Tag Archives: Counseling

Teenagers and Depression

Every year, every month, and every day, many teenagers complain of feeling down, depressed, or sad and some of them just act with immense irritability. You probably knew that. But, how many teens are experiencing symptoms of depression?

Estimates are wide ranging. The National Institute of Mental Health reported that approximately 12.5% of U.S. youth from 12-17 years-old experienced at least one episode of major depressive disorder. That’s a huge number of American teenagers (about 3 million).

Add to that the many more teenagers who complain of feeling depressed or down, but who don’t officially meet the diagnostic criteria for clinical depression. By some estimates, that brings the number to close to 50% of teens who are consistently bothered by sad, bad, and irritable feelings.

If you’re a parent of a teen, it’s easy to feel concerned about your teenager’s emotional health.

You may have questions like the following

  • Is my teenager clinically depressed or just going through the normal emotional ups and downs of adolescence?
  • Should I take my son or daughter to a mental health professional?
  • What about medications? Are any of the antidepressants safe and effective for teenagers?

The answers to these questions are complex. It’s hard to tell whether a teenager is in a normal emotional angst or experiencing something more insidious and chronic. And, the answer to the question about whether antidepressant medications are safe and effective with teens is a solid: “Maybe, but maybe not.”

In the latest Practically Perfect Parenting Podcast, Dr. Sara and I take on the serious topic of teenage depression. There are no laughs or giggles, but you’ll get to hear Sara ask me many questions about teen depression, and you’ll get to hear me try to answer them, which is sort of funny. You’ll hear the answer to my favorite trivia question: “What percent of children “recovered” from their depressive symptoms in the first-ever double-blind, placebo-controlled study of antidepressant medications?” And yes, once again, you’ll hear Sara find a way to mention sex during our podcast.

If you have teenagers yourself, or you know someone who has teenagers, or you’re a helping professional who works with teenagers, this podcast may be of interest or helpful to you. Check it out here on iTunes: https://itunes.apple.com/us/podcast/practically-perfect-parenting-podcast/id1170841304?mt=2

If you listen and like it, please share it, and then do us one little favor—rate the podcast on iTunes. That way Sara and I can keep climbing up the charts in reality—rather than just in our imaginations.

JSF Dance Party

Goodnight, South Carolina

Some days . . . the news is discouraging. Some days . . . evidence piles up suggesting that nearly everyone on the planet is far too greedy and selfish. On those days, I can’t help but wonder how our local, national, and worldwide communities survive. It feels like we’re a hopeless species heading for a cataclysmic end.

Sunset on StillwaterBut then I have a day like yesterday. A day where I had the honor and privilege to spend time hanging out with people who are professional, smart, compassionate, and dedicated to helping children learn, thrive, and get closer to reaching their potentials. I’m sure you know what I mean. If you turn off the media and peek under the surface, you’ll find tons of people “out there” who wake up every day and work tremendously hard to make the world just a little bit better, for everyone.

For me, yesterday’s group was the South Carolina Association of School Psychologists. They were amazing. They were kind. About 110 of them listened to me drone on about doing counseling with students who, due, in part, to the quirky nature of universe, just happen to be living lives in challenging life and school situations. The school psychologists barely blinked. They rarely checked their social media. They asked great questions and made illuminating comments. They were committed to learning, to counseling, to helping the next generation become a better generation.

All day yesterday and into the night I had an interesting question periodically popping up in the back of my mind. Maybe it was because while on my flight to South Carolina, I sat next to a Dean of Students from a small public and rural high school in Wisconsin. Maybe it was because of the SCASP’s members unwavering focus and commitment to education. The question kept nipping at my psyche. It emerged at my lunch with the Chair of the Psychology Department at Winthrop University.  It came up again after my dinner with four exceptionally cool women.

The question: “How did we end up with so many people in government who are anti-education?”

Yesterday, I couldn’t focus in on the answer. I told someone that–even though I’m a psychologist–I don’t understand why people do the things they do. But that was silly. This morning the answer came flowing into my brain like fresh spring Mountain run-off. Of course, of course, of course . . . the answer is the same as it always has been.

The question is about motivation. Lots of people before me figured this out. I even had it figured out before, but, silly me, I forgot. Why do people oppose education when, as John Adams (our second President) said, “Laws for the liberal education of youth, especially for the lower classes of people, are so extremely wise and useful that to a humane and generous mind, no expense for this purpose would be thought extravagant.”

The answer is all about money and power and control and greed and revenge and ignorance. Without these motivations, nearly everyone has a “humane and generous mind” and believes deeply in funding public education.

Thanks to all the members of the South Carolina Association of School Psychologists, for giving me hope that more people can be like you, moving past greed and ignorance and toward a more educated and better world.

Good night, South Carolina. It’s been a good day.

 

Revisiting the 3-Step Emotional Change Trick — Including a Video Example

One of my current students asked where she might find a video example of the 3-Step Emotional Change Trick. Since I made up the Emotional Change Trick in 1997, the answer was easy: No such video exists.

Then I remembered that this past summer, while putting together video content with Wiley for our Clinical Interviewing text, I did a video demo of the 3-Step ETC with a 12-year-old girl. Due to space considerations, the footage didn’t make it into the text, but Wiley sent me a copy of the 6:44 minute clip.

Keep in mind that the girl in this video is exceptional. She’s the daughter of some friends and she agreed to be filmed for educational purposes. My sense is that she could have taught me the 3-Step ECT, but I tried to make it look like I was teaching her anyway.

Here’s the youtube link: https://www.youtube.com/watch?v=ITWhMYANC5c

And below you can read a version of the Emotional Change Technique adapted from Tough Kids, Cool Counseling:

*************************

The Three-Step, Push-Button Emotional Change Technique

            An early and prominent Adlerian therapist, Harold Mosak, originally developed and tested the push-button technique as a method for demonstrating to clients that thinking different thoughts can effectively change mood states (Mosak, 1985). The purpose of Mosak’s technique was to help clients experience an increased sense of control over their emotions, thereby facilitating a sense of encouragement or empowerment (Mosak, 2000, personal communication).

            Mosak’s push-button technique can be easily adapted to work with young clients. When we implement this technique with younger clients, we are playful and call it an emotional change trick. When using this technique with teenagers, we describe it as a strategy for gaining more personal control over less desirable emotions. In essence, the three-step, push-button, emotional change technique is an emotional education technique; the primary goal is to teach clients that, rather than being at the mercy of their feelings, they may learn some strategies and techniques that provide them with increased personal control over their feelings.

The following example illustrates Adlerian emotional education principles and Mosak’s push-button technique expanded to three distinct steps.

Case example.  Sam, a 13-year-old European American boy, was referred because of his tendency to become suddenly stubborn, rigid, and disagreeable when interacting with authority figures. Sam arrived for his appointment accompanied by his mother. It quickly became obvious that Sam and his mother were in conflict. Sam was sullen, antagonistic, and difficult to talk with for several minutes at the outset of the session. Consequently, the Three-Step, Push-Button Emotional Change Technique (TSPB) was initiated:

Preparation/Explanation.

JSF:     I see you’re in a bad mood today. I have this . . . well, it’s kind of a magic trick and I             thought maybe you’d be interested. Want to hear about it?

S:         (Shrugs).

JSF:     It’s a trick that helps people get themselves out of a bad mood if they want to. First, I need to tell you what I know about bad moods. Bad moods are weird because even             though they don’t really feel good, lots of times people don’t want to get out of their bad mood and into a better mood. Do you know what I mean? It’s like you kind of want to stay in a bad mood; you don’t want anybody forcing you to change out of a bad mood.

S:         (Nods in agreement.)

JSF:     And you know what, I’ve noticed when I’m in a bad mood, I really hate it when someone comes up to me and says: “Cheer up!” or “Smile!”

S:         Yeah, I hate that too.

JSF:     And so you can be sure I’m not going to say that to you. In fact, sometimes the best thing to do is just really be in that bad mood—be those bad feelings. Sometimes it feels great to get right into the middle of those feelings and be them.

S:       Uh, I’m not sure what you’re talking about.

JSF:     Well, to get in control of your own feelings, it’s important to admit they’re there, to get to   know them better. So, the first step of this emotional change trick is to express your bad feelings. See, by getting them out and expressing them, you’re in control. If you don’t  express your feelings, especially icky ones, you could get stuck in a bad mood even    longer than you want.

As you can see, preparation for the TSPB technique involves emotional validation of how it feels to be in a bad mood, information about bad moods and how people can resist changing their moods or even get stuck in them, hopeful information about how people can learn to change their moods, and more emotional validation about how it feels when people prematurely try to cheer someone up.

Step 1: Feel the feeling. Before moving clients away from their negative feelings, it’s appropriate—out of respect for the presence and meaning of emotions—to help them feel their feelings. This can be challenging because most young people have only very simplistic ideas about how to express negative feelings. Consequently, Step 1 of the TSPB technique involves helping youth identify various emotional expression techniques and then helping them to try these out. We recommend brainstorming with young clients about specific methods for expressing feelings. The client and counselor should work together (perhaps with a chalk/grease board or large drawing pad), generating a list of expressive strategies that might include:

  • scribbling on a note pad with a black marker
  • drawing an angry, ugly picture
  • punching or kicking a large pillow
  • jumping up and down really hard
  • writing a nasty note to someone (but not delivering it)
  • grimacing and making various angry faces into a mirror
  • using words, perhaps even yelling if appropriate, to express specific feelings.

The expressive procedures listed above are easier for young clients to learn and understand when counselors actively model affective expression or assist clients in their affective expression. It’s especially important to model emotional expression when clients are inhibited or unsure about how to express themselves. Again, we recommend engaging in affective expression jointly with clients. We’ve had particular success making facial grimaces into a mirror. (Young clients often become entertained when engaging in this task with their counselor.) The optimal time for shifting to Step 2 in the TSPB technique is when clients have just begun to show a slight change in affect. (Often this occurs as a result of the counselor joining the client in expressing anger or sadness or general nastiness.)

Note: If a young client is unresponsive to Step 1 of the TSPB technique, don’t move to Step 2. Instead, an alternative mood-changing strategy should be considered (e.g., perhaps food and mood or the personal note). Be careful to simply reflect what you see. “Seems like you aren’t feeling like expressing those yucky feelings right now. Hey, that’s okay. I can show you this trick some other day. Want some gum?”

Step 2: Think a new thought (or engage in a new behavior). This step focuses on Mosak’s push-button approach (Mosak, 1985). It’s designed to demonstrate to the client that emotions are linked to thoughts. Step 2 is illustrated in the following dialogue (an extension of the previous case example with John and Sam):

JSF:     Did you know you can change your mood just by thinking different thoughts? When you think certain things it’s like pushing a button in your brain and the     things you think start making you feel certain ways. Let’s try it. Tell me the funniest thing that happened to you this week.

S:         Yesterday in math, my friend Todd farted (client smiles and laughs).

JSF:     (Smiles and laughs back) Really! I bet people really laughed. In fact, I can see it makes you laugh just thinking about it. Way back when I was in school I had a friend who did that all the time.

The content of what young people consider funny may not seem particularly funny to adults. Nonetheless, it’s crucial to be interested and entertained—welcoming the challenge to empathically see the situation from the 13-year-old perspective. It’s also important to stay with and build on the mood shift, asking for additional humorous thoughts, favorite jokes, or recent events. With clients who respond well, counselors can pursue further experimentation with various affective states (e.g., “Tell me about a sad [or scary, or surprising] experience”).

In some cases, young clients may be unable to generate a funny story or a funny memory. This may be an indicator of depression, as depressed clients often report greater difficulty recalling positive or happy events (Weerasekera, Linder, Greenberg, & Watson, 2001). Consequently, it may be necessary for the counselor to generate a funny statement.

S:         I can’t think of anything funny.

JSF:     Really? Well, keep trying . . . I’ll try too (therapist and client sit together in silence for about 20 seconds, trying to come up with a positive thought or memory).

JSF:     Got anything yet?

S:         Nope.

JSF:     Okay, I think I’ve got one. Actually, this is a joke.  What do you call it when 100 rabbits standing in a row all take one step backwards?

S:         Huh?

JSF:     (repeats the question)

S:         I don’t know.  I hate rabbits.

JSF:     Yeah.  Well, you call it a receding hare line.  Get it?

S:         Like rabbits are called hares?

JSF:     Yup.  It’s mostly funny to old guys like me.  (JSF holds up his own “hare line”)

S:         That’s totally stupid, man (smiling despite himself). I’m gonna get a buzz cut pretty             soon.

When you tell a joke or a funny story, it can help clients reciprocate with their own stories.  You can also use teasing riddles, puns, and word games if you’re comfortable with them.

We have two additional comments for counselors who might choose to use a teasing riddle which the client may get wrong. First, you should use teasing riddles only when a strong therapeutic relationship is established; otherwise, your client may interpret teasing negatively. Second, because preteen and teen clients often love to tease, you must be prepared to be teased back (i.e., young clients may generate a teasing riddle in response to a your teasing riddle).

Finally, counselors need to be sensitive to young clients who are unable to generate a positive thought or story, even after having heard an example or two. If a young client is unable to generate a funny thought, it’s important for you to remain positive and encouraging. For example:

JSF:     You know what. There are some days when I can’t think of any funny stories either. I’m sure you’ll be able to tell me something funny next time. Today I was able to think of some funny stuff . . . next time we can both give it a try again if you want.

Occasionally, young clients won’t be able to generate alternative thoughts or they won’t understand how the pushbutton technique works. In such cases, the counselor can focus more explicitly on changing mood through changing behaviors. This involves getting out a sheet of paper and mutually generating a list of actions that the client can take—when he or she feels like it—to improve mood.

Sometimes depressed young clients will need to borrow from your positive thoughts, affect, and ideas because they aren’t able to generate their own positive thoughts and feelings. If so, the TSPB technique should be discontinued for that particular session. The process of TSPB requires completion of each step before continuing on to the next step.

Step 3: Spread the good mood. Step 3 of this procedure involves teaching about the contagion quality of mood states. Teaching clients about contagious moods accomplishes two goals. First, it provides them with further general education about their emotional life. Second, if they complete the assignment associated with this activity, they may be able to have a positive effect on another person’s mood:

JSF:     I want to tell you another interesting thing about moods. They’re contagious. Do you  know what contagious means? It means that you can catch them from being around other  people who are in bad moods or good moods. Like when you got here. I noticed your  mom was in a pretty bad mood too. It made me wonder, did you catch the bad mood from    her or did she catch it from you? Anyway, now you seem to be in a much better mood. And so I was wondering, do you think you can make your mom “catch” your good mood?

S:         Oh yeah. I know my mom pretty well. All I have to do is tell her I love her and she’ll get all mushy and stuff.

JSF:     So, do you love her?

S:         Yeah, I guess so. She really bugs me sometimes though, you know what I mean?

JSF:     I think so. Sometimes it’s especially easy for people who love each other to bug each other. And parents can be especially good at bugging their kids. Not on purpose, but they bug you anyway.

S:         You can say that again. She’s a total bugging expert.

JSF:     But you did say you love her, right?

S:         Yeah.

JSF:     So if you told her “I love you, Mom,” it would be the truth, right?

S:         Yeah.

JSF:     And you think that would put her in a better mood too, right?

S:         No duh, man. She’d love it.

JSF:     So, now that you’re in a better mood, maybe you should just tell her you love her and spread the good mood. You could even tell her something like: “Dude, Mom, you really   bug me sometimes, but I love you.”

S:         Okay. I could do that.

It’s obvious that Sam knows at least one way to have a positive influence on his mother’s mood, but he’s reluctant to use the “I love you” approach. In this situation it would be useful for Sam to explore alternative methods for having a positive effect on his mother’s mood.

Although some observers of this therapy interaction may think the counselor is just teaching Sam emotional manipulation techniques, we believe that viewpoint makes a strong negative assumption about Sam and his family. Our position is that successful families (and successful marriages) include liberal doses of positive interaction (Gottman et al., 1995). Consequently, unless we believe Sam is an exceptionally manipulative boy (i.e., he has a conduct disorder diagnosis), we feel fine about reminding him of ways to share positive (and truthful) feelings with his mother.

To spread a good mood requires a certain amount of empathic perspective taking. Often, youth are more able to generate empathic responses and to initiate positive interactions with their parents (or siblings, teachers, etc.) after they’ve achieved an improved mood state and a concomitant increased sense of self-control. This is consistent with social–psychological literature suggesting that positive moods increase the likelihood of prosocial or altruistic behavior (Isen, 1987). Because of developmental issues associated with being young, it’s sometimes helpful to introduce the idea of changing other people’s moods as a challenge (Church, 1994).  “I wonder if you have the idea down well enough to actually try and change your mom’s mood.”

Once in a while, when using this technique, we’ve had the pleasure of witnessing some very surprised parents. One 12-year-old girl asked to go out in the waiting room to tell her grandmother that she was going to rake the lawn when they got home (something Grandma very much wanted and needed). Grandma looked positively stunned for minute, but then a huge smile spread across her face. The girl skipped around the office saying, “See.  I can do it.  I can change her mood.”

One 14-year-old boy thought a few minutes, then brought his mom into the office and said “Now Mom, I want you to think of how you would feel if I agree to clear the table and wash the dishes without you reminding me for a week.” Mom looked a bit surprised, but admitted she felt good at the thought, whereupon I (John) gave the boy a thumbs up signal and said, “Well done.”

Step 4.

At this point, readers should beware that although we’re describing a Three-Step technique, we’ve now moved to Step 4. We do this intentionally with young clients to make the point that whenever we’re working with or talking about emotions, surprising things can happen.

In keeping with the learn-do-teach model, we ask our young clients to teach the TSPB procedure to another person after they learn it in therapy. One girl successfully taught her younger brother the method when he was in a negative mood during a family hike. By teaching the technique to her brother, she achieved an especially empowering experience; she began to view herself as having increased control over her and her family’s emotional states.

A Brief Description of Motivational Interviewing

In response to some questions on CESNET, I’m posting a brief description of Motivational Interviewing. Of course, Miller and Rollnick’s Motivational Interviewing text is a much more thorough source and is highly recommended if you want more complete information.

This description is an excerpt from the second edition of our Counseling and Psychotherapy Theories textbook. If you’re interested, you can check it out here: http://bcs.wiley.com/he-bcs/Books?action=index&itemId=0470617934&bcsId=7103

For the third edition (in preparation now), we’ll be substantially expanding this section and so if you have insights, publications, or other information that you think we should be aware of, please email me at john.sf@mso.umt.edu.

Here’s the excerpt:

Motivational Interviewing: A Contemporary PCT Approach

Person-Centered Therapy (PCT) principles have been integrated into most other approaches to counseling and psychotherapy. However, there are three specific approaches that are explicitly new generation person-centered therapies. These include:

  1. Motivational interviewing
  2. Emotion-focused therapy
  3. Nondirective play therapy

Next, we discuss motivational interviewing. Due to its strong integrational characteristics, emotion-focused therapy is covered in Chapter 14. Additional resources are available on nondirective play therapy (Landreth, 2002).

Moving Away From Confrontation and Education

In his research with problem drinkers, William R. Miller was studying the efficacy of behavioral self-control techniques. To his surprise, he found that structured behavioral treatments were no more effective than an encouragement-based control group. When he explored the data for an explanation, he found that regardless of treatment protocol, therapist empathy ratings were the strongest predictors of positive outcomes at 6 months (r = .82), 12 months (r = .71), and 2 years (r = .51; W. R. Miller, 1978; W. R. Miller & Taylor, 1980). Consequently, he concluded that positive treatment outcomes with problem drinkers were less related to behavioral treatment and more related to reflective listening and empathy. He also found that active confrontation and education generally led to client resistance. These discoveries led him to develop motivational interviewing (MI).

MI builds on person-centered principles by adding more focused therapeutic targets and specific client goals. Rollnick and Miller (1995) define MI as “a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence” (p. 326).

Focusing on Client Ambivalence

Client ambivalence is the primary target of MI. When it comes to substance abuse and other health related behaviors, Miller and Rollnick (2002) view ambivalence as natural. Most all problem drinkers recognize or wish they could quit, but continue drinking for various reasons. Miller and Rollnick described what happens when therapists try to push healthy behaviors on clients:

[The therapist] then proceeds to advise, teach, persuade, counsel or argue for this particular resolution to [the client’s] ambivalence. One does not need a doctorate in psychology to anticipate what [the client’s] response is likely to be in this situation. By virtue of ambivalence, [the client] is apt to argue the opposite, or at least point out problems and shortcomings of the proposed solution. It is natural for [the client] to do so, because [he or she] feels at least two ways about this or almost any prescribed solution. It is the very nature of ambivalence. (pp. 20–21)

In many situations, humans are naturally inclined to resist authority. Therefore, when resistance rises up in clients, MI advocates person-centered attitudes and interventions. This leads to Miller and Rollnick’s (2002) foundational person-centered principle of treatment:

It is the client who should be voicing the arguments for change (p. 22).

Although Miller and Rollnick describe Rogers as collaborative, caring, and supportive—they emphasize that he was not nondirective (W. R. Miller & Rollnick, 1998). Instead, they note that Rogers gently guided clients to places where they were most confused, in pain, or agitated and then helped them stay in that place and work through it. The four central principles of MI flow from their conceptualization of Rogers’s approach (W. R. Miller & Rollnick, 2002). According to these principles, it’s the therapist’s job to:

  • Use reflective listening skills to express empathy for the client’s message and genuine caring for the client.
  • Notice and develop the theme of discrepancy between the client’s deep values and current behavior.
  • Meet client resistance with reflection rather than confrontation (Miller and Rollnick refer to this as “rolling with resistance”).
  • Enhance client self-efficacy by focusing on optimism, confidence that change is possible, and small interventions that are likely to be successful.

MI is both a set of techniques and a person-centered philosophy or style. The philosophical MI perspective emphasizes that motivation for change is not something therapists can effectively impose on clients. Change must be drawn out from clients, gently and with careful timing. Motivational interviewers do not use direct persuasion.

A Sampling of MI Techniques

Miller and Rollnick (2002) provide many excellent examples of how reflection responses reduce resistance. The following interactions capture how reflection of client efforts lessens the need for resistance:

Client: I’m trying! If my probation officer would just get off my back, I could focus on getting my life in order.

Interviewer: You’re working hard on the changes you need to make.

or

Interviewer: It’s frustrating to have a probation officer looking over your shoulder.

Client: Who are you to be giving me advice? What do you know about drugs? You’ve probably never even smoked a joint!

Interviewer: It’s hard to imagine how I could possibly understand.

Client: I couldn’t keep the weight off even if I lost it.

Interviewer: You can’t see any way that would work for you.

or

Interviewer: You’re rather discouraged about trying again. (pp. 100–101)

In the following excerpt from Clinical Interviewing (2009), we describe the MI technique of amplified reflection:

Recently, in hundreds of brief interviews conducted by graduate students in psychology and counseling with client—volunteers from introductory psychology courses, consistent with Miller and Rollnick’s (2002) motivational interviewing work, we found that clients have a strong need for their interviewers to accurately hear what they’re saying. When their interviewer made an inaccurate reflection, clients felt compelled to clarify their feelings and beliefs—often in ways that rebalanced their ambivalence.

For example, when an interviewer “went too far” with a reflection, the following exchange was typical:

Client: I am so pissed at my roommate. She won’t pick up her clothes or do the dishes or anything.

Interviewer: You’d sort of like to fire her as a roommate.

Client: No. Not exactly. There are lots of things I like about her, but her messiness really annoys me.

This phenomenon suggests that it might be possible for interviewers to intentionally overstate a client’s position in an effort to get clients to come back around to clarify or articulate the more positive side of an issue. In fact, this is a particular motivational interviewing technique referred to as amplified reflection.

When used intentionally, amplified reflection can seem manipulative, which is why amplified reflection is used along with genuine empathy. Instead of being a manipulative response it can also be viewed as an effort on the interviewer’s part to more deeply empathize with the client’s frustration, anger, discouragement, and so on. Examples of this technique include:

Client: My child has a serious disability and so I have to be home for him.

Interviewer: You really need to be home 24/7 and really need to turn off any needs you have to get out and take a break.

Client: Actually, that’s not totally true. Sometimes, I think I need to take some breaks so I can do a better job when I am home.

Client: When my grandmother died last semester I had to miss classes and it was a total hassle.

Interviewer: You don’t have much of an emotional response to your grandmother’s death—other than it really inconveniencing you.

Client: Well, it’s not like I don’t miss her, too.

Again, we should emphasize that amplified reflection is an empathic effort to get completely in touch with or resonate with one side of the client’s ambivalence (from J. Sommers-Flanagan & Sommers-Flanagan, 2009, pp. 316–317).

End of excerpt

On Becoming a Counselor: What’s a Rogerian, Anyway? by Lauren Leslie

carl-rogers

IMHO, more people should read Carl Rogers. But I understand, sometimes there just isn’t enough time in the day to fit in your Yoga class, mindfulness meditation practice, cardio workout, meal prep, work and family-life, and other responsibilities. So here’s an option: Below you’ll find a review of a classic Carl Rogers work: On Becoming a Person. It was written by Lauren Leslie to fulfill an assignment I give in our Counseling Theories class. It’s a fun read and gives you an abbreviated glimpse of the amazing Carl Rogers from the perspective of a first-year graduate student in clinical mental health counseling.

On Becoming a Counselor: What’s a Rogerian, Anyway?

Lauren Leslie
University of Montana

            Carl Rogers’ On Becoming a Person is a collection of essays and edited speeches written between 1951 and 1961, while client-centered humanistic therapy was being simultaneously embraced and challenged by the establishment. Rogers states he intends to write to professional psychologists, members of the counseling profession, and informed laymen, different populations who nonetheless have at least one thing in common:

. . .while the group to which this book speaks meaningfully will…have many wide-ranging interests, a common thread may well be their concern about the person and his  becoming, in a modern world which appears intent upon ignoring or diminishing him. (Rogers, 2012, “To the Reader” para. 8)

Throughout the text, Rogers offers a picture of himself as a person and a therapist. He provides insights into the growth of his theoretical framework as well as therapy transcripts to flesh out central elements of client-centered practice. Ultimately, the text crystallizes the effectiveness of empathy, congruence, and unconditional positive regard within a therapeutic relationship, and it is difficult to argue against Rogers’ persuasive and clear writing. Critics insist Rogers’ model is incomplete or insufficient, but the core tenets remain central to the practice of contemporary psychotherapy.

On Becoming a Person collects texts of varying genres into a sort of holistic catalog of Rogerian thought. Due to this variety of genre, Rogers’ tone and subject matter shifts; he addresses his own personality and life, includes transcripts of counseling sessions, and tries to systematize examples of his practice into stages of client development to analyze effectiveness of treatment. Rogers philosophizes on the human condition and therapeutic practice, Kierkegaard and Buber, and scientific research and personal change. It is a sweeping book which attempts meaningful understanding and data-driven conclusions. At one point, Rogers claims “There is no general agreement as to what constitutes ‘success’ [in psychotherapy]…. The concept of ‘cure’ is entirely inappropriate, since … we are dealing with learned behavior, not with a disease” (Rogers, 2012, p. 227). He consistently moves in opposition to the kind of concrete, experimental thinking favored in certain parts of the psychological community and comes off far more as a philosopher studying existential questions than as a data-driven scientist.

In considering himself, Rogers (2012) states, a client “discovers how much of his life is guided by what he thinks he should be, not by what he is. Often he discovers that he exists only in response to the demands of others…” (p. 109). In the same passage, he muses on the insight of Kierkegaard on this point: “He points out that…the deepest form of despair is to choose ‘to be another than himself.’ On the other hand, ‘…to be that self which one truly is, is indeed the opposite of despair,’” (p. 109). If this isn’t existential philosophy, the reader must ask, what is? In his own practice, Rogers (2012) characterizes a fundamental shift from “How can I treat, or cure, or change this person?” (p. 32) to his later, fuller question “How can I provide a relationship which this person may use for his own personal growth?” (p. 32). From his training in psychology, Rogers claims to have followed his own instincts into client-centered therapy. His writing overtly embraces that exploration.

Despite his philosophical bent, in large sections of his writing, Rogers draws on established scientific structures or language. He writes a whole chapter which tries to formulate a “general law of interpersonal relationships,” then launches into a lengthy and example-laden consideration of the firmness of knowledge and conclusions within the behavioral sciences at the time. His cognitive resting place seems to be that the behavioral sciences are in their infancy, and while practitioners may rely on a lot of interesting information now being discovered, exploration, philosophy, and instinct still hold places of honor within the field. More than fifty years after the book’s first publication, the situation seems to have changed very little, though there is more data in certain areas. Though Rogers seems to have viewed psychotherapy as a scientific practice, his person-centered view showed him countless variables with which to contend. Perhaps in an environment without controls, philosophy and instinct present better-formed or more immediate solutions than experimentation can.

Rogers seems to boil complex situations down to essentials wherever he can: relationship is his central theme, and empathy, congruence, and unconditional positive regard are the three relationship components. This pursuit of simplicity may be attentiveness to the broad audience of On Becoming a Person or may be indicative of Rogers’ own worldview. Whatever its source, it leaves Rogers open to criticism from those who see things as unsimplifiable. In a similar way, the individual variation and client focus implicit in Rogers’ therapy leave him open to criticism from those who see him acting only as a clarifying mirror for clients, not as a truly congruent party to change-spurring relationships. In one example of a common critique, Ralph H. Quinn (1993) contends that “[a] fully person-centered therapist…would feel compelled to stay with the client’s lead…[and] trust that the client knows best” (p. 20) rather than confronting the client in a moment of genuine human response.

Genuineness in psychotherapy…does not mean simply the willingness to confront a client…. More than anything it means that the therapist must strive to be fully present with the client, to bring all of himself or herself to the therapeutic relationship. As therapists, we must be willing to risk as much as we ask our clients to risk, to be as transparent and courageous as they must be, if the therapy is to produce real life change. (Quinn, 1993, p. 20-21)

This section includes the assertion that bold congruence and full presence are not already parts of person-centered therapy, and Rogers was remiss in not addressing them. Quinn (1993) later implies a fully person-centered approach can easily be seen as practicing “Pollyannish optimism and therapeutic passivity” (p. 21). Such criticism is valid enough, and points out elements of Rogers’ work that may be over-simplified. However, the complexity with which Rogers addresses each essay, idea, and client interaction suggests he did not see humanity or psychotherapy as simple, and did not approach them passively. Rogers may not have dwelled enough in his writing on the practice of congruence; perhaps it was an element that seemed also to contain infinite variables and defy simple definition. I tend to think this criticism stems from a misinterpretation of Rogers’ intentions and practices. In the final analysis, even critic Quinn (1993) only suggests practicing more (riskier?) congruence on the part of the therapist, not abandoning Rogers’ principles.

In terms of my own use of this book, its variety in tone and subject matter makes it a uniquely useful text. Each section and each essay can be read independently, and dipping into Rogers’ world is a clarifying and centering experience that could bring me back to the core of therapeutic practice in times of questioning and uncertainty. Reading this book now gave me a window into the complexities inherent in a model that can be seen as very simple (by Rogers’ design, admittedly). Considering this approach in my own attempts to define or grasp client “distress” has been helpful in placing myself in the wide world of this human-helping profession, and has helped me frame my own conception of what I am doing here and what a client might want or need from me in this role. This reading has been one new way of incorporating personal change into myself: deliberately approaching the self I am discovering myself to be.

 

References

Quinn, R.H. (1993). Confronting Carl Rogers: A developmental-interactional approach to

person-centered therapy. Journal of Humanistic Psychology, 33(1), 6-23. doi:

10.1177/0022167893331002

Rogers, C. (2012). On Becoming a Person. [Kindle Voyage version]. Retrieved from

Amazon.com

The 6th Edition of Clinical Interviewing is Now Available

Way back in 1990, a university book salesman came by my faculty office at the University of Portland. He was trying to sell me some textbooks. When I balked at what he was offering, he asked, “Do you have any textbook ideas of your own?” I said something like, “Sure” or “As a matter of fact, I do.” He handed me his card and a paper copy of Allyn & Bacon’s proposal guidelines.

Not having ever written a book, I never thought they’d accept my proposal.

They did. But after three years, A & B dropped our text.

Lucky for us.

Two  years later, Rita and I decided to try to resurrect our Clinical Interviewing text. We polished up a proposal, sent it out to three excellent publishers, and immediately got contract offers from W. W. Norton, Guilford, and John Wiley & Sons.

We went with Wiley.

Here we are 18 years later in the 6th edition. It’s been fun and a ton of work. Over the past five years we’ve started recording video clips and interviewing demonstrations to go along with the text. For the 6th edition, we got some pretty fantastic reviews from some pretty fancy (and fantastic) people. Here they are:

“I’m a huge admirer of the authors’ excellent work.  This book reflects their considerable clinical experience and provides great content, engaging writing, and enduring wisdom.”
John C. Norcross, Ph.D., ABPP, Distinguished Professor of Psychology, University of Scranton

“The most recent edition of Clinical Interviewing is simply outstanding.  It not only provides a complete skeletal outline of the interview process in sequential fashion, but fleshes out numerous suggestions, examples, and guidelines in conducting successful and therapeutic interviews.  Well-grounded in the theory, research and practice of clinical relationships, John and Rita Sommers-Flanagan bring to life for readers the real clinical challenges confronting beginning mental health trainees and professionals.  Not only do the authors provide a clear and conceptual description of the interview process from beginning to end, but they identify important areas of required mastery (suicide assessment, mental status exams, diagnosis and treatment electronic interviewing, and work with special populations).  Especially impressive is the authors’ ability to integrate cultural competence and cultural humility in the interview process.  Few texts on interview skills cover so thoroughly the need to attend to cultural dimensions of work with diverse clients.  This is an awesome book written in an engaging and interesting manner.  I plan to use this text in my own course on advanced professional issues.  Kudos to the authors for producing such a valuable text.”
—Derald Wing Sue, Ph.D., Professor of Psychology and Education, Teachers College, Columbia University

“This 6th edition of Clinical Interviewing is everything we’ve come to expect from the Sommers-Flanagan team, and more!  Readers will find all the essential information needed to conduct a clinical interview, presented in a clear, straightforward, and engaging style.  The infusion of multicultural sensitivity and humility prepares the budding clinician not only for contemporary practice, but well into the future.  Notable strengths of the book are its careful attention to ethical practice and counselor self-care. The case studies obviously are grounded in the authors’ extensive experience and bring to life the complexities of clinical interviewing.  This is a ‘must-have’ resource that belongs on the bookshelf of every mental health counselor trainee and practitioner.”
Barbara Herlihy, PhD. NCC, LPC-S, University Research Professor, Counselor Education Program, University of New Orleans

You can check out the text on Amazon https://www.amazon.com/Clinical-Interviewing-John-Sommers-Flanagan/dp/1119215587/ref=dp_ob_title_bk  or Wiley http://www.wiley.com/WileyCDA/WileyTitle/productCd-1119215587.html  or other major (and minor) booksellers.

 

 

The Practically Perfect Parenting Podcast — Episode 2

Hello Parents, Fans of Parents, and Fans of Healthy Child Development:

I need a tiny bit of your time and help.

As you know, the Practically Perfect Parenting Podcast was launched on October 31. Yesterday, Episode 2 became live. The title: Practically Perfect Positive Discipline. Today, I’m flexing my marketing muscles (which, as it turns out, are disappointingly more like Gilligan’s than the Incredible Hulk)

Podcasts are a competitive media genre. One way we can try to improve our status from way out here in little Missoula, Montana is for people to listen, like, and rate.

Here’s how you can help:

If you use iTunes, here’s the link. https://itunes.apple.com/us/podcast/practically-perfect-parenting/id1170841304?mt=2#episodeGuid=2d80f23353e2c7f9d21af865f190d2c4

Please check it out and if you like it, like it, and then give it the rating you think it deserves. We’re trying to get enough ratings to climb up the iTunes rating list.

If you don’t use iTunes, you can get to our podcasts via this link: http://practicallyperfectparenting.libsyn.com/2016

And, either way, we’d love it if you’d like our Facebook page. To do that, go here: https://www.facebook.com/Practically-Perfect-Parenting-Podcast-210732536013377/?notif_t=page_fan&notif_id=1479160427608384

In addition to your social media ratings, we’re ALWAYS interested in your supportive or constructive feedback. We also take questions and suggestions for new show topics. You can provide any or all of that here on my blog or directly to me via email at john.sf@mso.umt.edu

Thanks!

Dr. John and Dr. Sara, The Practically Perfect Podcasters

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