Rita and I got our copies in the mail two days ago. Thanks to Bryan Cochran, the book is better than ever, and the cover is more beautiful than ever. Bryan asked Brian Christianson, a local photographer in Missoula, Montana permission to use one of his photos and, wow, it looks great.
The feeling of opening a box, getting out a book, and holding it in my hands never gets old. And, when the book has your name on it, the feelings are magnificent.
I feel like Steve Martin in the old classic film, The Jerk, when he gets a new phone book and finds his name in it.
Our books are for students in the mental health professions and mental health professionals, so they will never be bestsellers. Nevertheless, we get some sweet, meaningful, and validating feedback—which I treasure. Here’s the latest, forwarded to me by a former doctoral student at the University of Montana who is now a professor and who is already using our book (which is very kind and affirming). One of her students wrote,
“. . .let them know their text is easy to digest and has this magical ability to pull the reader in. There are moments in the first chapter where I felt like I was part of the authors’ lived experience. That feeling makes it easy to read and learn! I have enjoyed the text so far.”
Hopefully the magic will continue beyond the first chapter.
I’ll try to be more consistent in posting a few excerpts from the book on this blog. . .despite the fact that I’m not all that great at consistency! If you’re interested, you can find the text online.
For the 4th edition of Counseling and Psychotherapies in Context and Practice we added an amazing new author. I’ve introduced him on this blog before, but here’s his official bio for the new textbook:
Bryan Cochran, PhD., is a clinical psychologist, professor, and director of clinical training for the PhD program in clinical psychology at the University of Montana. His research areas of interest are LGBTIQ+ health and substance use treatment. He is the co-author of dozens of articles and book chapters on these issues, and 23 years into his academic career, has enjoyed being involved with this textbook project as a way of expanding his thinking and his knowledge of counseling theories and lenses. He doesn’t currently have a blog like John and Rita do but undoubtedly feels the pressure to do so every time he reads their musings on life and on their work. He works with clients in a clinical role using a variety of perspectives that you’ve read about in this text. While not at work, he loves hiking, swimming in Flathead Lake, hunting thrift and antique stores for mid-century treasures, and doing home renovations.
Working with Bryan has been nothing short of fabulous. . .in so many ways. Today, I’m featuring his introduction to the all-new Chapter 2, titled, Viewing Counseling and Psychotherapy Theories Through Contemporary Lenses. Here you go!
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LENSES, THEORIES, AND METHODS, OH MY!
Take a seat. We’d like to start this chapter with an eye (vision) examination. Or, if you prefer, think of this as an ear (hearing) exam. It’s both … and more. This chapter is a perception check.
Lenses clarify and distort. They provide more brightness or less brightness, an array of colors, and more clarity or more distortion. In this chapter, we’re not prescribing corrective lenses. If you’re familiar with an eye exam, think of the optometrist comparing lenses and repeatedly asking, “Which is clearer?” Your “vision” as a psychotherapist is as unique as your personal history and fingerprint.
This process—offering up different lenses for improving your perceptual acuity in counseling and psychotherapy—is far slower and more complex than an eye examination. But the analogy carries truth. As you try on and experiment with different lenses from this chapter, you may see your clients and their distress more accurately. You and your clients will benefit.
Lenses are different from theories. It may seem confusing, but our aim is to create a distinction that illuminates, rather than conflates, these concepts. Most therapy approaches in this book align with a particular theoretical perspective; behavioral psychotherapy is linked to theories of operant and classical conditioning. Psychoanalysis is deeply rooted in theories regarding the interplay of different mental structures, or psychodynamics. However, there’s no reason you can’t put on a queer theory lens when doing cognitive therapy, where you help a client to identify maladaptive thinking errors and discuss how those thoughts are likely to come about in a heteronormative society (one in which heterosexuality is the dominant paradigm for understanding relationships and family structures, and other configurations are seen as outside that norm). You can use lenses, such as critical race theory, queer theory, or intersectionality, to deepen your application of psychotherapy theories and tailor your treatment to a given client’s identities and needs.
New therapists often are frustrated by the need “to pick” a particular theoretical perspective, as if doing so means you’re entering an exclusive relationship with that choice. Like romantic partners, though, you’re unlikely to resonate with every aspect of every theoretical perspective. Unlike with a romantic partner (unless you’re setting yourself up for a series of arguments), you can analyze theoretical perspectives through various lenses to separate the parts of the theories that are most useful from those that are less useful.
So, what do we mean by a lens, in comparison to a theory? Lenses transcend disciplines—they often emerge outside of psychology but can be applied to psychological theories. Whereas a theory might tell you what to do as a therapist—what to assess, how to intervene—a lens informs how you go about doing it. Because a lens transforms how you view the world, you might adopt (or already have adopted!) a lens without being aware of it. Since one of the key principles of counseling is to understand what biases we bring into the therapeutic process, spending time talking about key lenses in a chapter new to this edition seemed like a good idea to us.
As you adapt a particular lens for viewing a counseling theory, it may be tempting to throw out the history and background of that theory because it doesn’t stand the test of time. A good example of this is the waves of critiques that have been leveled against Freudian psychoanalysis. While there are few current theorists who would say young women suffer from castration anxiety or that the Oedipal complex is a major influence on young men, the idea that some of the determinants of our behavior operate outside of our consciousness remains robust, supported by empirical research and lived experience. We believe it’s possible to hold onto both a lens and a theory at the same time. Let’s spend some time exploring some different lenses for viewing counseling and therapy so you can further develop your sense of who you might be as an emerging clinician.
Today I found a creepy AI audio summary of the 3rd edition of our theories text. Maybe I should have liked it, because it was super-glowing. But the AI voice overweening on my behalf felt wrong.
In contrast, the following content is real and excerpted from our forthcoming 4th edition of Counseling and Psychotherapy Theories in Context and Practice
To continue with the creepy, the following is what was generated when I asked ChatGPT to create an image of itself.
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Theories and lenses are tools we use to make sense of our complicated world. We’re not saying that the world is more complicated in 2026 than it was 23 years ago, when the first version of this text was published, but the proliferation of information in the modern digital age means that there’s more to sift through than our brains can handle. We hope this text provides you with intellectual structure, insights, practical tools, and fun companionship on your road to understanding and engaging in counseling and psychotherapy.
While walking across the University of Montana campus the other day (which is beautiful on any day, but especially during the fall here in Montana), we noticed an annual tradition on campus had recurred—a fresh, large, orange pumpkin was placed on the top of a spire on University Hall, over 100 feet above the ground, just in time for Halloween. The impossibly steep roof of the clock tower, and the brazenness of putting a fresh gourd up there each year (for decades!) leads to speculation—let’s call them theories—about how a pumpkin could possibly make it on top of the spire.
Is it a renegade group of rock climbers who scale the building each October? Is the University somehow complicit in keeping the tradition alive while sternly warning students not to climb the building? With advancements in drone technology, has someone figured out how to hoist a heavy pumpkin and drop it on that precise point? Is it a 3-D optical phenomenon that doesn’t exist other than in socially constructed reality?
Which theory is correct? But what if it’s not one theory; maybe the pumpkin tradition has evolved over time. After decades of being on campus, our guess is, we’ll never know. The same is probably true with theories and lenses of counseling. We’ll never know—for certain—if the perspective we take is “the correct” one. The best we can do is continue learning about human behavior and the theories that explain it and do our best for our clients by using lenses and theories to help understand their unique situations and help make things better. The pumpkin problem is much easier.
We encourage you to carry theories and lenses from this textbook around with you to help you to make sense of the world—not just in terms of counseling and therapy, but in terms of understanding complexities of the world we live in. At a time where there’s a tendency to over-rely on artificial intelligence to get “the answer” to your questions, playing with different theories is good for your neural connectivity—and probably good for your clients’ well-being, because embracing and valuing different perspectives is good for all of us as we try to navigate this wildly complex world.
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We believe in several things: First, we cannot help but be affected by contemporary socio-cultural-political events. Second, regardless of socio-cultural-political movements, the counseling and psychotherapy space needs to be safe, sacred, and inclusive for everyone, and especially people with limited resources, diverse identities, and a history of distress or trauma. Third, although we talk about creating a safe space for clients to explore their lives, our offices are not instantly safe, and simply saying the words, “this is a safe space” won’t magically create trust and safety. We need work with clients to, over time, make it experientially safe.
We hope you can use the theories in this text to create and support an inclusive psychotherapy where positive and transformative work happens.
WHAT’S NEW IN THE FOURTH EDITION?
We’ve been receiving solicited and unsolicited feedback on this “Theories text” since 2003. Most of the feedback has been overwhelmingly positive. At conferences, people often approach us and say how much they love this book. They love the anecdotes, our irreverent attitudes, and our occasional efforts at humor. Yes, we believe this theories text is the funniest one on the market. Positive feedback from students and faculty has been incredibly affirming, mostly because our primary goals were to create an engaging, interesting, and practical theories text.
As a side note, we recognize there’s not much competition for funniest theories book on the market. But if there was a formal theories textbook humor competition, we would win hands down.
We’ve also received constructive feedback. Although less affirming, constructive feedback is essential to our personal and professional growth and development. We’ve tried to use constructive feedback to create an even better textbook. We invite you to provide us with whatever type of feedback you like.
So. . .what’s new in the Fourth Edition?
To add perspective to the text, we added a co-author. Bryan Cochran is a professor of psychology and LGBTIQ+ scholar. His voice and perspective are woven into every chapter, but especially our two new chapters. In chapter 2, Bryan describes several lenses that influence how we all practice counseling and psychotherapy. These lenses include: (a) Critical race theory; (b) Queer theory; (c) Intersectionality, and (d) a few other important contemporary perspectives. These lenses are not counseling or psychotherapy theories, but they can and should be used with theories and evidence-based approaches to make us more sensitive, humble, and competent in working with all clients.
In chapter 13, Bryan takes us on a deep dive into third wave behavioral treatments. These treatments include:
Mindfulness-based stress reduction (MBSR),
Dialectical behavior therapy (DBT),
Prolonged exposure (PE), and
The unified protocol (UP).
Each of these treatments incorporate mindfulness; they also have substantial empirical support. Learning about them will make you a better therapist.
To better address culture and social justice issues, we’ve done what Derald Wing Sue recommended 15 years ago. We eliminated the “multicultural chapter” and distributed cultural and diversity content throughout the other chapters, with a big emphasis in chapter 2. Our goal was to more fully integrate diversity into all theoretical approaches. We look forward to hearing from you regarding whether we accomplished that goal.
As before, every chapter includes sub-sections titled (a) cultural sensitivity, (b) gender and sexuality, and (c) spirituality. As it turns out, we still haven’t discovered the neurological basis of everything, but apparently folks are still trying. Neuroscience is featured in chapter 1 and incorporated throughout the text via the “Brain Box” feature that appears in most chapters.
WORDS TO (and from) THE WISE
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Language is liberating and activating. Although we’ve done our best to follow professional language guidelines, no doubt, sometimes you will react to our language choices, our examples, and our content. If we were in the same room as you as you had an emotional reaction, we would say something like, “Thank you for your passion.” And then we would do our best to non-defensively explore your reaction and our language, example, or content. If you engage in class discussions with classmates (or your instructor) about this text, we hope you will afford each other mutual respect and compassion for the emotions that can and will arise from studying counseling and psychotherapy.
You may be wondering (I know I am), what does a glimpse and quote from the illustrious Laura Perls have to do with suicide prevention slides for North Carolina State University?
If you have thoughts on the connection, please share. I see a connection, but maybe it’s just because I wanted to post both these things. First, here’s a bit of content from Laura Perls from our Counseling and Psychotherapy Theories text.
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Although the contributions of Laura Posner Perls to Gestalt therapy practice were immense, she never receives much credit, partly due to the flamboyant extraversion of Fritz and partly because her name, somewhat mysteriously (at least to us), is not on many publications. She does, however, comment freely on Fritz’s productivity at the twenty-fifth anniversary of the New York Institute for Gestalt Therapy (an organization that she co-founded with Fritz).
Without the constant support from his friends, and from me, without the constant encouragement and collaboration, Fritz would never have written a line, nor founded anything. (L. Perls, 1990, p. 18)
REFLECTIONS
We hear resentment in the preceding quotation from Laura Perls. We feel it too, because we’d like to know more about Laura and for her to have gotten the credit she deserved. If you want more Laura, here’s a nice tribute webpage: https://gestalt.org/laura.htm?ya_src=serp300. And here’s a quotation from her (obtained from the webpage and compiled by Anne Leibig): “Real creativeness, in my experience, is inextricably linked with the awareness of mortality. The sharper this awareness, the greater the urge to bring forth something new, to participate in the infinitely continuing creativeness in nature. This is what makes out of sex, love; out of the herd, society; out of wheat and fruit, bread and wine; and out of sound, music. This is what makes life livable and incidentally makes therapy possible.”
Now, don’t you want to hear more from Laura?
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And here’s the North Carolina State University link:
At long last, we’ve begun work on revising our Counseling and Psychotherapy Theories text for its 4th edition. Over the past several weeks, I’ve been putting in an hour or two a day, chipping away on chapter revisions, reaching out to reviewers, and planning with our new and very exciting co-author, Dr. Bryan Cochran, a highly esteemed psychology professor at the University of Montana. If you’re reading this, I want you to know of Bryan’s awesomeness (and if you’re Bryan, I want you to feel the pressure of this public announcement of your awesomeness) [hahahaha!]
You all probably know that our Theories textbook is far and away the Theories textbook with the most hilarity. No doubt, this is a rather low bar, given that I can’t find any funny stories in any other theories texts. We view theories hilarity to be extremely important in a theories text, because reading many theories texts can parallel the proverbial experience of watching paint dry.
Bryan’s addition to the writing team will give us something we need—an expert in the LGBTQ+ domain, and someone with a talent for telling stories that are simultaneously engaging, informative, and fun to read. Right now, he’s busy writing a “Lenses” chapter (to be Chapter 2) to orient readers to important theory-related lenses like (a) Queer theory, (b) Critical Race theory, (c) Intersectionality, and more. I, for one, can hardly wait for his Queer theory quips.
News Flash: In the past, I’ve put out broad calls for chapter reviewers. This time, I’m being selective and directly asking prominent theories experts to review chapters and offer guidance. Some examples: For the Adlerian chapter we’ve got Marina Bluvshtein (woohoo!) and Jon Sperry (wow!). For the Psychoanalytic chapter, we got Nancy McWilliams (amazing!) and Pratyusha Tammala-Narra (fantastic!).
If you happen to be a specific theories subject matter expert, you should email me at john.sf@mso.umt.edu to get in on the fun. Or if you have a prominent theories friend/colleague to recommend, have them email me.
As one last theories teaser, below I’m pasting a few excerpts from Nancy McWilliams’s 2021 article titled, “Diagnosis and Its Discontents: Reflections on Our Current Dilemma.” I love this article as it gives a glimpse into problems with contemporary diagnoses and how psychodynamic therapists use individualized assessment in ways to honor the real-life complexities clients bring into psychotherapy. The excerpts below are from her article, which is linked at the end of this post.
On Labeling
The idea that one is anxious (or depressed or obsessive) about something that has meaning is being lost. Fitting an individual into a category tends to foreclose exploration of what is unique to a patient; it especially prevents insights into unexpected aspects of a person’s psychology or exploration of areas that are felt as shameful – the very areas that are of particular value in planning and carrying out psychotherapy.
On the vexing ways in which patients think about themselves and their diagnoses
It used to be that a socially avoidant woman would come for therapy saying something like, “I’m a painfully shy person, and I need help learning how to deal better with people in social situations.” Now a person with that concern is likely to tell me that she “has” social phobia – as if an alien affliction has invaded her otherwise problem-free subjective life. People talk about themselves in acronyms oddly dissociated from their lived experience: “my OCD,” “my eating disorder,” “my bipolar.” There is an odd estrangement from one’s sense of an agentic self, including one’s own behavior, body, emotional and spiritual life, and felt suffering, and consequently one’s possibilities for solving a problem. There is a passive quality in many individuals currently seeking therapy, as if they feel that the prototype for making an internal psychological change is to describe their symptoms to an expert and wait to be told what medicine to take, what exercises to do, or what self-help manual to read.
On “chemical imbalances”
. . . viewing psychological suffering as a set of disorders that can be fixed or improved chemically can easily invite the obverse assumption that those painful experiences are ultimately caused by random or genetically based chemical differences among individuals. This is a false conclusion, of course, something like saying that because marijuana improves appetite, the cause of low appetite is lack of marijuana. But it is nevertheless a frequent leap of illogic – in the thinking of nonprofessionals and of some professionals as well – to ascribe much severe psychological suffering to a “chemical imbalance.” Such a construction tempts us to ignore all the painful other sources of psychological suffering, such as poverty, neglect, trauma, and the myriad ways in which human beings can injure each other psychologically.
On not overgeneralizing research findings/recommendations to unique patients
. . . consider patients at the extreme end of the obsessive-compulsive continuum, whose obsessions border on delusional beliefs, who suffer profound annihilation anxiety, who wholeheartedly believe they will die if they fail to carry out their rituals, and who regard the therapist with suspicion for not sharing their conviction – in other words, the subgroup of obsessive patients that Kernberg (1984) would consider as psychologically organized at the low borderline or psychotic level. My experience suggests that with this group exposure therapy not only fails, it demoralizes the patients, makes them feel like failures personally, and kills any hope they may have that psychotherapy can help. It also demoralizes therapists, who have been told again and again that exposure therapy is the treatment of choice for OCD. If they believe their teachers, such clinicians can easily conclude they are simply not good enough therapists.
If I’ve piqued your interest in “Diagnosis and its discontents” by Nancy McWilliams, here’s a pdf of the article.
I keep getting a steady stream of requests for the “long version” of our Theoretical Orientation Test. The TOT-Long is from our Study Guide, pictured here:
When taking our TOT-Long, keep some or all of the following in the back (or front) of your mind.
This questionnaire is for self-exploration; it’s not an “assessment” with established psychometrics. What that means–in the spirit of Adler–is that this so-called test is an idiographic assessment process.
I’m not a big fan of counselors and psychotherapists pigeon-holing themselves into strict theoretical positions. Instead, finding a compatible theory can help you align with ways you can transform your ideas into practical ways of being and ways of working with clients. Don’t let your theoretical orientation stop you from flexibly providing clients with the services they need and want.
All theory-based approaches work best from a relational foundation. If you question this basic assumption, try doing cold CBT with ambivalent or reluctant teenagers. . . or just imagining how that would go might be enough.
I hope you enjoy contemplating where our theoretical “sorting hat” sends you. As with all assessments, you’re the final authority of whether the shoe (or hat) fits.
Please let me know what you think of the test and, if you’re so inclined, post your theoretical orientation as a comment here. I look forward to hearing and seeing your reactions and results.
Recently someone mistook me for an Adlerian. This got me thinking, “Maybe I am an Adlerian?” Then again, if you look at the history of counseling and psychotherapy, most of us are Adlerians. At one presentation I attended back when we attended those things, the presenters started with, “In the beginning, there was Adler.”
As a Happy Birthday tribute to Alfred Adler, below is an excerpt from our Adlerian theories chapter. There’s much more, of course, like, for example, what Adlerian theory would have to say about the Super Bowl.
Happy Birthday Dr. Adler.
Historical Context
Freud and Adler met in 1902. According to Mosak and Maniacci (1999), Adler published a strong defense of Freud’s Interpretation of Dreams, and consequently Freud invited Adler over “on a Wednesday evening” for a discussion of psychological issues. “The Wednesday Night Meetings, as they became known, led to the development of the Psychoanalytic Society” (p. 3).
Adler was his own man with his own ideas before he met Freud. Prior to their meeting he’d published his first book, Healthbook for the Tailor’s Trade (Adler, 1898). In contrast to Freud, much of Adler’s medical practice was with the working poor. Early in his career, he worked extensively with tailors and circus performers.
In February 1911, Adler did the unthinkable (Bankart, 1997). As president of Vienna’s Psychoanalytic Society, he read a highly controversial paper, “The Masculine Protest,” at the group’s monthly meeting. It was at odds with Freudian theory. Instead of focusing on biological and psychological factors and their influence on excessively masculine behaviors in males and females, Adler emphasized culture and socialization (Carlson & Englar-Carlson, 2017). He claimed that women occupied a less privileged social and political position because of social coercion, not physical inferiority. Further, he noted that some women who reacted to this cultural situation by choosing to dress and act like men were suffering, not from penis envy, but from a social-psychological condition he referred to as the masculine protest. The masculine protest involved overvaluing masculinity to the point where it drove men and boys to give up and become passive or to engage in excessive aggressive behavior. In extreme cases, males who suffered from the masculine protest began dressing and acting like girls or women.
The Vienna Psychoanalytic Society members’ response to Adler was dramatic. Bankart (1997) described the scene:
After Adler’s address, the members of the society were in an uproar. There were pointed heckling and shouted abuse. Some were even threatening to come to blows. And then, almost majestically, Freud rose from his seat. He surveyed the room with his penetrating eyes. He told them there was no reason to brawl in the streets like uncivilized hooligans. The choice was simple. Either he or Dr. Adler would remain to guide the future of psychoanalysis. The choice was the members’ to make. He trusted them to do the right thing. (p. 130)
Freud likely anticipated the outcome. The group voted for Freud to lead them. Adler left the building quietly, joined by the Society’s vice president, William Stekel, and five other members. They moved their meeting to a local café and established the Society for Free Psychoanalytic Research. The Society soon changed its name to the Society for Individual Psychology. This group believed that social, familial, and cultural forces are dominant in shaping human behavior. Bankart (1997) summarized their perspective: “Their response to human problems was characteristically ethical and practical—an orientation that stood in dramatic contrast to the biological and theoretical focus of psychoanalysis” (p. 130).
Adler’s break from Freud gives an initial glimpse into his theoretical approach. Adler identified with common people. He was a feminist. These leanings reflect the influences of his upbringing and marriage. They reveal his compassion for the sick, oppressed, and downtrodden. Before examining Adlerian theoretical principles, let’s note what he had to say about gender politics well over 90 years ago:
All our institutions, our traditional attitudes, our laws, our morals, our customs, give evidence of the fact that they are determined and maintained by privileged males for the glory of male domination. (Adler, 1927, p. 123)
Raissa Epstein may have had a few discussions with her husband, exerting substantial influence on his thinking (Santiago-Valles, 2009).
A good summary is a beautiful thing. But summaries are always unfair and limited representations of that which is bigger. Nevertheless, below, I’ve tried to summarize the primary listening focus and the primary change mechanisms for each of 13 theoretical orientations included in our textbook, Counseling and Psychotherapy Theories in Context and Practice (John Wiley & Sons, 2018). In addition, yesterday I filmed myself using a memory-palace strategy while describing all 13 perspectives below. You can read the summary below and/or watch me try to pull off this 15 minute theories overview on YouTube: https://youtu.be/VJFK6cCHCU8
Theory
What to Listen For. . .
Change Mechanisms
PsychoanalyticPsychodynamic
Old maladaptive intrapersonal conflicts and repetitive, unconscious, and dysfunctional interpersonal patterns.
Make unconscious conscious, catharsis, and working through new intra- and interpersonal dynamics.
Adlerian
Basic mistakes imbedded in the style of life, including excess self-interest and inferiority/superiority.
Awareness, insight, and encouragement (courage) to face the tasks of life.
Existential
Anxiety over and avoidance of core existential life dynamics like death, isolation, meaninglessness, and freedom.
Feedback and confrontation to help clients gain awareness and face life’s ultimate existential demands.
Person-Centered
Emotional distress, incongruence (discrepancies between real and ideal selves), and conditions of worth.
A relationship characterized by congruence, unconditional positive regard, and empathic understanding.
Gestalt
Unfinished emotional and behavioral baggage from the past that blocks awareness or disturbs self-other boundaries.
Guidance on using here-and-now experiments to deal with unfinished emotional and behavioral experiences.
Behavioral
Disturbing emotions (e.g., anxiety), maladaptive behavior patterns, and environmental contingencies.
New learning or re-learning via operant, classical, and social processes.
A question and brief discussion on Twitter about integrating multicultural competence into CBT inspired me to look back and see what the heck we wrote for that section in our theories text. In the Twitter discussion, we agreed that Pam Hays’s work on CBT and multicultural content is good.
Here’s what I found in our theories text. Obviously it’s a short section and limited, but there are a few interesting points and a citation or two.
Cultural and Diversity Considerations in CBT
CBT focuses on symptoms as manifest within individuals. This position can be (and is) sometimes viewed as disregarding important culture, gender, and sexual diversity issues. For most cognitive-behavioral therapists, culture, gender, and sexuality aren’t primary factors that drive successful outcomes.
This position is a two-edged sword. In the featured case (in Chapter 8), Richard is a white male living a life squarely in the middle of the dominant culture. The therapist was committed to Richard’s well-being. If the client had been an Asian Indian or a bisexual or a woman experiencing domestic abuse the cognitive-behavioral therapist would have been equally committed to the client’s well-being. This is the positive side of CBT being less diversity-oriented.
The negative side is that CBT can be viewed and experienced as blaming clients for their symptoms, when the symptoms may be a function of diversity bias. D. Dobson and K. S. Dobson (2009) articulated the potential for clients to experience blame,
By virtue of looking for distorted thoughts, cognitive-behavioral therapists are more likely than other therapists to find them. Furthermore, some clients do react to the terms distorted, irrational, or dysfunctional thinking. We have heard clients say something to the effect—” Not only do I feel bad, but now I’ve learned that my thoughts are all wrong.” (p. 252)
Awareness of the possibility of client blaming is crucial. For example, what if Richard were a Black American male? And what if his therapist noticed that Richard’s thought record included numerous personalization examples? If so, instead of concluding that Richard is displaying oversensitivity and paranoid cognitions, his therapist should explore the possibility of microaggressions in Richard’s daily life.
The term microaggression was coined by Chester Pierce (1978). Microaggressions were originally defined as “the everyday subtle and often automatic ‘put-downs’ and insults directed toward Black Americans” but now this is expanded so they “can be expressed toward any marginalized group in our society” (Sue, 2010, p. 5).
Microaggressions are typically unconscious. For example, we had a female client come to us in great distress because her vocational instructor had told her “You’re pretty strong for a girl.” Although the vocational instructor defended his “compliment,” the young woman clearly didn’t experience the statement as a compliment. In this circumstance if a therapist is insensitive to culture and gender issues, the young woman might feel blamed for having irrational thoughts and overreactive behaviors. Sue (2010) recommends that mental health professionals exercise vigilance to address microaggression issues inside and outside of counseling. One way in which cognitive behavioral practitioners have addressed the potential for committing microaggressions against sexually diverse clients is by using LGBTQ affirmative CBT (Pachankis, Hatzenbuehler, Rendina, Safren, & Parsons, 2015).
Returning to racial/cultural microaggressions, let’s briefly pretend that Richard is a 6′7′′ Black American male. In his thought record he notes:
Situation: Walking into the local grocery store. Young female makes eye contact with me and then quickly turns around and goes back and locks her car.
Thoughts: She thinks I’m going to steal her car.
Emotions: Anger.
Behavior: I act rude toward her and toward other white people I see in the store.
If the Black American version of Richard has a therapist who looks at this thought record and then talks with Richard about the distorted thinking style of mind-reading (“Richard, you didn’t really know what she was thinking, did you?”) this therapist is showing cultural insensitivity and will likely be fired by Richard. This is an example of one of the many growing edges CBT should address with respect to women and minority clients.
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As always, your reactions to this content are welcome.
Rita keeps saying I’ve been laughing more. Last night we were watching an Australian soap opera featuring an overly aggressive goat. I got the giggles. Maybe it’s all this focus on happiness lately. Then again, we’re also writing a suicide assessment and treatment book, which partly translates into living in and cherishing every moment. So who really knows what’s up with me thinking angry goats are funny?
Last week I did a Zoom appearance in Dr. Julia Taylor’s theories class at the University of Virginia. As usual (this is my third year visiting her class), Julia had her students well-prepped; we had a fantastic discussion. One student, much to my delight, said our theories text was the funniest text ever, and that she learned more from it than she had in four years of reading undergraduate textbooks. I, of course, heartily agreed and thanked Elexus (I still remember her name) for her wonderful comments.
As a textbook writer, I don’t get a ton of positive feedback, but when I do, it tickles my heart and makes my day.
Today, after doing a private consultation with a mental health counselor in Denmark, I sent out a copy of the CBT chapter from our theories text. Before sending it, I read the first paragraphs, and laughed out loud. I’d forgotten that we somehow left my free associations about cognition in the chapter opening. I laughed partly because the prose was hilarious and partly because of a tinge of embarrassment that my irreverent writing might be just too much for some readers. Oh well. I hope not.
We have many ideas about how to open a chapter about cognition. John wanted to say something pithy like, “You are what you think,” but Ralph Waldo Emerson got there first. Rita was considering, “As a woman thinketh” (a feminist version of James Allen’s 1903 book titled, “As a man thinketh”), but John countered with “As a person thinketh” and by then we’d grown weary of the word thinketh. Then Rita waxed Shakespeare-esk, saying, “There is nothing either good or bad but thinking makes it so” which seemed a little better than the Buddha’s, “What you think you become” until we found the writings of Hafiz (a 14th century Persian poet):
Zero
Is where the Real Fun starts
There’s too much counting
Everywhere else!
(Ladinsky, 1996, p. 47)
Although Albert Ellis might respond to this poem by asking, “What the Holy Hell are you thinking,” we thought it was about clearing a cognitive space for meditation. Let’s start with zero.
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Okay. Just in case you’re not ROTFL now, here’s a clip from the existential chapter that will knock your socks off. This comes under the heading, “The I-Am Experience”
Excerpt Two: Existentialists and Hyphens
Existentialists like to use hyphens to capture the interconnectedness of phenomenological experience. For example, in contrast to May’s I-am experience, Boss (1963) and Binswanger (1933) used Dasein (which is translated to being-in-the-world) to describe the sense-of-existence. Also, the phrase, “Dasein choosing,” which is translated to the-person-who-is-responsible-for-his-existence choosing is used. We should note that this practice is in no way related to our own hyphenated last names, although it has inspired John to consider adding a hyphenated middle name so he can refer to himself in the third person as, “John-who-is-responsible-for-his-existence-Sommers-Flanagan,” which he thinks sort of rolls right off the tongue.
It follows, as-if-anything-really-follows-from-the-preceding, that existential therapy is nearly always in the service of self-awareness or self-discovery. However, unlike psychoanalysts, existentialists expand and illuminate client self-awareness rather than interpreting client unconscious processes. This is because existentialists believe the entirety of an individual’s human experience is accessible to consciousness.
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And now, the grand finale (although there are many more where these come from), and my personal favorite, from Chapter 11: Constructive Theory and Therapy
Excerpt Three: I’m Not Afraid of Philosophers
In this chapter, we de-emphasize distinctions between constructivist and social constructionist perspectives. Mostly, we lump them together as constructive theories and therapies and emphasize the intriguing intervention strategies developed within these paradigms. This may upset staunch constructivists or radical social constructionists, but we take this risk with full confidence in our personal safety—because most constructive types are nonviolent, strongly preferring to think, write, and engage in intellectual discussion. Therefore, within our own socially or individually constructed realities, we’ve concluded that we’re in no danger of bodily harm from angry constructive theorists or therapists.
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I’m sure many of you haven’t gotten the delight out of these hilarious counseling and psychotherapy theories humor that I have. Maybe that’s a sign that you too, should start studying happiness. On the other hand, reading theories books may have permanently warped my sense of humor. Either way, I hope you find sparkling moments and laughter here and there in your lives.
The place to click if you want to learn about psychotherapy, counseling, or whatever John SF is thinking about.
John Sommers-Flanagan 