Tag Archives: Psychotherapy

Clinical Interviewing, Writing

Listening and Therapeutic Silence in the Clinical Interview

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Back in the day, I was so into person-centered (aka nondirective) listening that I coauthored a 1989 article in the journal Teaching of Psychology titled, “Thou Shalt Not Ask Questions.” The point was that by temporarily eliminating questions from our therapeutic repertoire, we grow more aware of how to listen without using directive methods for facilitating client talk.

I’m still a fan of limiting therapist questions, if only to become more aware of their power. Even in the case of solution-focused or narrative therapies, when questions are the central therapeutic strategy, we should be as person-centered as possible when asking questions.

Below, I’ve included an excerpt of our coverage of listening from the forthcoming 7th edition of Clinical Interviewing. In the early 1990s, along with the first edition of Clinical Interviewing, we described a concept called the listening continuum. The excerpt starts there and then focuses in on what’s likely the most non-directive skill of all, therapeutic silence.

Here’s the excerpt. I hope you enjoy it and find it useful.

The Listening Continuum in Three Parts

Nondirective listening behaviors give clients responsibility for choosing what to talk about. Consistent with person-centered approaches, using nondirective behaviors is like handing your clients the reins to the horse and having them take the lead and choose where to take the session. In contrast, directive listening behaviors (Chapter 5) and directive action behaviors (Chapter 6) are progressively less person-centered. These three categories of listening behaviors (and the corresponding chapters) are globally referred to as the listening continuum. To get a visual sense of the listening continuum, see Table 4.1.

Table 4.1 The Listening Continuum

Nondirective Listening Behaviors on the LEFT Edge (Chapter 4)Directive Listening Behaviors in the MIDDLE (Chapter 5)Directive Action Behaviors on the RIGHT Edge (Chapter 6)
Attending behaviors or minimal encouragersFeeling validationClosed and therapeutic questions
Therapeutic silenceInterpretive reflection of feelingPsychoeducation or explanation
ParaphraseInterpretation (classic or reframing)Suggestion
ClarificationConfrontationAgreement/disagreement
Reflection of feelingImmediacyGiving advice
SummaryOpen questionsApproval/disapproval
  Urging

The ultimate goal is for you to use behavioral skills along the whole listening continuum. We want you to be able to apply these skills intentionally and with purpose. That way, when you review a video of your session with a supervisor, and your supervisor stops the recording and asks, “What exactly were you doing there?” you can respond with something like this:

I was doing an interpretive reflection of feeling. The reason I chose an interpretive reflection is that I thought the client was ready to explore what might be under their anger.

Trust us; this will be a happy moment for both you and your supervisor.

Hill (2020) organized the three listening continuum categories in terms of their primary purpose:

  1. Nondirective listening behaviors facilitate client talk.
  2. Directive listening behaviors facilitate client insight.
  3. Directive action behaviors facilitate client action.

Skills for Encouraging Client Talk

We hope you still (and will always) remember the Rogerian attitudes and have placed them firmly in the center of your developing therapeutic self. In addition, at this point we hope you understand the two-way nature of communication, the four different types of attending behaviors, and how your listening focus can shift based on a variety of factors, including culture and theoretical orientation.

Next, we begin coverage of technical skills needed to conduct a clinical interview. See Table 4.2 for a summary of nondirective listening behaviors and their usual effects. Having already reviewed attending behaviors, we now move to therapeutic silence.

Therapeutic Silence

Most people feel awkward about silence in social settings. Some researchers have described that therapists-in-training view silence as a “mean” response (Kivlighan & Tibbits, 2012). Despite the angst it can produce, silence can be therapeutic.

Therapeutic silence is defined as well-timed silence that facilitates client talk, respects the client’s emotional space, or provides clients with an opportunity to find their own voice regarding their insights, emotions, or direction. From a Japanese perspective,

Silence gives forgiveness and generosity to human dialogues in our everyday life. Without silence, our conversation tends to easily become too clever. Silence is the place where “shu”… (to sense the feeling of others, and forgive, show mercy, absolve, which represents an act of benevolence and altruism) arises, which Confucius said was the most important human attitude. (Shimoyama, 1989/2012, p. 6; translation by Nagaoka et al., 2013, p. 151)

Table 4.2 Summary of Nondirective Listening Behaviors and Their Usual Effects

Listening ResponseDescriptionPrimary Intent/Effect
Attending behaviorsEye contact, leaning forward, head nods, facial expressions, etc.Facilitates or inhibits client talk.
Therapeutic silenceAbsence of verbal activityAllows clients to talk. Provides “cooling off ” or introspection time. Allows clinician time to consider next response.
ParaphraseReflecting or rephrasing the content of what the client saidAssures clients that you heard them accurately and allows them to hear what they said.
ClarificationRestating a client’s message, preceded or followed by a closed question (e.g., “Do I have that right?”)Clarifies unclear client statements and verifies the accuracy of what the clinician heard.
Reflection of feelingRestatement or rephrasing of clearly stated emotionEnhances clients’ experience of empathy and encourages further emotional expression.
SummaryBrief review of several topics covered during a sessionEnhances recall of session content and ties together or integrates themes covered in a session.

Silence also allows clients to reflect on what they just said. Silence after a strong emotional outpouring can be therapeutic and restful. In a practical sense, silence also allows therapists time to intentionally select a response rather than rush into one.

In psychoanalytic psychotherapy, silence facilitates free association. Psychoanalytically oriented therapists use role induction to explain to clients that psychoanalytic therapy involves free expression, followed by occasional therapist comments or interpretations. Explaining therapy or interviewing procedures to clients is always important, but especially so when therapists are using potentially anxiety-provoking techniques, such as silence (Meier & Davis, 2020).

CASE EXAMPLE 4.2: EXPLAIN YOUR SILENCE

While on a psychoanalytically oriented internship, I (John) noticed one supervisor had a disturbing way of using silence during therapy sessions (and in supervision). He would routinely begin sessions without speaking. He sat down, looked at his client (or supervisee), and leaned forward expectantly. His nonverbal behavior was unsettling. He wanted clients and supervisees to free associate and say whatever came to mind, but he didn’t explain, in advance, what he was doing. Consequently, he came across as intimidating and judgmental. The moral of the story: Use role induction—if you don’t explain the purpose of your silence, you risk scaring away clients.

[End of Case Example 4.2]

Examples of How to Talk About Silence

Part of the therapist’s role involves skilled explanations of process and technique. This includes talking about silence. Case Example 4.2 is a good illustration of how therapist and client would have been better served if the therapist had explained why he started his sessions with silence.

Here’s another example of how a clinician might use silence therapeutically:

Katherine (they/them) is conducting a standard clinical intake interview. About 15 minutes into the session the client begins sobbing about a recent romantic relationship break-up. Katherine provides a reflection of feeling and reassurance that it’s okay to cry, saying, “I can see you have sad feelings about the break-up. It’s perfectly okay to honor those feelings in here and take time to cry.” They follow this statement with about 30 seconds of silence.

There are several other ways Katherine could handle this situation. They might prompt the client,

Let’s take a moment to sit with this and notice what emotions you’re feeling and where you’re feeling them in your body.

Or they might explain their purpose more clearly.

Sometimes it’s helpful to sit quietly and just notice what you’re feeling. And sometimes you might have emotional sensations in a particular part of your body. Would you be okay if we take a few moments to be quiet together so you can tune in to your emotions and where you’re feeling them?

In each of these scenarios, Katherine explains, at least briefly, the use of silence. This is crucial because when clinicians are silent, pressure is placed on clients to speak. When silence continues, the pressure mounts, and client anxiety may increase. In the end, clients may view their experience with an excessively silent therapist as aversive, lowering the likelihood of rapport and a second meeting.

Guidelines for Using Silence Therapeutically

Using silence may initially feel uncomfortable. With practice, you’ll increase your comfort level. Consider the following suggestions:

  • When a client pauses after making a statement or after hearing your paraphrase, let a few seconds pass rather than jumping in verbally. Given an opportunity, clients can move naturally into important material without guidance or urging.
  • As you’re waiting for your client to resume speaking, tell yourself that this is the client’s time for self-expression, not your time to prove you can be useful.
  • Try not to get into a rut regarding silence. When silence occurs, sometimes wait for the client to speak next and other times break the silence yourself.
  • Be cautious with silence if you believe your client is confused, psychotic, or experiencing an acute emotional crisis. Excessive silence and the anxiety it provokes can exacerbate these conditions.
  • If you feel uncomfortable during silent periods, use attending skills and look expectantly toward clients. This helps them understand it’s their turn to talk.
  • If clients appear uncomfortable with silence, give them instructions to free associate (e.g., “Just say whatever comes to mind”). Or you can use an empathic reflection (e.g., “It’s hard to decide what to say next”).
  • Remember, sometimes silence is the most therapeutic response available.
  • Read the interview by Carl Rogers (Meador & Rogers, 1984). It includes examples of how Rogers handled silence from a person-centered perspective.
  • Remember to monitor your body and face while being silent. There’s a vast difference between a cold silence and an accepting, warm silence. Much of this difference results from body language and an attitude that welcomes silence.
  • Use your words to explain the purpose of your silence (e.g., “I’ve been talking quite a lot, so I’m just going to be quiet here for a few minutes so you can have a chance to say whatever you like”). Clients may be either happy or terrified at the chance to speak freely.
Clinical Interviewing, Personal Reflections, Writing

One Resource and One Request

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John Wiley and Sons recently informed me of the excellent and exciting news that the 7th edition of Clinical Interviewing (CI7) has gone to press and will drop in the U.S. on or before September 30. Our wish for this edition is the same as previous editions: To provide research-based, theoretically supported, clinically insightful, and culturally informed education and training on how to conduct basic and advanced clinical interviews.

The Resource

Part of CI7 includes video updates. Most of the updates offer greater representation of culturally diverse counselors and psychotherapists. For example, the video link below features Dr. Devika “Dibya” Choudhuri describing a “grounding” technique that she uses when conducting tele-mental health (aka virtual) clinical interviews, the topic of Chapter 14.

Although you may have your own approaches to facilitating grounding during tele-mental health sessions, I believe Dr. Choudhuri’s idea is innovative and may be a resource that you can add to your toolkit.

Stay tuned, because over the next several weeks I’ll be posting additional fresh new text and video content from CI7.

The Request

Traditionally, publishers ask authors to gather promotional endorsements for new books. This time around, maybe because it’s the 7th edition, neither Wiley nor the absent-minded authors of CI7 thought about gathering endorsements. In the past, we’ve had Derald Wing Sue, John Norcross, Victor Yalom, Pamela Hays, Barbara Herlihy, Allen Ivey, David Jobes, and Marianne and Jerry Corey write short blurbs. Here’s what Derald Wing Sue said about the 6th edition:

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

―Derald Wing Sue, Ph.D., Professor of Psychology and Education, Teachers College, Columbia University

This time around, we’re less than two weeks from publishing and are without formal endorsements. As a consequence, I’m asking: “Is there ANYBODY out there who has read a portion of the CI7 manuscript or used a previous edition, who would like to share their thoughts about how the book influenced you or how the videos helped with your training?

[I know this last paragraph sounds pathetic. However, if you know me, you probably know my sense of humor, and the “Is there anybody out there?” call is BOTH a sincere request for your input AND me mocking myself for making this request.]

To be completely serious: If you want to share something positive about your experience—from any point in time—with the Clinical Interviewing text, I hope you’ll write a sentence or two or three (you don’t have to write half a page, like Derald Wing Sue) on the particular ways in which you found the book and/or videos meaningful to you.

To share your thoughts on any edition of the text, please post them here on this blog, or send them to me at john.sf@mso.umt.edu.

Thanks very much for considering this request. Please, please, I hope someone “out there” is listening!

Cool Counseling, Therapy with Adolescents, Tough Kids, Tough Kids Cool Counseling

News Flash: Four FREE CEUs Coming Up This Saturday, August 26

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As a part of a virtual symposium offered by Texas A&M University – Corpus Christi, this coming Saturday, August 26, I’m doing a 2-hour free continuing education workshop from 12-2pm Mountain time (2pm-4pm Eastern). The cool thing is that the CEUs for this workshop are FREE. The less cool thing is that the workshop is on a Saturday.

My talk is: Tough Kids, Cool Counseling: Strategies for Engaging and Influencing Youth. Even better, I’ll be preceded by Dr. Russ Curtis and Dr. Katie Goetz (9am-11am Mountain time), who are presenting a 2-hour workshop on The Mindset and Clinical Skills Needed to Thrive in Integrated Care. . . and that’s 2 more FREE CEUs.

Below, I’ve pasted the blurbs and Zoom information for these online workshops.

You are invited to join Tex-Chip Virtual Symposium on Saturday, August 26, 2023, at 10am – 3pm (CST). 

Dr. Russ Curtis & Dr. Katie Goetz is scheduled to present from 10am – 12pm CST on “The Mindset and Clinical Skills Needed to Thrive in Integrated Care.” In this interactive presentation, participants will learn how to integrate clinical skills with enlightening philosophical premises to expand their understanding of providing inclusive whole-person care. Attendees will develop their clinical voice through lecture, case examples, and discussions to begin asking the right questions about how to provide next-generation integrated care.

Dr. Sommers-Flanagan is scheduled to present from 1pm – 3pm CST on “Tough Kids, Cool Counseling: Strategies for Engaging and Influencing Youth.” Engaging “tough kids” in behavioral health can be immensely frustrating or splendidly gratifying. The truth of this statement is so obvious that the supportive reference, at least according to many teenagers is “Duh!” In this 2-hour workshop, participants will learn, experience, and practice several strategies for engaging and influencing youth. Several cognitive, emotional, and constructive brief counseling techniques will be described and demonstrated. Examples include acknowledging reality, positive questioning, wishes and goals, the affect bridge, the three-step emotional change trick, what’s good about you?/asset flooding, and more. Essential counseling principles, countertransference, and cultural issues will be included. 

Join Zoom Meeting

https://tamucc.zoom.us/j/96049300393?pwd=V1VDSlVmY1c1RFVFTEhJN3ZFODJKQT09

Meeting ID: 960 4930 0393

Passcode: 625101

For more information, please contact Ada at auzondu@islander.tamucc.edu   

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

Relationship Factors in Counseling and Psychotherapy

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Hardly anyone with common sense or social skills ever argues about whether or not relationship factors are crucial to effective counseling and psychotherapy. Nevertheless, some scientists are reluctant to put relationship factors on par with counseling and psychotherapy techniques or procedures. IMHO, relationship factors are every bit as essential as so-called empirically-supported treatments.

This post is a pitch. Or it might be a pitch in a post. Either way, I am honored to share with you a hot-off-the-presses new book, titled Relationship Factors in Counseling, by Dr. Kimberly Parrow. Here’s the publisher’s link: https://titles.cognella.com/relationship-factors-in-counseling-9781793578754. The book is also available on Amazon and other booksellers.

Below, I’m pasting the Foreword to this book. Not only am I jazzed about the book, I’m also jazzed about the Foreword. You should read it. It’s really good. You’ll learn about Kimberly Parrow, as well as a bit of trivia about relationship factors that you should definitely know. I haven’t mentioned who wrote the Foreword, but I’m sure you’ll figure it out.

I first met Kimberly Parrow, before she was Dr. Kimberly Parrow, in a letter of recommendation from a psychology professor at the University of Montana. Having read well over 1,000 letters of recommendation over the years, this one imprinted in my brain. The professor wrote something like, “Kimberly Parrow is the real deal. You should admit her to master’s program in clinical mental health counseling. You will never regret it.”

We did (admit her into our master’s program . . . and our doctoral program). And we didn’t (ever regret it).

Kim Parrow was, is, and continues to be one of the most enthusiastic learners I’ve encountered.  She walked onto our campus at 44-years-old, as a first-generation college student, having waited with bated breath for the money and opportunity to pursue her college degree. Nine years later she strolled off campus with her bachelor’s, master’s, and doctoral degrees. If we were Notre Dame, we’d call her a triple domer (n.b., that’s what you call people with three degrees from Notre Dame). At the University of Montana, we just call her amazing.

In one of her first doctoral classes, I introduced Kim to the concept of evidence-based relationship factors (EBRFs). She was hooked; hooked in the way that only graduate students get hooked. She was hooked by an idea. So hooked that she immediately wanted more; she wanted to write a journal article on EBRFs (so we did). She wanted to do her dissertation on EBRFs (so she did). She wanted to do extra additional trainings for practicum and internship students on EBRFs (and so she did).  Kim’s attraction to EBRFs stemmed from her belief that relationships constitute the core of what’s therapeutic. As we explored EBRFs together, noting all the research supporting the idea that relationships drive counseling and psychotherapy, I came to see that Kim’s judgment was, and continues to be, practically perfect.

I’ve been reading dissertations for 30+ years. I’m embarrassed to say that I find reading most dissertations—even those written by students whom I love—drudgery. But Kim’s dissertation was electric. Page by page, she kept surprising me with new content and new learning; it was more than I expected. Kim had taken the basic knowledge and skills linked to EBRFs, contextualized them within the scientific literature, and then wrote about them in ways that inspired me to keep reading and keep learning. As she wrote more, her writing got better and better, and the content more illuminating.

About a month ago, I was unable to make it to my initial lecture for an advanced counseling theories course. I asked Kim to fill in. She quickly said yes. I offered to pay her. She quickly said no. To stick with the money theme, if I now had a dollar for every time one of my students has, since Kim’s lecture, mentioned Kim Parrow, eyes agog, and referenced the central role of relationship factors in counseling and psychotherapy, I would have many dollars. What I’m trying to say is that Kim is a natural and talented clinician-teacher. That’s a rare version of the real deal her former developmental psychology professor was trying to tell us about.

And now, a few words about this book. Kim has done what most scholars and professionals are unable to do. She has taken theoretical principles, empirical research findings, blended them with her common-sense-salt-of-the-earth style, and created a practical guide for helping counselors and psychotherapists be better. The book is aimed to slide into the educational development of practicum and/or internship students who have learned microskills and are facing their first clients. This particular point in student development is crucial; it’s a time when students sometimes lose their way as they try to make the improbable leap from microskills to counseling and psychotherapy techniques. In making that leap, they often fall prey to the urge to quickly “prove up” and “do something” with clients. In this process, they often abandon their microskills and forget about the therapeutic relationship. Kim’s overall point is this: Don’t forget about the therapeutic relationship because relationship factors are every bit as evidence-based as theory-based or research-based technical strategies. The renowned writer-researcher John C. Norcross put it this way:

Anyone who dispassionately looks at effect sizes can now say that the therapeutic relationship is as powerful, if not more powerful, than the particular treatment method a therapist is using.

The fact that therapeutic relationships are empirically supported makes Kim’s content relevant not only to students early in their clinical development, but also to all of us. Having taught this content with Kim, and to groups of professional counselors, psychologists, and social workers across the United States, I can say without hesitation that the content in this book can and will make all of us better therapists.

Kim covers 10 specific, evidence-based interactive relationship skills. What unique—and possibly the best thing about Kim’s coverage of relationship skills—is that she provides specific, actionable guidance for how to enact these 10 skills. As a preview, the 10 skills include:

  1. Cultural humility
  2. Congruence
  3. Unconditional Positive Regard
  4. Empathic Understanding
  5. The Emotional Bond
  6. Mutual Goal-Setting
  7. Collaborative Therapeutic Tasks
  8. Rupture and Repair
  9. Countertransference Management
  10. Progress Monitoring

In the pages that follow, you will get a taste of Kim Parrow’s relational orientation and a glimpse of the evidence supporting these 10 relationship factors as therapeutic forces that innervate counseling process. You will also experience the magic of a talented clinician-teacher. The magic—or, if you prefer, secret sauce—is Kim’s ability to make these distant intellectual relationship concepts real, practical, and actionable. To help make relationship concepts real, she has engaged several contributers (and herself) to write pedagogical break-out boxes titled, “Developing Your Skills.” Engaging with these skill development activities will, as the neuroscience fans like to say, “Change your brain” and help you develop neural pathways to enhance your relational connections.

As I write about skills and skill development, I’m aware that Carl (and Natalie) Rogers would view the reduction of his core conditions to “skills” as blasphemy. This awareness makes me want to emphasize that Kim “gets” Rogerian core conditions and does not reduce them into simple skills. Instead, she embraces the attitudinal and intentional dimensions of Rogerian core conditions, while simultaneously offering behaviors and words that counselors and psychotherapists can try on in hopes of expressing congruence, unconditional positive regard, and empathy.

I’ve had a few conversations with Derald Wing Sue over the years and he has always emphasized that culture in counseling and psychotherapy shouldn’t be relegated to a separate chapter at the end of the book—as if culture is ever a separate or standalone issue. Reading how Kim handles culture reminded me of Derald Wing Sue’s message. Instead of relegating it to the end, Kim begins with the relationship factor of cultural humility. That makes for a beautiful start.  Cultural humility involves, above all else, the adoption of a non-superiority interpersonal stance. . . which is a simple and excellent anti-racist message. But Kim doesn’t stop talking about culture after Chapter 1. She does what Derald Wing Sue recommends: She integrates cultural awareness, knowledge, and skill development into the whole book. This stance—non-superiority and anti-racist—is consistent with Kim’s interpersonal style and is also the right place to start as counselors set about the journey to collaborate and co-create positive outcomes.

One of Kim’s writing goals is to offer ideas and activities that are likely to increase counselor cognitive complexity. You can see that in the two preceding paragraphs. Instead of reducing Rogerian core conditions into skills, she honors how they can become both attitudes and skills. And instead of putting culture into a silo, she spreads seeds of culture through all her chapters.

This book is a remarkable accomplishment. The language, the examples, the science, the skill development activities, and the tone, welcome readers to engage with this book, and bring the material to life. I believe if you read this book and engage in the activities, your counselor self-efficacy will grow.

For anyone who has gotten this far in reading this foreword, I have some reading tips to share. First, read this book with your heart wide open. I say this because this book is about the heart of the counselor or psychotherapist. Second, as you read, keep yourself in relationship with Kim. The book is about relational factors and the details Kim shares will not only help you in your relationships with clients, but, as she often reminded me and other people whom she cornered so she could talk to us about relational factors, these relationship factors are relevant and applicable to all relationships. 

Obviously, I respect Dr. Kimberly Parrow and believe she has produced an excellent book. Obviously, I think you should read this book and do as so many of us have already done, learn about evidence-based relationship factors from someone who is a remarkably talented clinician-teacher.  To paraphrase what that developmental psychology professor wrote about Kim many years ago, you should accept Kim Parrow into your personal program of learning immediately, and begin learning from her as soon as you can. You will not regret it.

All my best to you in your counseling and psychotherapy work.

John Sommers-Flanagan

Missoula, Montana

Clinical Interviewing

The End of the Beginning: A Peek at The Closing Video for Clinical Interviewing (7th edition)

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In our Clinical Interviewing text, we open each chapter with a quotation. One of my favorite of all time is from Ursula K. LeGuin (the Left Hand of Darkness). She wrote: “

It is good to have an end to journey towards; but it is the journey that matters, in the end.” (p. 109)

Last week, we finished our year-long journey of revising Clinical Interviewing into the 7th edition. The last publication date was 2017, so this is, IMHO, a significant and important revision. With the help of the Amazing Dylan Wright, we recently uploaded the supplementary videos (there are over 100 clips that align with all of the textbook learning objectives). In the video recording process, we had much help, partly because this edition weaves in greater representation from professionals with diverse identities. Over the next several months, I will be posting additional sneak-peeks, including identity-diverse case examples and video clips. Stay tuned.

For today, I’m posting a rough copy of the final (of the 100+) Clinical Interviewing videos. In this one, I’m lamenting—while Rita consoles me—that our imperfect video recording project is ending. This video was recorded and produced by the multi-talented and aforementioned Dylan Wright, who took the liberty (as he often does in one way or another) of inserting laugh-tracks to help viewers “get” our silly efforts to be funny.  

You may wonder why Rita and I are on our cell phones during this clip. It’s because the last chapter is about clinical interviewing and technology. That’s just one example of how hilarious we are.

Here’s the link to our 2 minute, 8 second closing video. Enjoy: https://www.youtube.com/watch?v=G-6WTrhMf1k

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice

Evidence-Based Relationship Factors in Supervision and Practice

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Today I’ll be online providing a 2-hour workshop titled “Evidence-Based Relationship Factors in Supervision and Practice” on behalf of the Cognitive Behavioral Institute and Geneva College. This workshop content is related to the excellent work of John Norcross, Michael Lambert, and other prominent professionals who have advocated (and researched!) the scientific truth that RELATIONSHIPS are powerful influencers of positive treatment outcomes in counseling and psychotherapy. This topic is also the focus of a forthcoming book authored by a former doc student of mine, Kimberly Parrow (more on her excellent work in a future blog).

For now, I’m posting the ppts for today’s online workshop here:

ebrfs-for-cbi-and-geneva-college-2023Download

And here’s the workshop description: Counselors and psychotherapists have a long and storied history of arguing with one another over what makes therapy effective. Some say: We should teach and supervise our students to use empirically-supported treatments (i.e., procedures, as in medicine). Others say: We should teach and supervise our students to establish therapeutic relationships. Although it’s clear that specific treatments and therapeutic relationships both contribute to outcomes, when supervisors and practitioners think of empirically-supported approaches, they tend to think of manualized treatments or procedures. However, in recent years, specific relationship factors have been identified and linked to positive counseling and psychotherapy outcomes (Norcross & Lambert, 2018). These factors include: cultural humility, congruence, unconditional positive regard, empathic understanding, emotional bonds, mutual goal-setting, and more. In this workshop, participants will learn to identify, describe, and apply evidence-based relationship factors in supervision and practice. Video-clips, live demonstrations, and reflective opportunities will be used to facilitate learning.

I hope you have an excellent day and weekend wherein you are enacting as many evidence-based relationship factors as you can fit into your life!

Best,

John S-F

Cool Counseling, Counseling and Psychotherapy Theory and Practice, Happiness, Personal Reflections

Tough Kids, Cool Counseling in Ypsilante

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Yesterday I had a marvelous day with a group of about 35 wonderful mental health professionals and students in Ypsilante, Michigan. I was hosted by generous and kind faculty of Eastern Michigan University. I learned about the historical significance of “Ipsy,” along with anecdotes pertaining to the Ipsy water tower on post-cards, details of which—obviously because I’m so classy and sophisticated—I will not mention here.

The weather was marginally dreadful. We worried the in-person workshop would be cancelled and replaced with Zoom. Despite the weather, some people drove 90 minutes or more to arrive, which was just one small measure of their commitment to learning and their commitment to serving youth and families in counseling and psychotherapy. Whenever I’m in a room with professionals like the group yesterday, I have renewed hope in the world and in the future. The participants were: Just. Good. People.

As is my practice, I’m posting the ppts from the workshop here:

eastern-michigan-2023-tkcc-workshopDownload

I’m also posting the “Extra” and more detailed handout here:

eastern-michigan-2023-extra-tkcc-handoutDownload

And here’s a PG-rated image of the Ypsilante water tower.

Toward the end of the workshop I engaged two participants in an activity that involved shaking imaginary soda pop bottles and opening them. One participant had brought her five-year-old daughter for the day (because of a school closure). As her mother and the woman next to her pretended to shake their imaginary bottles, and I was saying, “Shake, shake, shake,” the five-year-old, who had been incredibly well-behaved for the preceding 8 hours, began giggling in a way that couldn’t be described as representing anything other than pure joy.

In honor of my new five-year-old friend, I encourage you all to find time to giggle this weekend. Even better, find a child to giggle with; it will be time well-spent.

And here’s a photo of me having a giggle with a young person.

Cool Counseling, Happiness, Tough Kids Cool Counseling

The Three-Step Emotional Change Trick, Revisited (Again) . . . with a side note on plagiarism

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I’ve said it before and I’ll say it again: I have a friend who repeatedly espouses the glories of redundancy. Maybe that’s why some politicians stay on-message, regardless of the veracity of their statements. Of course, George Orwell and Hannah Arendt also commented on redundancy as persuasion, and not in a good way. I should emphasize that my goal for using redundancy and writing about the three-step emotional technique again has nothing to do with shaping your reality through political messaging.

When I presented on positive psychology to a bunch of UM STEM graduate students back in August, 2022, I made it very clear that I was not advocating toxic positivity. Nevertheless, in one of the student evaluations, someone complained that all I was doing was telling graduate students to “Cheer up.” Oh my. Sometimes people just hear what they want to hear. That’s a problem with over-valuing “lived experience.” When we over-value lived experience, then everything is viewed through our own, usually narrow and biased, personal lenses. Adler called this private logic. Too much private logic is too much private logic. Although we should strive to value, learn from, and share lived experiences, we should also have a shared value of this thing called . . . wait for it . . . science!

The next time I presented to the UM STEM grad students (in January, 2023), I made an explicit point of emphasizing my “non-toxic positivity street cred” by beginning the lecture with a short lesson on the three-step emotional change trick (which, BTW, with inspiration from Alfred Adler and Harold Mosak, we created as a youth psychotherapy technique in the mid-1990s). You can even find our (with Rita) original three-step article here: https://www.tandfonline.com/doi/abs/10.1300/J019v17n04_02 and a later book chapter here: https://psycnet.apa.org/record/2002-01308-098 and, of course, I’ve written about it on this blog, and have a youtube video demonstration: https://www.youtube.com/watch?v=ITWhMYANC5c, yada, yada, yada.

While presenting the 3SECT (which is what cool people call it) to the STEM students, there was a woman sitting toward the back. She had stationed her 8-year-old son still farther back, where he was sitting, head down, playing on her phone. I did the 3SECT thing, including the famous “And so I put my cat on my head” scene, emphasizing throughout, that the WHOLE reason for the 3SECT existing was because we should NEVER SAY CHEER UP to anyone, anytime!

The next day, I received the following email from the anonymous woman in the back (who generously gave me permission to share it here):

Hi John,

I was at your happiness seminar yesterday and was very disappointed I had to leave early. You may have noticed my son (who is 8) was sitting in the back playing a game on my phone during the seminar. I was delighted to find out this morning, while my 6-year-old daughter was having a meltdown trying to do her hair for school, that my son had been listening and absorbed your 3-step emotional change trick. He remembered the whole thing, and he asked his sister this morning if she wanted to learn it, but only if she wanted to change her own mood. He was clear that it wasn’t because he was trying to tell her to cheer up. He heard it all yesterday! Thought you might enjoy that little anecdote.

A few days later, she wrote:

We have gotten a lot of mileage out of your emotional change trick in the last few days.

I have to admit, I absolutely love it when people listen and get the message, but I truly and deeply love it EVEN MORE when 8-year-olds absorb messages while allegedly playing on a cell phone. I believe this may just be the scientific evidence (or is it my lived experience) I needed to validate that I am not and never have been a proponent of toxic positivity.

One other notable note. When searching (via Google) for my very own 3SECT video, I found that a counselor in Tennessee has copied one of my three-step blog posts and posted it as his own blog post. I was gobsmacked—with annoyance and flattery in equal proportions. If you want to read the blog post worthy of plagiarism (not the plagiarist’s version, which is the same, but my version that was so darn tempting that it literally caused plagiarism, here you go: https://johnsommersflanagan.com/2020/04/15/the-three-step-emotional-change-technique/

I’m ending now with a few core messages:

  • Don’t say “cheer up” to anyone.
  • Don’t get too over-focused on your own lived experiences, because, after all, everyone has their own lived experiences, and we should complement them all with scientific knowledge.
  • Don’t plagiarize.
  • If the person you plagiarized emails you, asking you to stop plagiarizing or provide a citation, don’t ignore that person.
  • And, whenever appropriate, follow in the anonymous 8-year-old’s footsteps and spread the good mood – without saying cheer-up!
Boys and Men, Cool Counseling, Parenting, Therapy with Adolescents, Tough Kids Cool Counseling

Tough Kids, Cool Counseling Visits Eastern Michigan

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In 1990, when I moved back to Missoula, Montana to join Philip and Marcy Bornstein in their private practice, my goal was to establish a practice focusing on health psychology. I believed deeply in the body-mind connection and wanted to work with clients/patients with hypertension, asthma, and other health-related conditions with significant behavioral and psychosocial components.

Turns out, maybe because I was the youngest psychologist in town, all I got were referrals from Youth Probation Services, Child Protective Services, local schools, and parents who asked if I could “fix” their children’s challenging behaviors.

I’d say that I made lemonade from lemons, but it turns out I LOVED working with the so-called “challenging youth.” There were no lemons! The work led to our Tough Kids, Cool Counseling book (1997 and 2007), along with many articles, book chapters, and demonstration counseling videos. Over the years I’ve had the honor of working extensively with parents, families, youth, and young adults.

In about 10 days, I’ll be in Ypsilanti, Michigan doing a full-day professional workshop on “Tough Kids, Cool Counseling.” If you’re concerned about the title, don’t worry, so am I. In the first few minutes of the day, I’ll explain why using the terminology “Tough Kids” is a bad idea for counselors, psychotherapists, and other humans.

Just in case you’re in the Eastern Michigan area, the details and links for the conference are below. I hope to see you there . . . and hope if you make the trip, you’ll be sure to say hello to me at a break or after the workshop.

What: Tough Kids, Cool Counseling: Cognitive, Emotional, & Constructive Change Strategies

When: Friday, March 10, 2023, 8:30 AM – 5:00 PM EST

Where: Eastern Michigan University Student Center, Second Floor – Ballroom B Ypsilanti, MI 48197

Counseling so-called “tough kids” can be immensely frustrating or splendidly gratifying. The truth of this statement is so obvious that the supportive reference, at least according to many teenagers is, “Duh!” In this workshop, participants will sharpen their counseling skills by viewing and discussing video clips from actual counseling sessions, discussing key issues, and participating in live demonstrations. Attending this workshop will add tools to your counseling youth tool-box, and deepen your understanding of specific interventions. Over 20 cognitive, emotional, and constructive counseling techniques will be illustrated and demonstrated. Examples include acknowledging reality, informal assessment, the affect bridge, the three-step emotional change trick, asset flooding, empowered storytelling, and more. Four essential counseling principles, counselor counter-transference, and multicultural issues will be highlighted.

The link: https://www.eventbrite.com/e/tough-kids-cool-counseling-cognitive-emotional-constructive-change-tickets-470275485637

Register on Eventbrite
Clinical Interviewing

Checklists from the Forthcoming 7th Edition of Clinical Interviewing

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Textbook writing is a particular kind of writing that requires a variety of ways to present relatively boring material to students and aspiring professionals. Although we pride ourselves on writing the most entertaining textbooks in the business, our efforts to entertain are all part of a reader-friendly delivery system.

Another (less humorous) reader-friendly delivery strategy is the checklist. We intermittently use checklists to summarize essential information in our Clinical Interviewing text. Below, I’m including links to three checklists. Please note, these checklists are in process, and so if you see any typos or missing information or have some excellent feedback to share with me . . . post your feedback here on this blog or email me: john.sf@mso.umt.edu. I will greatly appreciate your feedback!

From Chapter 10: A Checklist on Suicide Assessment Documentation:

suicide-documentation-checklistDownload

From Chapter 12: A Checklist on Strategies and Techniques for Working with Client Ambivalence or Natural Client Resistance.

checklist-for-challenging-client-behaviorsDownload

From Chapter 13: A Checklist on Getting Prepped for Your First Session with a Child or Adolescent Client

checklist-to-prep-for-young-clientsDownload

For those of you who are still reading (and I hope that’s everyone), I’m still looking for someone who can write me a short (400 word) case or two on working with LGBTQ+ youth. A transgender case would be especially nice. If you’re interested, send me an email: john.sf@mso.umt.edu