Tag Archives: Workshop

What You Missed in Cincinnati: Part II

While in Cincinnati, I ran short on time and we missed a chance to watch a video clip on “Generating Behavioral Alternatives.” And so as a substitute, I’m posting the verbatim script of the clip we were supposed to watch, and although we’ll miss out on discussing, the clip is fun on its own. Here it’s an excerpt from our Counseling and Psychotherapy Theories book and placed in the context of “Problem-Solving Therapy.”

Generating Behavioral Alternatives With an Aggressive Adolescent

As noted previously, problem-solving therapy (PST) focuses on teaching clients steps for rational problem solving. In this case vignette, the therapist (John) is trying to engage a 15-year-old White male client in stage 2 (generating solutions) of the problem-solving model. At the beginning of the session, he client had reported that the night before, a male schoolmate had tried to rape his girlfriend. The client was angry and planning to “beat the s*** out” of his fellow student. During the session, John worked on helping the boy identify behavioral alternatives to retributive violence.

The transcript below begins 10 minutes into the session.

Boy: He’s gotta learn sometime.

JSF: I mean. I don’t know for sure what the absolute best thing to do to this guy is . . . but I think before you act, it’s important to think of all the different options you have.

Boy: I’ve been thinking a lot.

JSF: Well, tell me the other ones you’ve thought of and let’s write them down so we can look at the options together.

Boy: Kick the shit out of him.

JSF: Okay, I know 2 things, actually maybe 3, that you said. One is kick the [crap] out of him, the other one is to do nothing . . .

Boy: The other is to shove something up his a**.

JSF: And, okay—shove—which is kinda like kicking the s*** out of him. I mean to be violent toward him. [Notice John is using the client’s language.]

Boy: Yeah, Yeah.

JSF: So, what else?

Boy: I could nark on him.

JSF: Oh.

Boy: Tell the cops or something.

JSF: And I’m not saying that’s the right thing to do either. [Although John thinks this is a better option, he’s trying to remain neutral, which is important to the brainstorming process; if the client thinks John is trying to “reinforce” him for nonviolent or prosocial behaviors, he may resist brainstorming.]

Boy: That’s just stupid. [This response shows why it’s important to stay neutral.]

JSF: I’m not saying that’s the right thing to do . . . all I’m saying is that we should figure out, cause I know I think I have the same kind of impulse in your situation. Either, I wanna beat him up or kinda do the high and righteous thing, which is to ignore him. And I’m not sure. Maybe one of those is the right thing, but I don’t know. Now, we got three things—so you could nark on him. [John tries to show empathy and then encourages continuation of brainstorming.]

Boy: It’s not gonna happen though.

JSF: Yeah, but I don’t care if that’s gonna happen. So there’s nark, there’s ignore, there’s beat the s**. What else?

Boy: Um. Just talk to him, would be okay. Just go up to him and yeah . . . I think we need to have a little chit-chat. [The client is able to generate another potentially prosocial idea.]

JSF: Okay. Talk to him.

Boy: But that’s not gonna happen either. I don’t think I could talk to him without, like, him pissing me off and me kicking the s*** . . . [Again, the client is making it clear that he’s not interested in nonviolent options.]

JSF: So, it might be so tempting when you talk to him that you just end up beating the s*** out of him. [John goes back to reflective listening.]

Boy: Yeah. Yeah.

JSF: But all we’re doing is making a list. Okay. And you’re doing great. [This is positive reinforcement for the brainstorming process—not outcome.]

Boy: I could get someone to beat the s*** out of him.

JSF: Get somebody to beat him up. So, kind of indirect violence—you get him back physically—through physical pain. That’s kind of the approach.

Boy: [This section is censored.]

JSF: So you could [do another thing]. Okay.

Boy: Someone like . . .

JSF: Okay. We’re up to six options. [John is showing neutrality or using an extinction process by not showing any affective response to the client’s provocative maladaptive alternative that was censored for this book.]

Boy: That’s about it. . . .

JSF: So. So we got nark, we got ignore, we got beat the s*** out of him, we got talk to him, we got get somebody else to beat the shit out of him, and get some. . . . [Reading back the alternatives allows the client to hear what he has said.]

Boy: Um . . . couple of those are pretty unrealistic, but. [The client acknowledges he’s being unrealistic, but we don’t know which items he views as unrealistic and why. Exploring his evaluation of the options might be useful, but John is still working on brainstorming and relationship-building.]

JSF: We don’t have to be realistic. I’ve got another unrealistic one. I got another one . . . Kinda to start some shameful rumor about him, you know. [This is a verbally aggressive option which can be risky, but illustrates a new domain of behavioral alternatives.]

Boy: That’s a good idea.

JSF: I mean, it’s a nonviolent way to get some revenge.

Boy: Like he has a little dick or something.

JSF: Yeah, good, exactly. [John inadvertently provides positive reinforcement for an insulting idea rather than remaining neutral.]

Boy: Maybe I’ll do all these things.

JSF: Combination.

Boy: Yeah.

JSF: So we’ve got the shameful rumor option to add to our list.

Boy: That’s a good one. (Excerpted and adapted from J. Sommers-Flanagan & R. Sommers-Flanagan, 1999)

This case illustrates what can occur when therapists conduct PST and generate behavioral solutions with angry adolescents. Initially, the client appears to be blowing off steam and generating a spate of aggressive alternatives. This process, although not producing constructive alternatives, is important because the boy may be testing the therapist to see if he will react with judgment (during this brainstorming process it’s very important for therapists to remain positive and welcoming of all options, no matter how violent or absurd; using judgment can be perceived and experienced as a punishment, which can adversely affect the therapy relationship). As the boy produced various aggressive ideas, he appeared to calm down somewhat. Also, the behavioral alternatives are repeatedly read back to the client. This allows the boy to hear his ideas from a different perspective. Finally, toward the end, the therapist joins the boy in brainstorming and adds a marginally delinquent response. The therapist is modeling a less violent approach to revenge and hoping to get the boy to consider nonphysical alternatives. This approach is sometimes referred to as harm reduction because it helps clients consider less risky behaviors (Marlatt & Witkiewitz, 2010). Next steps in this problem-solving process include:

  • Decision making
  • Solution implementation and verification

As the counseling session proceeds, John employs a range of different techniques, including “reverse advocacy role playing” where John plays the client and the client plays the counselor and provides “reasons or arguments for [particular attitudes] being incorrect, maladaptive, or dysfunctional” (A. M. Nezu & C. M. Nezu, 2013).

The Long Road to Eagle Pass Texas

Hi.

I’m re-posting this because today, exactly one year since I made my long trek to Eagle Pass from Montana . . . I’m back again. The drive was just as long as before, but I’m back because the folks in the Eagle Pass School District are pretty darn fun to hang out with. And so here’s the original post from last year:

 

It’s a very long way from Missoula, Montana to Eagle Pass, Texas.

Just saying.

This epiphany swept over me after the early morning Missoula to Denver flight and after the Denver to San Antonio flight and right about when, after driving from San Antonio in a rental car for about an hour, I finally saw a green mileage sign that said: Eagle Pass – 95 miles. I just laughed out loud. And even though I was all by myself, I said, “It’s a long way from Missoula to Eagle Pass.” This is just a small taste of the profound thoughts I think while traveling alone.

But time and space are relative and so I entertained myself by listening to a radio station, en Espanol. Given that I have the Spanish vocabulary of a toddler, I was quite delighted with myself when I discerned that I’d tuned in to a Christian radio station. The repeated use of the words, palabra, familia, and Dios helped me make that revelation. I also monitored the temperature via my rental car thermometer and happily observed that the outside temperature never rose above 104 degrees during my drive from San Antonio to Eagle Pass.

I like to think of myself as navigationally skilled; then again, it’s also good to remind myself that denial is more than just a river in Egypt. What I did manage to efficiently find were the Texas road construction crews. Getting to my hotel was harder. I had planned to use my internet telephone GPS, which would have been a great idea had there been internet access in Eagle Pass. This prospect began dawning on me when I passed the sign saying: Eagle Pass, pop. 26,864. At that point it was still unclear to me exactly how the Eagle Pass School District (conveniently located on the Rio Grande River) decided to have me come from Montana to do a full-day Tough Kids, Cool Counseling workshop. But, given that I’d never been to Texas before and they happened to want to pay me and then they decided to purchase 45 copies of Tough Kids, Cool Counseling, I found myself faced with an offer I couldn’t refuse.

And so, I decided to engage in a bit of disoriented driving, while studiously avoiding the bridge to Mexico. I finally found a man from India at a random hotel, who spoke English in addition to Punjab and Spanish. He was kind enough to let me use his Internet because he’d never heard of the hotel I’d booked. Then, a few wrong turns later and following an episode where my rental car transformed itself from an automatic into a manual transmission, I finally made it to the bargain Microtel hotel where they obviously take the term “micro” very seriously. Staying there required that I change into my secret Ant-man identity, thereby shrinking my expectations for Internet access, pool length, fitness facilities, and room into the size of an ant while retaining the physical strength and intellectual functioning of an adult male (I should note that I intentionally selected this hotel because it’s relatively green and was happy with my choice, despite my lightly mocking tone). The good news was that Taco-Morales was right across the street and I got to experience some authentic fajitas and red rice at prices an ant could afford.

The next day, in a coffee-free state (there are no Starbucks in Eagle Pass), I found my way to the Eagle Pass Junior High library (home of the Eagles—what a surprising team name!). That was when I discovered how they’d chosen me as their School Counseling Workshop leader. As it turns out, Montana Street is just a block or two from Eagle Pass Junior High and so they had apparently thought I lived right there ON Montana Street (and not IN the State of Montana). . . which is probably why they chose to pay me a flat rate and let me cover my own travel.

But very soon I discovered everything wonderful about Eagle Pass. I got to spend the day with Mr. Salinas, Ms. Gutierrez, Mr. Lopez, Connie, Karla, Luis, Toyoko, three women named Dora, and just enough School Counselors to scoop up 45 copies of Tough Kids, Cool Counseling. This was a group with immense compassion and dedication to making the lives of their students better. They teased me, laughed at my jokes, gently corrected my Spanish mis-pronunciations, asked for me to sign their books, and treated me with mucho mas respeto than I could ever deserve. By lunchtime they began talking about when I’d come back (I gently suggested January instead of August for my next visit). After lunch, Luis beat me at the Hand-Pushing game (I was depleted and distracted from all the energy it took to keep intermittently changing into an ant-sized person to fit into my hotel). However, one of the three Doras made an excellent volunteer for my mental set riddles (thank you Dora, for demonstrating in front of your peers that, in fact, learning can happen).

In the end, I return from Eagle Pass with renewed and sustained faith and hope in the human race. The big hearts and amazing dedication of the Eagle Pass School Counselors was inspiring. Thank-you Eagle Pass, for helping to expand my world. . . while simultaneously shrinking my expectations for hotel accommodations.