Tag Archives: psychological assessment

Making Memories in L.A.

I’ve never been the sort of person who can memorize a script or speech. My preference is to have an outline handy so I can speak to a coherent set of points and go free form from there. Memorizing or reading speeches always struck me as too lacking in spontaneity. This is probably pure rationalization. More likely, I either don’t have the self-discipline or cognitive ability to memorize speeches. But I’d just as soon forget that explanation.

Tomorrow I’ll be participating in an Alexander Street Press video recording session in L.A. It would be nice to have memorized at least some of my 2+ hours of content. I comfort myself with the unrealistic hope that—when the moment strikes—I’ll be locked in, spontaneous, and articulate, in a profound sort of way.

Last month I was in my first-ever theatrical performance. I had a bit role (or two) in Death by Dessert, put on by the Old Stone Players in Absarokee, MT. The crowds were immense (upwards of 90). Fortunately, my lines were short, and I memorized them all. The longest of my 14 lines (some of which included, “Okay” and “Yes sir.”) was: “What a shocking development. A set of twins. A boy and a girl.” I nailed those 13 words in four straight performances. Tomorrow, all I need to do is fill up about 130 minutes.

So I made up a pretend script for my L.A. recording. Most of which I’m fairly sure I’ll forget in the heat of the moment. I’ve also made up some personal notes, but because, when on camera, I’m too proud to want to let myself look down at my notes, they’ll probably go unused. This means I’ll achieve my goal of being spontaneous and being spontaneous usually works well if I’m not too anxious. The bad news is that because this will be video-recorded I will of course be anxious and Mr. Anxiety will exert his ugly head and super-funny sense of humor. The way it works for me is that Mr. Anxiety grabs a big eraser, causing all my profound thoughts to suddenly disappear, leaving me with the sort of blank mind that I wish for when trying to meditate. Then, I’m forced to fill in the blank, which makes me sound more like Sarah Palin than the silver-tongued sophisticate that I imagine myself to be.

The reassuring part of all this is that Dr. Matt Englar-Carlson (one of the nicest guys on the planet), son of Dr. Jon Carlson (one of the other nicest guys on the planet) will be interviewing me and facilitating the process. That’s good, because when I start sounding like Sarah Palin, it’s best to be around very nice and forgiving people.

Anyway, this brings me to my script, which I’m studying right now in one way or another. I’ve included a portion below. It seemed prudent to post this now, because by tomorrow at this time, the screen will be blank.

Matt E-C: Can you talk about your approach to counseling?

John S-F: I consider myself dogmatically eclectic. I believe, rather strongly, that we counselor-types need to shift our approach depending on the client, problem, goals, setting, and other factors. I think counselors should modify their theory to fit the client; clients shouldn’t be expected to adapt to their counselor’s theory.

That said, I think most of what we do requires a relational connection or working alliance. It’s important to establish credibility and trust. With this in mind I follow concrete steps linked to what Norcross has called “Evidence-Based Relationships.” There are several relational factors that appear to contribute substantially to positive counseling outcomes. A few examples include: (a) the working alliance (which includes the Adlerian concept of goal alignment); (b) Rogers’s core conditions; and (c) progress monitoring. Overall, I hope to establish a positive and collaborative working relationship and then use specific techniques, activities, and homework assignments that fit with clients and their problems/goals.

Matt E-C: If the counseling is effective what do you want to see happen?

John S-F: Early in the process of working with teenagers I use what I call an authentic purpose statement. This is a clear statement of MY PURPOSE in the room. It varies depending on the client, the referral situation, the setting, and other factors, but one example is: “My goal is to help you accomplish your goals, as long as they’re legal and healthy.” Occasionally I’ll add, “. . . and sometimes we might disagree on what’s legal and healthy and need to talk about it.”

Mostly I want clients to achieve their counseling goals. But I’d be lying if I didn’t admit that I have my own thoughts and values about good counseling goals. For example, I value social interest, healthy egalitarian and respectful relationships, self-management, healthy habits, and psychological/emotional awareness. I think these are usually good goals for most clients. You may notice I didn’t include happiness or anxiety management in my list of good counseling goals. Although I value symptom reduction and often work directly on that, overall I think a life well-lived is a better way to alleviate depression and anxiety than providing treatments that are too circumscribed.

Matt E-C: Can you tell the viewers a little about your background and how you learned the skills of professional counseling?

John S-F: I have an early pivotal memory. I was a Junior at Oregon State University. Having just transferred from a Community College where I pretty much ONLY focused on athletics, I had only recently declared myself to be a psychology major. I remember the first time I “tried” to do counseling in a pre-practicum undergraduate psychology class. My professor was a man named Thomas Murphy. He was Native American. At that point I was fairly lost in terms of my potential professional career. He set us up to do “counseling” with each other in front of the class. My counseling partner had a bicycle accident on her way to class. She showed up; she wasn’t physically injured, but was very distressed and angry. All I did was use my best listening skills. The feedback I got from Dr. Murphy and the class was fabulously positive (you might say encouraging). I think that was the day I became a counselor.

Later, I got my Ph.D. in clinical psychology from the University of Montana. At the time, the program was purposefully eclectic. We had cognitive, psychoanalytic/hypnoanalytic, person-centered, existential, and behavioral professors. While in that program, I volunteered to help with a dissertation and got training in Constance Fischer’s collaborative assessment approach, which was profound and enlightening.

I also did a year-long psychoanalytic internship in Syracuse, NY.

Looking back, none of my training experiences were perfect (and I wasn’t either), but in every situation I was able to learn and grow and develop myself as a person and professional.

Matt E-C: When you train counselors what are some of the most important areas that you want to make sure they learn or develop?

John S-F: If students aren’t able to listen non-directively, then I think they should find a different profession. When I hear myself say that, it sounds too bIunt and narrow minded, but I mean it. I don’t expect students to be constantly person-centered, but if they can’t ever become person-centered and do so intentionally, that’s a big problem and they’ll need to address it in their professional development. It scares them when they hear this, but I want them to understand my expectations.

Students should be open to supervision; that’s another expectation. When they’re not, it drastically limits their professional development. It’s not so much that I want them to be open to me, but they should be open to the possibility that there’s a better way to do counseling than what they’re doing; and they should keep trying to improve themselves.

I also want students to learn theory AND techniques and to understand how the two are related. One of my old supervisors used to talk about how it was unacceptable to “fly by the seat of your pants.” I still don’t really get the metaphor, but when I’m supervising, I want to be able to pause the recording and get a solid answer when I ask, “What are you doing and where are you going?” I tell students that we may not agree on what’s best at any specific point, but I want them to be able to articulate their rationale.

Students should respect scientific research and not be woo-woo. On the other hand, I want them to be open to intuition and to the fact that much of the variation that contributes to positive counseling outcomes is simply unknown. Minuchin used to say, “Don’t be too sure” and I like that attitude very much. When students act too sure, I usually try to teach them a constructive lesson about letting go of some of their certainty.




Cultural Adaptations in the DSM-5: Insert Foot in Mouth Here

Sometimes it just seems easier to be snarky than balanced. This basic truth comes to mind because of a recent analysis I did of the Cultural Formulation Interview (CFI) from the DSM-5. As I read about the CFI and looked through its Introduction and 16 questions for “patients,” I kept thinking to myself things like,

“Seriously . . . could this really be the best cultural sensitivity that the American Psychiatric Association can manage when it comes to guidelines for interviewing minority cultures?”


“Who wrote this and why didn’t they ask me for some help?” (insert smiley face here; please note that some of my colleagues at the University of Montana have noticed—and commented—on the fact that I tend to insert a smiley face icon right after texting or emailing my personal version of punchy, snarky, sarcasm).

Ha! is all I have to say to them (FYI: Ha! is my programmed default back up to my default smiley face snark signal).

Anyway . . . the point! It’s way easier for me to be critical of the American Psychiatric Association than balanced. In truth, the CFI is a reasonable effort. And, if you think about where the APA is coming from (and likely going to) then the CFI is a massive effort. I should be saying, “Cool! I’m so excited to see the CFI as part of the DSM-5.

All this is prologue for the excerpt I include below. This is an excerpt from a draft chapter I’m writing for the Handbook of Clinical Psychology . . . to be published at some point in the not too distant future. Here’s the excerpt; it focuses on cultural adaptations we can make when conducting initial clinical interviews with minority clients; forgive the roughness of the draft.

Cultural Adaptations

A clinical interview is a first impression, and first impressions are powerful influences on later relational interactions, which is why we need to make cultural adaptations when conducting clinical interviews. One of the best sources for cultural adaptations is the already-existing guidance from psychotherapy research on working multiculturally. These guidelines include: (a) using small talk and self-disclosure with some cultural groups, (b) when feasible, conducting initial interviews in the patient’s native language, (c) seeking professional consultations with professionals familiar with the patient’s culture; (d) avoiding the use of interpreters except in emergency situations; (e) providing services (e.g., childcare) that help increase patient retention, (f) oral administration of written materials to patients with limited literacy, (g) having awareness and sensitivity to client age and acculturation, (h) aligning assessment and treatment goals with client culturally-informed expectations and values, (i) regularly soliciting feedback regarding progress and client expectations and responding immediately to client feedback, and (j) explicitly incorporating cultural content and cultural values into the interview, especially with patients not acculturated to the dominant culture (see Griner & Smith, 2006; Hays, 2008; Smith, Rodriguez, & Bernal, 2011).

Cultural awareness, cross cultural sensitivity, and making cultural adaptations are especially important to assessment and diagnosis. This is partly because mental health professionals have a long history of inappropriately or inaccurately assigning psychiatric diagnoses to cultural minority groups (Paniagua, 2014). To address this challenge, in the latest edition of the Diagnostic and Statistical Manual (DSM-5; American Psychiatric Association, 2014), a Cultural Formulation Interview (CFI) protocol is included to aid the diagnostic interview process.

The CFI is a highly structured brief interview. It is not a method for assigning clinical diagnoses; instead, its purpose is to function as a supplementary interview that enhances the clinician’s understanding of potential cultural factors. It also may aid in the diagnostic decision-making process. The CFI includes an introduction and four sections (composed of 16 specific questions). The four sections include:

1. Cultural definition of the problem
2. Cultural perceptions of cause, context, and support
3. Cultural factors affecting self-coping and past help seeking
4. Cultural factors affecting current help seeking

Questions from each section are worded in ways to help clinicians gently explore cultural dimensions of their clients’ problems. Question 2 is a good representation: “Sometimes people have different ways of describing their problem to their family, friends, or others in their community. How would you describe your problem to them?” (American Psychiatric Association, 2014).

Clinicians are encouraged to use the CFI in research and clinical settings. There is also a mechanism for users to provide the American Psychiatric Association with feedback on the CFI’s utility. It may be reproduced for research and clinical work without permission, which is a cool thing.

If you Google: “Cultural Formulation Interview” the first non-advertised hit should be a .pdf of the CFI.

If you Google: “Clinical Interviewing” the first several hits will take you to some form or another of our text on the topic.

Here’s a photo of me “working” inter-culturally with my brother-in-law (insert smiley face here):