Tough Kids, Cool Counseling

1. Tough Kids, Cool Counseling Top Techniques for Influencing Challenging Students – Introductory John Sommers-Flanagan, Ph.D. University of Montana John.sf@mso.umt.edu Presented at the NASP annual conference February 24, 2017, San Antonio, TX Blog and Resources: johnsommersflanagan.com

2. Workshop Overview • This workshop is rated “R” • It’s a blend of theory, clinical experience, and evidence-based material (relational and technical) • Caveats and excuses • Working with youth is not a perfectly linear process – and neither is this workshop

3. Participation Guidelines • Input is welcome, not mandatory (TIMING) • Try to make connections with your work • Be open to new and old ideas • Communicate respectfully • It’s okay to critique what you see • Have as much fun as you can while learning

4. Learner Objectives • Understand four key principles underlying effective work with challenging middle and high school students, • Identify five evidence-informed assessment and engagement techniques for working with challenging students, and • Describe how cultural and family diversity can be addressed sensitively in the context of a counseling relationship.

6. Four Evidence-Based Principles • Use radical acceptance, radical respect, and radical interest (reframe tough kids) • Be transparent (genuine) and non-threatening • Use counter-conditioning mojo (stimuli) • Offer collaboration

7. Working with Adolescents • 1990 – Discovery – My input not appreciated • 1997 – Clever Title: Tough Kids, Cool Counseling [we’ll come back to this] • But who are these “Tough Kids”

8. The Tough Kids? • Take yourself back (or forward) in time • To a situation with a “challenging” young person • Think about: What makes the tough kids tough? • 30 Minutes of Profanity

9. Video Clip of TJ • TJ and I are talking about experiences that bother him and trigger anger • Think about, for you, what might make working with TJ difficult?

10. Video Clip of TJ • Two minute reflections/discussion • Now, tell me: What’s the Problem with this Workshop Title?

11. Principle One Use Radical Acceptance (Respect and Interest) • Being judgmental will interfere with therapeutic process and outcomes [UPR] • Reframe: The “kids” are not “tough” – their situations (including counseling) are tough • Unless we ALREADY HAVE a strong and influential relationship . . . pushing students to accept responsibility for misbehavior can lock-in defensiveness

12. Principle Two If you want cooperation, be transparent (genuine) and non-threatening • Big evidence base on this – especially in school settings • The Portland VA Hospital Story • AUTHENTIC PURPOSE STATEMENTS*

13. Principle Three Find your counter-conditioning mojo: We should use counter-conditioning to get students more comfortable with us • What do you recall about Mary Cover Jones? • One BIG hurdle is ANXIETY • How do we get reluctant clients, students, parents, and teachers comfortable “in the room” with us?

14. Principle Four Offer Collaboration • True collaboration comes from a place of not knowing too much of not being too much of an expert • We know more than middle and high schoolers . . . so how do we do this? • Later, I’ll highlight a technical strategy called “Invitation for collaboration” [Question about process]

15. Deconstructing Resistance • Freud: Nearly anything in opposition to the analyst’s goals – The problem is the client • de Shazer: Didn’t believe in resistance, so he held a funeral and buried it in his back yard – The problem is the therapist • Both-And: Resistance (or ambivalence or reluctance) is a function of the client AND the therapist

16. No More Tough Kids • Only so-called tough kids • Only kids in tough situations • And therapy is one of those • The invisible antenna • It’s not useful to think that way

17. Time for Techniques • The principles are woven into the engagement and assessment techniques • The point of using these techniques is to: • Build relationship (and teach) • The point of building relationship is to: • Have a positive influence (and teach)

18. The Top Techniques • And now . . . • We review 12 engagement and assessment techniques based on empirical research and clinical wisdom • Each technique has a purpose and likely outcome

19. Top Techniques [see handout supplement] 1. Acknowledging Reality [AKA: Congruence or Transparency = ES = .43; Kolden et al, 2011] 2. Sharing Referral Information Principle: Students need to know what you know about them Clinician Behavioral Examples: • Share referral information • Educate referral sources • Describe other realities?

20. The Top Techniques 3. The Authentic Purpose Statement Principle: Students need to hear your reason for being in the room. Make this statement brief and clear; tweak for each client (Person-centered; congruence) Clinician Behavioral Examples: • “My goals are your goals. . .” from Meagan video • “I’d love to. . .” from TJ video • “I want to help you get along with your parents” • Think about and practice what YOU want to say

21. Clip2: Meagan • She says she’s got a terrible temper • Watch for: • Your reaction to her as a client • Specific opening techniques • The affect bridge and emotional discussion

23. 3 Minute Reflection • Turn to your neighbor and briefly discuss: • What you saw/heard • What you liked/disliked • Your reactions to Megan

24. The Top Techniques 4. Wishes and Goals Principle: Collaborative goal-setting has strong empirical support. But goal-setting with students can be tricky. Wishes and goals can help you launch an individualized and collaborative goal-setting process. Clinician Behavioral Examples: • Three wishes • Goal-setting (and limiting) with parents/caregivers • SFBT opening: If we have a great session . . . • Miracle question

25. The Top Techniques 5. The Affect Bridge and Early Memories Principle: You can follow affect like a river to the past to learn more about emotional triggers (Adlerian; Hypnoanalytic, Watkins, 1971; CBT application) Clinician Behavioral Examples: • Earliest recollections • Take me back to a memory of the first time you felt anger like that • Via hypnotic induction

26. The Top Techniques 6. Reflection of Emotions and Emotional Education Principle: Emotional states and emotional reactions are complex – young people need help in understanding their emotional lives; they also need help identifying their goals. Clinician Behavioral Examples: • Reflection of feeling: “You felt embarrassed, then mad, then embarrassed again” • Interpretive reflection of feeling: “You looked sad when you said that” • Feeling validation: “That’s a perfectly natural emotion”

27. Engagement Techniques 7. Radical Acceptance as Attitude (from DBT) “I completely accept you as you are and am fully committed to helping you change for the better” • We use this attitude especially when young people or parents say something extreme

28. Practicing Radical Acceptance • Let’s practice the skill of radical acceptance – while keeping concession, empathy, and validation in mind. Here’s a parent example: • Parent Volley: “I know it’s not popular, but I believe in spanking. When I was a kid, if I talked back to my parents I’d be picking myself up off the floor. Kids don’t have any discipline these days and as a parent, I have a right to parent my kids any way I want.”

29. Practicing Radical Acceptance • Step One: Thank you or “I appreciate” • Option One: Validate/universalize • Option Two: Show empathy • Option Three: Concede to the underlying truth of the message (or identify a common underlying goal)

30. *Bonus – RA + Invite to Collab • How many of you are parents? • How many not? • How to deal with questions about your competence to work with parents

31. Practicing Radical Acceptance • Possible Therapist Response: “Thanks for being so honest about what you’re thinking. Lots of people believe in spanking and I’m glad you’re being straight with me about your beliefs. And I agree that lots of parents are afraid to be the boss. I hear you saying you have a right to parent the way you want to parent.” • BUT: You must believe in what you’re saying.

32. Radical Acceptance as Skill • Example 2: “I don’t need no stupid-ass shrink telling me how to live my life. I can take care of myself. This counseling shit is worthless. It’s for pansy-ass wimps like you who need to sit around and talk rather than doing any real work.” • RA Return: “Wow. Thanks for being so honest about what you’re thinking. Lots of people really hate counseling but they just sit here and pretend to cooperate. So I really appreciate you telling me exactly what you’re thinking.”

33. Practicing Radical Acceptance • Example 3: “I’m not talking to you and you can’t make me” • Thank you . . . concede, validate, universalize

34. Radical Acceptance – Again • Example 4: Adolescents are known for pushing emotional buttons. For example: Counselor: Welcome to counseling. I hope we can work together in ways you find helpful. Client: You talk just like a shrink. I punched my last counselor (client glares and awaits a response). (From Sommers-Flanagan and Bequette, 2013)

35. Radical Acceptance Some More • Possible Response: “Thanks for telling me that. I would never want to say anything that makes you so mad you want to punch me. How about if I ever do say anything that makes you mad, you tell me, and then I’ll try my best not to do it again?” • This is an example of using reflection of meaning, combined with self-disclosure, along with an invitation for collaboration

36. Practicing Radical Acceptance Example 5: 14 year-old speaking to a School Psychologist • “I just don’t think Fags have a right to even be on the planet.” • Two Minute Discussion (what can you say back in this situation that is respectful and accepting?)

37. Practicing Radical Acceptance • Group participation – Volunteer example • Thank you . . . because . . .

38. The Top Techniques 8. What’s Good About You? Principle: Reflecting on strengths, although difficult, can be emotionally soothing and reduce attachment anxiety—it also provides informal assessment data Introduce this with an invitation for collaboration

39. Clip 3: Kristen • Refers to self as a “Bitch” • Reports self-esteem and mood management problems • Watch for: • Content and process • Her reaction to positive feedback

41. 3 Minute Reflection • Turn to your neighbor and briefly discuss: • What you saw/heard • What you liked/disliked • Your reactions to Kristen

42. The Top Techniques 9. Using Riddles and Games Principle: Play and playful interaction is a part of many different evidence-based treatments (see Drewes, 2009). We need to engage young people when making therapeutic points • Volunteer demonstrations – Hand-pushing; Tic Tac Toe; riddles; dollar

43. The Techniques 10. Food and Mood Principle: Look around the room. Use COUNTERCONDITIONING (Jones, 1924a, 1924b)! And never do counseling with hungry children • Healthy snacks • Hot drinks • Sharing • What do you use?

44. The Top Techniques 11. Addressing Culture – IMHO avoid a formula 12. Rupture and Repair Principles: We can ask culturally diverse students about their experiences – but not completely rely on them for cultural information. We need to acknowledge and take back our inaccurate reflections

45. Clip 4: Michael • Referred for PTSD symptoms and gang affiliation behavior • Watch for: • Your reaction/response to Michael • Michael’s response to paraphrases • Your reaction to counselor spontaneity and self-disclosure

47. Michael - Discussion • I’m not getting it • Making a recipe?? • Incorrect gang affiliation • What do you think of the spontaneous disclosure? • Address culture as needed (Saudi story)

48. Review: Principles and Techniques • What are the four principles? • What engagement and assessment techniques do you want to remember and try out? • Reflections on a cultural take-away?

49. Conclusions • The WHOLE purpose of assessment and engagement techniques • Engage and have interest • Closing comments • For more information, go to: johnsommersflanagan.com • Listen to the practically perfect parenting podcast

50. Two of John’s Books