at the bar? You probably want to fuck him. Take birth control pills so I don’t have to wear condoms. Get on top. Make out with girls. Watch the kids. If you make it to 17 without having your own, you are doing pretty good. Stay together for the kids. Let them be angry with you. It is your fault it didn’t work after all. If you had just tried harder. Everything’s fine. It’s all in your head. It’s always something. Make me a cup of tea. Avoid conflict. Smooth it over. Just say you’re sorry and it will be ok. Keep the family together. Use sexuality as a weapon. Just the right amount. Don’t talk about it. Lie about how many men you’ve slept with and the size of their penises. They don’t really want to know even when they ask. Make sure you lay down in just the right position that your belly looks flat and your hip bones protrude just enough to create a small shadow. Enjoy strip clubs. It makes you an edgy chic. Agonize over bathing suit season and buy something that costs twice as much as a shirt for a pile of strings half the size. And make sure it makes your boobs look perky. And by the way all women should be able to wear tube tops. Get a tan and pedicures. Our feet are supposed to be cute, small and smooth. Giggle at lewd comments. It’s a compliment. Be a doll. Orbit around your man. Create a nice home for him. Be his mother and his servant. The way to a man’s heart is through his stomach. Be chaste enough to make him wait but marry him if he knocks you up. Continuously ask yourself whether you are an imposter and when you will be found out. Offer to pay but be ready to and hope he picks up the tab. Say thank you for everything you are given even if you earn it. Apologize for everything that goes wrong even if it’s not your fault. Perpetually wonder if you are good enough, not knowing what you’re wondering you are good enough for.

 

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