Month: April 2021

Reversal Theory “On The Couch”

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Reversal Theory “On The Couch” 

This one’s not going to make much sense if you haven’t been following the Reversal Theory series, but if you want to check them out, here’s #1, #2, #3, and #4.

Here, as promised, are some RT-based techniques (and tweaks on classic techniques) that I’ve used in really cool and fun ways in therapy, to good effect. 

 

  • Intake Questions: Most clinical interview/intake questions are aimed at determining the client’s presenting issues and background information for diagnostic purposes. Sometimes, questions are included about clients’ expectations for therapy, their goals, and their perceived strengths.
    • RT transformation:
      • How much do you experience yourself as being serious and goal oriented? In which area of your life do you experience the best sense of “achievement”? In which area of your life do you experience that the least?
      • Playful/enjoyment; Being like others/fitting in; Being an individual/freedom; etc.
  • Cognitive Therapy: Thoughts, feelings and behavior are all connected, and that clients can overcoming difficulties and meet their goals by identifying and changing inaccurate, maladaptive thoughts. First steps are identifying maladaptive thoughts, evaluating them for accuracy/utility, and then  developing reasonable counter-thoughts, which clients tend to struggle with.
    • RT transformation:
      • The opposing nature of the RT states gives a quick, easy way to begin identifying potential, but reasonable, counterthoughts. For ex, clients often have anxiety provoking thoughts such as “this  storm is very dangerous” or “I can’t do well at this and that’s awful”. Clients tend to try to create counterthoughts in the same state, and these can be hard to swallow or not very accurate. For ex, “this storm isn’t all that dangerous” or “Maybe I am good enough at this after all”
      • Changing states creates fresh, conceivable options. For ex, “This storm is fascinating and awe-inspiring”  or “I don’t need to do well at everything to be valuable.”
  • Couples Work
    • Couples are taught to identify the RT states they are in during typical conflicts. They re-enact the conflicts in session, with an emphasis on “getting into the partner’s state” (each in turn) to improve empathy, reflection, and problem solving.
    • Techniques to help couples see from their partner’s perspective include overt state-disclosure, switching seats, mimicking partner’s posture/expression/tone, letting the partner “paint the picture,” guessing the partner’s state, and state-mapping
  • Group Work
    • This is a psychodrama-type technique I call “the gauntlet.” Two rows of 4 pairs of players (“auxiliary egos”) line up and each speak from the opposing states on the problem the protagonist has identified. The protagonist (the client who is doing the current work) “walks the gauntlet” and listens, makes comments, moves players (sit down, back up, etc.), turns the volume up and down, etc., in an improvisational way.
  • Guided Imagery
    • In the Eight Rooms technique (specific to Reversal Theory) an individual or group is instructed by a leader in a guided imagery session. The participants envision a hallway with eight rooms, four on each side. Each pair of rooms represents a pair of RT states. The participants are instructed to enter each room and fill it with colors, objects, scents, memories, and anything that helps to define each state for them. For example, a telic room may have paneling on the walls, a large clock, diplomas, and a work desk. A paratelic room may have brightly painted walls, a hammock, a tiki bar, loud music, and a bubble-machine. The participants are instructed to use as many senses as possible and not to limit themselves to ordinary furniture or objects. They are encouraged that, after the guided imagery, they will be able to use their memory of each room in order to induce the state desired at the time.

COmment below: What ways can you imagine using RT in session? 

 

 

 

Preposterous Quote – Plans

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Frankly, this seems like a great way to alienate people and to accomplish less than you’re capable of. 

First, research is clear that sharing your individual goals (even if you don’t want help with them) improves outcomes, especially if you tell a friend or mentor. 

Second, other people can offer all kinds of support -not just encouragement and emotional support, but instrumental and tangible support! 

Third, the people who are going to be pleased by seeing your results are probably the people you want to tell, who want to help you. The people you don’t want to tell – unhelpful jerks? – aren’t going to be impressed. They’re still going be jerks.

Could we just change this one to say “Don’t tell unhelpful jerks your plans?” 

 

 

 

 

Online Resources (Vol 2)

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Online Resources (Vol 2)

Here’s another installment of some free, evidence-based online resources and apps I’ve stumbled upon lately… (here’s Vol 1 if you didn’t see it)

 

  • An ebook about Getting The Most Out of Brief Therapy – could be great for clients really early on, or if they are feeling stuck.
  • This is an incredible introduction to sleep, sleep hygiene, and common sleep issues by the AMAZING Dr. Jade Wu. 
  • I like this little explanation of the R.A.I.N model of radical compassion, and it includes a 20 minute meditation. 
  • These are easy and evidence based screeners for multiple mental health conditions, like depression, anxiety, psychosis. 
  • I’m loving Dr. Russ Harris’ videos about Acceptance and Commitment Therapy! 
  • For therapists, I really like Jeff Zeig’s 5 minute therapy tip s, esp if you’re kind of existential or experiential. 
  • And here is an abnormal psyc textbook that is completely open source – it’s not my favorite abnormal book ever, and of course it’s at the undergrad level, but could be a good resource for clients

And some apps!

  • FITZ – Functional Imagery Training is an evidence based blend of imagery and motivational interviewing that shows tremendous benefits over standard habit-changing models. 
  • SmilingMind – This is an Australian meditation app – it’s really good, especially compared to the for-profit apps! 
  • UCLA Mindful – This doesn’t have the kind of sleek, fancy feeling that some of the other apps do, but it’s really good and accurate and useful, with mindfulness exercises and meditations that are similar to the ones used in research protocols. 
  • Mindfulness study – an app based on the Palouse school’s resources, which are Top Notch! Note – they mean for you to do the whole 8 week program, but who wouldn’t want to do that? It’s amazing! 

Comment below: Have you seen any of these? What do you think? Have any new, other recommendations to post? 

 

 

 

 

Behaviorism for Parents 2

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Behaviorism for Parents – New Behaviors (Lesson 2)

If you haven’t read Behaviorism for Parents – The Basics, start there! 

You want behaviors done differently, or you want more complex behaviors.

(1) First, assume your kids want to behave and troubleshoot with them before assuming they are oppositional.

If your kids aren’t doing what you want them to do, make sure they CAN do it and KNOW that they are supposed to. So many instances of what parents think is “defiance” is actually a child not being capable for one reason or another, because we didn’t train them how (we just assumed they should know), or not knowing or remembering what they’re supposed to do when. Sometimes, they really didn’t hear you because they were focused on Minecraft they same way you don’t always hear your partner when you’re focused on a work email.

Kids are not shorter adults! They don’t have the same capacity for memory, sustained attention, fine motor skills, frustration tolerance, etc. as we do! Asking your kid to do the dishes is not equivalent to you doing the dishes. Kendra doesn’t wipe down the counters because she hates the feeling of crumbs in her hand and doesn’t have great coordination when she has to reach up so high. Marcus finds your “highly efficient” system for managing his multiple homework subjects too difficult to grasp and he’s already overwhelmed from struggling in Algebra 2.

Teach Kendra to hold a plate under the lip of the counter to catch the crumbs instead. Just give Marcus one big folder for homework and let him search through it at the beginning of class.

Be willing to train your kids (remember, that’s one of the main jobs of parents!) – that involves choosing behaviors they are capable of and then modeling, giving explicit instruction, doing it with them, helping while they practice, and then supervising their practice with feedback before they can do a behavior on their own!

Be willing to negotiate, or choose your battles. Is this behavior totally necessary for the family to function or for your kid to be a functioning adult? If they don’t make their bed, is it going to damage anything or just bother you? (Just bothering you isn’t a good enough reason to cause discord and stress in the family system!) If they eventually have a bed partner who wants it made, they can learn it then, can’t they?

(2) Second, you can build new or more complex behaviors through shaping.   

Shaping means starting with where your kid is (or where you are) and the making doable baby-steps toward the thing you ultimately want (successive approximations toward the goal). Sometimes this is pretty easy. If you want Jillian to make her bed, first show her how and then go through the training process (but don’t expect military corners if she’s only 6, please!), including showing, teaching, helping, and supervising. The first time she does it on her own, and it’s hot mess, just comforter pulled up and pillows askew, reward it anyway, however it is. That’s your starting point. The next day, or next week, up the ante a little. Remind her to pull up the inside sheet first – show, teach, help, supervise. Then, only reward a bed making that includes the inside sheet being pulled up. Don’t reward a bed-making if the underneath sheet is down. Just give a gentle reminder. Do the training again if need be. After another week or so, up the ante again. Remind her that all of her pillows and stuffed animals should be on the bed, at the top, facing front. Show, teach, help, supervise. Then, when she does it on her own, only reward a bed that is made with the comforter pulled up, the inner sheet pulled up, and the pillow and animals correct. Voila!  

You’ll also want to use this as your kids age, as an easy way to update their behaviors. For example, when kids are very little, they’ll need the whole training sequence to learn how to put their toys in their toybox. As they get a little older, they won’t need much training to put away toys and books, but they won’t be able to do things like “clean their room.” If you keep on top of how their capacities are increasing, you can increase the scope and complexity of their rule-following behaviors with relative ease.

Sometimes this is very hard, especially if you and your kid have gotten into a deep behavioral hole. If the behavior you have during a conflict is screaming+cursing+storming off, and the behavior you want is listening-quietly-with-a-calm-attitude-and-joining-you-pleasantly-for-dinner… there’s more work to do there than your kid will be able to do in one try, no matter how big the punishment or reward. So, even though you won’t want to do it, you will still need to reward the baby steps. That means that if your kid screams and curses, but doesn’t storm off – that behavior gets rewarded. That’s right. You heard me. After they are reliably not storming off, then you work on the cursing, then on the volume. I know it seems counterintuitive, but let me guess… you’ve already been trying it “your way” and it hasn’t gotten better, right? So, be willing to give it a try!

Note: There’s a Behaviorism for Parents Vol 3 here.

 

 

Comment: What other issues have your parent-clients had with implementing behavioral strategies at home? 

 

Misophonia

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Misophonia

Misophonia, or “hatred of sound,” is characterized by selective sensitivity to specific sounds accompanied by emotional distress, and even anger, as well as behavioral responses such as avoidance.

Or, as my 8 year old says, “Just thinking about the noise makes me die! Not literally. Metaphorically.” (Because yes, we do have ‘speaking accurately’ as a family value. What can I say? I’m a psychologist and a super-nerd.) Note, she says this while holding her ears and writhing. She follows up, “It’s like the sound goes inside my ears and then it gets in my body and makes all my muscles squeeze.” She squeals, like she’s something between angry and afraid. 

Yes, my darling. I hear you. For me, it’s like the sound goes inside my ears and then scrapes down all my nerves through my spinal cord. My teeth clench and my eyes close and my neck twists and my hip flexors tighten involuntarily. My autonomic system starts kicking in, but my brain has trouble turning that into a well-labeled emotional experience – something like completely irrational, slightly panicky anger disgust that’s not quite anger because I can’t quite get the cognitions to line up right.

For my daughter, it’s the sound of rubbing the seatbelt fabric. For me, the sound of a pencil writing on paper. For my husband, the sound of a rubber ball bouncing. 

If you’ve experienced this, you probably know it by now. But you can read more about misophonia here. Though it’s experienced by tons of people, it’s pretty new in terms of research and diagnostics. There is some cool brain data about the experience. It’s difficult to categorize, but if it’s significantly impairing a client’s ability to perform their basic life roles, it could probably be diagnosed at this point as Other Specified Obsessive and Compulsive Related Disorder. Though, I imagine in a decade or so, we’ll have a whole section about sensory issues and it’ll fit better there.  

Treatment is up in the air at the moment, though physicians, audiologists, and mental health folks are working on it. In our world, definitely there’s a place for distress tolerance work and maybe exposure & response prevention. But the place I’ve done the most clinical work on misophonia is couple’s therapy, believe it or not! Oh yes, most people can tolerate the discomfort on their own, but when it’s their partner making the sound, it takes on a whole new life! 

This is an experience that needs to be handled gently and cooperatively. (I mean, like we want everything handled in couples’ therapy, honestly!) The person who does not understand this probably needs to hear some of the science from us and be assured that their partner is not just making up their distress. The distressed partner probably needs to work on their distress tolerance and be sure they aren’t using their distress as a weapon. I will say that I have found that asking for a small behavior change when it’s possible is often easier, and that couples rarely want this to be the main issue. So, if the one partner could just not chew gum, that’d be great. Or throw away all the pencils with no eraser left – they’re just pencils! Consider ways to handle this issue as quickly and pragmatically as possible. Also, use it as an opportunity to talk about legitimate partner differences in experience! 

 

 

Comment below: Do you have this experience? For which sounds? Have you had clients bring it up, ever?