Tag Archives: Counseling

Informed Consent in Counseling and Psychotherapy: Problems and Potential

A quick review of recent informed consent research leads me to think that informed consent should be a perfect blend of evidence-based information about the benefits, risks, and process of psychotherapy. Like all good hypnotic inductions, informed consent, has the potential to stir positive expectations or activate fear. But when I look at all that we’re supposed to include in informed consents I wonder, does anyone really read them? Informed consent could have significant effects on treatment process and outcome. But only if clients actually read the written document.

The alternative or a complementary strategy is a good oral description of informed consent. Again, as someone trained in hypnosis and sensitive to positive placebo effects, I’m inclined to use informed consent to set positive expectations. I think that’s appropriate, but it’s also easy for us, as practitioners, to become too enthusiastic and unrealistic about what we have to offer. The truth is that no matter how much passion I may have for a particular intervention, if there’s absolutely no scientific evidence to support my niche passion, and there is evidence to support other approaches, then I could come across like someone promoting ivermectin for treating COVID-19. If you think about the people who promote ivermectin, it’s likely they’re either (a) uninformed/misinformed and/or (b) profit-driven. To the extent that all professional helpers or healers aim to be honest and ethical in our informed consent processes, we should strive to NOT be uninformed/misinformed and to NOT be too profit-driven. I say “too profit-driven” because obviously, most clinical practitioners would like to make a profit. All this information about being balanced in our informed consent highlights how much we need to read and understand scientific research related to our practice and how much we need to check our enthusiasm for particular approaches, while remaining realistic, despite potential financial incentives. 

Informed Consent: Who Reads Them? Who Listens?

If informed consents are difficult to read and comprehend, they may be completely irrelevant. On the other hand, in their obtuseness, they may function like the confusion technique in hypnosis and psychotherapy. Although the confusion technique is pretty amazing and I’ll probably write more about it at some point, it’s inappropriate and unethical to use the confusion technique in the context of informed consent.

In medical and some therapy settings, informed consent often feels sterile. If you’re like me, you quickly sign the HIPAA and informed consent forms, without taking much time to read and digest their contents. The process becomes perfunctory. 

I recall a particularly memorable pre-surgery informed consent experience. After hearing a couple of low probability frightening outcomes and experiencing the sense of nausea welling up in my stomach, I stopped listening. I even recall saying to myself, “I can choose to not listen to this.” It was an act of intentional dissociation. I knew I needed the surgery; hearing the gory details of possible bad outcomes only increased my anxiety. Here’s a journal article quote supporting my decision to stop listening, “Risk warnings might cause negative expectations and subsequent nocebo effects (i.e., negative expectations cause negative outcomes) in participants” (Stirling et al., 2022, no page number)

Informed consent flies under the radar when clients or patients stop listening. Informed consent also flies under the radar because many people don’t bother reading them. In our theories textbook we have nice examples of how therapists can write a welcoming and fantastic informed consent that cordially invites clients to counseling. Do these informed consents get read? Maybe. Sometimes.

Informed consent has the potential to be powerful. To fulfill this potential, we need to contemplate on big (and long) question: “How can we best and most efficiently inform prospective clients about psychotherapy and maintain a balanced, conversational style that will maximize client absorption of what we’re saying, while appropriately speaking to the positive potential of our treatment and articulate possible risks without activating client fears or negative expectations?”

Here’s an abbreviated guide: Provide essential information. Use common language. Be balanced.

For example:

“Most people who come to counseling have positive responses and after counseling, they’re glad came. A small number of people who come to counseling have negative experiences. If you begin to have negative experiences, we should talk directly about those. Sometimes in life, confronting old patterns and talking about emotionally painful memories will make you feel bad, sad, or worse, but these negative feelings should be temporary. Getting through negative or difficult emotions can open us up to positive emotions. My main message to you is this: No matter what you’re experiencing in counseling, it’s good and important for you to share your thoughts, feelings, and reactions with me so we can make the adjustments needed to maximize your benefits and minimize your pain.”

I could go on and on about informed consent, but that might reveal too much of my nerdiness. These are my reflections for today. Tomorrow may be different. I just thought I should inform you in advance that consistency may not be my forte.

Suicide Assessment and Treatment Planning Handouts for the Montana Association of School Psychologists — Billings — 2022

Emily Sallee and I had an excellent (and inspiring) day 1 at the 2022 MASP Summer Institute. The MASP members and other participants have been fabulous. Today, we built a foundation upon which we will build great things tomorrow.

What’s up for tomorrow? Advanced treatment planning using the seven-dimensional strengths-based model. Just in case you’re at the Summer Institute OR you want a peek into what we’re doing, here are some handouts.

Two Short Suicide and Psychotherapy Video Clips

As a part of my presentations for ACA last week, I prepared a couple of short video clips. These clips are part of a much, much longer, three-volume (7.5 hour) video series produced and published by psychotherapy.net. Victor Yalom of psychotherapy.net gave me permission to occasionally share a few short clips like these. If you’re interested in purchasing the whole video series (or having your library do so), you can check out the series here: https://www.psychotherapy.net/videos/expert/john-sommers-flanagan

IMHO, although the whole video series is excellent and obviously I recommend it, these clips can be used all by themselves to stimulate class discussions. Check them out if you’re interested.

Clip 1: Opening a Session with Kennedy: https://www.youtube.com/watch?v=gR7YU0VrHqw

Kennedy is a 15-year-old cisgender female referred by her parents for suicidal ideation. Although a case could be made for using a family systems approach, this opening is of me working 1-1 with Kennedy. When I show this video, I like to emphasize that I’m using a “Strengths-based Approach” AND I’m also asking a series of questions that pull for Kennedy to talk about her distress. This is because clients generally need to talk about their distress before they can focus on strengths or solutions. Instead of practicing “toxic positivity” this approach emphasizes the need to come alongside and be empathic with client pain and distress.

Clip 2: A Trial Interpretation with Chase: https://www.youtube.com/watch?v=UNBR3bKyE4I

Chase is a 35-year-old cisgender Gay male. In this brief excerpt, I try (somewhat poorly) to use a pattern interpretation to facilitate insight into his history of social relationships. Chase’s response is to dismiss my interpretation. Back in my psychoanalytic days, we talked about and used trial interpretations to gauge whether an abstract-oriented psychodynamic approach was a good fit for clients. Chase’s response is so dismissive that I immediately shift to using a very concrete approach to analyzing his social universe. Then, when Chase isn’t able to identify anyone who is validating, I use a strategy I call “Building hope from the bottom up” to help him start the brainstorming process.

A Visual of Chase’s Social Universe

A big thanks to psychotherapy.net and Victor Yalom for their support of this work.

As always, if you have thoughts or feedback on these clips or life in general, please feel free to share.

John S-F

Resources from my American Counseling Association Conference Presentations

Last week I had the honor of presenting three times at the American Counseling Association meeting in Atlanta. Today, I’m posting the Abstracts and Powerpoints from those presentations, just in case someone might find the information useful.

On Friday, April 8: The way of the humanist: Illuminating the path from suicide to wellness. Invited presentation on behalf of the Association for Humanistic Counseling.

At this moment, counselors are hearing more distress, anxiety, and suicidal ideation than ever before. In response, we are called to resonate with our clients’ distress. On behalf of the Association for Humanistic Counseling, John Sommers-Flanagan will describe how humanistic principles of acceptance and empathy can paradoxically prepare clients to embrace wellness interventions. Participants will learn five evidence-based happiness strategies to use with their clients and with themselves.

Also, on Friday, April 8: Using a strengths-based approach to suicide assessment and treatment in your counseling practice. Invited presentation on behalf of ACA Publications.

Most counselors agree: no clinical task is more stressful than suicide assessment and treatment planning. When working with people who are suicidal, it’s all-too-easy for counselors to over-focus on psychopathology and experience feelings of hopelessness and helplessness. However, framing suicidal ideation as an unparalleled opportunity to help alleviate your client’s deep psychological pain, and embracing a strengths-based orientation, you can relieve some of your own anxiety. This practice-oriented education session includes an overview of strengths-based principles for suicide assessment and treatment.

On Saturday, April 9, Being seen, being heard: Strategies for working with adolescents in the age of Tik Tok. Educational presentation (with Chinwe Williams).

Counseling and connecting with adolescents can be difficult. In this educational session, we will present six strategies for connecting with and facilitating change among adolescents. For each strategy, the co‐presenters, coming from different cultural and generational perspectives, will engage each other and participants in a discussion of challenges likely to emerge when counseling adolescents. Social media influences, self‐disclosure, and handling adolescents’ questions will be emphasized.

Thanks for reading. I hope some of these resources are helpful to you in your work.

JSF

Savoring and Gratitude in Billings with Montana School Counselors

Several months ago, Renee’ Parker Schoening, executive director of the Montana School Counselor Association, all-around master-organizer, and unstoppable inspirational force, asked me if I could provide a closing keynote speech for the MSCA spring conference that was evidence-based, uplifting, and funny. Channeling my internal family systems (IFS) inner scientist and entertainer selves (while ignoring my own good judgment), I quickly said, “Yes. Sure. Of course, I can do that.”

This exchange is an example of saying yes to ambitiously unattainable ideas, and then needing to find people to help me accomplish whatever it is I’ve agreed to do. In honor of my disdain for pithy, rhyming, oversimplification (think of trite things like, ugh, “fight or flight”), I’ve decided to enhance my influencer legacy by delivering profound wisdom using pithy, rhyming, oversimplifications.  In the case of today’s description of last week’s questionably unattainable commitment to providing an evidence-based, uplifting, and funny closing keynote speech, I’m saying (and you may want to write this down), “If you’re running out of steam, it helps to have a good team.”  

For the potential MSCA debacle, I asked two talented graduate students in Counseling at the University of Montana to help me create closing keynote magic. I suspect, because I’m a faculty member and technically one of their supervisors, the grad students may have experienced my “ask” as an offer they couldn’t refuse. Regardless of (or despite) their internal lamentations, they accepted the offer they couldn’t refuse . . . and planning started happening.

Turns out that Lillian Martz, one of the grad students, has a history of competitive Karaoke. She’s a current doc student, former M.A. student, and former school counselor. In honor of her expertise, I may or may not have suggested we infuse Karaoke into our keynote. You know how it is. With three people together generating bad ideas, it’s hard to discern where the blame belongs. Anyhow, Lillian agreed, later noting in an email that she felt “regret” for having made said agreement. But it was too late to back out; she selected a song, transforming it into a school counseling narrative (apparently that’s what competitive Karaoke people do), and suggested that the other grad student and I provide choreography.

Turns out the other grad student, Dylan Wright, has a strong theatre background, having worked a couple decades for Missoula Children’s Theatre, which is my way of saying Dylan thought him and me teaming to supply choreography for Lillian’s crooning was a fabulous idea, which is my way of admitting to, once again, saying yes to something that I might have had the good judgment to decline. All I remember is hearing Rita’s voice in the back of my brain saying, “Don’t hurt yourself.”

Dylan’s presence on our “closing keynote” team is why, somehow, we decided to weave in a brief improv experience. As many of you already know, I co-invented Karaoke, along with Mike Bevill, Neil Balholm, and Greg Hopkins, back in Mike’s basement back in 1974, and so saying yes to a Karaoke performance felt right. But, I’ve never done improv. Dylan was all-in on the improv, down with the Karaoke, and loved my terrible idea that we should open the keynote by spontaneously breaking into inappropriate songs.

Lest you worry, we did have content. Our main themes were savoring and gratitude, both being evidence-based practices popular in the positive psychology movement.

One of the lessons I’ve learned over the years is that it’s not unusual to end up receiving the gift you’re trying to give others. What I mean is that, at the conclusion of our phrenetic, non-traditional keynote speech, I experienced big doses of savoring and gratitude. Lillian and Dylan were marvelous planners and co-presenters and Renee’ was moved to tears by the video Dylan and Lillian created for the ending. Thanks to being on a great team and thanks to presenting to a generous and amazing audience of nothing-less-than-fantastic Montana school counselors, my savoring and gratitude cup were full all weekend.

Although there may be concrete evidence of the magnificence of this event in the form of video clips and photos, I’ll leave you with two short testimonials.

So much FOMO. I can’t make out any of the audio, but the visuals are very impressive. At one point it seems as though they become Zumba instructors. – UM faculty member, watching via social media video clips

I feel like I’m in a fever dream! – UM M.A. student

Love, Sex, Racism, Suicide, Goal-Setting, Awards, Stories, Burnout, Flexibility, and the Whole Genome at the Psychotherapy Networker Symposium Conference

The View from the Corner

As I type, Steven Hayes, the creator of acceptance and commitment therapy (ACT), is talking in a variety of voices about mindful acceptance. Earlier, he mentioned something about the whole human genome. In case you don’t already know, Steve is an older white guy. His writing about psychotherapy is fantastic. I really like his Ted talk. I’ve found his question, “What shall we do with our difficult thoughts?” an excellent prompt to reflect on.

Steve and I have a history. I’m glad to say that I’ve mindfully accepted that he missed his supervision appointment with me at AABT (now ABCT) back in 1987 in Los Angeles. Really. I’ve let go Steve standing me up, not because I’m all that good at forgiveness, but because him skipping out on our chance to meet makes for a better story. In fact, in this mindful moment, I’ve accepted him missing our meeting so completely that I have no urge to try to meet him today.

This is my first Networker “Symposium.” I hadn’t realized it was quite the distinctive thing. They’ve got numbers you can put on your badges to represent how many times you’ve attended the Symposium. Although it’s just a conference, it does have a particular flair and feel. From the beginning, there was movement, talk about love and sex-tech, dancing, singing, and learning. The breadth of content and diversity of attendees has been marvelous.

I started the first day with a workshop on Love and the Therapeutic relationship with Sabrina N’Diaye. Later, I took in a workshop on Tech-Sex with Tammy Nelson, author of Getting the Sex you Want. Nelson basically blew my mind. Did you know there are “devices” you can use to remotely vibrate your romantic partner’s genitalia? I didn’t . . . and maybe I didn’t want to. Did you know someone commented in the session that “Dominants” use that vibrating device to issue “commands?” I was sitting next to a professional cuddler and sexual surrogate. She was delightful. Steve Hayes (and Ram Dass) would be proud of the fact that I managed my difficult thoughts by staying in the here and now instead of trying to imagine her work or think about what the dominatrix had shared. Just saying. My mind remained as pure as the water of the Stillwater River.

There’s been lots of talk about racism at the Symposium. That’s a good thing. I’m better for it. The more we can all be less racist or anti-racist and aware of our biases, the better. Of course, while I’m typing this, my almost erstwhile buddy Steve continues to talk (and sometimes mumble). I’m aware (somewhat painfully) that I’m more “like” him in age and gender and ethnicity and can’t help but lament that (sorry Steve). Being an old white guy brings privilege (or advantage, as our first keynote speaker preferred). At the same time, looking in the mirror and seeing myself as just another old white guy also brings along gut-level unpleasantness.

Yesterday’s highlights were listening to Ester Perel (very smart, very articulate, very impressive) and learning more about Susan Johnson and her personal history of growing up in a Pub. We also listened to three young women talk about the couple therapy experiences that changed them. Fabulous.

One of my (many) take-aways from the past two days is for me to NOT be THAT old WHITE guy. I want to be a different white guy. How does that work? Among other things, I will try not to think too much of myself . . . or mumble.

Steve is now trying to get us all to love ourselves. That’s a nice idea. Someday, Steve, I hope to get there. But, to channel our Saturday morning Symposium keynote speaker, Emily Nagoski, most of the time, things just don’t fucking work.

Wait. I know that sounds negative. Among many of her excellent points about coping with burnout, Emily played a cool song (of her twin sister’s), a song liberally infused with the F-word. If you’ve ever experienced technology frustration (which I suppose even happens with sex-tech), you should listen. Here’s the link: https://www.youtube.com/watch?v=eottd9Lw8l4 If you listen, don’t think about sex-tech at the same time. There’s no need to thank me for this great advice.

I’ve now abandoned Steve, in favor of one of the darling presenters of the Symposium and PESI. Sorry Steve . . . but I know you’ll mindfully accept your experience of me abandoning you. . . partly because you’ve never acknowledged my existence anyway (see, I’m totally over that 1987 incident).

There’s a woman talking . . . softly . . . without the changing voice routines of Steve Hayes. As she drones on, she mentions that therapy and therapists can be triggering. . . which is interesting given that I can’t find any affect in her voice. I’ve taken a seat on the floor in the back corner of the room and quickly recognized she’s right. She’s right because she instantly triggered me as I walked in the door with her monotone statement that talk therapy doesn’t work for trauma (what about CPT . . . or?). She continued to trigger me with her statement that PTSD was only identified in the 1970s (what about the diagnosis of war neurosis or battle fatigue or the many other earlier versions of PTSD?). And she finished triggering me with her laudatory comments on narrative therapy (does she NOT think of narrative therapy as “talk therapy?”).

I know my job here. Mindful acceptance. Learn what I can. Maybe the learning is about my own triggers or my own internal lament over being an increasingly irrelevant old white guy. Maybe the learning is about how to stay calm and embrace both ends of the constant dialectics and polarities of life.

On the whole, I’m so glad to be here at the Symposium, with Rita, and so grateful to continue learning. The fact that the conference has stimulated some of what Steve would call “difficult thoughts” is a blessing to be mindfully accepted. How else do we learn? How else do we grow? Should we expect to be constantly confronted with easy, comfortable, and affirming thoughts?

I think not. And I accept that . . . in my whole human genome.

The Foreword to The 15-Minute Case Conceptualization

Jon Sperry asked if I could write the foreword for a book he and his dad wrote with Oxford University Press.

Because the truth will set me free, I should admit, I’d never written a foreword before. More truth . . . I went ahead and said “Yes” to Jon because (a) I was honored and didn’t want the opportunity to write my first foreword slip away, (b) the book was (is) cool (it’s “The 15-Minute Case Conceptualization”), and (c) Jon Sperry is one of the nicest guys on the planet.

The book arrived in my mailbox yesterday. You too, can get a copy through your favorite bookseller. For more information, here’s the link to the book on the publisher’s website: https://global.oup.com/academic/product/the-15-minute-case-conceptualization-9780197517987?cc=us&lang=en&#

And for even more information about this excellent book, my first-ever foreword is below.

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

I’ve needed this book for 30 years.

Just last month (before reading this book), I was standing in front of a Zoom camera, trying to teach the basics of case conceptualization to a group of 23 master’s and doctoral students. All of my fine-grained case conceptualization wisdom was being channeled into a single visual and verbal performance.

“My left hand,” I said, “is the client’s problem.” Pausing briefly for dramatic effect, I then continued, “and my right hand is the client’s goal.”

My new-found nonverbal gestures are mostly a function of seeing myself onscreen, and therefore wanting to avoid seeing myself (and being seen by the class) as boring. To add spice to my case conceptualization gesturing. “Case conceptualization is simple,” I said. “All it is, is the path we take to help clients move from their problem state . . . toward their goal state (I finished with a flourish, by wiggling the fingers on my raised right hand).”

But boiled down truths are always partly lies. Despite my fabulous mix of the verbal and nonverbal, I was lying to my students. At the time, I had thought of it as a little white lie, all for the higher purpose of simplification. And although I still like what I said and still believe in the rough truth of my visual case conceptualization description, after reading Len and Jon Sperry’s illuminating work on case conceptualization, I better understand what I should have said.

Case conceptualization is not simple. As the Sperry’s describe in this book, case conceptualization—even when summarized well—includes multiple dimensions of human behavior along with clinician perception, judgment, and decision-making. I needed much more than a few wiggly fingers to communicate the detailed nuances of case conceptualization.

What these authors have done in this book is the gracious service that great writers do so well: They have done our homework for us. They’ve read extensively, taken notes, and gifted us with elegant summaries of dense and complex concepts. They’ve made it easy for us to understand and apply the principles and practices of case conceptualization.

What I might like best is how they transformed a bulky and inconsistent literature into simple, therapist-friendly principles. They emphasize the explanatory, tailoring, and predictive powers of case conceptualization. I’ve never organized case conceptualizations using those “powers” but doing so was like switching on a light-bulb. Of course, case conceptualizations should explain the relationships between client problems and client goals and shine a bright light along the path, but rarely do theorists or writers make this linkage so efficiently. Their second principle, “tailoring” case conceptualizations to individual and diverse clients, is an essential, idiographic, Adlerian idea. The whole idea of tailoring counters the all-too-frequent cook-book approach to case conceptualization. Tailoring breathes life into creating client-specific case conceptualizations. And of course, case conceptualizations need predictive power; Len and Jon equip us with enough foundational predictive language to improve how we evaluate our own work.

Many other examples of how elegantly the authors have done our homework are sprinkled throughout this book. Here’s another of my favorite examples.

In chapter 2, they take us (in a few succinct paragraphs) from what Theodore Millon described as eight evolutionarily-driven personality disorders to eight crisply described behavioral patterns. What I love about this is that Len and Jon’s wisdom transforms what might otherwise be viewed as a pathologizing personality disorder system into language that can be used collaboratively with clients to identify contextually maladaptive interpersonal patterns. This is a beautiful transformation because it spins psychopathology into something clients not only understand but will feel compelled to embrace. The process goes something like this:

  1. Therapist and client engage in an assessment process that touches on the client’s repeating maladaptive behavior patterns. These behavior patterns are palpably troubling and far less than optimal for the client.
  2. As all clinicians inherently know, touching upon clients’ repetitive maladaptive behavior patterns can activate client vulnerability. This is a primary challenge of all counseling and psychotherapy: How can we nudge clients toward awareness without simultaneously activating resistance? For decades, psychoanalysts managed this through cautious trial interpretations. Solution-focused therapists dealt with this by never speaking of problems. Gently coaxing ambivalent clients toward awareness and change is the whole point of motivational interviewing.
  3. When addressed in a sensitive and non-pathologizing way, deep maladaptive behavior patterns can be discussed without activating resistance or excessive emotionality. This is a critical and not often discussed part of case conceptualization. Len and Jon illuminate a path for gentle, sensitive, and collaborative case conceptualization.
  4. When clients can feel, recognize, and embrace their maladaptive behavioral patterns in the context of an accepting therapeutic relationship, insight is possible. In the tradition of Adlerian therapy, when insight happens, client interest is piqued and motivation to change spikes. Good case conceptualizations articulate problem patterns in ways that compel clients to invest in change.

I’m not surprised that Len and Jon Sperry have produced such a magnificently helpful book. If you dig into their backgrounds and conduct a case conceptualization of their personality patterns, you’ll discover they wholeheartedly embrace Alfred Adler’s work and consequently, much of what they do is all about social interest or Gemeinschaftsgefühl. Len and Jon Sperry are in the business of helping others. Reading their book has already helped me become better at teaching case conceptualization. I appreciate their work, and, no doubt, the next time I begin waving my hands in front of my Zoom camera, my students will appreciate their work too.

John Sommers-Flanagan – Missoula, MT

The Art & Science of Happiness 3.0 with JSF is Coming Soon – You can sign up now

Last year, for the first time, we offered the Art & Science of Happiness simultaneously as a 3 credit COUN 195 course through the University of Montana and as a non-credit course open to community members through UMOnline. The course was fully online. Many students took the course “live” and synchronously; others enrolled and completed the course at their convenience.

We had 50 students sign up for the course: 30 UM students took the course for credit; 20 were “community” members (hailing from Missoula, Browning, Billings, Pennsylvania, and Canada). Many of the UM students were 19 to 22 years-old. Many of the community members were 60 to 87 years-old. The inter-generational synergy was fabulous.

What You Get in the Art & Science of Happiness

  • 25+ instructional hours with John Sommers-Flanagan, and occasionally Rita Sommers-Flanagan. You can experience these lectures synchronously through Zoom, or asynchronously at times that work into your personal schedule.
  • 10+ hours of small group counseling designed to facilitate reflection, discussion, and experiencing of evidence-based happiness activities (these “lab” groups can be face-to-face or via Zoom)
  • 8 hours of individual supportive wellness counseling with a Master’s student from the Counseling Department at the University of Montana (these services are face-to-face or via Zoom and on a first-come, first served basis, because we have a limited number of available counselors-in-training)

The cost for community UMOnline participants is $250. If that sounds expensive, think of it this way. You get 40+ total hours of a combination of large group instruction, small group counseling, and individual counseling, which translates to $6.25 an hour.

Potential Benefits

Research from the two previous semesters indicate that some (not all) participants experience:

  • Reduced depression symptoms (in some cases, depressive symptoms were substantially reduced)
  • Increased hope and optimism
  • An increased rate of positive emotions
  • A reduction in headaches
  • Improved sleep
  • Greater feelings of social connection

Comments from Previous Community Participants

“Words are inadequate to express my gratitude for the Happiness Class and your amazing expertise. Literally transforming my life after a very difficult and sad nine months; plus, it’s a heckuva lot of fun. Again, thank you.”

“I found the course interesting and rewarding far beyond my expectations.”

“I feel a major shift in my thinking. I am now more focused on gratitude and living in the moment and have developed an unexpected confidence about facing the inevitable challenges that lie ahead, a confidence that even others have noticed.”

[In response to the group counseling component] “I appreciate the interactions that I have with everyone in my group. We are all very different, yet willing to be open and share our thoughts. I wasn’t sure what this would be like and I am already liking it a lot.”

[In response to a homework assignment] “I am applying a very simple formula to myself…When I become aware of how grumpy and scared and negative I feel about an issue in our family, I consciously think of two things for which I feel grateful. It fills the basket of my emotions with more positivity and opens up a new way of approaching my worries.”

When

The course is offered “live” on Tuesdays/Thursdays from 1pm to 2:20pm, beginning on January 18, 2022, ending the week of May 9, 2022. However, because the course is fully online via Zoom, you can also take the course asynchronously.

How to Enroll

To enroll as a community member, go to: https://www.campusce.net/umextended/course/course.aspx?C=627&pc=30&mc=&sc and follow the instructions.

To enroll for University of Montana credit, login to Cyberbear: https://www.umt.edu/registrar/Registration/Class%20Schedules.php. The course is COUN 195. The CRN is: 33330.

Why

I believe this course content is very helpful, and so I’d like to make this course available as widely as possible. Please help me by sharing this information with others. Also, because I’m paid by the University of Montana to teach this course, all proceeds are returned to the University of Montana in general, and the Department of Counseling, in particular.

The Art of Giving Feedback–Revised

[Note: This is an edited and updated version of a post I did a year or two ago.]

Giving and receiving feedback is a huge topic. In this blog post the focus is on giving and receiving feedback in classroom settings or in counseling/psychotherapy supervision. The following guidelines are far from perfect, but they offer ideas that instructors and students can use to structure the feedback giving and receiving process. Check them out, and feel free to improve on what’s here.

Before you do anything, remember that feedback can feel threatening. Hearing about how we sound and what we look like is pretty much a trigger for self-consciousness and vulnerability. Sometimes, when we look in the mirror, we don’t like what we see, and so obviously, when someone else holds up a mirror, the feedback we experience may be . . . uncomfortable. . . to say the least. To help everyone feel a bit safer, the following can be helpful:

  • Acknowledge that feedback is scary.
  • Emphasize that feedback is essential to counseling skill development.
  • Share the feedback process you’ll be using
  • Make recommendations and give examples of what kind of feedback is most useful.

Acknowledge that Feedback is Scary: You can talk about mirrors (see above), or about how unpleasant it is for most people to hear their own voices or see their own images, or tell a story of difficult and helpful feedback. I encourage you to find your own way to acknowledge that feedback triggers vulnerability.

Feedback is Essential: Encourage students to lean into their vulnerability and be open to feedback—but don’t pressure them. Explain: “The reason you’re in a counseling class is to improve your skills. Though hard to hear, constructive feedback is useful for skill development. Don’t think of it as criticism, but as an opportunity to learn from mistakes and improve your counseling skills.” What’s important is to norm the value of giving and getting feedback.

Share the Process You’ll be Using: Before starting a role play or in-class practice scenario, describe the guidelines you’ll be using for giving and receiving feedback (and then generate additional rules from students in the class). Here are some guidelines I’ve used:

  • Everyone who volunteers (or does a demonstration or is being observed) gets appreciation. Saying, “Thanks for volunteering” is essential. I like it when my classes establish a norm where whoever does the role-playing or volunteers gets a round of applause.
  • After being appreciated, the role-player starts the process with a self-evaluation. You might say something like, “After every role play or presentation, the first thing we’ll do is have the person or people who were role-playing share their own thoughts about what they did well and what they think they didn’t do so well.”
  • After the volunteer self-evaluates, they’re asked whether they’d like feedback from others. If they say no, then no feedback should be given. Occasionally students will feel so vulnerable about a performance that they don’t want feedback. We need to accept their preference for no feedback and also encourage them to solicit and accept feedback at some later point in time.

Giving Useful Feedback: It’s always good to start with the positive. Try to be very clear and specific about some things you especially liked. I usually take notes to help me with this; I’ll write down exactly what the role player said and put a + sign next to it so I can say something like, “I see in my notes that I put a + sign next to your very first paraphrase. You seemed to be tracking very well and you shared what you heard with your client in a way that felt nice.

Constructive or corrective feedback shouldn’t focus so much on what was done poorly, but emphasize what could be done to perform the skill even better. Constructive or corrective feedback might sound like this: “I noticed you asked several closed questions. Closed questions aren’t bad questions, but sometimes it’s easier to keep clients talking about important content if you replace your closed questions with open questions or with a paraphrase. Let’s try that. How could you change one of your closed questions to an open question or a paraphrase?” BTW: General and positive comments (e.g., “Good job!”) are pleasant and encouraging, but should be used in combination with more specific feedback; it’s important to know what was good about your job.

Constructive feedback should be specific, concrete, and focused on things that can be modified. For example, you can offer a positive or non-facilitative behavioral observation (e.g., “I noticed you leaned back and crossed your arms when the client started talking about sexuality.”). After making an observation, the feedback giver or the group can explore potential hypotheses (e.g., “Your client might interpret you leaning back and crossing your arms as judgmental”). The feedback giver can also offer an alternative (“Instead, you might want to lean forward and focus on some of your excellent nonverbal listening skills.”).

With constructive feedback you can take some of the evaluation out of the comment by just noticing or observing, rather than judging, “I noticed you said the word, ‘Gotcha’ several times.” You can also ask what else they might say instead, “To vary how you’re responding to your client, what might you say instead of ‘Gotcha’?”

General negative comments such as “That was poorly done.” should be avoided. To be constructive, provide feedback that’s specific, concrete, and holds out the potential for positive change. Feedback should never be uniformly negative. Everyone engages in counseling behaviors that are more or less facilitative. If you happen to be the type who easily sees what’s wrong and have trouble offering praise, impose the following rule on yourself: If you can’t offer positive feedback, don’t offer any at all. Another alternative is to consciously focus on using the sandwich feedback technique when appropriate (i.e., say something positive, say something constructive, then say another positive thing).

IMHO, significant constructive feedback is the responsibility of the instructor and should be given during a private, individual supervision session. The general rule: “Give positive feedback in public and constructive feedback in private” can be useful.

Finally, students should be reminded of the disappointing fact that no one performs perfectly, including the teacher or professor. Also, when you do demonstrations, be sure to model the process by doing a self-evaluation (including things you might have done better), and then asking students for observations and feedback.

The ACA Town Hall is Tomorrow

Rita and I get to be the guests for tomorrow’s online ACA Town Hall. The topic for the day is suicide, but more generally, the Town Hall, moderated by ACA President Dr. Kent Becker, is designed to be a community event for ACA members. The suicide discussion will be brief and there will be several other break-out groups in the Zoom format.

To participate, you’ll need to be a member of the American Counseling Association (ACA). As ACA members, you can attend for free, but you need to register in advance. Here’s the link: https://imis.counseling.org/store/events/registration.aspx?event=DOH2021SEP

My apologies for the late notice on this.

I hope everyone is well and thriving as much as possible.

John