Tag Archives: Counseling

Clinical Interviewing, Writing

Cultural Self-Awareness in the Clinical Interview

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To continue with my plan to feature culturally diverse case examples from the latest edition of Clinical Interviewing, the following excerpt is from Chapter One and focuses on cultural self-awareness. In particular, I LOVE the quotation on intersectionality from Kimberlé Crenshaw.

Cultural Self-Awareness

Those who have power appear to have no culture, whereas those without power are seen as cultural beings, or “ethnic.” (Fontes, 2008, p. 25)

Culture and self-awareness interface in many ways. As Fontes (2008) implied, individuals from dominant cultures tend to be unaware of and often resistant to becoming aware of their invisible and unearned culturally-based advantages (Sue et al., 2020). In the U.S., these “unearned assets” are often referred to as privilege in general, and White privilege in particular (McIntosh, 1998).

Privilege and oppression are best understood in the context of intersectionality. Intersectionality is the idea that overlapping or intersecting social identities within individuals create whole persons that are different from the sum of their parts (Crenshaw, 1989). Social identities that intersect include, but are not limited to: Gender, sexual orientation, sexual identity, race, ethnicity, religion, nationality, mental disorder, physical disability/illness, citizenship, and social class (Hays, 2022). Understanding multiple social identities helps clinicians understand how feelings of oppression can multiply, be activated under distinct circumstances, and be moderated under other circumstances.

Kimberlé Crenshaw (1989, 1991) introduced intersectionality as a lens to facilitate cultural awareness and understanding, but ideas about intersectionality date back at least to Black female abolitionists. In the 1860s, Sojourner Truth articulated Black women’s simultaneous oppression through classism, racism, and sexism (aka “Triple oppression”; Boyce Davies, 2008). Thirty years after she defined intersectionality, Time Magazine asked Crenshaw, “You introduced intersectionality more than 30 years ago. How do you explain what it means today?” (Steinmetz, 2020). She said,

These days, I start with what it’s not, because there has been distortion. It’s not identity politics on steroids. It is not a mechanism to turn white men into the new pariahs. It’s basically a lens, a prism, for seeing the way in which various forms of inequality often operate together and exacerbate each other. We tend to talk about race inequality as separate from inequality based on gender, class, sexuality or immigrant status. What’s often missing is how some people are subject to all of these, and the experience is not just the sum of its parts.

Through the lens of intersectionality, we can develop nuanced ways to have empathy for clients. For example, sometimes clients simultaneously feel privilege and oppression. Thinking and feeling from an intersectional frame can help clinicians be more prepared to view the world from clients’ perspectives (see Case Example 1.2).

CASE EXAMPLE 1.2: EMPATHY FIRST

Maya, an international student of color was in her first practicum. As was her routine, when introducing herself, she acknowledged her accent, her country of origin, along with her eagerness to be of assistance. Her client, a cisgender male university student, was initially polite, but quickly shifted the conversation to his feelings about White privilege, becoming somewhat agitated in the process. He said, “One thing I think you should know that I don’t believe in that White privilege thing. I just came from a class where that’s all everyone was talking about. I know I’m white, but I didn’t get any privilege. I grew up in a trailer park in West Texas. We were what they call ‘White trash.’ Nobody I grew up with had any privilege. We had poverty, abuse, alcoholism, meth, and government bullshit.”

Maya stayed calm. Even though she was activated by her client’s disclosure and was taking some of what he said personally, she focused on empathy first. She also remembered intersectionality and how common it could be for people to have multiple social identities. She said, “I hear you saying that the White privilege concept really doesn’t fit for you. Being in your very last class before coming here made you realize even more that it doesn’t fit. The idea of trying to make it fit feels annoying.”

Maya’s client simply said, “Damn right,” and continued ranting about White privilege, White fragility, and what he viewed as the politically correct environment at the university. As she continued listening and tried feeling along with him, she was able to see glimpses of his personal perspective. Not surprisingly, Maya’s client had social problems related to his tendency to be angry and abrasive. Eventually, after several sessions, they were able to begin talking about what was underneath his agitated emotional response to multicultural ideas and how his tendency to lead with his anger when in conversations with others might be contributing to him feeling even more isolated and different than everyone else. In the end, the client thanked Maya for “being patient with this dumb ass White boy” and helping him learn to be more aware, softer, and less reactive to triggering cultural conversations.

This case illustrates the importance of intersectionality as a concept that can facilitate counselor and client awareness, while also enhancing empathy. Although Maya’s client may have had even worse oppressive experiences had he been a person of color, he was neither interested nor ready to hear that message (Quarles & Bozarth, 2022). Instead, Maya used her knowledge of intersectionality to have empathy with the part of her client’s social identity that had experienced oppression.

Developing cultural self-awareness is difficult. One way of expressing this is to note, “We don’t know what we don’t know.” When someone tries to help us see and understand something about ourselves that’s outside our awareness, it’s easy to feel defensive. Despite the challenges, we encourage you to be as eager for change and growth as possible, and offer three recommendations:

  1. Be open to exploring your own cultural identity. Gaining greater awareness of your ethnicity is useful.
  2. If you’re from the dominant culture, be open to exploring your privilege (e.g., White privilege, wealth privilege, health privilege) as well as hidden ways that you might judge or have bias toward diverse groups and individuals (e.g., transgender, disabled).
  3. If you’re outside the dominant culture, be open to discovering ways to have empathy not only for members within your group, but also for other diversities and for the struggles that dominant cultural group members might have as they navigate challenges of increasing cultural awareness. Engaging in mutual empathy is a cornerstone of relational cultural psychotherapy (Gómez, 2020).

[End of Case Example 1.2]

Clinical Interviewing, Writing

Culture-Specific Expertise in Clinical Interviewing

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For the next several weeks I’ll be sharing from our almost new 7th edition of Clinical Interviewing.
One of our goals for the 7th edition of Clinical Interviewing is to move toward greater representation of different ethnic/cultural/sexual identities. We want all potential counseling, psychology, and social work students to be able to identify with counseling, psychology, and social work professionals. To accomplish this goal, we added greater representation by broadening our usual chapter content, as well as including case examples contributed by professionals with diverse identities.
Here’s an excerpt from Chapter 1 on culture-specific expertise

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Culture-Specific Expertise

Culture-specific expertise speaks to the need for clinicians to learn skills for working effectively with diverse populations. For example, learning the attitudes and skills associated with affirmative therapy is important for clinicians working with diverse sexualities, including lesbian, gay, bisexual, transgender, queer/questioning (sexual or gender identity), intersex, and asexual/aromantic/agender (LGBTQIA+) clients (Heck et al., 2013). Similarly, integrating skills for talking about spiritual constructs into your work with African American, Latinx, Indigenous, and traditionally religious clients is often essential (Mandelkow et al., 2021; Sandage & Strawn, 2022).

Stanley Sue (1998, 2006) described two general skills for working with diverse cultures: (a) scientific mindedness and (b) dynamic sizing.

Scientific mindedness involves forming and testing hypotheses about client culture, rather than coming to premature conclusions. Although many human experiences are universal, it’s risky to assume you know the underlying meaning of your clients’ behavior, especially minoritized clients. As Case Example 1.3 illustrates, culturally sensitive clinicians avoid stereotypic generalizations.

Dynamic sizing is a complex multicultural concept that guides clinicians on when they should and should not generalize based on an individual client’s belonging to a specific cultural group. For example, filial piety is a value associated with certain Asian families and cultures (Ge, 2021). Filial piety involves the honoring and caring for one’s parents and ancestors. However, it would be naïve to assume that all Asian people believe in or have their lives affected by this particular value; making such an assumption can inaccurately influence your expectations of client behavior. At the same time, you would be remiss if you were uninformed about the power of filial piety in some families and the possibility that it might play a large role in relationship and career decisions in many Asians’ lives. When clinicians use dynamic sizing appropriately, they remain open to significant cultural influences, but they minimize the pitfalls of stereotyping clients.

Another facet of dynamic sizing involves therapists’ knowing when to generalize their own experiences to their clients. S. Sue (2006) explained that it’s possible for clinicians who have experienced discrimination and prejudice to use their experiences to more fully understand the discrimination-related struggles of clients. However, having had experiences similar to a client may cause you to project your own thoughts and feelings onto that client—instead of drawing out the client’s emotions and showing empathy. Dynamic sizing requires that you know and understand and not know and not understand at the same time. Not knowing—or at least not presuming you know—is essential to interviewer-client collaboration.

CASE EXAMPLE 1.3: NOT AT HOME ANYWHERE

In this case, Devika Dibya Choudhuri, Ph.D., LPC (CT/MI), a self-described Buddhist, South Asian, cisfemale, middle-aged, middle-class, Queer, disabled counselor and professor at Eastern Michigan University, illustrates sophisticated cultural-specific expertise in cross-cultural work with a bi-cultural college student. Dr. Choudhuri uses self-disclosure, researches her client’s culture, and integrates culturally meaningful symbols into her sessions. Imagine how you can aspire to be like Dr. Choudhuri.

Darla, a 19-year-old Ghanian-American cisfemale college student, felt something was wrong with her. Her mother was from Ghana, while her father, with whom she had little contact, was generationally African American. She was halting in the first session, trying to decide whether she could trust me, and talking about her recent visit to Accra where her mother’s family lived. I said, “I know when I go to India, I’m American, and when I’m here, I’m Indian. Is it a bit like that for you?” She emphatically replied, “Yes! I’m not at home anywhere!” “Or,” I returned, “almost at home everywhere, like the rest of us global nomads.” She laughed, then spoke far more comfortably about her friends and boyfriend. I had, in that brief exchange, told Darla very important things about me. I self-disclosed casually about my ethnicity and international navigation, normalized her sense of homelessness, while reframing it to join a new group identity.

After having done some research, I asked Darla if her Ghanian kin were the majority Akan or a minority group. She said they were minority. I reflected on whether she might have picked up a sense of marginalization, not just from being Black in America, but also from being minority in Ghana. This became a deep and intense conversation. She reflected on how her American status in Ghana protected her from discrimination, but also alienated her from her cousins.

Another use of culture as intervention came when I brought in Adinkra (visual pictograph meaning saturated symbols originating in Ghana) for her use. Darla chose four to represent her aspirations, and then designed ways to use them in her daily life, incorporating her cultural roots into her present. One of them, Sankofa, is a symbol of the wisdom of learning from the past to build for the future; expressed in the proverb, “it is not taboo to go back for what you left behind.” Feeling grounded in multiple cultures, and being able to navigate from one context to another with her whole and complex self, rather than fragmenting, led her to see she wasn’t “wrong.” Sometimes the spaces were too limited; it was ok to fit and not fit, just as leftover food on a Ghanian table represented abundance.

[End of Case Example 1.3]

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As always, feel free to share your thoughts on and reactions to this content. We’re always looking for practical feedback that will help us continue to become better learners and teachers.

Clinical Interviewing, Writing

Clinical Interviewing – 7th Edition: Video Resources

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The 7th edition of Clinical Interviewing became available earlier this year. As a part of the text revision, we updated the accompanying videos, videos that Victor Yalom of Psychotherapy.net considers to be the best of their kind. And, possibly having watched more professional training videos than anyone on the planet, Victor knows what he’s talking about, and we are humbled by his endorsement.

Videos that accompany the text cover 72 learning objectives and are extensive. The bad news is that they usually, but not always, feature me. The good news is that in our video revision and upgrade, we included numerous counselors/psychotherapists of color. . . so it’s not just all me talking about how to develop your clinical interviewing skills.

The other good news–and possibly the best news–is that these videos are now available online, for free. Although we want you to buy or adopt the Clinical Interviewing textbook for your classes or professional development, you can access these videos without adopting or purchasing the book. Here’s the link: https://higheredbcs.wiley.com/legacy/college/sommers-flanagan/1119981980/vids/9781119981985_Videos.html?newwindow=true

If you watch them, I hope you enjoy the videos. And, if you feel so moved, please share your reactions or suggestions with me here or via email: john.sf@mso.umt.edu.

Have a fantastic evening.

John S-F

Group counseling, Group therapy

Group Leadership: Talking More and Talking Less

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Teaching Group: Talking More and Talking Less

Lately, when presenting, I find myself naturally saying, “I’m a university professor. That means I can talk all day long.”

But because I know that me talking too much is a bad idea, I complement my university professor disclosure with, “I’d rather have a conversation, so please interrupt me with comments, questions, and reactions.” I also try to offer an experiential learning or reflection activity.

In group class, I have so many stories to tell that I can feel my already prodigious talking urges escalate. I could unleash my breathless wordy-self for three straight hours. The students would leave having been entertained (I am funny), and with a bit of knowledge, but without skills for running counseling groups.

All this circles back to my plan to make the course as experiential as possible. I want students to feel the feelings of being in the group facilitator chair. Some of those feelings will be nerves, but it’s better for students to feel more nerves in group class, and fewer nerves when they’re leading real groups.

We recently hit Day 1 of the transformative experiential chaos.  

I know from the takeaways that students write me every week that there were nerves. In a fishbowl group, I asked members to share one positive interpersonal quality. As a second and optional prompt, I suggested they could also share one less positive interpersonal quality.

My goal was for us to briefly look at and talk about Yalom’s concept of interpersonal learning.

I shared first (to demo leader self-disclosure and modeling); I intentionally described a positive and less positive interpersonal quality. The first student to disclose felt instant awareness of the past, present, and future. Afterward, she described feeling a burden to follow my lead, anxiety in the moment, along with instant recognition that she was about to become a role model. She shared both (a positive and less positive interpersonal quality). Everyone followed her lead. Some members felt more anxiety when sharing the positive qualities; for others, it was the opposite.

One takeaway involved the speed and power of norm-setting. I’m reminded of the social psych compliance research. More or less, people consciously or less consciously feel the “norm” and comply. The corollary takeaway is that when leaders set the norm, we need to do so carefully so as to not imply everyone needs to fall in line.

Jumping ahead, the next week I discussed Kelman’s theory of group cohesion. Although I absolutely love Yalom’s definition (“Cohesion is the attraction of the group for its members”), Kelman’s theory is complementary, and was introduced to my be my 1975 Mount Hood Community College football coach. Kelman (and my coach) identified three phases: Compliance, Identification, and Internalization. After talking about Kelman’s theory, several students reflected in their email takeaways about the nature of cult groups. . . and how compliance can become leader-driven. Wow. So good.

In response to one student’s takeaway, part of my email included the following:

“For groups to be safe, IMHO, that also means freedom; freedom to have dissenting beliefs and different experiences and different values. The “internalization” shouldn’t be too tight, or it does feel like a cult. I’m not sure I have great answers about safeguards to the abuse of group processes, and so you’ve given me things to chew on as well.”

Maybe the right recipe is for there to be leader-guided modeling, combined with clear rules and norms that support independent thinking and personal freedom. This is a VERY tricky balance. It’s easy for leaders (including me) to get too enamored with the sound of our own voices and the rightness of our own values.

This brings me back to reflecting on how much leaders should talk and how much leaders should listen. Of course, this depends on the type of group: psychoeducational groups involve more group leader talking. In contrast, counseling groups—even discussion-based groups or support groups—benefit from the group talking more and the leader talking less. This has been a repeated epiphany for students and for me: being aware of the need to balance leader-talk and leader modeling with group member talk and group member modeling.

For the next class, I gave everyone an electronic copy of a long list of 23 group counseling skills to integrate into one of their experiential groups. Here’s the list:

basic-group-counseling-responses-2024Download
Cool Counseling, Happiness, Writing

More Therapeutic Writing: The Best Possible Self

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Last week was about emotional journaling. This week, we stick with the power of words and writing and take a dive into an evidence-based therapeutic writing activity called the Best Possible Self.

You all already know about optimism and pessimism.

Some people see the glass half full. Others see the glass half empty. Still others, just drink and savor the water, without getting hung up on how much is in the glass. Obviously, there are many other responses, because some people spill the water, others find a permanent water source, and others skip the water and drink the wine or pop open a beer.

Reducing people to two personality types never works, but that doesn’t stop people from labeling themselves or others as optimists or pessimists. This week’s activity—The Best Possible Self—is an optimism activity. You don’t have to be a so-called optimist to use it. And the good news is, regardless of your labels, the Best Possible Self writing activity is supposed to crank up your sense of optimism. That’s cool, because generally speaking, optimism is a good thing. Here’s what the researchers say about the Best Possible Self (BPS) activity.

[The following is summarized from Layous, Nelson, and Lyubomirsky, 2012]. Writing about your Best Possible Self (also seen as a representation of your goals) shows long-term health benefits, increases life satisfaction, increases positive affect, increases optimism, and improves overall sense of well-being. Laura King, a professor at U of Missouri-Columbia developed the BPS activity.

King’s original BPS study involved college students writing about their Best Possible Selves for 15 minutes a day for two weeks. The process has been validated with populations other than college students. If you want to jump in that deep, go for it. On the other hand, if you want a lighter version, here’s a less committed alternative:

  • Spend 10 minutes a day for four consecutive days writing a narrative description of your “best possible future self.”
  • Pick a point in the future – write about what you’ll be doing/thinking then – and these things need to capture a vision of you being “your best” successful self or of having accomplished your life goals.
  • As with all these activities, monitor your reactions. Maybe you’ll love it and want to keep doing it. Maybe you won’t.
  • If you feel like it, you can share some of your #writing on social media.

Berkeley’s Greater Good website includes a nice summary of the BPS activity. Here’s a pdf from their website: 

best_possible_self-from-berkeleys-greater-goodDownload

Being a counseling and psychotherapy theories buff, I should mention that this fantastic assignment is very similar to the Adlerian “Future Autobiography.” Adler was way ahead of everyone on everything, so I’m not surprised that he was thinking of this first. Undoubtedly, Adler saw the glass half full, sipped and savored his share, and then shared it with his community. We should all be more like Adler.

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice, Personal Reflections

The Effectiveness and Potential of Single-Session Therapeutic Interventions

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Imagine the possibility of a scalable single-session intervention that has been shown to be effective with a wide range of mental health issues. In these days of widespread mental health crisis and overwhelmed healthcare and mental health providers, you might think that effective single-session interventions are a fantasy. But maybe not.

This morning, my older daughter emailed me a link to two videos from the lab of Dr. Jessica Schleider of Northwestern University. Dr. Schleider’s focus is on single-session therapeutic interventions. Although I hadn’t seen the website and videos, I was familiar with Dr. Schleider’s work and am already a big fan. Just to give you a feel for the range and potential of single-session interventions, below I’m sharing a bulleted list of titles and dates of a few of Dr. Schleider’s recent publications:

  • Realizing the untapped promise of single‐session interventions for eating disorders – 2023
  • In-person 1-day cognitive behavioral therapy-based workshops for postpartum depression: A randomized controlled trial – 2023
  • A randomized trial of online single-session interventions for adolescent depression during COVID-19 – 2022
  • An online, single-session intervention for adolescent self-injurious thoughts and behaviors: Results from a randomized trial – 2021
  • A single‐session growth mindset intervention for adolescent anxiety and depression: 9‐month outcomes of a randomized trial – 2018
  • Reducing risk for anxiety and depression in adolescents: Effects of a single-session intervention teaching that personality can change – 2016

Single-session therapy or interventions aren’t for everyone. Many people need more. However, given the current mental health crisis and shortage of available counselors and psychotherapists, having a single-session option is a great thing. As you can see from the preceding list, single-session interventions have excellent potential for effectively treating a wide range of mental health issues. Given this good news about single-session interventions, I’m now sharing with you that link my daughter shared with me: https://www.schleiderlab.org/labdirector.html

I’ve been interested in single-session interventions for many years. Just in case you’re interested, here’s a copy of my first venture into single-session research (it’s an empirical evaluation of a single-session parenting consultation intervention, published in 2007).

single-session-consults-with-parentsDownload

I hope you all have an inspiring Martin Luther King, Jr. weekend.

JSF

Clinical Interviewing, Uncategorized

Thoughts on Ethnic Matching From Clinical Interviewing (7th edition)

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Every chapter in Clinical Interviewing has several pop-out boxes titled, “Practice and Reflection.” In this–the latest–edition, we added many that include the practice and perspective of diverse counselors and psychotherapists. Here’s an example from Chapter One.

PRACTICE AND REFLECTION 1.3: AM I A GOOD FIT? NAVIGATING ETHNIC MATCHING IN PRIVATE PRACTICE

The effects of ethnic matching on counseling outcomes is mixed. In some cases and settings, and with some individuals, ethnic matching improves treatment frequency, duration, and outcomes; in other cases and settings, ethnic matching appears to have no effects in either direction (Olaniyan et al., 2022; Stice et al., 2021). Overall, counseling with someone who is an ethnic/cultural match is meaningful for some clients, while other clients obtain equal meaning and positive outcomes working with culturally different therapists.

For clients who want to work with therapists who have similar backgrounds and experiences, the availability of ethnically-diverse therapists is required. In the essay below, Galana Chookolingo, Ph.D., HSP-P, a licensed psychologist, writes of personal and professional experiences as a South Asian person in independent practice.

On a personal note, being from a South Asian background in private practice has placed me in a position to connect with other Asians/South Asians in need of culturally-competent counseling. In my two years in solo private practice, I have had many individuals reach out to me specifically because of my ethnicity and/or the fact that I am also an immigrant to the U.S. (which I openly share on my website). These individuals hold an assumption that I would be able to relate to a more collectivistic worldview. Because I offer free consultations prior to meeting with clients for an intake, I have had several clients ask directly about my ability to understand certain family dynamics inherent to Asian cultures. I have responded openly to these questions, sharing the similarities and differences I am aware of, as well as my limitations, since I moved to the U.S. before age 10. For the most part, I have been able to connect with many clients of Asian backgrounds; this tends to be the majority of my caseload at any given time.

As you enter into the multicultural domain of counseling and psychotherapy, reflect on your ethnic, cultural, gender, sexual, religious, and ability identities. As a client, would you prefer working with someone with a background or identity similar to yours? What might be the benefits? Alternatively, as a client, might there be situations when you would prefer working with someone who has a background/identity different than yours? If so, why and why not?

Reflecting on Dr. Chookolingo’s success in attracting and working with other Asian/South Asian people . . . what specific actions did she take to build her caseload? How did she achieve her success?

[End of Practice and Reflection 1.3]

For more info on ethnic matching, see these articles:

Olaniyan, F., & Hayes, G. (2022). Just ethnic matching? Racial and ethnic minority students and culturally appropriate mental health provision at British universities. International Journal of Qualitative Studies on Health and Well-being, 17(1), 16. doi:https://doi.org/10.1080/17482631.2022.2117444

https://www.tandfonline.com/doi/full/10.1080/17482631.2022.2117444

Stice, E., Onipede, Z. A., Shaw, H., Rohde, P., & Gau, J. M. (2021). Effectiveness of the body project eating disorder prevention program for different racial and ethnic groups and an evaluation of the potential benefits of ethnic matching. Journal of Consulting and Clinical Psychology, 89(12), 1007-1019. doi:https://doi.org/10.1037/ccp0000697

https://psycnet.apa.org/doiLanding?doi=10.1037%2Fccp0000697

Happiness, Personal Reflections

Exploring Irritability with CBT

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Irritability is a fascinating experience. It’s hard to perfectly describe, so I looked up the definition online. Dictionary says: “The quality or state of being irritable.” Hahaha. This is the sort of helpfulness I’ve been experiencing from the pesky universe lately. . . with the exception of the IT guy who helped me for 45 minutes a couple weeks ago. He was nice and tried to help, but sadly, I’m the guy who was once told by IT person at UM that maybe I had swallowed a magnet because of how well electronics work in my presence. Maybe it’s my magnetic personality? Even more hahaha.

Let’s get back to irritability. Lately, I’ve been beset with intermittent bouts of irritability, which, I understand is the quality or state of being irritable. The definition of irritable is more illuminating: “having or showing a tendency to be easily annoyed or made angry.”

Yes, I’ve got that. In my defense, there are SO MANY irritating things in the world.

But there’s really no good excuse for my irritability. I feel it burble up, usually in response to something psychologically, emotionally, or physically painful. I’ve had some chronic pain for the past three months, which makes it easier for my irritability button to get pushed. I’ve also had more than my share of tech problems.

After working out at the gym, a particular Dean whom I saw on campus, asked me, “Did you have a good workout?” I muttered something about never having good workouts anymore. Not surprisingly, he noticed my irritability. Then he shared a few Buddhist thoughts about “All is suffering” with me. Despite my internal lean toward being “easily annoyed” (even with my friend the Dean) I listened and immediately glimpsed my lifelong nemesis peeking at me from around the corner. No . . . it wasn’t the Dean, or Lee Jeffries the red-headed bully who tormented me in junior high. Strangely, my lifelong nemesis happens to be the nemesis of many. I’m betting it may be yours as well.

Given that our nemesis has multitudes, let’s give it the pronoun they. They have a name. Expectations.

My expectations are routinely laughably unrealistic. I know that about myself. I also know that when I set myself up with expectations for an hour or a day, the hour or the day includes more irritability. My friend the Dean was commenting on the All-American tendency to expect happiness, whereas the Buddhists embrace that “all is suffering.” 

Several weeks ago, the focus of the Happiness Challenge was on goal-setting. I didn’t do much goal-setting back then, which is okay, because goal-setting should happen when we’re ready for goal-setting. I also know that this week’s Happiness Challenge is about cognitive behavior therapy (CBT). And so this week I’ve been working on a goal to be more immediately self-aware of my expectations and irritability triggers, and to make a concerted effort to manage my irritability in ways I feel good about.

To enhance my self-awareness, I completed the “column technique” for myself and my relationship with irritability. Although I’m not a natural fan of CBT, I found the process helpful, if not illuminating. What was most helpful was to fill out the columns—like a journal—and then read through what I had written. My response was to feel a little embarrassed at the triviality of my irritability triggers. And . . . as Alfred Adler wrote about a century ago, insight (aka self-awareness) is a natural motivator.

For anyone interested, here’s my completed column log activity.

ch-8-lab-tech-irritability-jsfDownload

In the end, glimpsing my process and experiences through the column technique this week has made me more motivated that ever to address my irritability in a positive and constructive way.

Cool Counseling, Happiness, Personal Reflections, Therapy with Adolescents, Writing

Let’s Do the “Three-Step” (Emotional Change Trick)

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This morning’s weekly missive of “most read” articles from the Journal of the American Medical Association included a study evaluating the effects of high-dose “fluvoxamine and time to sustained recover in outpatients with COVID-19.” My reaction to the title was puzzlement. What could be the rationale for using a serotonin specific reuptake inhibitor for treating COVID-19? I read a bit and discovered there’s an idea and observations that perhaps fluvoxamine can reduce the inflammation response and prevention development of more severe COVID-19.

To summarize, the results were no results. Despite the fact that back in the 1990s some psychiatrists and pharmaceutical companies were campaigning for putting serotonin in the water systems, in fact, serotonin doesn’t really do much. As you know from last week, serotonin-based medications are generally less effective for depression than exercise.

For the happiness challenge this week, we’re touting the effectiveness of my own version of what we should put in the water or in the schools or in families—the Three-Step Emotional Change Trick. Having been in a several month funk over a variety of issues, I find myself returning to the application of the Three-Step Emotional Change Trick in my daily life. Does it always work? Nope. Is it better than feeling like a victim to my unpleasant thoughts and feelings? Yep.

I hope you’ll try this out and follow the instructions to push the process outward by sharing and teaching the three steps. Let’s try to get it into the water system.

Active Learning Assignment 9 – The 3-Step Emotional Change Trick

Almost no one likes toxic positivity. . . which is why I want to emphasize from the start, this week’s activity is NOT toxic positivity.

Back in the 1990s I was in full-time private practice and mostly I got young client referrals. When they entered my office, nearly all the youth were in bad moods. They were unhappy, sad, anxious, angry, and usually unpleasantly irritable. Early on I realized I had to do something to help them change their moods.

An Adlerian psychologist, Harold Mosak, had researched the emotional pushbutton technique. I turned it into a simple, three-step emotional change technique to help young clients deal with their bad moods. I liked the technique so well that I did it in my office, with myself, with parents, during professional workshops, and with classrooms full of elementary, middle, and high school students. Mostly it worked. Sometimes it didn’t.

This week, your assignment is to apply the three-step emotional change trick to yourself and your life. Here’s how it goes.

Introduction

Bad moods are normal. I would ask young clients, “Have you ever been in a bad mood?” All the kids nodded, flipped me off, or said things like, “No duh.”

Then I’d ask, “Have you ever had somebody tell you to cheer up?” Everyone said, “Yes!” and told me how much they hated being told to cheer up. I would agree and commiserate with them on how ridiculous it was for anyone to ever think that saying “Cheer up” would do anything but piss the person off even more. I’d say, “I’ll never tell you to cheer up.* If you’re in a bad mood, I figure you’ve got a good reason to be in a bad mood, and so I’ll just respect your mood.” [*Note to Therapists: This might be the single-most important therapeutic statement in this whole process.]

Then I’d ask. “Have you ever been stuck in a bad mood and have it last longer than you wanted it to?”

Nearly always there was a head nod; I’d join in and admit to the same. “Damn those bad moods. Sometimes they last and last and hang around way longer than they need to. How about I teach you this thing I call the three-step emotional change trick. It’s a way to change your mood, but only when YOU want to change your mood. You get to be the captain of your own emotional ship.”

Emotions are universally challenging. I think that’s why I never had a client refuse to let me teach the three-steps. And that’s why I’m sharing it with you now.

Step one is to feel the feeling. Feelings come around for a reason. We need to notice them, feel them, and contemplate their meaning. The big questions here are: How can you honor and feel your feelings? What can you do to respect your own feelings and listen to the underlying message? I’ve heard many answers. Here are a few. But you can generate your own list.

  • Frowning or crying if you feel sad
  • Grimacing and making angry faces into a mirror if you feel angry
  • Drawing an angry picture
  • Punching or kicking a pillow (no real violence though)
  • Going outside and yelling (or screaming into a pillow)
  • Scribbling on a note pad
  • Writing a nasty note to someone (but not delivering it)
  • Using your words, and talking to someone about what you’re feeling

Step two is to think a new thought or do something different. This step is all about intentionally doing or thinking something that might change or improve you mood. The big question here is: What can you think or do that will put you in a better mood?

I discovered that kids and adults have amazing mood-changing strategies. Here’s a sampling:

  • Tell a funny story (“Yesterday in math, my friend Todd farted”)
  • Tell a joke (What do you call it when 100 rabbits standing in a row all take one step backwards? A receding hare-line).
  • Tell a better joke (Why did the ant crawl up the elephant’s leg for the second time? It got pissed off the first time.)
  • Exercise!
  • Smile into a mirror
  • Talk to someone you trust
  • Put a cat (or a chicken or a duck) on your head
  • Chew a big wad of gum

I’m sure you get the idea. You know best what might put you in a good mood. When you’re ready, but not before, use your own self-knowledge to move into a better mood.

Step three is to spread the good mood. Moods are contagious. I’d say things like this to my clients:

“Emotions are contagious. Do you know what contagious means? It means you can catch emotions 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 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 better mood. I’m wondering. Do you think you can make your mom “catch” your good mood?”

How do you share good moods? Saying “Cheer up” is off-limits. Here’s a short list of what I’ve heard from kids and adults.

  • Do someone a favor
  • Smile
  • Hold the door for a stranger
  • Offer a real or virtual hug
  • Listen to someone
  • Tell someone, “I love you”

Step four might be the best and most important step in the three-step emotional change trick. With kids, when I move on to step four, they always interrupt:

“Wait. You said there were only three steps!”

“Yes. That’s true. But because emotions are complicated and surprising, the three-step emotional change trick has four steps. The fourth step is for you to teach someone else the three steps.”

Here’s a youtube link to me doing the 3SECT: https://www.youtube.com/watch?v=ITWhMYANC5c

If you want to chase down an early version/citation, here’s a link for that: https://www.tandfonline.com/doi/abs/10.1300/J019v17n04_02