Tag Archives: therapy

Separating the Psychological (Emotional) Pain from the Self: A Technique for Working with Suicidal Clients

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I’m working on a Suicide Assessment and Treatment Planning manuscript and here’s a small piece of what I just wrote:

Rosenberg (1999; 2000) and others have described a helpful cognitive reframe intervention for use with clients who are suicidal. She wrote,

The therapist can help the client understand that what she or he really desires is to eradicate the feelings of intolerable pain rather than to eradicate the self (1999, p. 86).

Shneidman’s (1996) guidance on this was similar, but perhaps even more emphatic. He recommended that therapists partner with clients and with members of the client’s support system (e.g., family) to do whatever possible to reduce the psychological pain.

Reduce the pain; remove the blinders; lighten the pressure—all three, even just a little bit (p. 139).

Suicidal clients need empathy for their emotional pain, but they also need to partner with therapists to fight against their pain. Framing the pain as separate from the self can help because therapists can be empathic, but simultaneously illuminate the possibility that the wish isn’t to eliminate the self, but instead, to eliminate the pain.

Rosenberg (1999) also recommended that therapists help clients reframe what’s usually meant by the phrase feeling suicidal. She noted that clients benefit from seeing their suicidal thoughts and impulses as a communication about their depth of feeling, rather than an “actual intent to take action” (p. 86). Once again, this approach to intervening with suicidal clients can decrease clients’ needs to act, partly because of the elegant cognitive reframe and partly because of the therapist’s empathic message.

Here’s a case vignette to illustrate how therapists can work with clients to separate the emotional pain from the self and then partner with clients to reduce the pain. As always, this case vignette is a composite compiled from clinical work and simulations with various individuals.

Case Vignette. Kate is a 44-year-old cisgender married female with two children. She arrived for counseling in extreme emotional distress. She was also agitated, stating, “It just hurts so badly to be alive. It hurts so badly.”

Much of Kate’s emotional pain was centered around the recent death of her mother, whom Kate had cared for over the past seven years. Kate had an ambivalent relationship with her; her mother had been diagnosed as having schizophrenia and caring for her was extremely challenging. Kate’s acute emotional distress was accompanied by fears of turning out like her mother and thoughts of reunifying with her mother. She said, “I just need to be with her.”

To help Kate separate her intense emotional pain from the self, I began by noticing that there were two different parts of Kate, and that these two different parts had different ideas about how to move forward. Noticing and articulating different perspectives of the self is a common approach from a person-centered theoretical perspective. Because of Kate’s family history of schizophrenia, I wouldn’t use an expressive Gestalt technique to separate her different ego states, but it felt like reflecting her obvious ambivalence was a safe approach. Specifically, I said, “Sounds like a part of yourself thinks the solution is to die, and that your kids will be better off. But there’s another part of you that says, maybe the solution isn’t to die. Maybe I can come in here and talk. Maybe my kids actually would suffer if I died.”

Kate accepted that she was “of two minds” about how to go forward. Next, I tried to further clarify these parts of herself, emphasizing that I wanted to align with the “second” part of herself, so that we could work together on her emotional pain.

The one part of yourself thinks your only hope of dealing with the pain is to kill yourself. The other part thinks, maybe I can stay alive, work in counseling to get rid of the pain, and then my children wouldn’t suffer from my death. How about, for now, we work from that second perspective. We can be a team that works hard to decrease the emotional pain you’re feeling. It might not go away immediately, but if you stay alive and we work together, we can chip away at the pain and make it shrink.

You may notice the words I used were somewhat redundant. Using redundancy with clients who are feeling suicidal may be needed because the agitated, depressed state of mind makes cognitive focusing difficult. Sometimes, if you don’t repeat the therapeutic perspective and keep focused on it, the therapeutic perspective can slip away from your clients’ cognitive grasp.

Linehan often uses a more provocative way of talking about partnering with clients to diminish their pain. For example, she might say, “Getting through this is like going through Hell. But I know therapy can help and I want to work with you on this. But I have to tell you this, therapy will only work if you stay alive. Therapy doesn’t work on dead people. So I want you to stay alive and work with me at attacking your pain. Will you give me six months for us to go through hell together so we can get control of your pain?

Either way, the goal is to partner with clients to work on decreasing emotional or psychological pain. This approach combines empathic listening, with an emphasis on the therapeutic alliance. As therapist and client partner together, then cognitive-behavioral problem-solving can commence.

Using Therapeutic Storytelling with Children: Five Easy Steps

Books

Everybody loves a good story.

Good stories grab the listener’s attention and don’t let go. I’ve been reading and telling stories for as long as I can remember. Whether its kindergartners, clients, or college students, I’ve found that stories settle people into a receptive state that looks something like a hypnotic trance.

Nowadays, mostly we see children and teens entranced with their electronic devices, television, and movies. Although it’s nice to see young people in a calm and focused state, the big problem with devices (other than their negative effects on sleep, attention span, weight, brain development, and nearly everything else having to do with living in the real world), is that we (parents, caretakers, and concerned adults), don’t have control over the electronic stories our children see and hear.

Storytelling is a natural method for teaching and learning. Children learn from stories. We’re teaching when we tell them. We might as well add our intentionally selection of stories to whatever our children might be learning from the internet.

Way back in 1997, Rita and I wrote a book called Tough Kids, Cool Counseling. One of the chapters focused on how to use therapeutic storytelling with children and teens. Although the content of Tough Kids, Cool Counseling is dated, the ideas are still solid. The following section is good material for counselors, psychotherapists, parents, and other adults who want to influence young people.

In counseling, storytelling was originally developed as a method for bypassing client resistance. Stories are gentle methods that don’t demand a response, but that stimulate, “thinking, experiencing, and ideas for problem resolution” (Lankton & Lankton, 1989, pp. 1–2)

Storytelling is an alternative communication strategy. For counselors, it should be used as a technique within the context of an overall treatment plan, rather than as a treatment approach in and of itself. For parents and caregivers, stories should be fun, and engaging . . . and told in a way to facilitate learning.

Story construction. Even if you’re an excellent natural storyteller, it can help to have a guide or structure for story construction and development. I like using a framework that Bill Cook, a Montana psychologist, wrote about and shared with me. He uses the acronym S-T-O-R-I, to organize the parts of a therapeutic story.

S: Set the stage for the story. To set the stage, you should create a scenario that focuses on a child living in a particular situation. The child can be a human or an animal or an animated object. The central child character should be described in a way that’s positive and appealing. Because much of my work back in the 1990s involved working with boys who were angry and impulsive, the following story features a boy who has an arguing problem. Depending on your circumstances, you could easily feature a girl or a child who doesn’t have a particular gender identity.

Here’s the beginning of the story.

Once upon a time there was a really smart boy. His name was Lancaster. Lancaster was not only smart, he was also a very cool dresser. He wore excellent clothes and most everyone who met Lancaster immediately was impressed with him. Lancaster lived with his mother and sister in the city.

In this example, the client’s name was Larry. If it’s not too obvious, you can give the central character a name that sounds similar to your client’s name. You may also develop a story that has other similarities to your client’s life.

T: Tell about the problem. This stage includes a problem with which the central character is struggling. It should be a problem similar to your client’s or your child’s. This stage ends with a statement about how no one knows what to do about this very difficult and perplexing problem.

Every day, Lancaster went to school. He went because he was supposed to, not because he liked school. You see, Lancaster didn’t like having people tell him what to do. He liked to be in charge. He liked to be the boss. The bad news is that his teachers at school liked to be in charge too. And when he was at home, his mother liked to be the boss. So Lancaster ended up getting into lots of arguments with his teachers and mother. His teachers were very tired of him and about to kick him out of school. To make things even worse, his mother was so mad at him for arguing all the time that she was just about to kick him out of the house. Nobody knew what to do. Lancaster was arguing with everyone and everyone was mad at Lancaster. This was a very big problem.

O: Organize a search for helpful resources. During this part of the story, the central character and family try to find help to solve the problem. This search usually results in identifying a wise old person or animal or alien creature as a special helper. The wise helper lives somewhere remote and has a kind, gentle, and mysterious quality. In this case, because Larry (the client) didn’t have many positive male role models in his life, I chose to make the wise helper a male. Obviously, you can control that part of the story to meet the child’s needs and situation.

Because the situation kept getting worse and worse and worse, almost everyone had decided that Lancaster needed help—except Lancaster. Finally, Lancaster’s principal called Lancaster’s mom and told her of a wise old man who lived in the forest. The man’s name was Cedric and, apparently, in the past, he had been helpful to many young children and their families. When Lancaster’s mother told him of Cedric, Lancaster refused to see Cedric. Lancaster laughed and sneered and said: “The principal is a Cheese-Dog. He doesn’t know the difference between his nose and a meteorite. If he thinks it’s a good idea, I’m not doing it!”

But eventually Lancaster got tired of all the arguing and he told his mom “If you buy me my favorite ice cream sundae every day for a week, I’ll go see that old Seed-Head man. Lancaster’s mom pulled out her purse and asked, “What flavor would you like today?”

After hiking 2 hours through the forest, they arrived at Cedric’s tree house late Saturday morning. They climbed the steps and knocked. A voice yelled: “Get in here now, or the waffles will get cold!” Lancaster and his mom stepped into the tree house and were immediately hit with a delicious smell. Cedric waved to them like old friends, had them sit at the kitchen table, a served them a stack of toasty-hot strawberry waffles, complete with whipped cream and fresh maple syrup. They ate and talked about mysteries of the forest. Finally, Cedric leaned back, and asked, “Now what do you two want . . . other than my strawberry waffles and this pleasant conversation?”

Lancaster suddenly felt shy. His mom, being a sensitive mom, looked up at Cedric’s big hulking face and described how Lancaster could argue with just about anyone, anytime, anywhere. She described his tendency to call people mean names and mentioned that Lancaster was in danger of being kicked out of school. Of course, Lancaster occasionally burst out with: “No way!” and “I never said that,” and even an occasional, “You’re stupider than my pet toad.”

After Lancaster’s mom stopped talking, Cedric looked at Lancaster. He grinned and chuckled. Lancaster didn’t like it when people laughed at him, so he asked, “What are YOU laughing about?” Cedric replied, “I like that line. You’re even stupider than my pet toad. You’re funny. I’m gonna try that one out. How about if we make a deal? Both you and I will say nothing but “You’re even stupider than my pet toad” in response to everything anyone says to us. It’ll be great. We’ll have the most fun this week ever. Okay. Okay. Make me a deal.” Cedric reached out his hand.

Lancaster was confused. He just automatically reached back and said, “Uh, sure.”

Cedric quickly stood up and motioned Lancaster and his mom to the door, smiling and saying, “Hey you two toad-brains, see you next Saturday!!”

Searching for helpful resources can be framed in many ways. For counselors, you might construct it to be similar to what children and parents experience during their search for a counselor. Consistent with the classic Mrs. Piggle Wiggle book series, the therapeutic helper in the story has tremendous advantages over ordinary counselors. In the Lancaster example, Cedric gets to propose a maladaptive and paradoxical strategy without risk, because the whole process is simply a thought experiment. Depending on your preference and situation, you can use whatever “treatment” strategy you like.

R: Refine the therapeutic intervention. In this storytelling model, the initial therapeutic strategy isn’t supposed to be effective. Instead, the bad strategy that Cedric proposes is designed for a core learning experience. During the fourth stage (refinement) the central character learns an important lesson and begins the behavior change process.

Both Lancaster and Cedric had a long week. They called everyone they saw a “stupid toad-brain” and said, “You’re even stupider than my pet toad” and the results were bad. Lancaster got kicked out of school. That morning, when they were on their way to Cedric’s, Lancaster got slugged in the mouth for insulting their taxi driver and he was sporting a fat lip.

When Lancaster stepped into Cedric’s tree house, he noticed that Cedric had a black eye.

“Hey, Mr. Toad-Brain, what happened to your eye?” asked Lancaster. “Probably the same thing that happened to your face, fish lips!” replied Cedric.

Lancaster and Cedric sat staring at each other in an awkward silence. Lancaster’s mom decided to just sit quietly to see what would happen. She was felt surprisingly entertained.

Cedric broke the silence. “Here’s what I think. I don’t think everyone appreciates our humor. In fact, nobody I met seemed to like the idea of having their brain compared to your pet toad’s brain. They never even laughed once. Everybody got mad at me. Is that what things are usually like for you?”

Lancaster muttered back, “Uh, well, yeah.” But this week was worse. My best friend said he doesn’t want to be best friends and my principal got so mad at me that he put my head in the toilet of the boys’ bathroom and flushed it.”

Cedric rolled his eyes and laughed, “And I thought I had a bad week. Well, Lanny, mind if I call you Lanny?”

“Yeah, whatever, Just don’t call me anything that has to do with toads.”

“Well Lanny, the way I see it, we have three choices. First, we can keep on with the arguing and insulting. Maybe if we argue even harder and used different insults, people will back down and let us have things our way. Second, we can work on being really nice to everyone most of the time, so they’ll forgive us more quickly when we argue with them in our usual mean and nasty way. And third, we can learn to argue more politely, so we don’t get everyone upset by calling them things like ‘toad brains’ and stuff like that.”

After talking their options over with each other and with Lancaster’s mom, Cedric and Lancaster decided to try the third option: arguing more politely. In fact, they practiced with each other for an hour or so and then agreed to meet again the next week to check on how their new strategy worked. Their practice included inventing complimentary names for each other like “Sweetums” or “Tulip” and surprising people with positive responses like, “You’re right!” or “Yes boss, I’m on it!”

As seen in the narrative, Lanny and Cedric learn lessons together. The fact that they learn them together is improbable in real life. However, the storytelling modality allows counselor and client the opportunity to truly form a partnership and enact Aaron Beck’s concept of collaborative empiricism.

I: Integrating the lesson. In the final stage of this storytelling model, the central character articulates the lesson(s) learned.

Months later, Lancaster got an invitation from Cedric for an ice cream party. When Lancaster arrived, he realized the party was just for him and Cedric. Cedric held up his glass of chocolate milk and offered a toast. He said, “To my friend Lanny. I could tell when I first met you that you were very smart. Now, I know that you’re not only smart, but you are indeed wise. Now, you’re able to argue politely and you only choose to argue when you really feel strongly about something. You’re also as creative in calling people nice names as you were at calling them nasty names. And you’re back in school and, as far as I understand, your life is going great. Thanks for teaching me a great lesson.”

As Lanny raised his glass for the toast, he noticed how strong and good he felt. He had learned when to argue and when not to argue. But even more importantly, he had learned how to say nice things to people and how to argue without making everyone mad at him. The funny thing was, Lanny felt happier. Mostly, all those mad feelings that had been inside him weren’t there anymore.

At the end of this story (or whatever story you decide to use), you can choose to directly discuss the “moral of the story” or not. In many cases, leaving the story’s message unstated is useful. Or you might ask the child, “What do you think of this story?”

Letting the child consider the message provides an opportunity for intellectual stimulation and may aid in moral development. Although it would be nice to claim that therapeutic storytelling causes immediate behavior change, the more important outcome is that storytelling provides a way for an adult and a child to have pleasant interactions around a story . . . with the possibility that, over time, positive behavior change may occur.

The 6th Edition of Clinical Interviewing is Now Available

Way back in 1990, a university book salesman came by my faculty office at the University of Portland. He was trying to sell me some textbooks. When I balked at what he was offering, he asked, “Do you have any textbook ideas of your own?” I said something like, “Sure” or “As a matter of fact, I do.” He handed me his card and a paper copy of Allyn & Bacon’s proposal guidelines.

Not having ever written a book, I never thought they’d accept my proposal.

They did. But after three years, A & B dropped our text.

Lucky for us.

Two  years later, Rita and I decided to try to resurrect our Clinical Interviewing text. We polished up a proposal, sent it out to three excellent publishers, and immediately got contract offers from W. W. Norton, Guilford, and John Wiley & Sons.

We went with Wiley.

Here we are 18 years later in the 6th edition. It’s been fun and a ton of work. Over the past five years we’ve started recording video clips and interviewing demonstrations to go along with the text. For the 6th edition, we got some pretty fantastic reviews from some pretty fancy (and fantastic) people. Here they are:

“I’m a huge admirer of the authors’ excellent work.  This book reflects their considerable clinical experience and provides great content, engaging writing, and enduring wisdom.”
John C. Norcross, Ph.D., ABPP, Distinguished Professor of Psychology, University of Scranton

“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 6th edition of Clinical Interviewing is everything we’ve come to expect from the Sommers-Flanagan team, and more!  Readers will find all the essential information needed to conduct a clinical interview, presented in a clear, straightforward, and engaging style.  The infusion of multicultural sensitivity and humility prepares the budding clinician not only for contemporary practice, but well into the future.  Notable strengths of the book are its careful attention to ethical practice and counselor self-care. The case studies obviously are grounded in the authors’ extensive experience and bring to life the complexities of clinical interviewing.  This is a ‘must-have’ resource that belongs on the bookshelf of every mental health counselor trainee and practitioner.”
Barbara Herlihy, PhD. NCC, LPC-S, University Research Professor, Counselor Education Program, University of New Orleans

You can check out the text on Amazon https://www.amazon.com/Clinical-Interviewing-John-Sommers-Flanagan/dp/1119215587/ref=dp_ob_title_bk  or Wiley http://www.wiley.com/WileyCDA/WileyTitle/productCd-1119215587.html  or other major (and minor) booksellers.

 

 

The Practically Perfect Parenting Podcast — Episode 2

Hello Parents, Fans of Parents, and Fans of Healthy Child Development:

I need a tiny bit of your time and help.

As you know, the Practically Perfect Parenting Podcast was launched on October 31. Yesterday, Episode 2 became live. The title: Practically Perfect Positive Discipline. Today, I’m flexing my marketing muscles (which, as it turns out, are disappointingly more like Gilligan’s than the Incredible Hulk)

Podcasts are a competitive media genre. One way we can try to improve our status from way out here in little Missoula, Montana is for people to listen, like, and rate.

Here’s how you can help:

If you use iTunes, here’s the link. https://itunes.apple.com/us/podcast/practically-perfect-parenting/id1170841304?mt=2#episodeGuid=2d80f23353e2c7f9d21af865f190d2c4

Please check it out and if you like it, like it, and then give it the rating you think it deserves. We’re trying to get enough ratings to climb up the iTunes rating list.

If you don’t use iTunes, you can get to our podcasts via this link: http://practicallyperfectparenting.libsyn.com/2016

And, either way, we’d love it if you’d like our Facebook page. To do that, go here: https://www.facebook.com/Practically-Perfect-Parenting-Podcast-210732536013377/?notif_t=page_fan&notif_id=1479160427608384

In addition to your social media ratings, we’re ALWAYS interested in your supportive or constructive feedback. We also take questions and suggestions for new show topics. You can provide any or all of that here on my blog or directly to me via email at john.sf@mso.umt.edu

Thanks!

Dr. John and Dr. Sara, The Practically Perfect Podcasters

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Using an Invitation for Collaboration in Counseling and Psychotherapy

As I’m sure you know, I believe (rather strongly) that counselors and psychotherapists should work hard to collaborate with clients. Being an authoritarian therapist is passe.

Sometimes collaboration sounds easy in theory, but it can be difficult in practice. It’s especially difficult if clients come into your office not “believing in therapy” and not trusting you. In the following excerpt from the forthcoming 6th edition of Clinical Interviewing, you can see how a skilled therapist deals with some initial client hostility.

Case Example 3.1: An Early Invitation for Collaboration

Sophia, a 26-year-old mother of two was referred for counseling by her children’s pediatrician. When she sat down with her counselor, she stated:

I don’t believe in this counseling thing. I’m stressed, that’s true, but I’m a private person and I believe very strongly that I should take care of myself and not have anyone take care of my problems for me. Besides, you look like you might be 18 years old and I doubt that you’re married or have children. So I don’t see how this is supposed to help.

It’s easy to be shaken when clients like Sophia pour out their doubts about therapy and about you at the beginning of the first session. Our best advice: (a) be ready for it; (b) don’t take it personally, Sophia is speaking of her doubts, don’t let them become yours; (c) be ready to respond directly to the client’s core message; and (d) end your response with an invitation for collaboration. An invitation for collaboration is a clinician statement that explicitly offers your client an opportunity to work together. In some cases, an invitation for collaboration is a time-limited “let’s try this out” offer.

Here’s a sample counselor response to Sophia:

Counselor: I hear you loud and clear. You don’t believe in counseling, you’re a private person, and you’re concerned that I don’t have the experiences needed to understand or help you.

Sophia: That’s right. [Sometimes when the counselor explicitly reflects the client’s core message (i.e., “. . . you’re concerned I don’t have the experience needed to understand or help you”) the client will retreat from this concern and say something like, “Well, it’s not that big of a deal.” But that’s not what Sophia does.]

Counselor: Well then, I can see why you wouldn’t want to be here. And you’re right, I don’t have a lot of the life experiences you’ve had. . But I do have knowledge and experience working with people who are stressed and concerned about parenting and I’d very much like to have a chance to be of help to you. How about since you’re here, we try out working together today and then toward the end of our time together I’ll check back in with you and you can be the judge of whether this might be helpful or not?

Sophia: Okay. That sounds reasonable.

In this case the counselor responded directly and with empathy to Sophia and then offered an invitation for collaboration. As the session ends, Sophia may or may not accept the counselor’s invitation. But either way, the counselor’s skillful response provides an opportunity for a collaborative relationship to develop.

Round Bales

 

Teaching Teens Better Strategies for Getting What they Want

On Thursday of this week I’ll be at the Hilton Garden Inn in Missoula doing a day-long workshop on how to work effectively with challenging youth and challenging parents. Of course, the first point to make about this is that this entire concept is flawed; it’s flawed because it’s not fair to call youth and parents “challenging” when, in fact, for them, the whole idea of sitting down and talking with a counselor is challenging. It would be equally reasonable to hold a workshop for parents and youth titled, “Working with Challenging Counselors.”

One of the approaches featured during the workshop will be to engage teenagers in using better (healthier and more legal) strategies for getting what they want. Rita and I wrote about this approach in our book, Tough Kids, Cool Counseling. . . and so here’s an excerpt that describes the approach and provides a case example:

INTERPERSONAL CHANGE STRATEGIES

The following techniques focus more specifically on interpersonal behavior patterns.

Teaching “Strategic Skills” to Adolescents
Weiner (1992) described many delinquent or “psychopathic” adolescents as inherently understanding the importance of using strategies to obtain their desired goals (p. 338). Despite this general understanding, disruptive, behavior-disordered adolescents frequently utilize ineffective interpersonal strategies and thereby obtain outcomes opposite to what they desire. For example, increased freedom is commonly identified by adolescents as one of their primary therapy goals. However, attention-deficit and disruptive, behavior-disordered adolescents consistently engage in behaviors that eventually restrict their personal freedom (e.g., curfew violation, disrespect toward parents, illegal behavior). The “strategic skills” intervention is designed to help adolescents understand how their own behavior contributes to their inability to attain personal goals (e.g., perhaps by producing increased limits and restrictions).

The therapist must provide two relationship-based explanations to implement the strategic skills procedure. First, the therapist must directly inform them of a willingness and commitment to assist them in personal goal attainment. For example:

It sounds like you want more freedom in your life. I imagine it’s a drag being 15 and still having all the restrictions you have. I want you to know that I’m willing to work very hard to help you have more freedom. We just have to put our heads together and think of some ways you can get more freedom.

The purpose of this statement is to reduce resistance and distrust. Many, if not most, adolescents expect therapists to side with their parents, teachers, or authority figures. The process of valuing the adolescent’s pursuit of freedom can surprise the adolescent and thereby reduce resistance.

Second, therapists must set clear limits on the type or quality of behaviors they are willing to support and promote. This is because adolescents may try to manipulate therapists into supporting illegal or self-destructive behavior patterns (Weiner, 1992; Wells & Forehand, 1985).

I need to tell you something about what I am willing to help you accomplish. I’ll help you figure out behaviors that are legal and constructive and help you get more freedom. In other words, I won’t support illegal and self-destructive behaviors because in the end, they won’t get you what you want. And there may be times when you and I disagree on what is legal and constructive; we’ll need to talk about those disagreements when and if they arise.

If adolescents respond positively to their therapists’ offer of support and assistance, the door is open to providing feedback about how to engage in freedom-promoting behaviors. Therapists can then tell their clients: “Okay, let’s talk about strategies for how you can get more of what you want out of life.” Subsequent discussions might include the following problem areas that frequently contribute to adolescents’ restrictions: staying out of legal trouble, developing respect and trust in the adolescents’ relationships with parents and authority figures, and analyzing and modifying inaccurate social cognitions. Essentially, therapists have facilitated client motivation and cooperation and can move on to analyzing faulty cognitions, modeling and role-playing strategies, and other effective psycho-therapeutic interventions.

Case example. A 12-year-old boy entered the consulting room in conflict with his father over how many pages he was supposed to read for a specific homework assignment given to him by a teacher whom he “hated.” The boy was disagreeable and nasty in response to his father’s comments; direct discussion of issues while both father and son were present was initially ineffective. Therefore, the father was dismissed. After using distraction strategies and a mood-changing technique (See Chapter 3), the boy was able to focus in a more productive manner on the conflict he was having with his father. The boy indicated that his father was partially correct in his claims about the reading assignment, but that the boy’s “hate” for this particular teacher made him want to resist the assignment.
The individual discussion between the boy and his therapist focused on (a) how the boy’s dislike for the teacher produced a “bad mood,” which subsequently produced his resistance to the assign-ment, (b) how the boy’s bad mood and resistance to the assignment had produced disagreeable behavior toward his dad, and (c) how the boy’s bad mood, resistance to the assignment, and disagreeable behavior had produced a bad mood and disagreeable behavior within the father (who was now resisting the boy’s request that the assignment be modified). Consequently, after the boy’s mood was modified, the boy and therapist were able to brainstorm strategies for helping the father change his mood and become more receptive to the son’s request. With assistance, the boy chose to tell the father “You were right about the assignment . . . “ when his father returned to the room. This “improved” interpersonal strategy (which had been role-played prior to father’s return) had an extremely positive effect on the father. Additionally, the boy was able to introduce a compromise (“I’ll do the assignment if my dad will listen to me without disagreeing when I bitch about how unfair and stupid this teacher is”). In response to his son’s admission “Dad, you’re right,” the father stated (with jaw open): “I don’t know what happened in here when I was gone, but I’ve never seen Donnie change his attitude so quickly.” Donnie and his father successfully negotiated the suggested compromise, and before Donnie left, the therapist pointed out (by whispering to the boy) how quickly he had been able to get his father’s mood to change in a positive direction.

In this case scenario, the therapist helped to modify the son and father’s usual reciprocal negative interactions in a manner similar to one-person family therapy advocated by Szapocznik et al. (1990).

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Non-Drug Options for Dealing with Depression

Evidence supporting the efficacy of antidepressant medications continues to be weak. That doesn’t mean they never work; some individuals with depressive symptoms find them very helpful and that’s okay. But for many, antidepressant meds just don’t work very well . . . there are side effects and less than desirable antidepressant effects. This is why many people wonder: What are some of the best non-drug alternatives for treating symptoms of depression?

Here’s a short list that might be helpful.

1. Counseling or Psychotherapy: Going to a reputable and licensed mental-health professional who offers counseling or psychotherapy for depression can be very helpful. This may include individual, couple, or family therapy.

2. Vigorous aerobic exercise: Consider initiating and maintaining a regular cardiovascular or aerobic exercise schedule. This could involve a specific referral to a personal trainer and/or local fitness center (e.g., YMCA). In a recent small study of adolescents with clinical depression, 100% of the teens in the aerobic exercise group no longer met the diagnostic criteria for depression after receiving several months of exercise treatment.

3. Herbal remedies: Some individuals benefit from taking herbal supplements. In particular, there is evidence that omega-3 fatty acids (fish oil) and St. John’s Wort are effective in reducing depressive symptoms. It’s good to consult with a health-care provider if you’re pursuing this option.

4. Light therapy: Some people describe great benefits from light therapy. Specific information on light therapy boxes is available online and possibly through your physician.

5. Massage therapy: Research indicates some patients with depressive symptoms benefit from massage therapy. A referral to a licensed massage therapy professional is advised.

6. Bibliotherapy: Research indicates that some patients benefit from reading and working with self-help books or workbooks. The Feeling Good Handbook (Burns, 1999) and Mind over Mood (Greenberger and Padesky, 1995) are two self-help books used by many individuals.

7. Post-partum support: There is evidence suggesting that new mothers with depressive symptoms who are closely followed by a public-health nurse, midwife, or other professional experience fewer post-partum depressive symptoms. Additionally, new moms and all individuals suffering from depressive symptoms may benefit from any healthy and positive activities that increase social contact and social support.

8. Mild exercise and physical/social activities: Even if you’re not up to vigorous exercise, you should know that nearly any type of movement is an antidepressant. These activities could include, but not be limited to, yoga, walking, swimming, bowling, hiking, or whatever you can do! In the same exercise study mentioned above, 71% of the teenagers in the mild exercise group experienced a substantial reduction in their symptoms of depression.

9. Other meaningful activities: Never underestimate the healing power of meaningful activities. Activities could include (a) church or spiritual pursuits; (b) charity work; (c) animal caretaking (adopting a pet); and (d) many other activities that might be personally meaningful to you.

The preceding list is adapted from a tip-sheet in our book, “How to Listen so Parents will Talk and Talk so Parents will Listen.” See: http://www.amazon.com/How-Listen-Parents-Will-Talk/dp/1118012968/ref=la_B0030LK6NM_1_9?s=books&ie=UTF8&qid=1413432346&sr=1-9
Or: http://lp.wileypub.com/SommersFlanagan/

John and his sister working on their positive emotions.

Peg and John Singing at Pat's Wedding