Therapy with Adolescents

Getting Your Buttons Pushed by Teenage Clients

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The following material is adapted from Tough Kids, Cool Counseling.

Although we generally suggest not taking your client’s degrading comments personally, in the real world, we all get our buttons pushed sometimes. A graphic example of a therapist over-reacting to provocative client behavior was captured in the feature film, Good Will Hunting (Van Sant, 1997). 

You may recall the scene. The main character, Will, played by Matt Damon, is an extremely intelligent but emotionally disturbed young man with mathematical genius. His would-be mentor, in an effort to help Will fulfill his potential, sends him to several different counselors, none of whom are able to help Will. Finally, Will ends up in the office of Sean McGuire, played by Robin Williams.

During his initial session with McGuire, Will is his provocative and nasty self. He begins insulting McGuire’s deceased wife which “activates” McGuire’s emotional buttons. The result: McGuire grabs Will around the neck and slams him up against the wall. Of course, McGuire also decides to take on Will as a client and eventually (and rather magically) he successfully helps Will move forward in his life.

We’d like to emphasize two key points related to this excellent example of resistance and countertransference from Good Will Hunting. First, be aware of your emotional buttons. If you’re getting your buttons pushed, seek support and counseling for yourself. Second, no matter how provocative your young clients may act, avoid using Robin Williams’s “Choking the client” technique.  It may play well in Hollywood, but physical contact with resistant, aggressive, and/or angry clients is highly ill-advised. If you think rationally about the “Will Hunting” character and the fact that he had a history of physical trauma, touching him in an aggressive way would be ESPECIALLY contraindicated.

 If you’re having your emotional buttons pushed occasionally by teenage clients or students, consider yourself normal. On the other hand, if the button pushing begins to cause you to contemplate acting on destructive impulses, it’s time to get therapy for yourself, and/or support from a collegial supervision group. Many psychoanalytically-oriented writers have warned about the powerful regressive countransference impulses that young clients can ignite in their counselors (Dass-Brailsford, 2003; Horne, 2001). 

Counseling and Psychotherapy Theory and Practice

Go Go Gestalt: The Theories Video Shoot, Part I

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There’s nothing quite like experiencing embarrassment in the Here and Now.

Today Rita and I started a several day video shoot to produce counseling and psychotherapy demonstrations to go with the second edition of our theories text (Counseling and Psychotherapy Theories in Context and Practice. Rita did demos of Person-Centered and Feminist therapy and I got to do a Gestalt therapy demonstration.

In honor of the Gestalt approach, below I’ve inserted a short excerpt from our text describing the Gestalt principle of the figure-formation process. Tomorrow or the next day or whenever I’ve recovered I’ll post a short description of the Gestalt demonstration for those who may be interested.

The Figure-Formation Process

Humans are able to constantly shift their cognitive or perceptual focus. This may be especially true in our contemporary, media-based society where distractibility is normative. In Gestalt psychology, this is referred to as the figure-formation process.

An amazing human quality is the ability to intentionally shift the focus of consciousness. If you’re reading these words your focus (or figure) are the words on this page (or screen) and their meaning. This process puts you in your head—literally. You’re all eyes and intellectual processing.

This visual and intellectual experience is a function of your focus, but you might just as well focus on something else. If, as you read these words you intentionally shift focus to your ears, what happens?  Or, if you are listening to this book instead of reading, shift to the smells in the room.  Can you simultaneously focus completely on every sound wave or every odor bouncing around you without losing your intellectual focus? You may still be seeing or hearing the words, but now they’ve drifted into the background. If you consciously focus on auditory perception, then sound will take over the foreground or figure. And if we take this further we could have you alternate between different sounds and smells in your environment (maybe there’s music or a dull hum of lights, or your breathing, or someone’s perfume or your gym clothes in the corner, or . . .). In each case, your attention is shifting, more or less, and placing different perceptual experiences at the forefront. You’re engaging in a figure-formation process.

Perhaps an everyday example will help even more. Let’s say you’re driving the Interstate in Montana. The speed limit is 75 mph (yes, thanks to the federal Department of Transportation, we do have a speed limit). There aren’t many cars on the road because you’re in Montana. A signal from your cell phone pops into your awareness, triggering a social need, which then produces disequilibrium, and so you decide to take action and check your new text message. You steer with one hand, hold your phone with the other, and shift your eyes back and forth from the road to the phone. Three seconds on the road, 3 seconds reading text on the phone. At first the road and steering wheel is figure and the phone in your hand is background. Then the phone and text message is figure and the road and steering wheel is background.

Suddenly, you have a background thought about what you’re doing. Having passed your driver’s test you possess internal knowledge about how far you travel in three seconds at 75 mph. You’re covering 333 feet—over the length of a soccer or football field—every 3 seconds. This internal memory emerges from background to figure along with a realization that you could have run over 111 deer on the highway standing side-by-side while checking three-seconds of your text message. Another linked thought crystalizes into figure and you can almost hear your parents in your head telling you they love you so much that they’d like you not to text and drive.

The figure-formation voice in your head brings with it a surge of anxiety and you tap your brake and slow down to an unheard of 55 mph so that you’re only covering 243 feet every 3 seconds. Somehow you rationalize and justify that you’re safe enough to text and equilibrium is restored.

The point is not so much that you’re endangering your life and the lives of hundreds of innocent deer, but that you’re always missing something when figure recedes into background and gaining something when figure-formation occurs. This losing or gaining is, to some extent, under voluntary control. You may choose to miss out on the text message or you may choose to miss out on the 333 feet of road—but you can’t have it both ways because something has to be figure and something has to be ground.

From the Gestalt perspective, you’re always just a little bit aware of the ground (or background) and part of the purpose of therapy is to turn up background noise volume by shifting your focus or awareness so you can evaluate whether whatever’s bubbling around in the background might be meaningful or useful. During Gestalt therapy not everything you focus on will be meaningful or useful. However, many parts of your human experience (including unfinished business from the past that’s affecting you in the present) might prove useful and meaningful.

This is the essence of Gestalt therapy: Shift your focus and then shift it again to embrace here and now awareness and the personal development it might stimulate. At the same time, you recognize that not every 333-foot stretch of Montana highway will be immediately and profoundly important, but you stay with that focus because to do otherwise threatens your existence.

The figure-formation perceptual process, as applied to therapy, suggests that the primary or dominant needs of an individual can emerge from background (ground) into focus (figure) at any given moment. This is why Gestalt therapists believe that a client’s unfinished business from the past will inevitably be brought into focus as therapists keep clients in the here and now.

Parenting

Saturday Morning with Rylee’s Blog

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This morning I woke up tumbling through a dream of Margaret and Davis and Chelsea and Seth and Rita. We were all walking together and I got the honor of carrying Margaret on the way home. . . her 21 month old arms around my neck and then—poof—I am awake in Montana and the twins are in Connecticut.

And Rylee is in Scotland.

This past Thursday, as a part of my closing Keynote speech for the Montana Prevent Child Abuse and Neglect Conference, I managed to weave in a 90 second video clip of my grandson Davis walking around with a bucket on his head. I thought my speech was awesome. I was on fire, stringing together clear, clean, and polished sentences. But afterwards most people seemed to think the best part was watching that little boy with the bucket on his head.

This morning instead of reading and grading papers I’m reading Rylee’s blog. http://thecolorlime.wordpress.com/

Yesterday we Skyped, which was fine, but sometimes it’s even better to sift through her blog and catch a little glimpse of what she’s thinking, feeling, and doing across the pond. Freud said “Words were originally magic.” This morning my little Rylee’s magical words make me smile and miss her more than usual.

What makes people so desperate and disturbed that they would abuse children? I have a few academic answers to that question. Maybe it’s their old abuse history, their new stress, emotional troubles, needs for power and control, frustration, misdirected anger, twisted inner worlds of confusion about what they want and what they’re doing. But you know what they say: There are many good excuses, but no good reasons.

On this rainy Missoula morning I’m missing the children in my life and wanting to offer tribute to the human service providers and foster parents I met this past week in Helena who have dedicated their lives to protecting children from abuse and neglect. You all deserve a raise. Even better, you deserve to have your dream of preventing child abuse and neglect come true.

Parenting

Heading to the 2012 Prevent Child Abuse and Neglect Conference in Helena, MT

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Thanks to Mary Peterson, who asked if I could return to Helena again this year to do a break-out session and closing keynote, I’m heading to Helena tomorrow morning for the 2012 Prevent Child Abuse and Neglect Conference. This is a conference attended by an array of social workers, foster parents, and a ranger of other professionals who work hard to prevent and reduce child abuse in Montana. This is a fantastic group of people and I’m honored to spend a few hours with them tomorrow and Thursday. The title of my break-out session is: “How to Get Parents to Listen to your Excellent Advice” and the Keynote is “Your Wild and Precious Life” (in honor of the Mary Oliver poem). Wherever you are and whoever you are spend a moment to think about how to contribute to reducing child abuse . . . an all too frequent and disturbing pattern of behavior that gets very little focus or attention in the media.

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A Tradition Like All Others

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The big sports event of this past weekend was the Master’s Golf Tournament at Augusta National Golf Course in Augusta, GA. As usual, the hyped advertising slogan included the phrase, “A tradition like no other.” This is especially ironic and basically such a good lie that would make post-modern theorists proud.

In fact, the Master’s is a tradition like nearly all other traditions. It’s run by an all male club that doesn’t allow women to be members and only allowed Blacks membership in 1990. It’s about money and power and exclusivity. According to Wikipedia (I know I’m not elevating my research reputation here), “. . . club co-founder Clifford Roberts is reputed to have said, ‘As long as I’m alive, golfers will be white, and caddies will be black.'”

This year’s Master’s champion got $1,440,000. When Martha Burk tried protesting the tournament in 2004, tournament officials decided to air the entire tournament without commercials. This is just a taste of the money and power linked to these particular links.

Now don’t get me wrong. I like sports. I enjoy golf. I even get excited about watching a bit of the Master’s golf tourney on television. It’s good theater, a beautiful venue, and there are some amazing golfers out there. But it’s a little hard to justify Augusta not allowing women members. . . and I say this not because I think men only and women only organizations shouldn’t exist . . . but because excluding women from something that is so prestigious and so associated with money and power smacks too much of discrimination. When I watch the Master’s I always feel a little dirty. 

And so I’m hoping that one of these years an excellent golfer (think Tiger or Phil) will decide to skip a tourney held at a club that wouldn’t let their daughters, girlfriends, wives, mothers, or grandmothers be members. Somebody besides Martha Burk and this insignificant blogger should take a stand to do the right thing. Please pass this message the next time you bump into a great professional golfer.

Parenting

Anger Management for Parents

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Anger Management Homework for Parents

We give the following assignment to parents interested in controlling or managing their anger.

Step 1: Before starting, make a clear commitment. Think about it. Do you really want to express your anger differently? If so, make a list of the top five or ten reasons why you want to change your anger behaviors. Also, make a list of the benefits you’ll experience from changing this behavior.

Step 2: Get curious before you get furious (an idea from Families First Boston). Take time to contemplate the “buttons” or “triggers” that, when pushed or pulled, result in an angry reaction. Draw some big buttons on a sheet of paper and label them. Common parent buttons include: (a) child disobedience, (b) children having a “smart mouth,” (c) children who lag behind when you’re in a hurry. Try to identify a reasonably long list of the main child behaviors that trigger your anger. Remember, when it comes to dealing with anger constructively, knowledge is power.

Step 3: Identify the signs and symptoms of your increasing anger. Some people say they become angry very quickly and that it’s hard to identify the signs. This may be the case for you. If so, study your anger patterns and ask for feedback from someone who knows you well. Your anger signals may include (a) feeling hot; (b) muscular tension; or (c) thinking angry thoughts. The purpose of knowing your anger signs is so you can begin derailing the process as soon as possible.

Step 4: Think prevention and self-care. We’re all more likely to get angry when stressed or when short on sleep. For some parents, prevention will help you move from having anger flareups to anger sparks. Prevention ideas include:

  •       Regular time to work out at home or at the gym (e.g., yoga, dance, or kick-boxing)
  •       Hot baths or hot-tubbing
  •       A regular date night for Mom and Dad
  •       Getting a therapeutic massage
  •       Regular meditation

Many other self-care strategies are available. Make your own best prevention and self-care list and then incorporate your unique self-care strategies into your life on a regular basis.

Step 5: Make an excellent plan for what you want to do instead of engaging in negative anger behaviors. Excellent plans are specific, clear, and easy to immediately implement. For example, you might decide—because music is a natural emotional shifter—that you’ll take a three-minute break to listen to one of your favorite calming songs if you feel yourself getting angry. To accomplish this, it will help to have a preplanned statement to make (“Daddy needs a quick break”) and a prerecorded playlist on your iPod or other music device to immediately listen to.

Step 6: Practice your plan. The best-laid plans aren’t likely to happen unless you practice them. Brain research suggests that whatever we practice (even as adults) generates changes in our brains to make us better at whatever we’re practicing (Jenkins, et. al., 1990). This also makes good common sense. Whether you repeatedly bite your fingernails or repeatedly get very angry and yell, you’ve developed neural pathways in your brain that make these patterns more likely. The best way to address this neural pattern is to develop a new neural pattern by practicing new anger behaviors. For example, if your plan is to use your spouse as a partner and for one of you to tag the other when you get too stressed and need a break, don’t just say, “How about if we tag each other when we’re stressed?” Instead, say it and then physically practice it like you’re preparing to perform in an upcoming drama production. It will feel silly, but practicing or rehearsing is one of the best ways to change an undesirable repeating behavior pattern.

Step 7: Reward yourself. Many people make the mistake of thinking they should be able to change pesky, habitual behavior patterns solely on the basis of willpower. If that were the case, most of us would be practically perfect. Instead of completely relying on willpower, develop a reward system for yourself. For example, if you make it an hour or a day or a week without an undesirable anger explosion, give yourself a reward. Your reward can be as simple as thinking a positive thought (“I’m doing very well at this”), or a much more elaborate system of awarding yourself points for handling life’s challenges calmly and taking them away when you blow up. If you have a spouse or romantic partner, the two of you can develop a program for supporting and rewarding each other. Self-behavior management is one of the best uses for behavioral techniques.

Counseling and Psychotherapy Theory and Practice

Opening Thoughts on Feminism

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This is the opening section from our feminist chapter in Counseling and Psychotherapy Theories in Context and Practice — written with help from Maryl Baldridge, M.A.

For years, psychiatric journals have touted the salutary effects of antidepressants by printing “before” and “after” pictures showing a woman leaning on a mop looking despondently at her kitchen floor, and then happily mopping it after taking her medication.

—E. Kaschak, Engendered Lives (1992, p. 22)

At the American School Counselor Association National Conference in 2011, Georgie Bright Kunkel, a 90-year-old woman, delivered a keynote address. She bounded onto the stage—not looking a day over 80. She introduced herself as the oldest stand-up comic in Washington state (Was there an older stand-up comic somewhere else on the planet?). She proceeded to crack jokes about everything from sex to . . . well . . . sex, and then sex again. In the middle of her routine, she slipped in a serious story that went something like this:

I was working as a school counselor at an elementary school. To kick off our career day, I contacted a woman friend of mine who was an airplane pilot. She agreed to land her one-person plane in the middle of our schoolyard. We were all very excited. We gathered the students outside and watched as she guided the plane down and smoothly landed on the playground. The students crowded around as she emerged from the tiny plane, helmet in hand. When it became apparent she was a woman, one of our male students turned to me and asked, “Where’s the pilot?” It was clearly a one-person plane, but in this boy’s mind, men were pilots and women were stewardesses. This was a sad truth for many of our students. But what interested me more was the impact of this event on our students’ career ambitions. We had decided to take a student survey before and after career day. Before my friend landed on our playground, exactly 0% of our female students listed “airplane pilot” as one of their potential career choices. After career day, about 40% of the girls listed airline pilot as a career to consider in the future.

This is an example of a feminist working therapeutically to bring about development, change, options, and liberation. Feminist therapy can be transformative. It was designed, in part, to break down unhelpful stereotypes and free all humans to fulfill their potentials.

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Something Different

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This is a poem that came to me at about 30K feet. It’s about aging and memory.

If you don’t like poetry or metaphor — it might be good to stop reading here:).

If you like poetry, you might want to read it twice.

 

Another Visitation

One armed men

And withered women

Hold candles where their teeth should be

Wax dripping

Burning

Staining

Carpet that needs replacing

It’s hard to find your way

This way

Because wrinkles

Will not slacken

And carpets

Will not give up the floor

Stubbornly

Refusing to move

As successors greedily lie in wait

Rolled into a consciousness contracting

In a universe expanding

Small orbits

Are especially strong

And wrinkles, old carpets,

Even dimming candlelight

Are intriguingly pleasant

As drops of hot wax

Blister your fingers

Partly because scars

Last longer

Than memories

Counseling and Psychotherapy Theory and Practice

Reflections on Listening to Irvin Yalom at the ACA Conference

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After a few hectic and overstimulating days at the ACA World Conference in San Francisco, I’ve now secured the back table at a Starbucks in Vancouver, WA for brief written reflection. This reflection weaves quotations (and paraphrases) from the great Irvin Yalom into my own personal conference experiences.

My formal conference highlight was watching and listening as NPR’s Craig Windham interviewed Yalom onstage for the keynote. After listening to Yalom’s keynote six years ago, I think the interview format was an ingenious method for capturing a more personal glimpse into Yalom and his writing than a stand and deliver keynote speech.

I especially enjoyed listening to Yalom reflect on his early years. Two statements stand out:

On his career decision-making as a child of Russian immigrants: “We had two choices: We could become a doctor or a failure.”

On his unparalleled greatness within the field of group psychotherapy: “My wife thinks it’s rather ironic that I became an expert in group psychotherapy, because I’m really quite uncomfortable in groups.”

Early in his “speech” Yalom emphasized the importance of counselors to the field of psychotherapy. In several ways he made curiously stimulating statements emphasizing (I’m paraphrasing now) that counselors are the future of psychotherapy. As a hybrid counselor and psychologist, I wonder if he would have made the same statements had he been keynoting at the annual American Psychological Association meeting.

My reactions to Yalom’s claim about counselors being the future of psychotherapy are free-ranging like the chickens in our backyard, but here are two:

Yes, I think counselors will be the future of psychotherapy, but only if we’re able to stop getting in our own way . . . And psychologists will undoubtedly be the future of measuring psychotherapy efficacy . . . if they (or we) can manage to focus on issues more meaningful than pharmacology and neuroscience.

For those curious about where Yalom finds his writing inspiration, in response to Windham’s questioning, he disclosed that as a Californian he has mastered the evening hot tub experience. Subsequently, he’s able to write most productively in the morning about “what I’ve learned in the hot tub.” I suspect there’s a bit more to it than that . . . but for those of us aspiring toward more writing greatness it makes for a solid rationale for nightly inspirational hot-tubbing.

On the popularity of his Group Psychotherapy text, Yalom stated: “I suspect it’s because of the stories in the book that I smuggled in . . .”

On his personal experience of fame (keep in mind that about 4K of us had to line up like rock concert fans to see him), he shared his own sort of dissociated imposter feelings:

“There’s a part of this that is very unreal. I don’t have any foundation. My parents were uneducated. They had very little schooling. I don’t have any foundation behind me. It’s a little shaky for me. I compare it to a lily growing in a swamp. There’s no foundation underneath. No matter how successful I am, I question . . . is this really me. Am I really successful?”

As an existential psychotherapist, it’s not surprising that Yalom believes deeply in helping clients pursue meaning. This is where it gets personal for all of us. He said, “Cancer cures psychoneurosis” and that “Life cannot be postponed.” Over the years he has helped many clients focus on their regrets—which often translate into moments when they weren’t able to face life and life fully in the moment. But we shouldn’t mistake Yalom’s live-in-the-moment philosophy for old-fashioned California hot-tub hedonism.  Yalom’s version of living in the moment is at once emotional AND intellectual; it is inspirational AND intentional.

Yalom also said that “Storytelling . . . may be the very best way I can teach.” Lucky for me I’ve gathered a few teaching stories over the years. Sometimes a combination of reality and my own constructive fiction, at this ACA I had a chance to share many stories. First, in a six hour pre-conference Learning Institute on Wednesday attended by 32 fabulous counselors, and later in an ACA-sponsored Friday session on Connecting and Working Effectively with Challenging Youth attended by about 200. In terms of reaping my own share of attention and praise, this was perhaps my best ACA conference ever.

But then Sunday morning comes. And when I awaken, what grand thoughts trickle into my consciousness? Do I think of the 25 people who lined up to have me sign copies of “Tough Kids, Cool Counseling?” Do I lie on the floor of my high-school educated parents home—where I’ve stopped for a short visit—feeling smug satisfaction about the glory I felt when Craig Windham of NPR fame also stood in line to have me sign a book FOR HIM. Do I reflect on the sweet and ego-boosting comments he shared with me about my work?

Nope. Nothing so grand knocks on the door of my early morning awareness. Instead, I’m transported back to a moment when, immediately after speaking to 200 conference attendees and spontaneously signing a couple books and receiving repeated praise from participants, a bold young woman approached me. She had attended BOTH my six hour workshop AND my 90 minute talk . . . and so forgive me my anticipation of praise as I looked into her eyes. But instead, she tells me that she’s not sure she learned anything from the six hour workshop. My well-practiced response is to welcome the criticism, while fending off disappointment and defensiveness. I feel precariously situated on my own lily pad. She goes on to explain that she’d “accidentally” gotten stuck in the 90 minute presentation and that based on what I’d talked about in there she thought I’d want the constructive feedback. “Of course I do,” I say . . . “Of course I do . . . and thank you very much for that.”

This is the stinging mantra to which I awaken this lovely and cloudy Sunday morning. A mantra of self-doubt . . . of possible regret . . . of wondering what I did wrong . . . of how I might improve myself.

Which brings me back to one of my favorite Yalom quotations (from his Group Psychotherapy text) about universality:

“During my own 600-hour analysis I had a striking personal encounter with the therapeutic factor of universality . . . I was very much troubled by the fact that, despite my strong positive sentiments, I was beset with death wishes for [my mother], as I stood to inherit part of her estate. My analyst responded simply, “That seems to be the way we’re built.” That artless statement offered not only offered considerable relief but enabled me to explore my ambivalence in great depth.” (p. 7)

Thank you Dr. Yalom for helping me and many others more deeply understand ambivalence, regret, self-doubt, personal meaning, death, and many of the other interesting ways the human psyche is built. And thank you, bold young woman, for providing me with hot-tub-free grist for my morning therapeutic writing mill.

The place to click if you want to learn about psychotherapy, counseling, or whatever John SF is thinking about.