Tammy, Dylan, and I are on our way to Polson, MT this morning to provide a 6-hour workshop on Counseling Youth.
The workshop title, “Tough Kids, Cool Counseling,” is a remnant of days gone by. Back in 1996, as Rita and I were driving from Missoula to Absarokee, we came up with that title, which we published as a book in 1997. The second edition came out in 2007.
For many years, we argued about who came up with what we considered a very nice title. I thought it was my idea. Rita thought it was hers. We were both equally shocked at each others’ claims. Have you ever had that experience with a romantic partner?
But, a few years after publishing the second edition, I gave up all claims to the title, because I suddenly realized that the title was neither nice nor cool. Constructing youth problems as “in them” was not good and not right. The title labeled the youth as “tough,” in essence, blaming them for their problems.
For the past two decades, I’ve seen youth problems differently. Now, I avoid using the phrase “Tough kids.” Instead, I advocate for framing the issues as “kids in tough life and personal situations.” I’ve decided that going to counseling is just another tough situation that many youth are forced into.
So why am I still using this title? I use it because I like to make the point–after using the phrase Tough Kids for the first five minutes–that I’ve stopped using it and that I won’t use it for the rest of the presentation and that we should all give it up together, and not even THINK about tough kids.
With that fun anecdote out of the way, I’m looking forward to a fun day of mutual learning with therapists who work for the Confederated Salish & Kootenai Tribes. And. . .here’s a pdf of the very long powerpoint slide deck.
For the 4th edition of Counseling and Psychotherapies in Context and Practice we added an amazing new author. I’ve introduced him on this blog before, but here’s his official bio for the new textbook:
Bryan Cochran, PhD., is a clinical psychologist, professor, and director of clinical training for the PhD program in clinical psychology at the University of Montana. His research areas of interest are LGBTIQ+ health and substance use treatment. He is the co-author of dozens of articles and book chapters on these issues, and 23 years into his academic career, has enjoyed being involved with this textbook project as a way of expanding his thinking and his knowledge of counseling theories and lenses. He doesn’t currently have a blog like John and Rita do but undoubtedly feels the pressure to do so every time he reads their musings on life and on their work. He works with clients in a clinical role using a variety of perspectives that you’ve read about in this text. While not at work, he loves hiking, swimming in Flathead Lake, hunting thrift and antique stores for mid-century treasures, and doing home renovations.
Working with Bryan has been nothing short of fabulous. . .in so many ways. Today, I’m featuring his introduction to the all-new Chapter 2, titled, Viewing Counseling and Psychotherapy Theories Through Contemporary Lenses. Here you go!
**********************************
LENSES, THEORIES, AND METHODS, OH MY!
Take a seat. We’d like to start this chapter with an eye (vision) examination. Or, if you prefer, think of this as an ear (hearing) exam. It’s both … and more. This chapter is a perception check.
Lenses clarify and distort. They provide more brightness or less brightness, an array of colors, and more clarity or more distortion. In this chapter, we’re not prescribing corrective lenses. If you’re familiar with an eye exam, think of the optometrist comparing lenses and repeatedly asking, “Which is clearer?” Your “vision” as a psychotherapist is as unique as your personal history and fingerprint.
This process—offering up different lenses for improving your perceptual acuity in counseling and psychotherapy—is far slower and more complex than an eye examination. But the analogy carries truth. As you try on and experiment with different lenses from this chapter, you may see your clients and their distress more accurately. You and your clients will benefit.
Lenses are different from theories. It may seem confusing, but our aim is to create a distinction that illuminates, rather than conflates, these concepts. Most therapy approaches in this book align with a particular theoretical perspective; behavioral psychotherapy is linked to theories of operant and classical conditioning. Psychoanalysis is deeply rooted in theories regarding the interplay of different mental structures, or psychodynamics. However, there’s no reason you can’t put on a queer theory lens when doing cognitive therapy, where you help a client to identify maladaptive thinking errors and discuss how those thoughts are likely to come about in a heteronormative society (one in which heterosexuality is the dominant paradigm for understanding relationships and family structures, and other configurations are seen as outside that norm). You can use lenses, such as critical race theory, queer theory, or intersectionality, to deepen your application of psychotherapy theories and tailor your treatment to a given client’s identities and needs.
New therapists often are frustrated by the need “to pick” a particular theoretical perspective, as if doing so means you’re entering an exclusive relationship with that choice. Like romantic partners, though, you’re unlikely to resonate with every aspect of every theoretical perspective. Unlike with a romantic partner (unless you’re setting yourself up for a series of arguments), you can analyze theoretical perspectives through various lenses to separate the parts of the theories that are most useful from those that are less useful.
So, what do we mean by a lens, in comparison to a theory? Lenses transcend disciplines—they often emerge outside of psychology but can be applied to psychological theories. Whereas a theory might tell you what to do as a therapist—what to assess, how to intervene—a lens informs how you go about doing it. Because a lens transforms how you view the world, you might adopt (or already have adopted!) a lens without being aware of it. Since one of the key principles of counseling is to understand what biases we bring into the therapeutic process, spending time talking about key lenses in a chapter new to this edition seemed like a good idea to us.
As you adapt a particular lens for viewing a counseling theory, it may be tempting to throw out the history and background of that theory because it doesn’t stand the test of time. A good example of this is the waves of critiques that have been leveled against Freudian psychoanalysis. While there are few current theorists who would say young women suffer from castration anxiety or that the Oedipal complex is a major influence on young men, the idea that some of the determinants of our behavior operate outside of our consciousness remains robust, supported by empirical research and lived experience. We believe it’s possible to hold onto both a lens and a theory at the same time. Let’s spend some time exploring some different lenses for viewing counseling and therapy so you can further develop your sense of who you might be as an emerging clinician.
Today I found a creepy AI audio summary of the 3rd edition of our theories text. Maybe I should have liked it, because it was super-glowing. But the AI voice overweening on my behalf felt wrong.
In contrast, the following content is real and excerpted from our forthcoming 4th edition of Counseling and Psychotherapy Theories in Context and Practice
To continue with the creepy, the following is what was generated when I asked ChatGPT to create an image of itself.
********************************
Theories and lenses are tools we use to make sense of our complicated world. We’re not saying that the world is more complicated in 2026 than it was 23 years ago, when the first version of this text was published, but the proliferation of information in the modern digital age means that there’s more to sift through than our brains can handle. We hope this text provides you with intellectual structure, insights, practical tools, and fun companionship on your road to understanding and engaging in counseling and psychotherapy.
While walking across the University of Montana campus the other day (which is beautiful on any day, but especially during the fall here in Montana), we noticed an annual tradition on campus had recurred—a fresh, large, orange pumpkin was placed on the top of a spire on University Hall, over 100 feet above the ground, just in time for Halloween. The impossibly steep roof of the clock tower, and the brazenness of putting a fresh gourd up there each year (for decades!) leads to speculation—let’s call them theories—about how a pumpkin could possibly make it on top of the spire.
Is it a renegade group of rock climbers who scale the building each October? Is the University somehow complicit in keeping the tradition alive while sternly warning students not to climb the building? With advancements in drone technology, has someone figured out how to hoist a heavy pumpkin and drop it on that precise point? Is it a 3-D optical phenomenon that doesn’t exist other than in socially constructed reality?
Which theory is correct? But what if it’s not one theory; maybe the pumpkin tradition has evolved over time. After decades of being on campus, our guess is, we’ll never know. The same is probably true with theories and lenses of counseling. We’ll never know—for certain—if the perspective we take is “the correct” one. The best we can do is continue learning about human behavior and the theories that explain it and do our best for our clients by using lenses and theories to help understand their unique situations and help make things better. The pumpkin problem is much easier.
We encourage you to carry theories and lenses from this textbook around with you to help you to make sense of the world—not just in terms of counseling and therapy, but in terms of understanding complexities of the world we live in. At a time where there’s a tendency to over-rely on artificial intelligence to get “the answer” to your questions, playing with different theories is good for your neural connectivity—and probably good for your clients’ well-being, because embracing and valuing different perspectives is good for all of us as we try to navigate this wildly complex world.
* * * some content is skipped here * * *
We believe in several things: First, we cannot help but be affected by contemporary socio-cultural-political events. Second, regardless of socio-cultural-political movements, the counseling and psychotherapy space needs to be safe, sacred, and inclusive for everyone, and especially people with limited resources, diverse identities, and a history of distress or trauma. Third, although we talk about creating a safe space for clients to explore their lives, our offices are not instantly safe, and simply saying the words, “this is a safe space” won’t magically create trust and safety. We need work with clients to, over time, make it experientially safe.
We hope you can use the theories in this text to create and support an inclusive psychotherapy where positive and transformative work happens.
WHAT’S NEW IN THE FOURTH EDITION?
We’ve been receiving solicited and unsolicited feedback on this “Theories text” since 2003. Most of the feedback has been overwhelmingly positive. At conferences, people often approach us and say how much they love this book. They love the anecdotes, our irreverent attitudes, and our occasional efforts at humor. Yes, we believe this theories text is the funniest one on the market. Positive feedback from students and faculty has been incredibly affirming, mostly because our primary goals were to create an engaging, interesting, and practical theories text.
As a side note, we recognize there’s not much competition for funniest theories book on the market. But if there was a formal theories textbook humor competition, we would win hands down.
We’ve also received constructive feedback. Although less affirming, constructive feedback is essential to our personal and professional growth and development. We’ve tried to use constructive feedback to create an even better textbook. We invite you to provide us with whatever type of feedback you like.
So. . .what’s new in the Fourth Edition?
To add perspective to the text, we added a co-author. Bryan Cochran is a professor of psychology and LGBTIQ+ scholar. His voice and perspective are woven into every chapter, but especially our two new chapters. In chapter 2, Bryan describes several lenses that influence how we all practice counseling and psychotherapy. These lenses include: (a) Critical race theory; (b) Queer theory; (c) Intersectionality, and (d) a few other important contemporary perspectives. These lenses are not counseling or psychotherapy theories, but they can and should be used with theories and evidence-based approaches to make us more sensitive, humble, and competent in working with all clients.
In chapter 13, Bryan takes us on a deep dive into third wave behavioral treatments. These treatments include:
Mindfulness-based stress reduction (MBSR),
Dialectical behavior therapy (DBT),
Prolonged exposure (PE), and
The unified protocol (UP).
Each of these treatments incorporate mindfulness; they also have substantial empirical support. Learning about them will make you a better therapist.
To better address culture and social justice issues, we’ve done what Derald Wing Sue recommended 15 years ago. We eliminated the “multicultural chapter” and distributed cultural and diversity content throughout the other chapters, with a big emphasis in chapter 2. Our goal was to more fully integrate diversity into all theoretical approaches. We look forward to hearing from you regarding whether we accomplished that goal.
As before, every chapter includes sub-sections titled (a) cultural sensitivity, (b) gender and sexuality, and (c) spirituality. As it turns out, we still haven’t discovered the neurological basis of everything, but apparently folks are still trying. Neuroscience is featured in chapter 1 and incorporated throughout the text via the “Brain Box” feature that appears in most chapters.
WORDS TO (and from) THE WISE
* * * some content is skipped here * * *
Language is liberating and activating. Although we’ve done our best to follow professional language guidelines, no doubt, sometimes you will react to our language choices, our examples, and our content. If we were in the same room as you as you had an emotional reaction, we would say something like, “Thank you for your passion.” And then we would do our best to non-defensively explore your reaction and our language, example, or content. If you engage in class discussions with classmates (or your instructor) about this text, we hope you will afford each other mutual respect and compassion for the emotions that can and will arise from studying counseling and psychotherapy.
But these posts are more than just about counseling and psychotherapy theories. They’re also about life. My first title was something like, “Things Everyone Should Know about Counseling and Psychotherapy Theories.” So, for episode one of the Theories Series, I’ve used both titles. Going forward, it will just be the Theories Series.
Each Theories Series episode will include an excerpt from our forthcoming 4th edition of our textbook, Counseling and Psychotherapy Theories in Context and Practice. As you may have heard, our theories text is, hands down, the funniest theories text on the market. As you may have also heard, the bar for producing the funniest theories text is rather low.
Here we go. The jokes are free, so they may also be worthless.
Many students ask us, “Should I get a PhD in psychology, a master’s degree in counseling, or a master’s in social work?”
This question usually brings forth a lengthy response, during which we not only explain the differences between these various degrees but also discuss additional career information pertaining to the PsyD degree, psychiatry, school counseling, school psychology, and psychiatric nursing. This sometimes leads to the confusing topic of the differences between counseling and psychotherapy. If time permits, we also share our thoughts about less-confusing topics, like the meaning of life.
The famous strategic therapist Jay Haley (1977) was once asked: “In relation to being a successful therapist, what are the differences between psychiatrists, social workers, and psychologists?” He responded: “Except for ideology, salary, status, and power, the differences are irrelevant” (p. 165). Many different professional tracks lead toward becoming a successful mental health professional—despite a few ideological, salary, status, and power differences.
In this section, we explore three challenging questions: What is psychotherapy? What is counseling? And what are the differences between the two?
[the excerpt skips some ground here]
A Working Definition of Counseling and Psychotherapy
Counseling and psychotherapy are mostly similar and often overlapping. Therefore, we use the words counseling and psychotherapy interchangeably. Sometimes we use the word therapy as a generic term representing psychosocial interventions.
To capture the natural complexity of this thing we call counseling or psychotherapy, we offer a 12-part working definition of counseling and psychotherapy. Counseling or psychotherapy is:
(a) a process that involves (b) a trained professional who abides by (c) accepted ethical guidelines and has (d) competencies for working with (e) diverse individuals who are in distress or have life problems that led them to (f) seek help (possibly at the insistence of others) or they may be (g) seeking personal growth, but either way, these parties (h) establish an explicit agreement (informed consent) to (i) work together (more or less collaboratively) toward (j) mutually acceptable goals (k) using theoretically based or evidence-based procedures that, in the broadest sense, have been shown to (l) facilitate human learning or human development or reduce disturbing symptoms.
Although this definition is long and multifaceted, it’s still probably insufficient. For example, it wouldn’t fit self-administered therapies, such as self-analysis or self-hypnosis—although we’re quite certain that if you read through this definition several times, you’re likely to experience a self-induced hypnotic trance.
*************************************
Hahaha. People come for the theories, but they stay for the jokes.
We’re in the throes of editing our Theories text, meaning I’m so deep into existential, feminist, and third wave counseling and psychotherapy theories that I may have lost myself. If any of you find me somewhere on the street babbling about Judith Jordan and Frantz Fanon and Bryan Cochran, please guide me home.
This brings me to a big ask.
As part of 4th wave feminism, we’re more deeply integrating intersectionality into the practice of feminist therapy. Among other things, intersectionality is about identity. I’m interested in using a variation of Irvin Yalom’s “Who are you?” group technique to explore identity in anyone willing to respond to this post.
To participate, follow these instructions.
Clear a space for thinking, writing, and exploring your identity.
Ask yourself the question: “Who am I?” and write down the response as it flows into your brain/psyche.
Repeat this process nine more times, for a total of 10 responses, numbering each response. One rule about this: You can’t use the same response twice.
After you finish your list of 10, write a paragraph or two about how you were affected by this activity.
If you’re comfortable sharing, send me your list of 10 identities along with your reflections (email: john.sf@mso.umt.edu). If you prefer the more public route, you can post your responses here on my blog. Either way, because I’m in 24/7 theories mode, you may not hear back from me until middle November!
There’s a chance I might want to quote one or more of you in the theories text, instructor’s manual, student guide, or in this blog. If that’s the case, I will email you and request permission.
Thanks for considering this activity and request. Identity and identity development are fascinating. Whether we’re talking about multiple identities (intersectionality), emotions and behaviors (Blake), or the “microbes within us” (Yong), we all contain multitudes.
At long last, we’ve begun work on revising our Counseling and Psychotherapy Theories text for its 4th edition. Over the past several weeks, I’ve been putting in an hour or two a day, chipping away on chapter revisions, reaching out to reviewers, and planning with our new and very exciting co-author, Dr. Bryan Cochran, a highly esteemed psychology professor at the University of Montana. If you’re reading this, I want you to know of Bryan’s awesomeness (and if you’re Bryan, I want you to feel the pressure of this public announcement of your awesomeness) [hahahaha!]
You all probably know that our Theories textbook is far and away the Theories textbook with the most hilarity. No doubt, this is a rather low bar, given that I can’t find any funny stories in any other theories texts. We view theories hilarity to be extremely important in a theories text, because reading many theories texts can parallel the proverbial experience of watching paint dry.
Bryan’s addition to the writing team will give us something we need—an expert in the LGBTQ+ domain, and someone with a talent for telling stories that are simultaneously engaging, informative, and fun to read. Right now, he’s busy writing a “Lenses” chapter (to be Chapter 2) to orient readers to important theory-related lenses like (a) Queer theory, (b) Critical Race theory, (c) Intersectionality, and more. I, for one, can hardly wait for his Queer theory quips.
News Flash: In the past, I’ve put out broad calls for chapter reviewers. This time, I’m being selective and directly asking prominent theories experts to review chapters and offer guidance. Some examples: For the Adlerian chapter we’ve got Marina Bluvshtein (woohoo!) and Jon Sperry (wow!). For the Psychoanalytic chapter, we got Nancy McWilliams (amazing!) and Pratyusha Tammala-Narra (fantastic!).
If you happen to be a specific theories subject matter expert, you should email me at john.sf@mso.umt.edu to get in on the fun. Or if you have a prominent theories friend/colleague to recommend, have them email me.
As one last theories teaser, below I’m pasting a few excerpts from Nancy McWilliams’s 2021 article titled, “Diagnosis and Its Discontents: Reflections on Our Current Dilemma.” I love this article as it gives a glimpse into problems with contemporary diagnoses and how psychodynamic therapists use individualized assessment in ways to honor the real-life complexities clients bring into psychotherapy. The excerpts below are from her article, which is linked at the end of this post.
On Labeling
The idea that one is anxious (or depressed or obsessive) about something that has meaning is being lost. Fitting an individual into a category tends to foreclose exploration of what is unique to a patient; it especially prevents insights into unexpected aspects of a person’s psychology or exploration of areas that are felt as shameful – the very areas that are of particular value in planning and carrying out psychotherapy.
On the vexing ways in which patients think about themselves and their diagnoses
It used to be that a socially avoidant woman would come for therapy saying something like, “I’m a painfully shy person, and I need help learning how to deal better with people in social situations.” Now a person with that concern is likely to tell me that she “has” social phobia – as if an alien affliction has invaded her otherwise problem-free subjective life. People talk about themselves in acronyms oddly dissociated from their lived experience: “my OCD,” “my eating disorder,” “my bipolar.” There is an odd estrangement from one’s sense of an agentic self, including one’s own behavior, body, emotional and spiritual life, and felt suffering, and consequently one’s possibilities for solving a problem. There is a passive quality in many individuals currently seeking therapy, as if they feel that the prototype for making an internal psychological change is to describe their symptoms to an expert and wait to be told what medicine to take, what exercises to do, or what self-help manual to read.
On “chemical imbalances”
. . . viewing psychological suffering as a set of disorders that can be fixed or improved chemically can easily invite the obverse assumption that those painful experiences are ultimately caused by random or genetically based chemical differences among individuals. This is a false conclusion, of course, something like saying that because marijuana improves appetite, the cause of low appetite is lack of marijuana. But it is nevertheless a frequent leap of illogic – in the thinking of nonprofessionals and of some professionals as well – to ascribe much severe psychological suffering to a “chemical imbalance.” Such a construction tempts us to ignore all the painful other sources of psychological suffering, such as poverty, neglect, trauma, and the myriad ways in which human beings can injure each other psychologically.
On not overgeneralizing research findings/recommendations to unique patients
. . . consider patients at the extreme end of the obsessive-compulsive continuum, whose obsessions border on delusional beliefs, who suffer profound annihilation anxiety, who wholeheartedly believe they will die if they fail to carry out their rituals, and who regard the therapist with suspicion for not sharing their conviction – in other words, the subgroup of obsessive patients that Kernberg (1984) would consider as psychologically organized at the low borderline or psychotic level. My experience suggests that with this group exposure therapy not only fails, it demoralizes the patients, makes them feel like failures personally, and kills any hope they may have that psychotherapy can help. It also demoralizes therapists, who have been told again and again that exposure therapy is the treatment of choice for OCD. If they believe their teachers, such clinicians can easily conclude they are simply not good enough therapists.
If I’ve piqued your interest in “Diagnosis and its discontents” by Nancy McWilliams, here’s a pdf of the article.
I’ve got two events coming up, one sooner and one later.
This Friday, I’m doing the closing talk for Tamarack’s Grief Institute (which is on Thursday and Friday in Missoula, and available online too!).
This is late notice, as the end of day tomorrow (March 3) is the registration deadline. The whole Institute is worth attending. The fantastic Dr. Joyce Mphande-Finn kicks things off on Thursday morning. Then, the amazing Dr. Micki Burns takes over . . . and I’ll be bringing it home Friday afternoon. Check it out. Here’s a registration link:
This June, I have the incredible fortune of joining Dr. Jeff Linkenbach and the renowned Montana Summer Institute in Big Sky, Montana (and Livestream) from June 17-20. Here’s a description of what’s happening!
Reimagining Community Health:
Uncovering Positive Norms and & Activating Hidden
Protective Factors
In Big Sky, Montana and via Livestream: June 17-20, 2025
Join us at the 2025 Montana Summer Institute for three and a half transformative days dedicated to advancing community well-being. Through thought-provoking keynotes, interactive workshops, and engaging discussions, you’ll explore innovative strategies that leverage positive norms and amplify protective factors.
Learn to uncover hidden community strengths, identify untapped opportunities, and craft impactful communications that drive meaningful change. With insights from leading experts and experienced practitioners, you’ll gain practical tools to reimagine your approach to data, messaging, and the people you serve—all through a positive, effective frame.
Don’t miss this opportunity to expand your expertise, deepen your impact, and shape healthier, more resilient communities. For more information, visit www.montanainstitute.com
Is there any chance you will join us in June? It would be wonderful to have you there! Here is the Montana Discount Code to give $100 off the price: MSIMONT which would give $100 off registration
***********************
And here’s a fancy flyer for the Montana Summer Institute:
This post is for my Chinese friends, or my friends who speak Mandarin . . . or anyone who wants to read about the process of self-evaluation, the pain of self-reflection, and personal/professional growth.
Last year I was asked to participate as a psychotherapist for the One-Way Mirror Project. The project was inspired by the old and now classic “Three Approaches to Psychotherapy” videos. Not surprisingly, I was honored to be asked to participate, and said yes despite a number of challenging factors, including doing therapy late at night with a Chinese woman via Zoom. I share this because this post is about transparency and so I’m transparently beginning by making excuses for not being the best therapist I imagine myself to be.
Here’s the scenario: One session. Minimal pre-meeting information. Post-session viewing (by me) and commentary on my performance. One other therapist also met with the same client. I get to watch his session; he gets to watch mine. We then have a Zoom meeting to debrief and share our thoughts about our respective sessions (mine was in English; his was in Mandarin).
This was a super-interesting process.
Below, I’m sharing my written self-reflection comments. There’s also a video version . . . which is similar to, but not verbatim from, these notes. The comments are numbered sequentially.
I hope you enjoy this self-reflection/analysis. Thanks for reading.
John S-F – Commentary on His Session with Evelyn
My first reaction to watching this video of myself was embarrassment. I’m sharing this reaction because it’s true. I don’t want to pretend that I think this is a particularly good session.
That said, I also don’t think it was a particularly bad session. I did some things well, and some things less well. In this commentary I will try to describe: (a) what I’m doing (or trying to do), especially from different theoretical perspectives, (b) how Evelyn is responding, (c) what I’m doing well and what I’m doing that’s much less good.
In critiquing my own work, I’m also hoping to connect with all of you. Whether you’re a beginning student or an experienced professional psychotherapist, watching ourselves and hearing ourselves can be humbling and embarrassing. It’s natural for all of us to make mistakes and be imperfect . . . and in this session I do an excellent job of being imperfect😊. . . so much so that while watching the video, during several points I kept shouting at myself to “shut up!” So, that’s a glimpse into one thing I would change about MY behavior in this session. Although I’m okay with being imperfect, I’m not very comfortable with being as imperfect as I was in this session.
How I Work – 0:10 – This explanation has three main goals. First, I’m showing transparency, which is consistent with person-centered and feminist therapies. Second, I’m explaining the process of our session, which is a role induction designed to help clarify expectations. Third, I’m including an invitation for collaboration.
SFBT Opening Question – 1:30 – “If we have a useful meeting, what will we accomplish?” This is a goal-oriented question to help me be more aware of Evelyn’s vision of a successful session.
Evelyn’s Goal – 1:50 – Evelyn says she wants a “different perspective” of what she’s worried about.
JSF’s Goal – In a single session treatment, and maybe most therapy sessions, it’s best to begin with what the client wants. Evelyn’s goal is a “cognitive goal.” In this moment, I decide to go with George Kelly’s “Credulous approach to assessment,” which essentially means “believe the client.” That could be a variation of Carl Rogers’s assertion that we should “Trust the client, because the client knows what hurts and where to go.” JSF – Your goal is my goal, as long as it’s legal and healthy.”
What I Know – 2:25 – This is another effort to be like Carl Rogers and show transparency.
Feelings and Thoughts Around That – 3:00 – Here, I’m trying to prompt her to explore feelings and/or thoughts. She says, “So many worries overwhelming” and talks about not knowing what is overwhelming and then references social media, and four main issues/worries: (a) Fitness/body image/comparison, (b) feelings of unfairness related to gender issues, (c) she loves her partner, but “he is a man” (with sarcasm, implying he therefore cannot understand), (d) humiliation linked to breasts filling with milk involuntarily.
A Broad Summary/Paraphrase – I respond with an accurate summary of her four “feelings and thoughts”
“You can choose; I cannot” – 7:10 – Evelyn focuses on the inherent sex/gender unfairness as related to having a baby. In response, we discuss the burden of social responsibility and how she has internalized societal expectations around being a woman.
May I Share an Observation? – 8:30 – At this point, I try to be a mirror that reflects back to Evelyn what I’m experiencing as one of her positive attributes or strengths. When working across cultures, it’s especially important to be affirming of client strengths. I end this reflection using first-person pronouns—which is a language skill that Rogers used and called “Walking within” – 9:10
Evelyn Continues – 10:45 – to talk about feeling powerless and influenced by her age, generation, societal expectations, and then notes that she wants to “make peace with what she wants to be and what she can be.” The thought of having a baby is a particular trigger for her anxious thoughts and fears. – 11:15
An Intellectual Grasp – 12:15 – I observe that Evelyn has a good intellectual grasp of feminism and of her internalized expectations about how women should be.
A Reflection and SFBT Question – 12:35–13:29 – Using too many words, I finally get out a “Unique outcomes” question: “How have you dealt with internalized fears and conflicts before?”
I Love That Question – 13:35 – Evelyn reflects on a story from age 24 and provides examples of how she felt time running out, dated like crazy, was very brave, and fought back toward her goal of a loving relationship even after having her heart broken.
How did you manage? – 15:03 – I continue to pursue Evelyn’s pre-existing strengths and insights around, with a bit of a focus on what motivated her to “fight back.”
As a Good Therapist – 15:35 – Evelyn expresses motivation to be a good therapist and that requires expansive live experiences.
Anything Else Pull You – 16:54 – Evelyn shares an early fear of death, noting, after an anecdote, that her class presentation on death left her feeling “more lonely (or different) than ever.” – 17:54. [not psychoanalytic]
I Reflect – 18:30 – Being a better therapist and fear of death motivate her to live a life full of experiences.
Imagine self at end of life – 19:00 – Found someone I love and would like to have a child. I want to try it. That would complete my experience. – 19:30
Values vs. Anxieties – 19:55 – Still feel anxieties. “I have to carry a child” etc. . . walking within. Amplifying expectations so she can hear them.
That’s my barrier –
Fought those off those expectations before – 20:45 – And yet . . . you have fought off expectations before. What makes you think you will be a victim to those expectations in the future? Here, I’m trying to identify what CBT people might consider an “irrational” or “maladaptive” thought/belief that doesn’t have much evidence to support it. Also, exception. . .
Focus on the Physical/Somatic – 22:25 – Evelyn notes this task is “harder” and supports that with physical changes she’s experiencing with aging. . . and I interpret that as “Anticipatory grief” regarding her physical decline [this is likely death anxiety too]
Self-Disclosure – 23:40 – May I share something? “I have a 35-y/o daughter with similar issues.” [Too many words! Should have stopped when Evelyn laughed and put her hand to her face and then explored her initial reaction]. I finally get to “What’s your reaction?” [Late, but I got there]. She says . . . and this is potentially central to “one” therapy goal: “I feel, like, less lonely.” [Again, I should just stop there or repeat it back. . . or “What’s it like inside to feel less lonely?”].
Curious about what I could learn from her – 25:35 – I turn this around. Why? Because I want her to value herself as a source of wisdom.
When I share with my partner – 26:25 – She notes “he can relate” and that “men are limited.” [This could have been good transference exploration or Adlerian basic mistake]
Session shift to “so much feeling” – 27:16 – Evelyn is talking about her emotionality, I’m reflecting ok. More on unfairness, but notes BF is pretty accepting. I do a strength-based reflection, “Openness, strength, do not run from feelings!” This is a little CBT as I want her to “perceive” herself with more strengths to cope with her future challenges.
Thoughts about yourself? – 31:00 – I’ve been working on some CBT stuff and now am shifting back to the important self-evaluation process. Her response is constructive as she describes lots of planning she has already done for this coming year.
I want to hear out my fears – 32:10 – This is a great insight on her part. It prompts me to have her listen to her fears in the here and now. Evelyn responds [33:10] that she likes that question and explores, perhaps with a tiny bit of surprise, that her fears are not harsh, but more of a gentle reminder to not have regrets. [Here, I could and probably should have had her get deeper into here and now processing. “Let’s have you hear the gentle voice of your fear right now. What’s it saying to you? Say it as if you are the fear. Also, could have used repetition.]
Reflections and WW – I stay with the themes and use WW to keep bringing them back. Why? In part, desensitization. Hearing her anxiety-producing words in a potentially trusting/comforting setting can take some edge or power out of them [MCJ – 1924]. She says, somewhat conclusively, “Sounds like fear just wants me to get prepared and not critique.” [One thought, I could have been her child and asked her to tell me what she has learned.]
Evelyn asks JSF Q – 36:28 – This is one place where I fall off the rails. She asked me a question and my obnoxious, intellectual, professor-self emerges. . . for far too long. [I could have said, “I have some thoughts about that, but I’d like to hear yours first.”] Instead, JSF blah, blah, blah, and to compound the error, I do not check in on her reaction.
Evelyn continues exploring – 40:52 – She notes Yuval Harrare and feminism as a new way to resolve conflicts without war. I do manage to shift back to listening with a pretty good paraphrase: “Communication with your partner may be your best way to grow and develop and maintain your feminist identity through childbirth and your relationship.”
Evelyn recognizes perfect equality not possible – 42:35 – JSF “Love what you said. What do you think? How does it feel?” [2 Qs, boo, but my focus on her self-evaluation is still pretty solid.] I continue with “What’s your assessment of yourself and your communication skills?” I’m hoping she can express trust in her communication skills.
Non-violent communication as restraint – 46:00 – This is an interesting side road where E says, “Sometimes I just want to be violent and like a child” and notes that she prefers “emotionally charged communication.” She finds emotions and aggressive communication to be helpful. [Note: at this point I’m beginning to feel time pressure. No time to go deeper. If more sessions, I’d earmark this and close. Instead, I ask, “Is it ok to have both” (nonviolent and emotional communication) as a quick prompt toward integration.
Moving toward closing – 49:00 – I’ve lost track of time because of early tech problems. I’d like to think that’s my excuse for ending poorly. First, I begin a summary. This isn’t good. It’s MY summary . . . and I should be asking for HER summary before offering mine. I’m far too verbal. The content isn’t terrible.
Thank-you so much – 52:45 – She’s tracking time, and this should be it. I’m not. And do another disclosure and ask for her summary.
Sorry for all the posts, but apparently there’s lots happening in early 2025.
The big NEWS post won’t be until tomorrow.
As you know, on this Friday, January 10, I’ll be doing an online, two-hour workshop on Strategies for Integrating Traditional and Strengths-Based Approaches to Suicide for the Cognitive Behavior Institute.
I’m posting the workshop handouts here, in advance, for anyone interested.
John Sommers-Flanagan 