For Pros: Joining with Teens in Therapy

feature-teensThe other day I was going through some old grad school papers and I found the following short paper I wrote as a MFT student in 1996 when I didn't have very much experience working with adolescents. Looking back on it now 17 years later, even though I've certainly learned a lot since then as a specialist working with teens, I'm happy to say I was definitely on the right track. [divider]

Short Paper #4 Some Thoughts on the Importance of Joining with Adolescents as a Therapeutic Intervention

Jonathan Sherman Northern Illinois University FCNS 584--Dr. Linda Derscheid--December 2, 1996

I am quite comfortable around adolescents and generally connect very well with adolescents on many topics. However, the therapy setting is another story. I have limited experience working with adolescents in a therapeutic setting. This is the main reason I chose to do my internship with the DeKalb County Youth Services Bureau. The problem with therapy is that it automatically sets up a distinct hierarchy between the adolescent and myself that is foreign to me--they have to be there and by default I am part of the system that is making them be there. This sets up a relationship that is therapeutically unproductive. I have struggled with how to deal with this issue. In this paper I will address some of my thoughts on what I am finding that works best for me in my work with adolescents in the therapy setting.

I have found it helpful to stop trying to do therapy with adolescents who do not want to be in therapy. I realized that if I had to go to therapy when I was an adolescent I certainly would not have wanted to be there. Also, if some therapist thought he/she could get inside my head I would have been happy to show them how ineffective their methods would have been on me. How “cooperative” would you be if you were in their shoes. Given that, why would I expect any of the adolescents I am working with to feel any differently than I would have felt? So I stopped asking therapy related questions and just started talking with them. I have been telling them up front that I realize they have to be here in therapy and that it is likely the last place they want to be. I also realize that I can’t make them talk if they don’t want to and that I’m not going to try. I tell them that if they feel like telling me something then I would be happy to listen, but for now I don’t see why they would want to as they don’t know me and why would they trust me in the first place since they don’t even know who I am? I tell them I don’t feel it would be respectful to them to try to make them talk when they didn’t feel like talking or if I tried to make them tell me things they didn’t want to tell me. I further tell them that if their main goal is to get out of having to come to therapy, and out of the legal system, I can help them figure out the fastest way to get it all over and done with. “Get me working for you instead of me working for the system that is making you be here,” I tell them. This statement can help mobilize the adolescent to become more responsible for his/her own actions and life which Ambert (1995) points out as a key roadblock to overcome. This goal leaves the door open to approach therapeutic issues when able and keeps the therapy from becoming only a place to chat. When all that is laid out on the table and they know where I stand I have found that the adolescents I’ve been working with, who have histories of claming up in therapy, talk freely about what they like to do. It’s not “therapy” in the traditional sense, but they are talking to me, which to me is vital in our talk-oriented business. It is also more enjoyable for the adolescent who isn’t dreading the ultra-boring hour of therapy with some bozo who is constantly, and futilely, drilling him/her for information. So we chat about nothing in particular and I’ve been noticing that in the course of this “non-therapeutic” chatter these adolescents are telling me bits and pieces of information that are related to therapy.

Offer and Schonert-Reichl (1992) point out that one of the primary factors a adolescent considers when seeking help from another is the characteristics of that person. It is reasonable to assume that they are more likely to seek help from someone when they know they are understood and respected by that person. The key is respecting their world (and doing so genuinely and not as a technique). All the interventions in the world are useless until this base is first established. It is really unrealistic for therapists to expect most adolescents to want to cooperate in a therapeutic setting. When they are uncooperative they are labeled resistant. Often these kids are seen as resistant which seems to be a cop out for the therapist who is trying to bypass laying this essential foundation. I have yet to meet a 13-year-old who wants to spill his guts to some stranger who is trying to get him to say and/or do things he’s not the least bit interested in a place he doesn’t want to be. When I was 13-years-old I wouldn’t have. So I am learning to respect and honor the adolescents resistance recognizing that underneath it is anger, mistrust, fear, etc. I engage them with respect and stroke the resistance and validate that it is understandable that this adolescent wouldn’t trust me and I don’t expect him/her to for a good while. I want to get to know this person, their world, what they like. Does he/she like to draw? I will ask him/her to draw a picture of anything they like or a picture of how they feel about coming to see me or a picture of their family which will give me an opening and he/she can tell me about the drawing.. I like to work with adolescents using the “mirroring process” as a way to build rapport, safety, trust, and connection and adolescents usually like to be mirrored as this is something that they often do not receive. The mirroring process can be an effective way to connect with a adolescent. Adolescents really want to be listened to and be heard and understood where they are coming from, from their world. I believe if I can enter into the world of the other and look around briefly and gain an understanding and share this with adolescents, that this will build trust, safety and connection. As Butman and Arp (1990) point out, adolescents desire respect and support from adults. This is an important element of joining.

In conclusion, the process of joining is an intervention I have found useful in my work with adolescents in therapy. Through this joining process I have been able to assess strengths and problems and encourage verbal interaction with the adolescent that other means have not allowed me to do with them.

References

Ambert, A. M. (1995). A critical perspective on the research on parents and adolescents: Implications for research, intervention, and policy. In D. H. Demo and A. M. Ambert (Eds.), Parents and adolescents in changing families, (pp. 291-305). Minneapolis: National Council on Family Relations.

Butman, R. E., & Arp, J. H. (1990). Adolescent depression in its developmental and maturational context. Journal of Psychology and Christianity, 9, 34-43.

Offer, D., & Schonert-Reichl, K. A. (1992). Debunking the myths of adolescence: Findings from recent research. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 1003-1014.

Q&A for Pros: Recommendations for a 12-year-old Who Lies and Steals?

Q&A QAQ: From a colleague who runs a residential treatment program for youth: Hey, Jonathan. Just a quick question about one of my clients. He is a 12 year old who was adopted and was sent away for a serious lying/stealing problem. These behaviors have not surfaced completely since he came. I wondered if you had any recommendations for literature for him to read that might speak to his lying/stealing? A: I don't have any literature specifically for 12-year-olds on this topic, though I'm sure if you did an Amazon search you would find some therapeutic titles for latency age kids. However, unless he's insight-oriented (most 12 year olds aren't), I wouldn't expect a bibliotherapy approach. I would be looking at finding out what his goals are using motivational-interviewing/solution-focused approaches to help him identify his goals on becoming more honest. That in addition to whatever work your program already does to address his unresolved past issues, current family dynamics and parenting strategies. Certainly any recreational/experiential delivery methods will help integrate these issues more than direct talking-based therapies or reading on his own.

Also, as you said, "these behaviors have not surfaced completely since he came" is no surprise, since from a systemic perspective he's no longer in his native home system where his lying/stealing may have served a purpose (the function of the problem) for him in that system. This is one of the problems inherent in treating the child and not treating the system (the family) around the child. Make sure the family is part of the treatment process.

Q&A for Pros: Recommendations for a 12-year-old Who Lies and Steals?

Q&A QAQ: From a colleague who runs a residential treatment program for youth: Hey, Jonathan. Just a quick question about one of my clients. He is a 12 year old who was adopted and was sent away for a serious lying/stealing problem. These behaviors have not surfaced completely since he came. I wondered if you had any recommendations for literature for him to read that might speak to his lying/stealing? A: I don't have any literature specifically for 12-year-olds on this topic, though I'm sure if you did an Amazon search you would find some therapeutic titles for latency age kids. However, unless he's insight-oriented (most 12 year olds aren't), I wouldn't expect a bibliotherapy approach. I would be looking at finding out what his goals are using motivational-interviewing/solution-focused approaches to help him identify his goals on becoming more honest. That in addition to whatever work your program already does to address his unresolved past issues, current family dynamics and parenting strategies. Certainly any recreational/experiential delivery methods will help integrate these issues more than direct talking-based therapies or reading on his own.

Also, as you said, "these behaviors have not surfaced completely since he came" is no surprise, since from a systemic perspective he's no longer in his native home system where his lying/stealing may have served a purpose (the function of the problem) for him in that system. This is one of the problems inherent in treating the child and not treating the system (the family) around the child. Make sure the family is part of the treatment process.

Q&A: How much does it cost to get a master's in MFT?

Practice Builders for Pros For colleagues improving their skills and practices and for students and potential students considering the therapy field.

Q: "Hey quick question for you - how much does it cost to get a master's in MFT (marriage and family therapy)?" —Undergrad student considering grad school

A: Quick answer--a lot! ;-) Actually I don't recall exactly. Varies of course. I got offered a tuition waiver in exchange for being a teacher's assistant which saved a bunch of money, and they paid a small monthly stipend.

Two good links:

http://www.ncfr.org/professional-resources/career-development/choosing-mft-program-s-right-you and http://mftprogress.blogspot.com/2008/12/best-mft-graduate-schools.html?m=1

They duplicate some info. The 2nd has a lot of user comments. You'll have to contact several schools that interest you and start getting current numbers from them and start comparing.

Good luck! Please share your findings for the benefit of others!

Q&A: How much does it cost to get a master's in MFT?

Practice Builders for Pros For colleagues improving their skills and practices and for students and potential students considering the therapy field.

Q: "Hey quick question for you - how much does it cost to get a master's in MFT (marriage and family therapy)?" —Undergrad student considering grad school

A: Quick answer--a lot! ;-) Actually I don't recall exactly. Varies of course. I got offered a tuition waiver in exchange for being a teacher's assistant which saved a bunch of money, and they paid a small monthly stipend.

Two good links:

http://www.ncfr.org/professional-resources/career-development/choosing-mft-program-s-right-you and http://mftprogress.blogspot.com/2008/12/best-mft-graduate-schools.html?m=1

They duplicate some info. The 2nd has a lot of user comments. You'll have to contact several schools that interest you and start getting current numbers from them and start comparing.

Good luck! Please share your findings for the benefit of others!

Q&A: For Pros—Recommendations for Working with Reactive Attachment Disorder (RAD) Adopted Teen?

Q: Do you have any suggestions on literature or websites to get information on treatment for adolescents with Reactive Attachment Disorder (RAD)? I am working with a 13-year-old boy that was adopted at the age of eight along with his younger brother from an orphanage in Russia. He is now from California and lived with his brother and adoptive mother before coming to our center. There is no father involved in their lives. Thank you for your help.—Treatment Center Director and colleague

A: Sure thing... I'm sharing this Q&A from my colleague as these are resources that parents will find helpful as much as professionals will.

Websites:

A few books:

  • Treating Attachment Disorders; From Theory to Therapy, by Karl Heinz Brisch
  • Parenting the Hurt Child: Helping Adoptive Families Heal and Grow, by Gregory C. Keck, Regina M. Kupecky
  • When Love is Not Enough: A Guide to Parenting Children with RAD - Reactive Attachment Disorder, by Nancy L. Thomas
  • All of these books are available here.

A few other considerations:

  • Hope mom's getting lots of parent training while he's getting treatment, as well as family therapy together. The worse thing you can do is treat "the problem child" without treating the entire family system the child lives in.

Staff & Parent Training:

There's simply no substitute for good training for both your staff and your client's parents. If you ever want to do a staff training and/or parent training on working with difficult teens, I do a workshop for professionals who work with teens and for parents. Here's the link and  description from my website:

  • "WORKING the System: Motivating and Strategizing with “Resistant” Teens to Achieve the Better Outcomes THEY Want" Systems, whether they be school, family or legal systems, can seem impossible for teens to successfully navigate. These systems can seem especially hard to figure out when they feel their only options are comply or rebel—neither option being what the teen really wants. Teaching them how to strategically “work the system” empowers them to actually achieve the better goals they want. And they do want to succeed. Many just don’t know how. The Working the System seminar teaches your people how to reach and teach the “unreachable” and “unteachable”.
  • "How to Talk to Teens about the Tough Stuff" This workshop is closely related to the "Working the System" above that is less clinical and more geared towards parents. It'd be fun to do a training with your people sometime if you like.
  • "Child Development & Attachment Disorder: What's "Normal" and What's Not" If you work with kids then knowing what's "normal" and not can make ALL the difference. I have given this training several times to The State of Utah's Guardian ad Litem's and CASA's Office.

Glad to hear of your work and your life.

Peace bro,

Jonathan

Q&A for Pros: Looking for Work? Do a Networking Blitz!

Q: I have a friend just graduated with his masters in clinical psychology and is looking for a job (does not have his license yet). Do you know of any places that may be hiring? A: Sorry, I'm not in the loop as far as any available jobs at this point. However, I would recommend doing a networking blitz:

1. Send a cover letter introducing himself with his resume to any/all of the treatment providers, mental health centers, rehabs, and agencies that interest him (and even the ones who don't, as you never know who will know someone who knows someone) and follow up the following week with a phone call. This may be an obvious suggestion, however, I'm always surprised by how many people don't.

When I was graduating in Illinois we knew we were moving back to Utah so Kara could resume her schooling. I only knew a few people in Utah professionally with whom to network. We had no money in reserve. I needed a job as soon as I got to Utah. So this was early Internet days so I looked up what I could online, but mostly scoured a Utah County phonebook I found at the library, for every single provider (solo, group, agency, etc) I could find and mailed them all the following networking letter with my resume.

May 1, 1997

Name Address Provo, UT 84604

Dear ________________,

I am currently exploring job opportunities in the Utah County and Salt Lake County areas. I am relocating myself and my family to Utah County where I am seeking employment as a mental health professional. I am looking forward to returning to the community where I had such rewarding experiences in the field. I am writing to you in the hope that you may be able to assist me in exploring employment opportunities with your organization or other organizations you are aware of that may have positions available.

I graduated from Brigham Young University in Family Sciences in 1993. Since then my training has been in the field of substance abuse with the Utah Alcoholism Foundation and in the field of marriage and family therapy at Northern Illinois University’s Marriage and Family Therapy graduate program.

I have enclosed my resume detailing my qualifications as well as my references. I will be available for an interview in your area after May 19th. Please feel free to call me if you have any further questions at (815) 756-xxxx prior to May 15th or at (801) 763-xxxx after May 18th. Any assistance you can grant will be greatly appreciated. I look forward to hearing from you. Thank you for your time and consideration.

Respectfully,

Jonathan D. Sherman

Enclosures: resume reference

I sent 70 of these. I then called most of them up. Nothing. However, that was the market then. But I did get one solid lead from the next method:

2. Contact the state division of his professional organization and see who there knows who's hiring. For my field it's the Utah Association for Marriage and Family Therapy. I'm sure he has one for clinical psychologists. This is how I got my first job out of grad school, which opened the door for every other opportunity I've had since.  I sent a modified version of my networking letter as follows:

May 2, 1997

Lynne Maynes, Ph.D. Counseling Center P.O. Box 681499 Park City, UT 84068-1499

Dear Dr. Maynes,

Beth Hughes with the UAMFT suggested I contact you. Last month I was able to talk with Becky at your organization and she suggested I send you my vita. I am currently exploring job opportunities in the Utah County and Salt Lake County areas. I am relocating myself and my family to Utah County where I am seeking employment as a mental health professional. I am looking forward to returning to the community where I had such rewarding experiences in the field. I am writing to you in the hope that you may be able to assist me in exploring employment opportunities with your organization or other organizations you are Daware of that may have positions available.

I graduated from Brigham Young University in Family Sciences in 1993. Since then my training has been in the field of substance abuse with the Utah Alcoholism Foundation and in the field of marriage and family therapy at Northern Illinois University’s Marriage and Family Therapy graduate program.

I have enclosed my resume detailing my qualifications as well as my references. I will be available for an interview in your area after May 19th. Please feel free to call me if you have any further questions at (815) 756-xxxx prior to May 15th or at (801) 763-xxxx after May 18th. Any assistance you can grant will be greatly appreciated. I look forward to hearing from you. Thank you for your time and consideration.

Respectfully,

Jonathan D. Sherman

Enclosures: resume references

3. And he's already doing #3--ask everyone you know who they know... And while I don't know of any leads specifically right now I'm happy to post the need on my Facebook and Twitter and see if anyone knows anything. It  may or may not yield anything, but you never know—and as of this writing POW! that's 4,700 people instantly added to his network! If there are any leads I'll forward them on to you, or your friend can friend me on Facebook and Twitter and keep an eye on these posts himself.

4. Consider the rural option. Question: Is he local, does he want to stay local or willing to relocate? There are often great jobs in rural settings/boonies and they are willing to pay more b/c a lot of people aren't willing to relocate and they desperately need providers. Further, many states have Rural Loan Repayment programs where by committing to work a min of 2 years in a rural setting he can get a lot and sometimes all of his grad school loans paid off.

Hope this helps.

—[ More "PRACTICE BUILDERS FOR PROS" tips here... ]—

Ask an MFT: Questions from College Students About Being an MFT

  ASK AN MFT: I spoke to a Family Systems class at Utah Valley University (UVU) about being a Marriage & Family Therapist. I had the students ask me questions ahead of time online. What questions would YOU ask? Here are their questions (organized in topics) that we covered.

Podcast coming soon: I recorded this Q&A and will post as a podcast for those who are interested in the answers I gave.

See what they thought: Their evaluation results are below.

You do a better job of connecting and marketing than most MFTs I know, and the students will be inspired by your energy." —Lori Schade, LMFT, UVU Adjunct Professor

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THE QUESTIONS

More than “Just” MFT 1. What do Marriage & Family Therapists treat? What kind of clients and issues do you see and deal with on a typical day?

In Session: Models & Approach 2. How do you decide which model/approach/theory to use when you meet with a couple? What is the information that is given to you from a client that directs that decision? 3. How do you show empathy to your client's problems and still be able to maintain your professionalism? 4. As a counselor do you find it more effective to help client's work out solutions to their own problems and only give them advice when they ask for it or what?

Couples: Revitalizing Marriage 5. What would you recommend a couple do to reclaim their marriage and have a GREAT relationship again? They love each other, get along well, work through their stressors well, but are “stuck in a rut,” their marriage has taken back-burner status and they are running on “auto pilot.”

Couples: Marriage Prep 6. What advice would you give to a couple before they get married? What should couples know before they get married?

Couples: Counseling One-Half of the Couple 7. What do you do when a couple comes in, and only one partner is trying to make their marriage work? 8. What if the other partner is stonewalling and wants nothing to do with the therapy sessions? 9. What happens with the other partner who wants to make it work?

Couples: Abuse & Domestic Violence 10. When a person has experienced an abusive marriage how do you counsel the person to be able to once again trust in a new relationship?

Being a Therapist: Making the Decision 11. What motivations drove you to become a marriage therapist? 12. Where did you get your MFT? 13. Is Utah a good place to do marriage therapy? How do I get clients to come to me?

Being a Therapist: Passion or Burnout? 14. How do you keep from becoming too emotionally involved or just plain burned-out? Do you find it can be very emotionally draining sometimes and if so how do you cope with that? 15. Do you know if many therapists seek counseling themselves to help them deal with their profession?

Being a Therapist: Impact On Your Own Marriage 16. Do you apply all the techniques that you give to the couples who come to you to your own marriage? 17. Does being a marriage therapist put stress on your own marriage, or does it give you a greater appreciation of how good you have it in your marriage? 18. Is there a high divorce rate among therapists because they spend so much of their time helping others that they are emotionally unavailable in their own relationships? 19. I imagine that you hear and feel more than your share of negativity and hopelessness, therefore, how do you not allow that to spill over into your important personal relationships?

Helping Your Family & Friends 20. I have a teen sibling with low self esteem. I am studying to be a therapist and have worked with troubled teens. When I talk to her about anything she shuts down because she thinks I am trying to "fix" her. How do you counsel your family members without them feeling like you are using the skills you learned for your job on them?

More Questions? Some have already been answered and more are coming! Visit the PRACTICE BUILDERS FOR PROS blog at MarriageEnvy.com/PracticeBuilders

Articles available now • Technology & Remote Counseling • Marriage & Family Therapist makes “50 Best Careers of 2011″ List • Clients on Facebook? Okay or Not? • For Pros: Working with Latency-Age Children • Tagline: Answer Their Pain • How to Thrive in Private Practice, Parts 1 • How to Thrive in Private Practice, Parts 2 • For My Colleagues: Making It as an Entrepreneur • PDF: 11 Ways to Thrive in Private Practice article

Upcoming posts... stay tuned! • Refusing to Devalue Your Work • Insurance Billing Resources for Private and Group Practices • Being a Marriage and Family Therapist • Don’t Be Too Quickly Flattered • Podcast Interview: 21 Questions for Jonathan Sherman on Being a Therapist • Podcast Interview: Questions from a Student Considering the MFT Field • Is Couples Therapy Stressful? • Is Private Practice for You? • “It’s a Long Way to the Top if You Wanna _________.” • MFT Info Link resources

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Book Jonathan

Please fill out this Speaker Request Form to book Jonathan to offer this presentation to your group. Thank you.

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Evaluation Results

I don't filter my evaluation results I give them here as straight as I get them. I figure if you're making the important decision to select the right speaker for your group is it better to just get filtered positive only testimonials about a potential speaker or to know how people respond to the speaker including both those who loved it and didn't? So if someone thought I stunk you'll hear it hear first. Obviously, I don't try to make everyone happy. Part of my utility is to get people out of their comfort zones. If the majority love an approach I use in a seminar I'll continue those items that resonate with most. If the majority hate an approach I'll drop it. If one or two people don't like what the majority love, then I don't give much heed to those critiques, of course. However, I appreciate all feedback, which is one of the reasons my evaluation results are consistently high: My audiences teach me what they like and what works best for them and I listen.

My evaluation form contains the following items:

  • 1-10 Rating: "Please rate your overall experience of this presentation"

  • The Good: "What was brilliant, superb, exhilarating, life-altering, or opened the heavens for you? In short, what did you like about the presentation?
  • One Thing: "What's one thing that you plan on using and/or implementing into your life from this presentation?" This tells me out of everything what was the one thing that had the most meaningful impact.
  • The Bad: "What stunk, turned your stomach, gave you a headache, made  you dizzy, or gave you gas? In short, what didn't you like that could be improved and/or what would you like to see covered that wasn't? (Go ahead, I can take it!)"
  • Requested eZine: This is actually also an evaluation measure: You'd think that someone who would give a lower rating didn't like the presentation. However, while it may not have been the favorite for that person, they got enough out of it that they would like to receive emails containing articles, tips, strategies and events on these topics from me.

Event: UVU Intro to Counseling and Psychology, Guest Speaker for Professor Lori Schade, LMFT Date: 9-7-2012, 2.5 hours Attendance: 18 Number of Evals Returned: 11 Average Rating for this Event: 9.5/10

[table] Rating,The Good,One Thing Different,The Bad,eZine?

10,"Great, very insightful and reassuring.","I'll look more into DBT.","It's all good!",-- 10,"I like that all questions were answered that the way it was presented it was relaxed, knowledgable, skilled. I liked his sense of caring for his audience and their concerns. That can tell us the person he is as a therapist. Very informational. Gained a lot of insights from it.","The model of genuine caring for your client and to see them as a struggling person and not a messed up one.","Nothing bad :-). Thank you!",Y 1o,"I really enjoyed when you talked about when a client enters the room you picture yourself 'What if it was me?' or think 'What if this was my daughter?' and treat them accordingly. You simply care for the client.","Learning about balance and learning to value myself and what I am doing. Learning to see and treat the system.","Really enjoyed the presentation and insights.",Y 10,"I liked the heads up on what happens in the real world and what you won't learn in school. I thought the information was VERY VALUABLE.","I want to take a look at mindfulness training.",--,Y 10,"You jumped around and covered so much stuff. Thank you. I enjoyed your obvious expertise and how confident you are saying that. Total and complete acceptance. The humanness/caring/honesty factor. Good stuff.","My husband—brilliant, genius, broken man—has borderline personality disorder. It kills, it is so hard. Anyway, I will familiarize myself with the DBT strong points and give him A LOT more acceptance as he works through his crap. I can't fix him. 'Partner, not therapist.' Yes!","Only wish there was more time!",Y 10,"Very personable. Good, natural flow in his lecture.","What you said about 'It's okay to be uncomfortable. It's okay if they are mad at you.'","Just how long it was.",Y 10,"Very knowledgable on how to help others cope and be able to keep boundaries and still be able to help people. Gave information about how to be yourself and take care of you. Realize to accept people for you they are and you're not trying to change them even as you're helping them change.","Learn to implement balance when speaking with people. It's okay to show emotion, but learn how to deal with it so you don't feel the burnout.","Nothing.",-- 9,"Great information and ideas for our furture as therapists and what to expect.","Focusing on where my center is and being confident with who and what I am.",--,Y 9,"I liked being able to ask questions rather than a set agenda. The business/practice-related advice was also very good, as well as the advise for picking a theory to specialize in while also being eclectic. The obvious (to me at least) Jungian principles were also great because I love Jung's theories.","The 'professional tithe' you do with your pro-bono work and studying to find my own balance.","I felt really good about it.",-- 8,"Balance between being detached and open. 'I'm my own worst enemy'-->How you pointed out that you wouldn't say that to someone else so don't say it to self.","Showing appropriate emotions with clients.","Thanks for coming!"-- 8,"Valuing myself and my work. I can see myself owning my own practice as a counselor and this gave me a vision of the path I need to walk and get there. It was inspiring and lifted my hopes and desires to continue down this path. Compassion for your clients makes up for your lack of knowledge and ability early on as a new therapist.","Go forward towards my dream. Don't give up. Center on how the person is. Don't take it all in.","By leaving the lights turned down I found my eyes and mind drifting to the computer and the screen and wondering 'What else we would watch' (must be my ADD). Perhaps I would focus better if the projector was off and the lights back on. After the break was great--lights on = eyeballs click.",Y

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Event: UVU Family Systems class, Guest Speaker for Professor Lori Schade, LMFT Date: 9-11-2012 Attendance: 20 Number of Evals Returned: 14 Average Rating for this Event: 9.6/10

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 Q: What questions would YOU like to ask about the field of MFT or what it's like to be a therapist?

Practice Builders—Technology and Remote Counseling

I wonder, I wonder, I wonder how technology will influence/change the nature of my field 10 years from now. National and International

10 years ago I never would've had clients in these states: Arizona, California, Colorado, Illinois, Kentucky, Michigan, Missouri, New York, Tennessee, Texas, Virginia, Washington AND these countries: Afghanistan, Canada (Alberta and Ontario), England, Mexico, Nigeria, Norway, ALL of whom I've been able to work with from the comfort of my own office and that they've been able to work with me from the comfort of their own homes or offices.

"Continuity of Care" and "Client-Centered" Realized

In the past it was local or nothing. Now my clients can choose who they work with. They can have real "continuity of care" rather than hope they find a good therapist when they move (and as we know, most don't make that transition to a new therapist successfully, and more than often drop out of counseling altogether). They no longer have to start over with someone new and tell their whole story fresh again. They have the freedom of continuing the work they began. And new clients from these places get to access who they want to work with. It is truly making it more and more client-centered, which is what we believe in this field, but sometimes isn't realized. Technology is giving my clients more choice and with choice comes power.

I am truly grateful for amazing technology and ALL the brilliant minds that have come together to make this all so "easy." Due props to all you awesome geeks and nerds out there!

For My Colleagues: Making It as an Entrepreneur

20111229-190759.jpg For my colleagues who desire to go out on their own into private practice, speaking business, etc. I highly recommend this GREAT article: How to Survive Your First Year as a Entrepreneur. Love it. Rings so true to my experience as an entrepreneur (minus the prostitutes). Great advice to anyone venturing into the fantastic world of entrepreneurship.

By the way, you still might fail on that first business. But now it’s too late for you. You’re never going back to the pencil factory. You’re an animal, you hunt in the wild, you dig your sharp teeth into flesh and enjoy it, and at the top of the mountain you roar like a lion and everyone cowers in fear."

Personally, there's no going back to the pencil factory for me (i.e., mental health agency or working for someone else in my case). LOVE working for self and CREATING!!! Tough, nerve-wracking, fantastic. If you've got the passion and heart to put yourself out there and aren't too risk-averse I highly recommend this crazy wonderful life.

Marriage & Family Therapist makes "50 Best Careers of 2011" List

I always knew I had a great job. I'm happy to know that Marriage and Family Therapist made US News' 50 Best Careers of 2011. The author, Henry Clay Webster, wrote:

"As one of the 50 Best Careers of 2011, this should have strong growth over the next decade.... While some counselors focus on the behavior of an individual, marriage and family therapists go a step further, addressing mental-health issues within the context of the family. By counseling couples, families, or individuals, marriage and family therapists tackle a host of problems: adult schizophrenia, substance abuse, anorexia, and marital conflict. Today, marriage and family therapy is considered a "core" mental-health profession, alongside social work, psychiatric nursing, psychology, and psychiatry. More than 1.8 million people are now receiving treatment from a marriage and family therapist."

[Read the full article here for more info on the field, pros/cons, average incomes (be sure to read the comments for some info on higher incomes, too), etc.

Clients on Facebook? Okay or Not?

Q: A therapist colleague asked me:

Do you ever say yes to a client's friend request on Facebook? And if so what are your rules about it? I have some that want to keep in touch with me after I move but I am just not sure and don't want to make a bad choice but there isn't much said about 'internet' and 'Facebook' stuff?"

A: Great question. Yes, I do. And yes, I know there's some controversy on this topic. I've read a lot on the subject and have given it a good deal of thought. Admittedly, for the field as a whole, this is still mostly uncharted territory. But it's one that isn't going away, and old school practitioners are going to find it hard to compete if they don't learn to adapt to where their clients are—which is where the market is.

For me and my clients, I'm all for embracing current technology and how people (our clients) communicate in real life. For example, I also do coaching via phone and Skype with clients all over the country and internationally. Some say it's not as good as face to face (I agree). However what it does for:

  1. Continuity of care for clients is simply phenomenal,
  2. Providing greater choice to clients in their selection of providers is unparalleled, especially in rural areas, as well as
  3. Greater flexibility and convenience in scheduling (just consider the convenience of a single mother or young couple not needing to arrange for a babysitter).

 

Face-to-face cannot always provide for these three very significant factors. There are pros and cons for each method.

I've always been an early adopter of integrating technology in our field as well as being a proactive marketer of wellness rather than passively waiting for clients to find me. I believe we as therapists have specialized knowledge and skill sets that are too important to just wait in our offices until people's problems reach the crisis point that they then start searching for a therapist. I'd much rather people get to know a good therapist long before they "need" one... Then when the need arises they don't have to scramble "hoping" they find someone that will work. The latter does not seem like good client care to me. Giving them the chance to pre-decide way ahead of time is much better for all as it insures a more proper "fit" with client and therapist which predicts greater successful outcomes for both.

So, to answer your question here are a few points (in no particular order and by no means comprehensive) I use on Facebook:

  1. First of all, I work with a high functioning clientele, so boundary issues are rarely (haven't had any yet actually) an issue. If I still worked for a community mental health agency I would very likely not "friend" my clients for the most part, even though they were wonderful people. Generally, in the discussion around where does coaching and therapy begin/leave-off, the thinking is that GAF (Global Assessment of Functioning) scores of 70+ are more "coaching" clients. That is open to debate, but it's the general thinking on the topic. When I say "high-functioning", though, that is what I'm talking about;
  2. My Facebook page is first and foremost for networking, so I stay mindful that my posts and pics will be seen by clients, colleagues, referrers, as well as friends and family. So is what I post something I'd feel sharing posting on a bulletin board or discussing in a seminar? Yes. Sometimes it's clinical. Sometimes funny. Sometime personal. The point in both therapy and social networking is to always be real, relevant and relatable;
  3. The broad mix of Facebook friends I feel provides the same anonymity and confidentiality that any other public social environment affords, such as the grocery store and the same rules there apply. For example, the client owns the relationship--meaning I won't acknowledge them as a client unless they want to self-identify publicly in a post that way such as, "You helped our marriage so much. Thanks!" Otherwise as far as anyone else knows they are just another acquaintance. It's similar if I run into a client in the grocery store--if they come up to me I'm happy to talk. If not, I politely avoid them to protect their privacy. If my kids ask who was that, I just say, "A friend of mine" to protect their confidentiality;
  4. Contrary, to conventional practice (which some of the research now supports me) I do believe in a good deal of self-disclosure. Many clients over the years have expressed frustration that they want a great relationship with their spouse or kids but have never seen that modeled in real life. The medium of Facebook and appropriate self-disclosure provides that. I'm by no means THE model, but I am one very real life example of a guy doing his level best at practicing about 80% as a husband and father of what he preaches as a therapist.
  5. I'm also pretty down to earth, silly and frank in my Facebook posts. This serves a dual purpose: 1. To remove the stigma of the stuffy, clinical therapist and 2. Markets myself to my ideal clients (ie., those who value plainness and authenticity) and screens out my non-ideal clients (ie., the ones who take themselves too seriously). This leads to a better fit on both sides. Potential clients get to "check me out" in advance and decide whether I will be a good fit for their style and their needs. Yellow Page ads and websites just don't give the same level of relate-ability or transparency that clients really want and value;
  6. After all that, I re-read your question and realized I neglected to directly answer your first question. Yes, I do accept my clients "friend" requests (remember my caveat: I have a high-functioning clientele with good boundaries). I also didn't mention what is likely obvious: Most people don't consider Facebook "friends" to be the same as friends in the traditional sense unless their page is strictly limited to immediate friends and family. This is one reason I don't consider my client who is also my Facebook "friend" as being a dual relationship anymore than I would consider having a friendly conversation with a client I happened to meet at the grocery store a dual relationship.

 

Now there may be others who will say you should never "friend" clients on Facebook. And they may be right depending on the population they work with or their own preferences. However, for me it's worked great. Client feedback is they value it. My approach has always to be client-centered and customer-driven. So, bottom line: I'm all about effectiveness. If it works keep doing it. If it doesn't, don't.

Your thoughts? Other questions?

Peace,

Jonathan

For Pros: Working with Latency-Age Children

Tips for new therapists and a Request to my seasoned colleagues

—NOTE: Please excuse typos and incomplete parts you may notice. This post is a rough draft—

A new, young and talented therapist in the field just passed his licensure exam and is going to be working with latency-age children. He asked for some literature and recommendations for working with this population. I LOVE to encourage and mentor the next generation of therapists, as I'm sure you do as well. I'm putting together a few notes, ideas and reading list for him and would value your recommendations as well (for him as well as for me). Just enter your recommendations in the comments below. THANK YOU FOR YOUR INPUT!

While there are MANY things to learn and know about working with this age population, and MANY fantastic books, I would recommend the following as a crash course to cover some of the broad strokes. Knowing that there is limited time to get up to speed, the books with the *asterisks are the ones I would say are the essential first reads. These are all clickable links to Amazon so you can get them right away.

Family Therapy

First and foremost: If you're working with kids you're working with families. Learn how to do family therapy—learn how to get comfortable in the chaos that can come with working with multiple people and dyanmics in the same room. Family therapy is your friend. Embrace it. I am amazed about how many therapists have only had one family therapy class in grad school (and no further post-grad training) who then go on to provide family therapy. Yikes! Further, I've sadly been amazed how much corrective work I've had to do for parents and kids who've been to therapists who've done "family therapy" that really wasn't. There are SO many books in this area I could recommend, of course, but this is a 101 Crash Course list.

*Family Therapy Techniques. You can't go wrong with studying the masters. This book is 30 years old and you'll be hard-pressed to find better. Minuchin was a family therapy pioneer. You would do well to study any of the family therapy greats: Whitaker, Haley, Madanes, the MRI Group, Milan Systemic, etc.

Working with Kids in Therapy in General

*The Child Psychotherapy Treatment Planner (Practice Planners) is a nuts and bolts idea-generator for when you are wondering what should I do with X situation?

Handbook of Evidence-Based Treatment Manuals for Children and Adolescents is another great go-to guide for getting ideas and strategies and goes into more depth than the first one. I have the first edition. This link is for the 2nd edition published in 2008.

Cognitive-Behavioral Therapy for Impulsive Children, Second Edition, is pretty self-explanatory...

Therapist's Guide to Clinical Intervention, Second Edition: The 1-2-3's of Treatment Planning (Practical Resources for the Mental Health Professional), is another great go-to-guide for "How might I approach X problem?" which covers many child/adolescent issues as well.

Play Therapy

*Play in Family Therapy, Eliana Gil. This was one of the best books I got in grad school that I devoured for ideas in working with kids in therapy of all ages.

Filial Therapy is one of the many forms of play therapy. The short version: It's basically parent training. Train the parent to be the in-home therapist as there's no one that is better situated in love and proxmity to be the best therapist than the parent is. I've done a lot of play, art and sandtray therapy with kids which is great. However, most of my work now with kids is in training the parent(s)...

Parent Training

Parents are interested only so much in developmental theory and your assessment. What they really want is to know WHAT TO DO in real-life practical situations at home and in-the-moment.

*Parenting With Love And Logic, by Jim Fay and Foster Cline. There are many fantastic parenting books out there. This one is worth it's weight in gold. It's solid and practical and parent-friendly in a way that empowers both parents and children. It's easily taught and also deep. I encourage the parents I work with (and new therapists) to learn one book well rather than many poorly or half-way. This is also true for therapeutic models. It's good to be eclectic and open in therapy. But watered-down versions of solid, research-based models is NOT good for anyone. So for the parent and the therapist LESS IS MORE. I wish I got a kick-back from them--Heaven knows I've sold enough of their books over the years for them just by telling parents to go buy them. This is such a great in-the-trenches model developed by a school principal and child pscyhiatrist.

Some more great Love and Logic resources:

Raising An Emotionally Intelligent Child The Heart of Parenting, John Gottman. Gottman was talking about emotional intelligence way before it became a buzzword. Classic solid Gottman stuff.

Before It's Too Late: Why Some Kids Get Into Trouble--and What Parents Can Do About It, by Stanton E. Samenow (pronounced sam-uh-naw) is a fascinating book by one of the leading clinical forensic researcher written for parents on how to catch and correct anti-social behavior "before it's too late."

Divorce

I taught the State's mandatory divorce parenting class for over a decade. I'll send you my handout packet I used for that.

Teach the grief process. Teach the importance of co-parenting.

Books:

*Vicki Lansky's Divorce Book for ParentsVicki Lansky's Divorce Book for Parents: Helping Your Children Cope with Divorce and Its Aftermath (Lansky, Vicki), I used this for years as the book for my divorce education class. Great, quick reference stuff.

Helping Your Kids Cope with Divorce the Sandcastles Way, M. Gary Neuman with Patricia Romanowski. This is a more in depth book than the above. Both offer great info and strategies for kids and fams.

Stepfamilies

Stepfamilies are THE most common family form. Learn stepfamily dynamics. If you don't know stepfamily dynamics (I'm amazed how many therapists don't!) then how will you be able to help the kids and parents you work with navigate a stepfamily successfully? [I do a workshop on this. Give me a call and we can set up a private training if you like on this or any of these areas).

ADHD and Behavior Modification/Shaping Basics

Funny, I've been treating ADHD for years in kids, teens and adults and I don't have any fav books that come right to mind. Hmmm.... Diagnose that. However, a parental fav many of my clients have found useful is: Parenting Children with ADHD: 10 Lessons That Medicine Cannot Teach (APA Lifetools)

I'll send you my draft of my upcoming book: 125 Alternate Solutions to Managing ADHD. This is available as a workshop as well. See the Parent Training section on the Seminars page.

I also teach a Study Smarter, Not Harder: Effective Learning Strategies for teachers, parents and students. You'll certainly be dealing with many bright kids who don't think they are bright because they've never learned how to succeed in school.

I'm happy to do private trainings for you 1:1 on any of these topic areas and/or I could come and do in-service trainings for your agency.