Tag Archives: youth

Please Support Trapper Creek Job Corps and the Other Job Corps Designated as Civilian Conservation Corps

Hi All.

I’m asking for help. All of the Job Corps designated as Civilian Conservation Corps are slated to be cut.

Below, I’m pasting information about Trapper Creek Job Corps. I’m also providing a link to a form letter with talking points, as well as an Excel sheet with contact info for various Senate Offices.

Thanks in advance for your help. Job Corps was started as part of LBJ’s war on poverty. It’s a program that gives youth and young adults ages 16-24 a chance to learn a trade and become a taxpayer who contributes to our country in positive ways.

I hope you will spread this message far and wide!

Here’s the letter:

Dear Friend of Job Corps.

This is not a drill. This is 911.

The media is out there; Secretary Acosta (Department of Labor) and Secretary Purdue (USDA) have made the agreement to eliminate the USDA’s role in the Job Corps Program. This means that Trapper Creek (as well as the other 24 Forest Service Centers, or CCCs) will be transferred to DOL, and Trapper Creek will be more or less eliminated as we know it. Our students will no longer be served by this program. Our communities will no longer be served by the extensive support of our amazing students. Our 55 hard working staff at Trapper Creek (and over 1,200 Nation-wide) who have dedicated their professional lives to helping disadvantaged youth will lose their jobs. It is clear this is an assault on our youth, our communities and our people.

My understanding is as such: the decision is to eliminate operations of the CCCs by September 30, 2019. This is not an arbitrary date: it is the last day of the fiscal year. Should this movement take place successfully, the contingent will have won; Trapper and the CCCs are over and done for. We lose our jobs and the thousands of young people served by the CCCs ever year will be without services. However, Congress was just notified today of this decision and, frankly, are not happy. The Forest Service Job Corps program has always had huge support from both sides of Congress; Democrats believe in the humanitarian component while Republicans believe in the fiscal responsibility of training young adults in poverty to learn the hard skills to get a living wage job and the soft skills to stay employed.

WHAT I NEED YOU TO DO: below are two documents.  The spreadsheet attached has contact information for Congressional folks in your states. Please make as many contacts as you can to them as well as to local political folks; mayors, city council, etc. We need as many calls and emails as possible from as many folks as possible. Democrats are already putting things in writing; Republicans are on board but all together too quiet. These folks need to hear of your displeasure of this decision.

Also attached is a form letter (5.23.19 CCC Agency Letter), talking points if you will, to use when visiting with these folks.

Please forward this message to all parties you know that care about our youth, our communities, our staff and the program at large. Facebook is a great tool to move information as well.

FEDERAL EMPLOYEES: do not use government time, equipment or material to move this information. You are welcome to use Facebook if you do not identify yourself as a Federal Employee.

The Talking Points letter is here: 5.23.19 CCC Agency Form Letter with Talking Points

The Excel spreadsheet with contact info is here: Copy of CCC Contact Sheet

 

 

 

Upcoming Workshops: L.A., Chicago, Morgantown, and Greensburg (outside Pittsburg)

Rainbow 2017

October is almost always a big month for counseling and psychology conferences and workshops. This October is no exception. I’m posting my October workshop presentation schedule here, just in case you want to say hello and possible collect some continuing education credit.

On Thursday, October 5, I’ll be in Orange County for the California Association for School Psychologists conference. Here’s a link: https://event.casponline.org/#intro

On Sunday, October 8, I’ll be in Chicago for the Association of Counselor Educators and Supervisors to present on the Mental Status Examination with Thom Field of the City University of Seattle.

On Thursday, October 12, I’ll be in Morgantown, WV for an afternoon workshop with counseling and psychology students from West Virginia University.

On Friday, October 13, I’ll be in Greensburg, PA (just outside Pittsburgh) for an all-day workshop sponsored by Indiana University of Pennsylvania. The link: https://www.iup.edu/counseling/centers/upcoming-workshops-and-events/

Today is the first day of Autumn . . . I hope this signals the end of hurricanes, floods, fires, and other challenges so many people are facing.

 

Goodnight, South Carolina

Some days . . . the news is discouraging. Some days . . . evidence piles up suggesting that nearly everyone on the planet is far too greedy and selfish. On those days, I can’t help but wonder how our local, national, and worldwide communities survive. It feels like we’re a hopeless species heading for a cataclysmic end.

Sunset on StillwaterBut then I have a day like yesterday. A day where I had the honor and privilege to spend time hanging out with people who are professional, smart, compassionate, and dedicated to helping children learn, thrive, and get closer to reaching their potentials. I’m sure you know what I mean. If you turn off the media and peek under the surface, you’ll find tons of people “out there” who wake up every day and work tremendously hard to make the world just a little bit better, for everyone.

For me, yesterday’s group was the South Carolina Association of School Psychologists. They were amazing. They were kind. About 110 of them listened to me drone on about doing counseling with students who, due, in part, to the quirky nature of universe, just happen to be living lives in challenging life and school situations. The school psychologists barely blinked. They rarely checked their social media. They asked great questions and made illuminating comments. They were committed to learning, to counseling, to helping the next generation become a better generation.

All day yesterday and into the night I had an interesting question periodically popping up in the back of my mind. Maybe it was because while on my flight to South Carolina, I sat next to a Dean of Students from a small public and rural high school in Wisconsin. Maybe it was because of the SCASP’s members unwavering focus and commitment to education. The question kept nipping at my psyche. It emerged at my lunch with the Chair of the Psychology Department at Winthrop University.  It came up again after my dinner with four exceptionally cool women.

The question: “How did we end up with so many people in government who are anti-education?”

Yesterday, I couldn’t focus in on the answer. I told someone that–even though I’m a psychologist–I don’t understand why people do the things they do. But that was silly. This morning the answer came flowing into my brain like fresh spring Mountain run-off. Of course, of course, of course . . . the answer is the same as it always has been.

The question is about motivation. Lots of people before me figured this out. I even had it figured out before, but, silly me, I forgot. Why do people oppose education when, as John Adams (our second President) said, “Laws for the liberal education of youth, especially for the lower classes of people, are so extremely wise and useful that to a humane and generous mind, no expense for this purpose would be thought extravagant.”

The answer is all about money and power and control and greed and revenge and ignorance. Without these motivations, nearly everyone has a “humane and generous mind” and believes deeply in funding public education.

Thanks to all the members of the South Carolina Association of School Psychologists, for giving me hope that more people can be like you, moving past greed and ignorance and toward a more educated and better world.

Good night, South Carolina. It’s been a good day.

 

Counseling Culturally Diverse Youth: Research-Based and Common Sense Tips

This is a rough preview of a section from the 6th edition Clinical Interviewing. As always, your thoughts and feedback are welcome.

Counseling Culturally Diverse Youth: Research-Based and Common Sense Tips

Research on how to practice with culturally diverse youth is especially sparse. To make matters more complex, youth culture is already substantially different from adult culture. This means that if you’re different from young clients on traditional minority variables, you’ll be experiencing a double dose of the cultural divide. These complications led one writer to title an article “A knot in the gut” to describe the palpable transference and countertransference that can arise when working with race, ethnicity, and social class in adolescents (Levy-Warren, 2014).

To help reduce the size of the knot in your gut, we’ve developed a simple research- and common-sense list to guide your work with culturally diverse youth (Bhola & Kapur, 2013; Norton, 2011; Shirk, Karver, & Brown, 2011; Villalba, 2007):

1. Use the interpersonal skills (e.g., empathy, genuineness, respect) that are known to work well with adult minority group members. Keep in mind that interpersonal respect is an especially salient driver in smoothing out intercultural relationships.

2. Find ways to show genuine interest in your young clients, while also focusing on their assets or strengths.

3. Treat the meeting, greeting, and first session with freshness and eagerness. There’s evidence that young clients find less experienced therapists easier to form an alliance with.

4. Use a genuine and clear purpose statement. It should capture your “raison d’etre” (your reason for being in the room). We like a purpose statement that’s direct and has intrinsic limits built in. For example: “My goal is to help you achieve your goals . . . just as long as your goals are legal and healthy.” One nice thing about this purpose statement is that sometimes young clients think the “legal and healthy” limitations are funny.

5. Don’t use a standardized approach to always talking with youth about your cultural differences. Instead, wait for an opening that naturally springs up from your interactions. For example, when a teen says something like, “I don’t think you get what I’m saying” it’s a natural opening to talk about how you probably don’t get what the youth is saying. Then you can discuss some of your differences as well as you’re desire to understand as much as you can. For example: “You’re right. I probably don’t get you very well. It’s obvious that I’m way older than you and I’m not a Native American. But I’d like to understand you better and I hope you’ll be willing to help me understand you better. Then, in the end, you can tell me how much I get you and how much I don’t get you.”

6. Provide clear explanations of your procedure and rationale and then linger on those explanations as needed. If young clients don’t understand the point of what you’re doing, they’re less likely to engage.

7. Be patient with your clients; research with young clients and diverse clients indicate that alliance-building (and trust) takes extra time and won’t necessarily happen during an initial session

8. Be patient with yourself; it may take time for you to feel empathy for young clients who engage in behaviors outside your comfort zone (e.g., cutting)

I hope these ideas can help you make connections with youth from other cultures. The BIG summary is to BE GENUINE and BE RESPECTFUL. Nearly everything else flows from there.

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).

P1030724

Handling Termination in Counseling and Psychotherapy

It’s that time of the year (at most colleges and universities) when those of us doing and supervising counseling and psychotherapy should be thinking about how to handle termination. Well, actually we should have been thinking about it before, but if not then, now is good.

Anyway, I just sent the following termination checklist out to my MA and Doc students here at U of MT and thought this could be helpful for others, so here it is. Keep in mind that it was written for working with youth, but can be modified to stimulate your thinking about termination with whatever population with which you work.

Termination Content Checklist

[Adapted from Sommers-Flanagan, J., and Sommers-Flanagan, R., (2007).
Tough Kids, Cool Counseling: User-Friendly Approaches with Challenging Youth.
Alexandria, VA: American Counseling Association]

The following termination content checklist may be helpful for you as you plan for counseling or plan for termination. Keep in mind that this is not a comprehensive checklist that you MUST complete at the end of counseling. Also, keep in mind that the sample statements are just samples and that you should find your own words for expressing these (or similar) things. The point is that this is a guide to help you think about termination—even though some of the details will be different for you and your client(s).

_____ 1. At the outset and throughout counseling, the counselor identifies progress toward termination (e.g., “Before our meeting today, I noticed we have 4 more sessions left,” or “You are doing so well at home, at school, and with your friends. . . let’s talk about how much longer you’ll want or need to come for counseling”).
_____ 2. The counselor reminisces about early sessions or the first time counselor and client met. For example: “I remember something you said when we first met, you said: ‘there’s no way in hell I’m gonna talk with you about anything important.’ Remember that? I have it right here in my notes. You were sure excited about coming for counseling” (said with empathic sarcasm).
_____ 3. The counselor identifies positive behavior, attitude, and/or emotional changes. This is part of the process of providing feedback regarding problem resolution and goal attainment: “I’ve noticed something about you that has changed. It used to be that you wouldn’t let adults get chummy with you. And you wouldn’t accept compliments from adults. Now, from what you and your parents tell me and from how you act in here, it’s obvious that you give adults a chance. You aren’t always automatically nasty to every adult you see. I think that’s nice.”
_____ 4. Acknowledge that the relationship is ending with counseling termination: “Next session will be our last session. I guess there’s a chance we might see each other sometime, at the mall or somewhere. If we see each other, I hope it’s okay for us to say hello. But I want you to know that I’ll wait for you to say hello first. And of course, I won’t say anything about you having been in counseling.”
_____ 5. Identify a positive personal attribute that you noticed during counseling. This should be a personal characteristic separate from goals the client may have attained: “From the beginning I’ve always enjoyed your sense of humor. You’re really creative and really funny, but you can be serious too. Thanks for letting me see both those sides. It took courage for you to seriously tell me how you really feel about your mom.”
_____ 6. If there’s unfinished business (and there always will be) provide encouragement for continued work and personal growth: “Of course, your life isn’t perfect, but I have confidence that you’ll keep working on communicating well with your sister and those other things we’ve been talking about.” You may want to explicitly describe how your client doesn’t “need” counseling, but that continued counseling or counseling in the future might be helpful: “You know some people come to counseling to work on big problems; other people come because they find counseling can be useful and help them move toward personal growth or greater awareness; and other people just like counseling. You might decide you want to continue in counseling or start up again for any of these reasons.”
_____ 7. Provide opportunities for feedback to you: “I’d like to hear from you. What did you think was most helpful about coming to counseling? What did you think was least helpful?” You can add to this any genuine statements about things you wish you’d done differently as long as it’s not based on new insights. For example, if your client got angry for you for misunderstanding something and this was processed earlier, you might say: “And of course I wish I had heard you correctly and understood you the first time around on that [issue], but I’m glad we were able to talk through it and keep working together.”
_____ 8. If it’s possible, let the client know that he or she may return for counseling in the future: “I hope you know you can come back for a meeting sometime in the future if you want or need to.”
_____ 9. Make a statement about your hope for the client’s positive future: “I’ll be thinking of you and hoping that things work out for the best. Of course, like I said in the beginning, I’m hoping you get what you want out of life, just as long as it’s legal and healthy.”
_____ 10. As needed, listen to and discuss client wishes about continuing counseling forever or client wishes about transforming their relationship with you from one of counselor–client to that of parent–child or friend: “Like you’ve known all along, counseling is kind of weird. It’s not like we’re mom and daughter or aunt and niece. And even though I like you and feel close to you, it isn’t really the same as being friends” (further discussion and processing of feelings follows).

For more information on termination with youth, go to: http://www.amazon.com/Tough-Kids-Cool-Counseling-User-Friendly/dp/1556202741/ref=la_B0030LK6NM_1_3?s=books&ie=UTF8&qid=1396895008&sr=1-3

 

 

 

Reformulating Clinical Depression: The Social-Psycho-Bio Model

At a 2007 Mind and Life Conference at Emory University, I had the privilege of watching and listening as Charles Nemeroff, M.D., presented a professional paper to His Holiness the Dalai Lama. [As my older daughter would likely say, Dr. Nemeroff is a very fancy biological psychiatrist.] Nemeroff noted, with some authority, that we now know that one-third of all depressive disorders are genetically-based and two-thirds are environmentally-based. Following this statement, Nemeroff continued to discuss the trajectory of “depressive illness,” focusing, in particular, on findings linked to mice with early maternal deprivation and related findings regarding trauma and depression. His conclusion was that, for some individuals (and mice), the brain is changed by early childhood trauma, while for others, the brain seems unaffected. Interestingly, at that point in the conference the Dalai Lama interrupted and there were animated interactions between him and his interpreter. Finally, the interpreter directed a question to Nemeroff, stating something like, “His Holiness is wondering, if two-thirds of depression is caused by human experience and one-third is caused by genetics, but that humans who are genetically predisposed to depression have to have a trauma for the depression to be manifest, then wouldn’t it be true to say that all depression is caused by human experience?” After a brief silence, Nemeroff responded, “Yes. That would be true.”

Most of us have heard about the biopsychosocial model in contemporary medicine. Below I’ve included some information about its origin (this info is adapted from a 2009 Journal of Contemporary Psychotherapy Article; you can find the whole article here: http://www.coping.us/images/Sommers_Campbell_2009_EBP_for_Kids.pdf).

In his 1980 call to medicine, Engel (1980; 1997) encouraged adoption of a biopsychosocial model of health and illness. Despite this recommendation and the increased use of ‘biopsychosocial’ language among non-medical practitioners, medicine has demonstrated little movement toward embracing a biopsychosocial perspective (Alonso, 2004). To some extent, the Nemeroff-Dalai Lama interaction illustrates medical professionals’ tendencies to formulate mental health problems as disease states even when their own data are contradictory. At the Mind and Life Conference, Nemeroff continued to present his illness-based depression formulation even after conceding environmental causality of depression (Nemeroff, 2007).

Although we (Sommers-Flanagan & Campbell) generally advocate medicine’s biopsychosocial model, we see utility in a slightly more radical reconceptualization of depression–especially among youth. This belief rests upon knowledge about the etiology, course, and treatment of depression, equivocal data regarding antidepressant medication effectiveness, potential developmental and medical dangers associated with short- and long-term SSRI use, research on child development and trauma, and our own clinical experience (Sommers-Flanagan & Sommers-Flanagan, 1995a; Sommers-Flanagan & Sommers-Flanagan, 2007). In short, instead of a biopsychosocial model for understanding and treating youth depression, we believe a social-psychological-biological approach is more consistent with current scientific and clinical knowledge.

A Social-Psycho-Bio Model of Clinical Depression

All humans are born into pre-determined social and cultural settings, which directly influence emotional, psychological, social, and biological functioning and development (Christopher, 1996; Sue & Sue, 2013). Although space precludes complete articulation of the social-psycho-bio model, we describe the major components below.

Social-cultural components. Many cultural factors contribute to children’s emotional and psychological development. For example, in the United States, babies are often born to socially isolated mothers living in poverty. These mothers may also be depressed themselves and have little community and governmental support (Goosby, 2007; Knitzer, 2007). In contrast, more communal and supportive cultural settings place less of a parenting burden on individual mothers, thus possibly decreasing depression. It’s likely that different degrees of cultural support to families and children translate into different degrees of relative risk for depressive experiences in children.

Recent research affirms diverging cultural assumptions about depression etiology. Whereas South Asian immigrants viewed depressive symptoms as stemming from social and moral influences (Karasz, 2005), European Americans attributed depression to biological influences. These cultural formulations or expectations likely influence medication or psychotherapeutic efficacy. Although biomedical researchers emphasize genetic contributions to depression, an individual’s depressive predisposition may be strongly influenced by overarching cultural factors. Given Nemeroff’s admission that depression is rooted in human experience, it seems appropriate to us that depression formulations lead with social and cultural, rather than biological factors.

Early caretaker-child interactions. Early caretaker-baby interactions appear to stimulate depression development in very young children. The best example of this comes from studies of maternal depression, which demonstrate that mothers’ depressive behaviors influence their children’s own emotional suffering and other neurological changes (Ashman & Dawson, 2002). This evidence for a direct effect of caregiver behavior on children’s neural activity and possible brain development supports the social-psycho-bio model.

Child trauma. Garbarino’s (2001) statement, “Risk accumulates; opportunity ameliorates” (p. 362) suggests that repeated trauma in the absence of support or opportunity can deeply damage children. Trauma typically occurs within a social and cultural context, and without requisite support and opportunity, it can initiate cognitive, emotional, and social pathology. Sufficiently intense trauma may also produce lasting “psychic scars” (Terr, 1990). Additionally, early childhood trauma drains children and adults of meaningfulness (Garbarino, 2001). There is little doubt about the powerful contribution of trauma to the development of clinical depression and other mental disorders.

Psychological/cognitive development of depressive symptoms. Considerable evidence supports a cognitive model of depression in adults, and to some extent, in adolescents and children (Kazdin & Weisz, 2003). The pioneering work of Aaron Beck (1970) emphasizes that personal experiences lead individuals to acquire specific negative beliefs about themselves, the world, and the future (i.e., the cognitive triad). Although empirical support for the cognitive triad’s contributory and maintenance roles in depression is strong, these belief systems do not rise autonomously within the psyche. Instead, as Beck notes, these deeply ingrained beliefs are learned vis-à-vis interpersonal experiences.

The development of schemata or internal working models. Theorists spanning analytic, neoanalytic, cognitive, and attachment perspectives have proposed concepts that can be described as schemata or internal working models (Ainsworth, 1989; Glasser, 1998; Morehead, 2002; Young, Klosko, & Weishaar, 2003). Although each theoretical perspective articulates the concept somewhat differently, all involve development of a psychological pattern of repetitive automatic beliefs and expectations. These beliefs and expectations, which implicate the self, the world, and others (or objects), generate repetitive behaviors and affect. A cognitive schema or internal working model arises from early social interactions and may contribute to depression and other emotional and behavioral maladies. From a behavioral perspective, depressogenic working models involve early maladaptive reinforcement contingencies, which must be unlearned before one can acquire more adaptive behavior patterns.

Regardless of theoretical orientation, the internal working model concept forms the foundation of many psychological interventions. For example, it clearly underlies CBT and interpersonal therapy (IPT), two evidence-based practices for treating depression in youth (Kazdin & Weisz, 2003). Essentially, internal working models or schemata include internalized early experiences, and they constitute the “psycho” component of the social-psycho-bio model. When positive, adaptive, and healthy early experiences predominate, internalized working models buffer or immunize the individual against stress and trauma. When critical, negative, and maladaptive experiences predominate, schemata can predispose an individual to acute, chronic, or recurrent depressive episodes.

Neurological (brain-based) manifestations of depression. In addition to social, cognitive, emotional, and motivational experiences, current and recent research has identified cortical functioning correlates of depression. These correlates include neurochemical changes and neural activity, which can be observed via Positron Emission Tomography or functional Magnetic Resonance Imaging. Typically, brain imaging studies in animals, youth, and adults are presented as evidence of biomedical or biogenetic causal factors of depression. In the social-psycho-bio model described here, we suggest that neural changes are natural and inevitable correlates of internalized depressive life experiences. Because we are all biological organisms, observable neural changes associated with clinical depression should come as no surprise. It is important to note, however, that brain changes represent a physical phenomenon correlated with depression; these changes may or may not be causative.

Individuals with more extreme, recurrent, or chronic depressive experiences are perhaps more likely to evidence neurochemical states that add to or maintain depression. Again, we view this as a natural biological process. In some circumstances, this state might require a biological agent (or medication) to be used in combination with psychotherapy to facilitate depression recovery.

Our social-psycho-bio model advocacy does not exclude biomedical contributors to depression. Instead, it identifies biological manifestations as correlates of social and psychological dimensions of depression. This argument has been articulated before, but without much success. We attribute the failure of this view to the din of medication marketing and a cultural orientation toward quick fixes. In fact, we are all biological creatures with intricately interconnected brains characterized by dazzlingly complex electrochemical communication. The search for fMRI and PET scan differences between depressed and non-depressed individuals represents a logical and natural development in our understanding of depression as it exists within the whole person. Although neurochemical changes might maintain depression, it is not necessarily the case that neurochemical factors (or the vernacular ‘chemical imbalances’) initiate depressive processes. Indeed, these neurochemical changes are just as likely to be consequences of depressive conditions. Based on this depression re-formulation, we believe that it would be appropriate to initiate antidepressant medication treatment as an adjunctive approach if previously attempted experiential interventions, including exercise, dietary adjustments, and psychotherapy failed to achieve desired effectiveness. Further, conceptualizing neurochemical changes as depressive correlates rather than causes, lead us to agree with others who maintain that medication treatment should be considered a palliative and not curative treatment (Overholser, 2006).

[Again, please note that much of the preceding is adapted from a previously published article in the Journal of Contemporary Psychotherapy. The article was titled, “Psychotherapy and (or) Medications for Depression in Youth? An Evidence-Based Review with Recommendations for Treatment.” Citations are available in the original article.]