The 3rd edition of Counseling and Psychotherapy Theories in Context and Practice will be available very soon. Just in case you’re longing to see the cover as much as I am, there’s a link to the new edition on Amazon. Although I’m betting your longing is much smaller than my longing, here’s the link anyway: https://www.amazon.com/Counseling-Psychotherapy-Theories-Context-Practice/dp/1119279127/ref=dp_ob_title_bk
To celebrate this forthcoming epic publication (it’s not really epic, but some days it felt like a long poem), I’m posting a case presentation from the feminist chapter. Honestly, I don’t know who gets to decide what’s epic or what’s feminist therapy. That being the case, you can decide on both points. Or you can decide you’ve had enough of JSF for today.
Here we go.
In an interesting twist, we’re featuring a case with a male therapist and male client in the feminist chapter to illustrate how working within a feminist model can work for boys and men. This case focuses on a 16-year-old male’s struggle with emotional expression. John SF is the therapist.
Josh was a White, 16-year-old heterosexual sophomore in high school. He had never met his biological father and lived in a middle-class neighborhood with his mother and three younger sisters. His mother was diagnosed with bipolar disorder. Josh’s main loves were consistent with his gender identity. They included basketball, cars, girls, and sarcasm. He very much disliked school.
Josh and I met for therapy for several years. At the beginning of one of our sessions Josh handed me a packet of photos.
“Hey, what’s this about?” I asked.
He responded with a half-mumble about a recent awards ceremony. I thought I discerned pride in that mumble. I looked through the pictures while he told me about each one. There was one in particular that he gently lifted from my hands. It was a picture of him in a line-up with five other people. He carefully pointed out that he was standing next to the Lieutenant Governor of Oregon. I teased him because there were no pictures of him and the actual governor.
“What’s the deal?” I asked. “Wouldn’t the Guv pose with you?” Josh rolled his eyes and signaled for me to move on to the next photo.
The Problem List and Problem Formulation
Unlike CBT, feminist therapy doesn’t involve collaboratively generating a concrete problem list and formulating problems as if the problems resided in the client. Instead, because problems and problem-formulation are inseparable, we can’t talk about the problems without also talking about cultural factors creating and contributing to the problems.
If client issues are discussed as problems, they’re likely discussed as situational challenges. In Josh’s case, his mother initially had brought him to therapy for anger management. Anger was consistently a regular focus in Josh’s therapy. Like many 16-year-old boys immersed in the dominant U.S. culture, Josh’s emotional life was highly constricted. He was living by Pollack’s boy code (2000) and unable or unwilling to risk feeling anything other than anger and irritation. From the feminist worldview, this wasn’t Josh’s problem; his issues around anger stemmed from him living in a culture that kept him in an emotional straitjacket.
Josh’s issues (and case formulation from a feminist perspective) looked like this:
- Learning to deal more effectively with sadness, grief, and anger within the context of a repressive emotional environment.
- Coming to an understanding that his beliefs and views of emotional expression were not in his best interest, but instead, foisted upon him by toxic cultural attitudes about how boys and men should experience and express emotion.
- Developing trust and confidence in himself—despite not having a father figure or a mother who could provide him and his sisters with a consistently safe and stable home environment.
- Learning to talk about what he really feels inside and pursue his life passions whatever they might be instead of reflexively pursuing culturally “manly” activities.
- Expanding Josh’s limited emotional vocabulary through consciousness-raising.
Feminist therapists are technically eclectic; they use a wide range of interventions imbedded in an egalitarian and mutually empathic relationship:
- Encouraging Josh to speak freely and openly about his life experiences.
- Empathic listening with intermittent focusing on more tender emotions, depending on how much of this Josh was willing or able to tolerate.
- Therapist self-disclosure and modeling.
As Josh and I looked at photos together, I responded with interest and enthusiasm. Because interpersonal connection is a core part of therapy, I didn’t rush him to move on to our therapy agenda. Instead, I shifted back and forth between saying, “Cool” or “What’s going on there?” to making sarcastic wisecracks like “Why exactly did the government let you into the capital building?” Sarcasm was used to express interest and affection indirectly, mirroring Josh’s humor and style. After seeing most of the photos I asked, “Who’s the person standing next to you?” I could tell from his response that I had asked a good question.
“Oh, yeah, her. Her name is Sharice; her mentor was getting the same award as my mentor. I danced with her. She’s a good dancer.”
We talked about dancing and what it was like for him to feel attracted to her. We were ten minutes into therapy and both of us had completely ignored the fact that we hadn’t been able to see each other for five weeks. Finally, I decided to break the avoidance pattern. I asked “So…how are you doing with all that’s been going on?”
He looked toward me, glancing downward.
“I’m doing okay, I guess.”
Because this was a young man who had been socialized to keep his emotions tightly wrapped, I probed, but gently.
“I understand it’s been pretty wild times?”
He looked up, eyes fixed on some invisible spot on the ceiling. I recognized this strategy—a surefire way avoid crying in public. An upward gaze constricts the tear ducts; tears cannot flow.
He looked back down and said, “I’ve been busy. My mom’s been in the hospital for about a month.”
“I heard she had a pretty hard time.”
He grunted and then, in a quiet growly voice, the words, “Let-me-tell-you-about-it” seeped out from behind his teeth. Silence followed. I cautiously probed a bit more by sharing more of what I knew.
“I talked with your mom yesterday. She told me that she got pretty caught up in some housing project.” This statement lit a fire in Josh and he plunged into the story.
“You won’t believe what she did. It was so f*ing stupid. Some punk developer is gonna build three houses. Three houses at the end of our street. This is no big deal. She just f*ing freaked out. She chained herself up to a tractor to stop them from building a house. Then she called the f*ing senator and road department and I don’t know who in hell else she called. She was totally nuts. So I told her she had a choice. I told her that she could go back home or I’d call the police and have her committed. She wasn’t taking care of my sisters. She was being a shit for a mom. So I just gave her a choice.”
I nodded and said, “You must be practicing to be a parent. That’s the kind of choice parents give their kids.”
His voice grew louder: “I gave her the choice five times. Five f*ing times! She tried to buy a Mercedes and a Volvo over the phone. So I called the cops. And the woman asked ME what to do. I’m f***ing 16 years old and they f *ing ask me what to do. I didn’t know what to say. I told ‘em to come get her. They finally sent some really big cops over to take her away.”
“Then what happened?”
“My mom was still acting nuts and my sisters were crying. So I just picked them up and held them and they took her away. We sat and they cried and we snuggled a while. And then I drove us home. I don’t have my license, but I can drive. My mom is still pissed at me about that, but I don’t give a shit!”
While listening to Josh, I formed an image of him in my mind. I saw an awkward 16-year-old boy “snuggling” his sobbing sisters, as the cops take their mother away. The girls were 9 and 6 and 4 years old—the same sisters he had complained about in previous therapy sessions.
Talking with teenage boys about emotional issues is tricky. Too much empathy and they retreat. No empathy and you’re teaching the wrong lesson. Throughout Josh’s storytelling, I used sarcasm, empathy, and emotional exploration, like, “What was that like for you to gather up your sisters and take care of them?” I suspected that if I asked too much about feelings or forced him to go too deep too fast, I would lose my “coolness rating” and there would be a relationship rupture.
Much of the session focused on empathy for Josh’s anger. Josh ranted and I listened. He was immensely angry and disappointed and hurt about his mother’s behavior. But I wanted to find a way to let Josh know that it’s okay, even a positive thing, for boys and men to feel and express more tender feelings.
About halfway through our session, I asked:
“So Josh,” I said, “When was the last time you cried?”
After a short pause he spoke with extreme deliberation, “I… don’t… cry… I… just… get… pissed.”
Josh expressed this masculine emotional principle very efficiently and then offered more about his socially coerced, but internalized emotional philosophy.
“Crying doesn’t do any good. It doesn’t change anything. It’s just stupid.”
“I know, I know” I said. “The whole idea of crying sounds pretty stupid to you. It’s not like crying will change your mom and make her better.”
“Nothing will ever change her.”
I renewed my pursuit of when he last cried. He insisted that was so long ago that he couldn’t recall, but we both knew that several years ago, after an especially hard week with his mother, he had sat on my couch and sobbed himself to sleep. Instead of bringing that up, I asked him what might make him cry now. Would he cry if his girlfriend broke up with him… if he lost his cell phone… if one of his sisters got cancer… if he didn’t graduate high school? Josh fended off my questions about tears by repeating his resolve to get “pissed” about everything that might make him feel sad. But the question about one of his sister’s getting cancer stumped him. He admitted, “Yeah, I might cry about that…” while quickly adding, “…but I’d do it alone!”
I responded, “Right. Absolutely. Some things might be worth crying about… even though it wouldn’t change things… but you’d want to do the crying alone.”
We talked indirectly and intellectually about sadness and tears, trying to model that we can talk about it—once removed—and if he cried someday, it would be perfectly okay, there would be no need to feel ashamed.
Toward the end of the session, I decided to lighten things up by teasing Josh about his social insensitivity. I said, “I can’t believe that we’ve talked this whole hour and you never asked a single thing about me.”
Josh grinned. He knew therapy was all about him and not about me. He probably thought I was playing some sort of therapy game with him. He was a good sport and played along.
“Okay. So what am I supposed to ask?”
I acted offended, saying, “After all those questions I asked you, at least you should ask me when I last cried.”
“God you don’t know when to drop things. Okay. So when did you cry?”
I said, “I think it was yesterday.”
Our eyes met. He looked surprised. I continued, “Yeah. I feel sad sometimes. It can be about really hard stories I hear in here or it can be about my own life. Even though it doesn’t change anything, it can feel better to let my sadness out.”
It was time for the session to end. We both stood and I said, “We have to stop for today, but we can talk more about this or whatever you want to talk about next time.”