Tag Archives: Psychotherapy

The Efficacy of Solution-Focused Therapy

The Efficacy of Solution-Focused Therapy

For years I’ve wondered about what the research says about the efficacy of solution-focused therapy. While revising our theories text, I reviewed some of the literature. If you’re interested, I published a short blog about it on psychotherapy.net. Check it out. http://www.psychotherapy.net/blog/title/the-miraculous-or-not-efficacy-of-solution-focused-therapy

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Another Funny (but not as in hilarious) but Shorter Promo Video for our Theories of Counseling and Psychotherapy textbook.

Another Funny (but not as in hilarious) but Shorter Promo Video for our Theories of Counseling and Psychotherapy textbook.

Reflections on Listening to Irvin Yalom at the ACA Conference

After a few hectic and overstimulating days at the ACA World Conference in San Francisco, I’ve now secured the back table at a Starbucks in Vancouver, WA for brief written reflection. This reflection weaves quotations (and paraphrases) from the great Irvin Yalom into my own personal conference experiences.

My formal conference highlight was watching and listening as NPR’s Craig Windham interviewed Yalom onstage for the keynote. After listening to Yalom’s keynote six years ago, I think the interview format was an ingenious method for capturing a more personal glimpse into Yalom and his writing than a stand and deliver keynote speech.

I especially enjoyed listening to Yalom reflect on his early years. Two statements stand out:

On his career decision-making as a child of Russian immigrants: “We had two choices: We could become a doctor or a failure.”

On his unparalleled greatness within the field of group psychotherapy: “My wife thinks it’s rather ironic that I became an expert in group psychotherapy, because I’m really quite uncomfortable in groups.”

Early in his “speech” Yalom emphasized the importance of counselors to the field of psychotherapy. In several ways he made curiously stimulating statements emphasizing (I’m paraphrasing now) that counselors are the future of psychotherapy. As a hybrid counselor and psychologist, I wonder if he would have made the same statements had he been keynoting at the annual American Psychological Association meeting.

My reactions to Yalom’s claim about counselors being the future of psychotherapy are free-ranging like the chickens in our backyard, but here are two:

Yes, I think counselors will be the future of psychotherapy, but only if we’re able to stop getting in our own way . . . And psychologists will undoubtedly be the future of measuring psychotherapy efficacy . . . if they (or we) can manage to focus on issues more meaningful than pharmacology and neuroscience.

For those curious about where Yalom finds his writing inspiration, in response to Windham’s questioning, he disclosed that as a Californian he has mastered the evening hot tub experience. Subsequently, he’s able to write most productively in the morning about “what I’ve learned in the hot tub.” I suspect there’s a bit more to it than that . . . but for those of us aspiring toward more writing greatness it makes for a solid rationale for nightly inspirational hot-tubbing.

On the popularity of his Group Psychotherapy text, Yalom stated: “I suspect it’s because of the stories in the book that I smuggled in . . .”

On his personal experience of fame (keep in mind that about 4K of us had to line up like rock concert fans to see him), he shared his own sort of dissociated imposter feelings:

“There’s a part of this that is very unreal. I don’t have any foundation. My parents were uneducated. They had very little schooling. I don’t have any foundation behind me. It’s a little shaky for me. I compare it to a lily growing in a swamp. There’s no foundation underneath. No matter how successful I am, I question . . . is this really me. Am I really successful?”

As an existential psychotherapist, it’s not surprising that Yalom believes deeply in helping clients pursue meaning. This is where it gets personal for all of us. He said, “Cancer cures psychoneurosis” and that “Life cannot be postponed.” Over the years he has helped many clients focus on their regrets—which often translate into moments when they weren’t able to face life and life fully in the moment. But we shouldn’t mistake Yalom’s live-in-the-moment philosophy for old-fashioned California hot-tub hedonism.  Yalom’s version of living in the moment is at once emotional AND intellectual; it is inspirational AND intentional.

Yalom also said that “Storytelling . . . may be the very best way I can teach.” Lucky for me I’ve gathered a few teaching stories over the years. Sometimes a combination of reality and my own constructive fiction, at this ACA I had a chance to share many stories. First, in a six hour pre-conference Learning Institute on Wednesday attended by 32 fabulous counselors, and later in an ACA-sponsored Friday session on Connecting and Working Effectively with Challenging Youth attended by about 200. In terms of reaping my own share of attention and praise, this was perhaps my best ACA conference ever.

But then Sunday morning comes. And when I awaken, what grand thoughts trickle into my consciousness? Do I think of the 25 people who lined up to have me sign copies of “Tough Kids, Cool Counseling?” Do I lie on the floor of my high-school educated parents home—where I’ve stopped for a short visit—feeling smug satisfaction about the glory I felt when Craig Windham of NPR fame also stood in line to have me sign a book FOR HIM. Do I reflect on the sweet and ego-boosting comments he shared with me about my work?

Nope. Nothing so grand knocks on the door of my early morning awareness. Instead, I’m transported back to a moment when, immediately after speaking to 200 conference attendees and spontaneously signing a couple books and receiving repeated praise from participants, a bold young woman approached me. She had attended BOTH my six hour workshop AND my 90 minute talk . . . and so forgive me my anticipation of praise as I looked into her eyes. But instead, she tells me that she’s not sure she learned anything from the six hour workshop. My well-practiced response is to welcome the criticism, while fending off disappointment and defensiveness. I feel precariously situated on my own lily pad. She goes on to explain that she’d “accidentally” gotten stuck in the 90 minute presentation and that based on what I’d talked about in there she thought I’d want the constructive feedback. “Of course I do,” I say . . . “Of course I do . . . and thank you very much for that.”

This is the stinging mantra to which I awaken this lovely and cloudy Sunday morning. A mantra of self-doubt . . . of possible regret . . . of wondering what I did wrong . . . of how I might improve myself.

Which brings me back to one of my favorite Yalom quotations (from his Group Psychotherapy text) about universality:

“During my own 600-hour analysis I had a striking personal encounter with the therapeutic factor of universality . . . I was very much troubled by the fact that, despite my strong positive sentiments, I was beset with death wishes for [my mother], as I stood to inherit part of her estate. My analyst responded simply, “That seems to be the way we’re built.” That artless statement offered not only offered considerable relief but enabled me to explore my ambivalence in great depth.” (p. 7)

Thank you Dr. Yalom for helping me and many others more deeply understand ambivalence, regret, self-doubt, personal meaning, death, and many of the other interesting ways the human psyche is built. And thank you, bold young woman, for providing me with hot-tub-free grist for my morning therapeutic writing mill.

Flaws in the Satanic Golden Rule

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Nearly always I learn tons of good stuff from my adolescent clients. A few years ago I learned what “Macking” meant. When I asked my 16-year-old Latino client if it meant having sex (I gently employed a slang word while posing my question), his head shot up and he made eye contact with me for the first time ever and quickly corrected me with a look of shock and disgust. “Macking means . . . like flirting,” he said. And as he continued shaking his head, he said, “Geeze. You’re crazy man.”

The next half hour of counseling was our best half hour ever.

I’m not advocating using the F-word or being an obtuse adult . . . just pointing out how much there is to learn from teenagers.

More recently I learned about the Satanic Golden Rule. A 17-year-old girl told me that it goes like this: “Do unto others as they did unto you.”

Now that’s pretty darn interesting.

Ever since learning about the Satanic Golden Rule I’ve been able to use it productively when counseling teenagers. The Satanic Golden Rule is all about the immensely tempting revenge impulse we all sometimes feel and experience. It’s easy (and often gratifying) to give in to the powerful temptation to strike back at others whom you think have offended you. Whether it’s a gloomy and nasty grocery cashier or someone who’s consistently arrogant and self-righteous, it’s harder to take the high road and to treat others in ways we would like to be treated than it is to stoop to their level to give them a taste of their own medicine.

There are many flaws with the Satanic Golden Rule . . . but my favorite and the most useful for making a good point in counseling is the fact that, by definition, if you practice the Satanic Golden Rule, you’re giving your personal control over to other people. It’s like letting someone else steer your emotional ship. And to most my teenage clients this is a very aversive idea.

After talking about the Satanic Golden Rule many teenage clients are more interested in talking about how they can become leaders. . . leaders who are in control of their own emotions and who proactively treat others with respect.

An excellent side effect of all this is that it also inspires me to try harder to be proactively respectful, which helps me be and become a better captain of my own emotional ship.

Reflections on Magic

I have a former graduate student (you know who you are) who always talks about using magic. If she wants something to work out a certain way, she simply “casts a spell” to make things right. Of course, like most of us, she expertly avoids paying attention to evidence refuting her magical abilities, while studiously attending to moments when it appears her spells have somehow affected reality.

This was all in good fun. We were driving many miles back and forth to an internship site at Trapper Creek and in some ways her spells were designed to counter my tendency to construct a firm deterministic viewpoint. Although I agree there are many mysteries in life and that there’s likely room for magic, I get quickly impatient with too many attributions about magic, miracles, past lives, and sinister ghosts in the halls of the female dorm at Trapper Creek Job Corps.

Despite my general avoidance of magical thinking, I find myself very intrigued with this old quotation of Freud’s that Steven de Shazer turned into a book title:

“Words were originally magic and to this day words have retained much of their ancient magical power. By words one person can make another blissfully happy or drive him [or her] to despair . . . . Words provoke affects and are in general the means of mutual influence among men [or women].”

I do think words have powerful influence . . . but it’s equally true that what we don’t say—the nonverbal, and listening in particular—can be just as magical. All this is a way of introducing the following excerpt soon be published in the 2nd edition of our Counseling and Psychotherapy Theories in Context and Practice textbook as food for thought this Monday morning. Here it is:

The Magic of Person-Centered Listening

Person-centered listening isn’t in vogue in the United States. It might be that most of us are too busy tweeting and expressing ourselves to dedicate time and space to person-centered listening. The unpopularity of person-centered approaches also might be related to the prominent “quick fix” attitude toward mental health problems. And so, call us old-fashioned, but we think that if you haven’t learned to do person-centered listening, you’re missing something big.

Years ago, when John was deep into the “Carl Rogers” stage of his development, he decided to create a person-centered video recording to demonstrate the approach. He recruited a volunteer from an introductory psychology course, obtained informed consent, set up a time and a place, welcomed a young woman into the room, and started listening.

Lucky for John, the woman was a talker. It’s much harder to get the magic to happen with nonverbal introductory psychology students.

It wasn’t long into the session when John attempted a short summary of what the woman had said. He felt self-conscious and inarticulate, but was genuinely trying to do the person-centered listening thing: He was paraphrasing, reflecting feelings, summarizing, walking within, and doing all he could to be present in the room and make contact or connect with the “client.” After his rambling summary, there was an awkward silence. John remained silent, trusting that the client knew where to go next. And she did. She cut through the awkwardness with a disclosure of having been sexually molested as a child. John continued listening non-directively as the woman told her story, shed a few tears, and spoke powerfully about her journey toward building inner strength.

The demonstration recording was a huge success . . . except for the fact that the audio was terrible. To hear the powerful disclosure and share in the magic of person-centered process, John had to force his class of 15 graduate students to gather within three feet of the television in perfect silence . . . which was also rather awkward.

The lesson of person-centered listening is that sometimes when you put it all together the client can take you places you never knew existed. There are many things about our clients that we’ll never know unless and until we listen empathically, communicate genuinely, and experience respect for the other person with our heart and soul. As Rogers (1961) said, “. . . the client knows what hurts. . .” and so it’s up to us—as therapists—to provide an environment where clients can articulate their pain and re-activate their actualizing tendency.