I spent my K-12 life at VSD #37. Today I’m back, doing a “Tough Kids” and suicide prevention workshop at Skyview H.S. Should be fun. Here are the handouts.
This past Thursday I had the honor of offering a full-day workshop on “Tough Kids, Cool Counseling” to the South Carolina Association of School Psychologists. For anyone who has misplaced their handout or who wants additional content, I’m including two handouts in this post.
The first handout includes all the powerpoint slides (except the cartoons and empowered storytelling).
The second handout includes additional content corresponding (mostly) to the content in the powerpoint slides.
For more information, you can check out our Tough Kids, Cool Counseling book, published by the American Counseling Association, https://www.amazon.com/Tough-Kids-Cool-Counseling-User-Friendly/dp/1556202741/ref=sr_1_10?s=books&ie=UTF8&qid=1491153299&sr=1-10&keywords=sommers-flanagan:
Or you can check out our book on working effectively with parents: https://www.amazon.com/How-Listen-Parents-Will-Talk/dp/1118012968/ref=sr_1_4?s=books&ie=UTF8&qid=1491153770&sr=1-4&keywords=sommers-flanagan
Young clients or students and their parents will sometimes be immediately resistant to your efforts to help them change. I don’t mean this in the old-fashioned psychoanalytic form of resistance that blames clients. I mean this as a natural resistance to change. I think we’ve all felt it. Someone has some helpful advice and we feel immediately disinclined to listen and even less inclined to follow the advice. I remember this happening with my father—even when he wanted to tell me something about sports. Of course, he knew a TON more about sports than I did, but logic was not the issue. When it comes to relationships and influencing people, logic is rarely relevant.
If we can buy into using the word resistance—despite the fact that Steve de Shazer buried it in his backyard and had a funeral for it, we would be likely to conclude that resistance behaviors are especially prominent among youth who view their presence in therapy as involuntary. Think of school, court, or parent referred children. Below, in an effort to capture what happens in these situations, Rita and I came up with what we call common resistance styles. Again, the point is not to blame clients or students; after all, they usually come into counseling or therapy with a history that makes their resistance totally natural. Besides, why should we expect them to pop into a therapist’s office and suddenly experience trust and share their deepest feelings.
In combination with these so-called resistance styles, we’ve also developed a range of possible therapeutic responses. To be with de Shazer’s (1985) solution-focused model and because they constitute a first best guess regarding how to respond to these particular resistance styles, we refer to these responses as “formula responses.” Keep in mind that if one formula response is ineffective, an alternative one may be used to reduce and manage this pesky resistance-like behavior.
Resistance Style: Externalizer/Blamer
This young person quickly blames everyone and everything for his or her problems. S/he may feel persecuted; there also may be evidence supporting his/her persecutory thoughts and feelings. Alternatively, the youth may simply have trouble accepting personal responsibility.
SAMPLE STATEMENT: “I would never have flunked science if it weren’t for my teacher. He sucks big-time.”
Formula Responses: One key to responding to this youth is to blatantly side with his or her affect. In the early stages, confrontation with this type of youth is generally ill-advised. For example, Bernstein (1996) states: “Despite a lack of evidence to back up their arguments, we listen carefully without passing judgment” (p. 45). The blamer is sometimes so hypersensitive to criticism that he sees it coming a mile away. Therefore, especially at the outset of therapy, therapists should be cautious about providing criticism or negative feedback. As the client blames others be sure to grunt and moan and say things like, “Oh yeah, I hate it when teachers aren’t fair.” or just use standard person-centered reflections, “You’re saying that being around your teacher really sucks . . .it feels real bad.”
Resistance Style: The Silent Youth
This youth may refuse to speak or may boldly claim that she doesn’t have to talk to you. This youth may have strong needs for power and control and/or may be afraid of what she might say during counseling.
SAMPLE STATEMENT: “I don’t have to talk to you. And you can’t make me.”
Formula Responses: For the completely silent youth who appears to be stonewalling, it may be useful to use a combination of youth-centered reflection of feeling/content and self-disclosure or forced teaming. For example, you might say: “Seems like you really don’t want to be here and you also really don’t want me to know anything about you.” And/or: “If I were you, I wouldn’t trust me either. After all, you were sent here by people you don’t trust and so you probably think I’m on their side. I’d like to prove I’m not on their side, but the only way we can really shock your parents (or probation officer) is by you talking with me and then you and I teaming up to help you have more control over your life.” In the case where the client boldly claims that she does not have to talk with you, it can be helpful to strongly agree with the youth’s assertion (and then simply inquire as to what has been happening in the youth’s life.: “You are absolutely right. You ARE totally in control over whether you talk with me and how much you talk with me.” Then, after a short pause say, “Now, what do you want to talk about?” Sometimes acknowledging the youth’s power and control can decrease his/her need for it.
Resistance Style: The Denier
This is the youth who Repeatedly says: “I’m fine” or “I don’t know” when neither statement is likely to be the truth. These youths can be especially frustrating to therapists because whatever life circumstances that led the youth to therapy are clearly difficult and progress might be made if the youth would admit to having problems. Unfortunately, these youths may have such fragile self-esteem that admitting that any problems are occurring in their lives is very threatening.
SAMPLE STATEMENT: “I’m fine, I don’t have any problems.”
Formula Responses: With youth who say, “I’m fine” we suggest one of two possible formula responses. First, you might say: “If you’re fine, then somebody in your life must not be fine, otherwise, you wouldn’t be here. So, tell me about who forced you to come and what his or her problems are?” The purpose of this statement is to get youths to at least become “blamers” so that you can side with the affect and start building rapport. Second, Bernstein (1996) suggests a statement similar to the following: “You may be right and you may be fine, but if you don’t talk with me about your life, I’ll never know whether you’re fine or not.” Suggested formula responses to “I don’t know” include: “Okay, then tell me something you do know about this problem” or “Tell me what you might say if you did know” or “Boy, it sounds like there are lots of things about your life that you don’t know anything about. We’d better get to work on figuring this stuff out” or John’s favorite, which is: “Take a guess.”
Resistance Style: The Nonverbal Provocateur
Some young clients are so good at irritating other people with their nonverbal behavior that they deserve an award. These youth are often keeping adults at a distance because they don’t trust that the adults will understand or appreciate their adolescent dilemmas. These youths also are notorious for being able to “piss off” their parents, teachers, probation officers, and therapists. They may do so through eye-rolls, sneers, lack of eye contact, or other irritating nonverbal behaviors. Analytic theorists believe this is because they have such profound self- hatred that they unconsciously believe they deserve to be treated poorly by others, especially adults (Willock, 1986, 1987).
SAMPLE STATEMENT: “Yeah, right. Duh” (while youth’s eyes roll back and she heaves a significant sigh).
Formula Responses: When faced with the nonverbal provocateur, we recommend using the strategy we have referred to elsewhere as “interpersonal interpretation” (See Tough Kids, Cool Counseling). This strategy includes several steps. First, the therapist allows the youth to make whatever disrespectful nonverbal behaviors she wants to, without acknowledgment. Second, after a substantial number of eye-rolls, etc., have occurred, the therapist makes a statement such as: “Are people treating you okay.” This statement is designed to provoke complaints from the youth about whomever has been treating her so poorly. Third, the therapist discloses his or her reactions to the nonverbal behaviors: “The reason I bring this up is because, for a moment, significant sigh).I felt like being mean to you.” Fourth, the therapist suggests that the youth may already realize why the therapist “felt like being mean” to the youth or discloses that these feeling arose in response to the youth’s nonverbal behaviors. Fifth, the therapist suggests that the reason other people are treating the youth poorly is related to eye-rolls, etc., outside of therapy. Sixth, the therapist inquires as to whether the youth has control over his/her irritating nonverbal behaviors. Seventh, the therapist encourages the youth to conduct an experiment to see how people treat him/her one day when using lots of eye-rolls and another day while not using eye-rolls.
Resistance Style: The Absent Youth
There are at least two types of absent youths. First, there are young people who arrive with their parent or parents, but who refuse to leave the waiting room. Second, there are young clients who, after an initial appointment, keep missing their subsequent appointments.
In either case, resistance is high. These youth may be even more afraid of therapy and losing power the control than other youth, who at least make it into the counseling office.
SAMPLE STATEMENT: “I’m not going back and you can’t make me.”
Formula Responses: It’s essential that young clients or students not be “dragged” into the therapy office. Therefore, the youth is simply informed that the session(s) will proceed without the youth present but that the session will still be “about” the youth. Subsequently, the session focuses on parent education and family dynamics. During this session, therapist should offer and serve food and drink to the participating family members. Also, partway through the session (if the young client is in the waiting room) one family member may ask once more if the youth would like to join them in the meeting. However, this request should only occur once and it should not involve any pleading. For young clients who miss their appointments, an invitation letter as suggested by White and Epston may be useful or, if you’re more behaviorally inclined, a contingency program may be designed to provide the youth with appropriate reinforcers and consequences.
Resistance Style: The Attacker
Similar to Matt Damon in the film Good Will Hunting, some youth will try to provoke the therapist by attacking whatever therapist personal traits that he or she can identify. It may be office decor, personal items (e.g., family pictures), clothing, the office itself, the voice tone, body posture, attractiveness, etc. The attacker’s ploy is often clear from the outset: The best defense (aka: resistance) is a good offense.
SAMPLE STATEMENT: “I noticed that everyone else here has a bigger office than you. You have a shitty little office; you must be a shitty little therapist.”
Formula Responses: We believe that two rules are crucial with young clients who consistently verbally attack the therapist. First, unlike Robin William’s character in the popular movie, you should not attempt to “choke” the youth (even therapist’s though you may feel like choking the client). In other words, therapists should not respond defensively or offensively to attacks by the youth. Second, the therapist may interpret the youth’s behavior by clearly demonstrating that the comments, whether true or not, say much more about the youth than they say about the therapist. After a few interpretations of the youth’s underlying psychodynamics, the youth usually will cease and desist with the attacks because he or she sees that every attack comes back to him or her in the form of an interpretation.
Resistance Style: The Apathetic Youth
The apathetic youth is similar to the denier, except that the formidable strategy of simply not caring about anyone or anything is the primary defense. This defense often arises out of depressive or substance related emotional and behavioral problems
SAMPLE STATEMENT: “Trust me, I really don’t give a shit about anything you’re saying!”
Formula Responses: Hanna and Hunt (1999) recommended using a sub-personality or ego state approach to dealing with adolescent apathy. This approach involves three steps: (a) take great care to empathize with the youth’s apathy; this might involve saying things like, “Okay, okay, I get it, you really don’t give a shit.”; (b) after empathizing, use a question like, “I know you don’t care, but isn’t there a little part of you, maybe a voice in the back of your head or something, that worries, maybe only a tiny bit about what might happen to you?”; (c) focus on the part of the youth that acknowledges caring about what happens and eventually begin labeling the “caring” part of the adolescent as the “real” self, while reducing the apathetic part of the self to the “fake” self.
More information about how to work through resistance is in our Tough Kids, Cool Counseling book, which happens to have five 5-star ratings on Amazon. Check it out:
Attached to this post are the handouts from the May 1 “Tough Kids, Cool Counseling” workshop in Spearfish, South Dakota.
It was a great day with about 85 wonderful, amazing, and exceptionally nice school and mental health counselors from throughout South Dakota.
This is the powerpoint:
And this is the supplementary handout:
I hope this information is helpful!
For me, the hardest thing about presenting professional workshops is time management. I want participants to comment, but how can I plan in advance for exactly how long their comments will be? Even worse, how can I accurately estimate the length of my own impromptu moments? It seems obvious that there’s a need for spontaneity. I don’t want to cut off potentially valuable comments from participants . . . and I don’t want to cut off my own creative musings either. Clearly, the clock is my workshop enemy.
For example, how could I know in advance that I would suddenly feel compelled to share a personal dream of mine with 85 of my new Cincinnati counselor friends? Never before had I shared with a workshop audience that 45 years-ago I dreamt I was Felix-the-Cat and then while crossing the road (as Felix), I got hit by a car . . . and died.
But then I woke up and have kept on living.
I like to think that particular disclosure is a perfectly normal thing to do when you’ve got a group of professional counselors to listen to you.
The point was to bust the myth that some teenage client have (and will talk about in counseling) that if they dream they die, it is prophetic and means they’ll die soon in real life also.
And beyond my personal dream disclosure, how would I know that one of the participants would have such passion that he would accept an invitation to come up to the microphone and share a physical relaxation technique that he uses with elementary school students.
These are just two samples of the sort of thing you missed because you weren’t in Cincinnati at the Schiff Center on the Xavier University campus yesterday.
But you also missed the start of the workshop where I decided on the spot that it was just the right time and place for me to open the workshop with a story of the most embarrassing moment in my life. It struck me as an awesome idea at the time . . . and it really was the most embarrassing moment of my life . . . until a few hours later when I shared my Felix-the-Cat dream.
There are always bigger mountains to climb.
You also missed meeting my incredibly gracious hosts from the Greater Cincinnati Counseling Association including, Butch Losey (who’s the most humble and understated guy who should be famous I’ve ever met), Kay Russ (who’s right up there with the most responsible person I’ve ever met), and Brent Richardson (who is as irreverent and insightful as ever), and Robert Wubbolding (who may be on his way to Casablanca to do a week long choice theory/reality therapy workshop by the time I post this and yet took eight hours out of his life to attend the workshop anyway).
So that’s just a little taste of what you missed in Cincinnati.
I’ll bet you wish you were there. I know I’m glad I was.
This is the supplementary handout for the Tough Kids, Cool Counseling workshop. It includes more detailed information about all of the techniques covered in the workshop (as well as a few extra). Of course, those interested in EVEN MORE details, should somehow get a hold of a copy of the Tough Kids, Cool Counseling book: http://www.amazon.com/Tough-Kids-Cool-Counseling-User-Friendly/dp/1556202741/ref=cm_cr_pr_product_top
Tough Kids, Cool Counseling
John Sommers-Flanagan, Ph.D.
University of Montana
“I have lived some thirty years on this planet, and I have yet to hear the first syllable of valuable or even earnest advice from my seniors” — Henry David Thoreau
The following techniques and strategies are discussed in the workshop. More extensive information is included in the Tough Kids, Cool Counseling (2007) book published by ACA publications and other resources listed in the reference section.
- Acknowledging Reality: Teenagers and some pre-teens are likely to be initially suspicious and mistrustful of adults – especially sneaky, manipulative, authority figures like mental health or school counselorsJ. To decrease distrust, it is important to simply acknowledge reality about the reasons for meeting, about the fact that you’re strangers, and to notice obvious differences between the therapist and teen.
- Sharing Referral Information: To gracefully talk about referral information with teens, therapists need to educate referral sources about how this practice will be used. Specifically, referral sources should be trained to give therapists information about clients that is both accurate and positive. If referral information from teachers, parents, or probation officers is especially negative, the therapist should screen and interpret the information so it is not overwhelming or off-putting to young clients. Simblett (1997), writing from a constructive perspective, suggested that if therapists are planning to share referral information with clients, they should warn and prepare referral sources about such a practice. If not, the referral sources may feel betrayed. Also, when sharing negative information about the client, it’s important for the counselor to have empathy and side with the client’s feelings, while at the same time, not endorsing the negative behaviors. For example, “I can see you’re really mad about your mom telling me all this stuff about you. I don’t blame you for being mad. I think I’d be upset too. It’s hard to have people talking about you, even if they might have good intentions.”
- The Affect Bridge and Early Memories: The affect bridge is designed to link current emotions with past emotions. Originally described as a hypnoanalytic technique by John Watkins (1971), the procedure can be used without a trance state to deepen your understanding of the origin and power of your client’s problematic affective states. The technique is simple and direct. For example, you might say: “You’re doing a great job telling me about some recent things that really make you mad. Now, tell me about an earlier time, when you were younger, when you felt similar feelings.” This technique or prompt will often elicit early memories that can then be used, similar to Adler’s early recollection method, to understand the client’s schema, cognitive map, or lifestyle.
- Reflection of Emotions: Emotional reflections or reflection of feeling (Rogers, 1942, 1961), are very important in counseling adolescents. This is because most youth are just learning about themselves and calibrating their emotional selves. Emotional reflections serve at least a two-fold purpose: (a) they provide youth a chance to see/hear themselves in an emotional mirror, and (b) they provide youth with a chance to tell the therapist that he or she has it all wrong (a corrective function). If the therapist begins noticing that he or she is consistently getting the emotional and content reflections incorrect with a given client, an effort at emotional repair is warranted. This simply involves apologizing for being incorrect, appreciating the client’s efforts to correct the therapist and a statement of commitment to continue trying.
- Coping with Countertransference: Research has shown that our countertransference reactions can teach us about ourselves, our underlying conflicts, and our clients (Betan, Heim, Conklin, & Westen, 2005; Mohr, Gelso, & Hill, 2005). For example, based on a survey of 181 psychiatrists and clinical psychologists, Betan et al., reported “patients not only elicit idiosyncratic responses from particular clinicians (based on the clinician’s history and the interaction of the patient’s and the clinician’s dynamics) but also elicit what we might call average expectable countertransference responses, which likely resemble responses by other significant people in the patient’s life” (p. 895). Countertransference is now widely considered a natural phenomenon and useful source of information that can contribute to counseling process and outcome (Luborsky, 2006). In fact, clinicians from various theoretical orientations have historically acknowledged the reality of countertransference. Speaking from a behavioral perspective, Goldfried and Davison (1976), the authors of Clinical Behavior Therapy, offered the following advice: “The therapist should continually observe his own behavior and emotional reactions, and question what the client may have done to bring about such reactions” (p. 58). Similarly, Beitman (1983) suggested that even technique-oriented counselors may fall prey to countertransference. He believes that “any technique may be used in the service of avoidance of countertransference awareness” (p. 83). In other words, clinicians may repetitively apply a particular therapeutic technique to their clients (e.g., progressive muscle relaxation, mental imagery, or thought stopping) without realizing they are applying the techniques to address their own needs, rather than the needs of their clients. There are many moments to reflect on how countertransference dynamics might affect the counseling process during the workshop.
- Exploring Attributions and Core Beliefs and Constructing Alternative, Strength-Based Theories: It’s a funny thing that most people, not just adolescents, seem to automatically adopt and hang onto negative core beliefs about the self. In the workshop video clip, you will see Rita SF as she gently helps her client explore his own beliefs and attributions. She then, using rational explanation, nudges him toward a shift in those beliefs. Interestingly, after she makes her intervention, the client then begins speaking in a different—and perhaps more positive—way about his primary conflict. Of course, we know that it is very challenging to convince clients of new, strength-based attributions about the self. Often clients take a step or two forward and then a step or two back—because it is often tremendously difficult to begin believing in a new and better self.
- What’s Good About You? This procedure provides an opportunity for a rich interpersonal interaction with teenage clients. It also generates useful information regarding child/adolescent self-esteem. I like to initially, introduce it as a “game” with specific rules: “I want to play a game with you. I’m going to ask you the same question 10 times. The only rule is that you cannot answer the question with the same answer twice. In other words, I’ll ask you the same question 10 times, but you have to give me 10 different answers.” When playing this game therapists simply ask their client, “What’s good about you?” (while writing down the responses), following each response with “Thank you” and a smile. If the client responds with “I don’t know” the therapist simply writes down the response the first time, but if the client uses “I don’t know” (or any response) a second time, the therapist reminds the client, in a light and possibly humorous manner, that he or she can use answers only one time. As with all techniques, this should be used with client consent or agreement. If the client is uncomfortable and does not want to proceed, his or her reluctance should be respected. In some cases, there may be cultural reasons (i.e., a client has a collectivist cultural background) for refusing to do this activity.
- Interpersonal Simulations: In this procedure the counselor provides the teen with an interpersonal scenario to solve. This technique is based on the fact that it is often easier for young people to openly discuss how they feel about impersonal situations that it is for them to openly discuss their own situations. The technique can be used for either assessment or intervention purposes and can be initiated as a generic question or “survey” that you’re using with teens or as a personal story/situation that you need help with. For example, you might say, “I’ve been doing a sort of survey with other teens and I’m interested in your opinion. Let’s say your parents are going to be out of town for the weekend. As they’re leaving, they tell you they trust you to take care of yourself and they trust you not to have a big party at home while they’re gone. After they left, what would you do?” Then, depending upon the youth’s response to this situation, you can ask many follow-up questions: “Would you have a party?, How many people would you invite? What if you didn’t want to have a party, but the rumor that your parents were gone got out and people started pressuring you? If you had a party, would you have alcohol? How about drugs? If your parents ask you if you had a party when they get back into town, how would you respond? Would you lie? How would that feel?” Finally, at the end you can ask the teen if he/she is interested in hearing about how others have responded to the questions/survey.
- Asset Flooding: With many teens who engage in challenging behaviors, communication breaks down because of how badly they are feeling about themselves. Consequently, communication and cooperation can be enhanced when the counselor simply stops and reflects on the teen’s positive qualities. Of course, you need to have several positive attributes available in your mind before beginning this intervention. You can proceed by saying something like: “You know, I was just thinking about how I think you have all sorts of good qualities. . . like you’re always on time, you hang in there and keep attending your classes, even though I know sometimes you don’t really like them. . . that tells me you’ve got courage, courage to face unpleasant things. . . I also like your sense of humor. . . and. . .”
- Generating Behavioral Alternatives: Frequently teens become focused on one or two maladaptive behavioral responses to challenging situations. For example, they may either yell at their teacher or run out of class, but they seem unable or unwilling to try a more moderate response such as discussing their conflict or problem with the teacher in order to seek resolution. In the workshop, I will discuss a counseling session illustrating a modified behavioral alternatives procedure designed to reduce behavioral aggression. The transcript for this session is included at the end of this handout.
- Using Riddles and Games: In the Tough Kids book we describe a number of interesting activities that therapists can use with young clients. One strategy is to initiate some “mental set” activities with your client. For example, you might say, “I’d like you to say the word ‘ten’ ten times and I’ll count.” The client then says, “10, 10, 10. . .” and at the end you say, “Okay, what are aluminum cans made of?” Often the youth will say, “TIN” which of course the wrong answer, because the correct answer is aluminum. After doing this you can then discuss how our minds sometimes will misinterpret things which is why we should always think twice before reacting.
- Food and Mood: Using food with young clients can help put them in a better mood and if they’re in a better mood, generally counseling proceeds a bit more smoothly. Our food guidelines include: (a) we try to keep relatively healthy snacks available (e.g., sugarless gum, juice, herbal tea, granola bars, carrots, grapes); (b) we don’t always offer something to eat (that usually depends on the time of day and the client’s hunger state), but we usually offer something to drink at the beginning of each session; (c) occasionally kids will overstep boundaries and ask for more and more food and sometimes they begin to expect treats, or even to criticize their counselor for the types of treats available—but of course, such behavior simply provides the astute professional with more material for exploration and interpretation. Perhaps children who act out with respect to food lack social inhibition—or are not eating well—or are impulsive—or are hungry for attention. Whatever the case, food items provide opportunity for discussion, feedback, and behavior change. And of course, food almost always improves mood.
- A Multicultural Opening: In the video clip with John and Michael, John begins by noting differences between the two of them and then asking Michael to share some of his personal experiences about being an African American gang member. This opening comes dangerously close to an inappropriate request – for Michael to educate John about his culture and lifestyle. However, because John emphasizes his interest in Michael’s personal experiences, the opening may be appropriate – but you can be the judge.
- Noticing Process in Counseling: When there’s a clear pattern that begins to manifest itself in the counseling session, it’s best to acknowledge that pattern. This may be a pattern, as in the John-Michael clip, where the counselor is not “getting it” or having trouble accurately listening to the client. Or, it may be a situation where the counselor is trying to convince the student of something, but the student is resisting. In these situations, it’s recommended that the counselor acknowledge the process reality in the session.
- Four Forms of Relaxation: Young clients are often resistant to relaxation techniques. During the workshop, four approaches to helping teens relax and self-soothe will be demonstrated. Generally, we recommend using all four approaches in a single session with young clients. These approaches include: (a) deep breathing; (b) visualization; (c) autogenic training; and (d) progressive muscle relaxation. The offering of these relaxation approaches in this particular order is designed to help young clients decide which approach will work best for them and to end on a light note that facilitates a positive mood.
- Cognitive Storytelling: Most teens, especially elementary teens, have a natural interest in stories and storytelling. In addition to using stories as metaphors, it can be useful for counselors to incorporate storytelling procedures that illustrate cognitive and behavior principles into counseling. The road rage, monkey surgery, or cherry story will be shared with participants in this workshop.
- Respect, Liking, and Interest: In person-centered counseling, it’s not the counselor’s microskills of listening, etc., that facilitate change, but instead, it is the therapist’s attitude of congruence, unconditional positive regard, and empathic understanding. Similarly, spontaneity and humor with young clients should be avoided unless you, as a therapist, experience the attitudes and feelings of respect, liking, and interest for the teen. There is no substitute for this therapeutic foundation. It must be genuine because teens are especially adept at detecting phoniness in adults. You should work toward feeling deep inside that there is no other place you would rather be than sitting in the room and listening and talking with your young client.
- Early Interpretation: In the Adlerian counseling spirit, early interpretations with adolescents are quick observations of the teen’s cognitive style or lifestyle. These interpretations are not particularly deep, but instead designed to provide insight into the surface dynamics with which the teen is struggling. There are two examples of early interpretations given in the workshop. First, I observe with Sean that he is “perfectionistic” which then allows exploration of how his perfectionism is affecting his anger. Second, I share with Meagan the observation that she seems very sensitive to “injustice,” which we then explore together. Early interpretations provide an initial formulation upon which both client and therapist can work.
- Self-Rating Strategies: There are many different rating strategies that can be used to facilitate the counseling process. The scaling question from the solution-focused framework can be helpful for identifying what it would look like if small amounts of change occurred. In the session with Sean, John tries using a 0-100 scale combined with a grading system to uncover Sean’s maladaptive thoughts.
- Using a Role-Reversal: Role reversals with teens can be interesting and sometimes fun. In the workshop example, I ask Sean to be my “counselor.” Sean responds by taking his role seriously and I surprise myself somewhat by taking my role very seriously (which may be, to some degree, a manifestation of countertransference). The purpose of role reversals is twofold. First, it helps teens work on the crucial cognitive task of perspective taking. Second, it can help the teen have more empathy for himself or herself.
- Self Disclosure: Self disclosure is risky, but necessary when working with teens. Most of the time, they don’t really want to hear long, boring stories about the therapist and so those stories should be avoided. Instead, short stories that serve to deepen the connection or to make a therapeutic point are recommended.
- The Fool in the Ring and Satanic Golden Rule: This technique is derived from Eva Feindler’s work with aggressive youth. It involves using the “Fool in the Ring” metaphor for helping youth see that they are giving up freedom when they react (predictably) and aggressively toward individuals who provoke them. The therapist draws a picture of two stick-figures engaging in a conflict and brainstorms how the young person being provoked might respond to conflict situations without engaging in retaliation and without engaging in behaviors likely to perpetuate aggression and result in negative consequences. Additionally, the message behind this metaphor and brainstorming activity is further developed by discussing the Satanic Golden Rule. In the end, youth are encouraged to use a more thoughtful and intentional response to provocation – instead of simply responding to aggression.
- Reconstructing the Client’s Story About the Self (Questioning the Main Maladaptive Narrative): One of the most powerful factors influencing human behavior is the self-story. Most teens spend mental time telling themselves about themselves. This inner story or narrative usually includes a number of old, negative, and maladaptive judgments about the self. For example, many teens will make claims like, “I have a terrible temper. I just blow my top if anybody gets on my case.” It’s important for therapists to question young clients when they make definitive claims about having a negative trait. In particular, using the questions: “Have you ever performed in a play?” and “How did you remember your lines?” can be used to point out to teens that they have been practicing the same “lines” about themselves for years and that it might be time to start learning and practicing some new and different lines about themselves.
- Alternatives to Suicide: This technique is virtually identical to generating behavioral alternatives except it’s used with young clients who are suicidal. It involves simply but compassionately listing the client’s options in life, including suicide. Then, after a list is jointly generated, the client ranks his/her top preferences. This process provides both assessment and intervention data.
- Neo-Dissociation: Adolescence is a time of ambivalence. Although adolescents often express very strong feelings, they also usually have underlying feelings that may even be contradictory to the strong feelings they are expressing. This technique is designed to capitalize on the teen’s underlying, prosocial thoughts and impulses. If a teen adamantly emphasizes that s/he doesn’t care about something, after you have empathized with his/her apathy, then you can explore for underlying feelings of caring or concern. For example, if the teen says, “I don’t care about math. It sucks. The teacher sucks. Anybody who likes math is a nerd. So I don’t care if I flunk,” you can respond with empathy: “Okay. I totally hear you. You hate math and you totally don’t care if you flunk.” Then, you can explore using the neo-dissociative technique by saying: “I’m guessing that even though you really don’t care about your math grade, there might be a part of you that cares just a little bit. I’d like to talk to that part of you for a minute.”
- Note-Passing: This technique can be used with students who have shut down and require a new communication modality. It involves the counselor noticing the “shut down” state and then writing a kind and supportive note to the student, folding it, and handing it over. It’s often hard for students to resist reading a handwritten passed note. Sometimes they’ll speak in response, other times they’ll write a note back, and sometimes they’ll continue in their shut down state. Drawing or artwork can also function as an alternative communication modality.
Berman, A. L., Jobes, D. A., & Silverman, M. (2006). Adolescent suicide: Assessment and intervention. (2nd ed.). Washington, D.C.: American Psychological Association.
Bernstein, N. (1996). Treating the unmanageable adolescent. Northvale, NJ: Jason Aronson.
Betan, E., Heim, A.K., Conklin, C. Z., & Westen, D. (2005). Countertransference phenomena and personality pathology in clinical practice: An empirical investigation. American Journal of Psychiatry, 162 (5), 890 – 898.
Castro-Blanco, D., & Karver, M. S. (2010). Elusive alliance: Treatment engagement strategies with high-risk adolescents. Washington, DC: American Psychological Association.
Creed, T. A., & Kendall, P. C. (2005). Therapist alliance-building behavior within a cognitive– behavioral treatment for anxiety in youth. Journal of Consulting and Clinical Psychology, 73, 498-505.
de Shazer, S. (1985). Keys to solution in brief therapy. New York: Norton.
Feindler, E. (1986). Adolescent anger control. New York: Pergamon Press.
Glasser, W. (2002). Unhappy teens. New York: HarperCollins.
Hanna, F. J., Hanna, C. A., & Keys, S. G. (1999). Fifty strategies for counseling defiant, aggressive adolescents: Reaching, accepting, and relating. Journal of Counseling & Development, 77(4), 395-404.
Hawley, K. M., & Garland, A. F. (2008). Working alliance in adolescent outpatient therapy: Youth, parent and therapist reports and associations with therapy outcomes. Child & Youth Care Forum 37(2), 59-74
Juhnke, G. A., Granello, P. F., Granello, D. H. (2011). Suicide, self-injury, and violence in the schools: assessment, prevention, and intervention strategies. Hoboken, NJ: Wiley.
Kazdin, A. E. (2008). The Kazdin method for parenting the defiant child: With no pills, no therapy, no contest of wills. Boston, MA: Houghton Mifflin Company.
Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York: Guilford Press.
Mohr, J. J., Gelso, C. J., & Hill, C. E. (2005). Client and counselor trainee attachment as predictors of session evaluation and countertransference behavior in first counseling sessions. Journal of Counseling Psychology, 52 (3), 298–309.
Rogers, C. R. (1961). On becoming a person. Boston: Houghton Mifflin.
Shea, S. C. (1999). The practical art of suicide assessment. New York: Wiley.
Sommers-Flanagan, J., & Bequette, T. (2013). The initial interview with adolescents. Journal of Contemporary Psychotherapy, 43(1), 13-22.
Sommers-Flanagan, J., Richardson, B.G., & Sommers-Flanagan, R. (2011). A multi-theoretical, developmental, and evidence-based approach for understanding and managing adolescent resistance to psychotherapy. Journal of Contemporary Psychotherapy, 41, 69-80.
Sommers-Flanagan, J., & Campbell, D.G. (2009). Psychotherapy and (or) medications for depression in youth? An evidence-based review with recommendations for treatment. Journal of Contemporary Psychotherapy, 32,111-120.
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2007). Tough kids, cool counseling: User-friendly approaches with challenging youth (2nd ed.). Alexandria, VA: American Counseling Association.
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2014). Clinical interviewing. (5th ed.). New York: Wiley.
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2012). Counseling and psychotherapy theories in context and practice: Skills, strategies, and techniques. New York: Wiley.
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2004). The challenge of counseling teens: Counselor behaviors that reduce resistance and facilitate connection. [Videotape]. North Amerst, MA: Microtraining Associates.
The TADS Team. (2007). The treatment for adolescents with depression study (TADS): Long term effectiveness and safety outcomes. Archives of General Psychiatry, 64(10), 1132-1144.
The TADS Team. (2004). Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for adolescents with depression study (TADS) randomized controlled trial. JAMA: Journal of the American Medical Association, 292(7), 807-820.
Turner, E.H., Matthews, A.M., Linardatos, E., Tell, R.A., & Rosenthal, R. (2008). Selective publication of antidepressant trials and its influence on apparent efficacy. The New England Journal of Medicine, 358, 252-360.
United States Food and Drug Administration. (2007). FDA proposes new warnings about suicidal thinking, behavior in young adults who take antidepressant medications. Retrieved January 10, 2008, from http://www.fda.gov/bbs/topics/NEWS/2007/NEW01624.html
Watkins, J. G. (1971). The affect bridge: A hypnoanalytic technique. International Journal of Clinical and Experimental Hypnosis, 19, 21-27.
Weisz, J., & Kazdin, A. E. (2010). Evidence-based psychotherapies for children and adolescents (2nd ed.). New York: Guilford.
Willock, B. (1986). Narcissistic vulnerability in the hyper-aggressive child: The disregarded (unloved, uncared-for) self. Psychoanalytic Psychology, 3, 59-80.
Willock, B. (1987). The devalued (unloved, repugnant) self: A second facet of narcissistic vulnerability in the aggressive, conduct-disordered child. Psychoanalytic Psychology, 4, 219-240.
If you have questions about this handout, or are interested in having John SF conduct a workshop or keynote for your organization, please contact John at: 406-243-4263 or email@example.com. You may reproduce this handout to share with your colleagues if you like, but please provide an appropriate citation. For additional free materials related to this workshop and other topics, go to John’s Blog at: johnsommersflanagan.com
This coming Thursday and Friday I’ll be in Columbus, OH for the Electronic Classrooms of Tomorrow (ECOT) conference. For Thursday, I’m presenting several break-out sessions on “How to Listen so Parents will Talk and Talk so Parents will Listen.” The powerpoints for that presentation are here:
On Friday I doing an all-day workshop with the ECOT counselors with a little of everything (Tough Kids, Cool Counseling, Suicide Assessment/Intervention, and Working with Parents). Here are the ppts for Friday’s workshop:
Thanks very much to Emma Baucher who has been incredibly helpful in arranging this.