Tag Archives: Creativity

Creativity

Creating comics with clients

By Devlyn McCreight February 1, 2018

Academic and clinical interest regarding the intersection of comics and health care is high right now, which is no surprise to readers of Counseling Today. The July 2017 issue of Counseling Today featured a cover story titled “‘Cultured’ counseling” that provided perspectives on the clinical utility of integrating pop culture (such as video games, movies and comic books) into counseling practice. Similarly, both the American Psychological Association and the American Medical Association have devoted time and journal space to covering the topic, signaling that mental health counselors are not alone in wanting to explore the positive impact that comics can have on delivery of services.

Case in point: The 2017 Comics & Medicine Conference was held this past June in Seattle. An eclectic cross section of cartoonists, medical doctors, mental health professionals, teachers, students and librarians from across the globe attended. The conference theme, “Access Points,” explored how comics can open new gateways to health care “because of its ability to provide a platform for marginalized voices.” Because this worldwide chorus of marginalized voices often includes people with mental health diagnoses and comorbid disorders, comics can also help bridge the gap between client and counselor when utilized correctly.

As the body of literature regarding the therapeutic value of comics grows, the question is raised: Can comics be used as an intervention apart from traditional bibliotherapy? The focus of this article is to explore the rationale for creating comics with clinical clients, gain guidance from practitioners who use comic creation as a direct intervention and provide resources for those who are interested in learning more.

Beyond bibliotherapy

In the fourth edition of the American Counseling Association’s Counseling Dictionary, the intervention bibliotherapy is defined as “generally understood to be the reading of selected literature to help individuals gain a better understanding of themselves and others as well as to produce at times a healing or helpful catharsis.”

The bulk of recent literature regarding comics and mental health has fallen squarely into the realm of bibliotherapy, focusing on using graphic novels and memoirs to help clients better understand their own challenges. Although strong clinical evidence exists to support using existing commercially available materials to help articulate client experiences, a growing number of health services practitioners are advocating that patients and clients begin writing and illustrating their own stories.

Ian Williams, a comics artist, writer and physician who co-founded the Graphic Medicine movement, has suggested that revisiting trauma using sequential art can provide a form of catharsis for the creator, citing examples of prominent figures in the graphic memoir field such as Art Spiegelman (Maus) and Katie Green (Lighter Than My Shadow). His assertion is that the combination of visual art and narrative structure allows clients to reauthor their experiences in ways that simply talking through them do not.

This same hypothesis was the driving force behind the Defense Advanced Research Projects Agency (DARPA) using graphic novel software to assist combat veterans in dealing with symptoms of posttraumatic stress disorder. This initiative led to DARPA commissioning California-based software developer Kinection to design the Warrior Stories Platform for use with veterans.

Similarly, several public schools across the country have begun using online comic-creation software to help address ongoing behavioral issues for children with special needs. In addition, educators and social science researchers alike are using comic creation to help children tackle difficult real-world issues (such as making positive choices in the face of peer pressure), develop a more robust understanding of historical events (such as the Holocaust) and cultivate sound safety habits when interacting with friends and strangers.

As professionals from a multitude of disciplines create comics with others to help bridge the gap between educational content and personal experience, clinical mental health counselors can do the same with their clients.

The therapeutic act of creating comics

Scott McCloud, renowned cartoonist and educator, once defined comics as “images deployed in a sequence to tell a story graphically or convey information.” Given that comics are a storytelling medium, it is perhaps not surprising that the therapeutic act of creating comics falls under the scope of narrative therapy.

Narrative therapy is primarily concerned with the stories that clients have within them — those internalized beliefs formed by clients’ interactions with the various familial, social and cultural forces throughout their lifetime. Narrative therapies also place primary emphasis on the act of externalization of client issues. As Michael White and David Epston, the primary developers of narrative therapy, once famously surmised, “The person is not the problem, the problem is the problem.”

Externalization is used to help clients who overidentify with their problematic symptoms (“I am depressed”) begin to understand these experiences as distinct from their core self (“I am dealing with a really difficult depressive episode right now”). When I interviewed Katharine Houpt, an artist, licensed clinical professional counselor, board certified art therapist and lecturer at the School of the Art Institute of Chicago, she shared that the main strength of creating comics with clients is that it fosters the externalization process: “The idea is that experiences can be overwhelming and can take up so much space that it’s helpful to externalize them, and [creating comics] literally puts a container around those experiences so you can put them away on a shelf, so to speak, and [the problems] are separated from the person.”

Having a physical representation of an internal experience can be valuable because the idea of containment is extremely important when dealing with sensitive parts of a client’s experience. Each panel in the comic sequence functions as a figurative container for potentially overwhelming psychic material, allowing clients to approach the issue with a feeling of control or mastery that might elude them otherwise. The comic format also allows clients to represent themselves, others and even their disorders pictorially through the creation of avatars.

Working with clients to graphically depict interactions between themselves and problematic symptoms can help them uncover new insights. As with any other type of therapeutic intervention, it is important to choose comic-making directives that reflect an understanding of individual clients, their struggles and what resources they bring to the situation. “An example of something I’ve done recently is ask a client to create characters to have a dialogue based on the person’s conflicting thoughts when trying to make a decision,” Houpt says. “But again, this was done with careful consideration of the person’s history, possible responses, coping tools, motivation, ability, etc.”

Suggestions and considerations

Possessing a clear sense of best practices when creating comics (or any other type of art) with clients can help clinicians avoid therapeutic pitfalls and unintended confidentiality issues and create a safe space for the creative process. What follows are suggestions and considerations for therapists who are interested in beginning to integrate comic creation into clinical practice.

Create a functional space. Rebecca Bloom, a board-certified art therapist and licensed mental health counselor who practices in Washington state, suggested that clinicians try making art themselves in client spaces before introducing any interventions into practice. “I tell everyone that comes to my workshop, ‘Sit where the client will sit and try and make art in that spot.’ People inevitably come back and say, ‘Oh, well, it’s impossible to make art there.’ So I respond, ‘Great, now figure out how it would be more possible. Do the art supplies need to be closer? Do you need a lap desk? Do you need a coffee table that’s easy to use?’”

If the space available is not amenable for making art, this might require an investment in additional furniture that could be cost prohibitive. If an existing space and furnishings can be rearranged to accommodate the activity, it is also important to think through whether the space can remain in that configuration for clients who are not making art. If it can’t, it might be necessary to reserve time to reset the office between client sessions.

Remember, art is messy. Another consideration in determining whether a space is appropriate for incorporating any art making is whether the space is shared with other practitioners. “Art takes a little thinking through,” Bloom explained. “In some settings, it’s really hard, like for people who are in institutional settings. … Art is really messy. So, if there’s no way to be messy where you are, that’s going be a little problematic for art making.”

This holds true for comic creation too. India ink can be spilled, markers can be dropped onto couches, and erasers can leave behind rubberized crumbs. The reality of potential messes requires that practitioners be thoughtful about what materials they are willing to use during a session.

“Also, there need to be limits around time and mess,” Bloom said. “I stop the art-making process 10 minutes before the session ends because I want to make sure the people are back in their conscious process. I want to make sure we have time to clean up. [There are] materials that I don’t use. I don’t use paint in my office because it’s so easy to get out of control. I do spend money on fancy Copic markers with brush tips so you can have that experience of painting but without the mess.”

Invest in quality materials. Investing in quality materials will allow clients to stay focused on the therapeutic process instead of struggling to work with dried-out markers, inkless pens, stubby crayons or dull pencils. Additionally, having a selection of higher-grade media to choose from can signal clients that you are taking the art-making process seriously and being thoughtful about the materials with which you are asking them to work. “Clients can take a bad art-making experience personally,” Bloom observed.

Try it yourself first. Another common mistake clinicians sometimes make when using art directives during session is believing that instruction alone will inspire a client to make therapeutically meaningful art. “The only thing I hate for clients is when a therapist says, ‘Draw your darkest fear,’ and the client looks at them like, ‘You try that first. You try drawing your darkest fear,’” Bloom said. “You don’t want to ask anybody to do something that didn’t work for you, because you’re not going to be able to sell it very well, and you’re not going to be able to take care of somebody if it doesn’t go right. And you’re not going to understand the resistance in not wanting to do it.”

This also holds true for comic creation. If the counselor has never drawn a comic, then it will be difficult to understand client process from an artistic and therapeutic standpoint. One practice that can be helpful for therapists new to comic making is to try working with their own “daily comics journal.”

Kurt Shaffert, a fellow in applied cartooning at the Center for Cartoon Studies, located in White River Junction, Vermont, endorsed this practice, acknowledging that he has used it himself. “The basic idea is to sit down every morning and draw a simple three- to four-panel cartoon that captures where you are in that moment,” he said. “It was very helpful for me when I was going through some difficult personal circumstances. And when I began sharing them with my friends and family, they began to have a better understanding of what was happening with me during
that time.”

Houpt also uses the daily comics journal exercise to help temper the high emotions and excitement that can accompany working with comics. “I always emphasize the importance of pacing with clients,” Houpt said. “I think people can get really excited about comics and want to get really deep really fast. So something that I’ve done a lot with folks is ask them to keep a daily comics journal with just six panels per page. It puts a little bit of structure around it so that the experience doesn’t become overwhelming. And that practice has been really helpful for people to identify problems and solutions in their lives, to start recognizing themes, patterns and alternative stories about who they are through their personal artistic languages.”

There are also many opportunities for clinicians to gain firsthand experience with art therapy and comic-making interventions by utilizing local resources. Many art therapists, including those interviewed for this article, offer community-based workshops for clinicians and laypeople alike. Connecting with local therapists who regularly use art-based interventions can also provide valuable networking opportunities and potential ongoing clinical support as counselors begin to integrate art into their practice.

Read comics … and talk about them. If you are reading this article, chances are that you have some interest in the medium of comics, which exists apart from the therapeutic value of making comics. Exposing yourself to a wide range of commercially available comic books and graphic novels can help expand your understanding of what comics are — or ultimately can be.

Cultivating a broader understanding of what is considered a comic can help the therapeutic process in the long run. “I do find that I have to explain comics in many different ways to people,” Houpt said. “Sometimes I won’t call them comics. Sometimes I’ll say, ‘stories using words and pictures,’ or I will talk about something they might be familiar with, like the Sunday cartoons. … There’s all kinds of different interpretations. So, I just use that and make that part of the process of making comics with the client because, same as any other identifier about a person, it will mean a different thing to each individual.”

Talking with clients about their own beliefs regarding the medium can put them more at ease, which might allow them to experience greater gains from creating comics as part of the therapeutic process.

Be aware of the ethics regarding client art. There are additional ethical considerations that accompany counselors asking clients to make art for a therapeutic purpose. “I definitely think that all kinds of people can do some basic art therapy directives,” Bloom said. “I produce books that have those directives in them. Lots of people do. One of the major differences between people [who] are trained as art therapists and people who are not is what happens to the art after [it has] been made. It’s very common that people who are not trained as art therapists will put the art right up on the wall. Whereas art therapists believe that’s a private clinical conversation and that the client either takes that artwork home with them, or they keep it in the client’s file, or maybe the client destroys it. But it’s not up for public view.”

Another unintended consequence is that if a client walks into a room filled with client art, this might unknowingly set the expectation that all client art will be displayed, which can be problematic. As Bloom explains, “The idea within art therapy is that you might release something on the page that is unattractive that you don’t want anybody [else] to see. … If you go into an environment that has people’s art up on the walls, people will make less revealing art, most likely.”

Additionally, displaying client art might unintentionally create a false standard of how comic-making interventions “should look” for clients. Because some clients are more artistically inclined than others, certain clients might be reluctant — or even outright refuse — to create art because of insecurity around their abilities.

Self-portraits drawn by Kurt Shaffert (top) and Katharine Houpt.

“I also like to talk with clients about what MK Czerwiec discusses in her chapter in the Graphic Medicine Manifesto, which is the ‘fourth-grade slump,’” Houpt says. “That’s the idea that before fourth grade, everybody raises their hand when the teacher asks, ‘Who in here is an artist?’ And then starting in fourth grade, everybody points to the one kid who draws the best. So, why do we do that to ourselves? Why should we limit this outlet for joy and expression in our lives just because we think we’re not the best at it?”

Allowing clients to create comics without the pressure of comparison is essential for therapeutic work to occur, and that should be the goal of any intervention used with clients. Counselors should also know that any art created during a therapy session receives the same protections under HIPAA (the Health Insurance Portability and Accountability Act) that any other physical media (such as audio recordings and written materials) would.

Resources

It can be difficult for those who aren’t art therapists to begin working with a medium such as comics because the sheer amount of available materials can be overwhelming. The following list serves as a brief primer on texts that might be useful when beginning to integrate comic making into an existing practice. These recommendations were provided by the clinicians interviewed for this article and are grouped into separate categories for clarity.

General art therapy

  • Art Is a Way of Knowing: A Guide to Self-Knowledge and Spiritual Fulfillment Through Creativity by Pat B. Allen
  • Square the Circle: Art Therapy Workbook by Rebecca Bloom
  • The Art Therapy Sourcebook by Cathy Malchiodi
  • Materials & Media in Art Therapy: Critical Understandings of Diverse Artistic Vocabularies by Catharine Moon

Comics and Cartooning

  • Cartooning: Philosophy and Practice by Ivan Brunetti
  • Comics and Sequential Art by Will Eisner
  • Cartooning: The Ultimate Character Design Book by Christopher Hart
  • Understanding Comics and Making Comics by Scott McCloud

Conclusion

Although interest regarding the intersection of health services delivery and comics is at an all-time high, empirical research regarding the efficacy of comic creation as a direct intervention is largely absent. This might dissuade practitioners from introducing comic making into their therapeutic work, but it is important to remember that every testable intervention begins with a theoretical question, moves to the gathering of qualitative/anecdotal evidence and then transitions to quantitative outcome measurements.

This article has briefly addressed the narrative frame of comic creating while also sharing anecdotal insights from practitioners who use the intervention directly. The next step for helping make comic creation a more widely accepted and accessible intervention is to conduct rigorous research regarding outcomes. For social science researchers, these pursuits do not have to be conducted in isolation. That is reassuring for therapists such as Houpt: “I think that’s part of what was so exciting to me [about going] to the Comics & Medicine Conference this year. It was my first one. And to see people from so many different fields … different silos, who are doing similar work with different frameworks, different approaches, but arriving at similar outcomes. So, there has to be something there, and I wonder if part of the answer is more interdisciplinary collaboration.”

 

Author Devlyn McCreight, LMHC, draws a comic at his art desk. Photo by Sarah McCreight.

 

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Devlyn McCreight is a licensed mental health counselor and owner of McCreight Psychotherapy & Clinical Consulting LLC. Contact him at devlyn@mccreightpsychotherapy or through his website at drdevlyn.com.

Letters to the editor: ct@counseling.org

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Stories of empowerment

By Lindsey Phillips September 26, 2017

In 2009, writer Chimamanda Adichie gave a TED Talk on the danger of reducing people to a single narrative, using her own personal stories to illustrate the complexity of individuals. In one of those stories, she revealed how her college roommate in the United States had a single understanding of Africa — one of catastrophe. Adichie, a middle-class Nigerian woman, did not fit this single-story narrative. To her roommate’s surprise, Adichie spoke English, listened to Mariah Carey and knew how to use a stove.

Adichie points out that people are impressionable and vulnerable in the face of a story. Stories are powerful, she says, but that power is dependent on who is telling the story and how it is told. “Power is the ability not just to tell the story of another person, but to make it the definitive story of that person,” Adichie says.

Storytelling can also be used to empower people, which is one of the primary functions of narrative therapy. In many ways, the story of narrative therapy began in the late 1970s through shared stories and conversations between Michael White and David Epston. This counseling approach assumes that culture, language, relationships and society contribute to the way that individuals understand their identities and problems and make meaning in their lives.

The narrative approach also separates the person from the problem — a technique that allows clients to externalize their feelings. “The spirit of externalizing the problem is so that the client doesn’t see that as something that they can’t change,” says Kevin Stoltz, an American Counseling Association member who is an assistant professor of counselor education at the University of New Mexico. Moreover, this approach places clients as the experts in their own lives (see sidebar, below).

Don Redmond, an associate professor of counseling at Mercer University in Atlanta and director of the university’s Center for the Study of Narrative (CSN), points out that White and Epston’s original vision of narrative therapy was not prescriptive. “It really is in some ways theoretical, even though there are specific techniques that you can learn. It really is about celebrating and appreciating each person’s unique story and helping them frame it in a way that is more self-affirming and less self-defeating,” he explains.

(Re)writing memories

Narrative therapy can help clients release the burden of painful memories. Cheryl Sawyer, professor of counseling at the University of Houston–Clear Lake, started using narrative therapy in part because of an aha moment she experienced while watching a scene in the movie Harry Potter and the Goblet of Fire. In the scene, Hogwarts headmaster Albus Dumbledore shows Harry the Pensieve, an object that stores thoughts and memories.

Sawyer specializes in trauma counseling and often works with children who are refugees or who have been abused. She wanted to help her child clients release their traumatic memories, so she created a narrative project in which children create memory books. As Sawyer explains, the memory books operate like the Pensieve, allowing the children to unpack their trauma and give it a safe place to live.

Children do not narrate the episodes of their lives chronologically, Sawyer notes. Instead, their level of trust determines where their stories begin. If they trust the counselor, she says, they will reveal more intimate details (e.g., “I was beaten up at my birthday party”) rather than offering only the generic version (e.g., “I received presents”).

Because children’s narratives typically are structured but not sequential, it can be hard to discern cause and effect, says Sawyer, a member of ACA. To overcome this, counselors can have child clients place events from their stories on a timeline. This technique allows clients to see the cause and effect, understand their own behavior and possibly project what might come next based on the patterns they notice.

In Stoltz’s experience, Adlerian theory and early recollections (an Adlerian process in which counselors instruct clients to remember actual events from their early life) work well with narrative therapy. This is because they help people understand their self-concept and self-identity and make meaning out of the experiences embedded in their lives.

In a classical Adlerian sense, early recollections are defined as memories before age 10, Stoltz says. “The time frame … is somewhat artificial in some aspects, but in other aspects, it’s good to understand the very core of when those first experiences started to come out for people — what they remember, what they really think is poignant that … shapes their beliefs and their worldview,” he says. Childhood memories are often distorted by one-dimensional thinking because people’s perception in childhood is different than in adulthood, he adds. Re-storying involves recalling these early memories and reinterpreting them with an adult mindset that is capable of higher cognitive exploration.

Stoltz is currently applying guided imagery to career narrative stories. As he explains, clients often have a fictional or real-life person they admired when they were young because the person’s traits or behaviors matched the way they thought the world should operate. Often, they used this hero narrative to move through life, Stoltz says.

For example, with one client who presented a heroic memory of Spider-Man, Stoltz noticed a pattern: The client kept using the word conflict in his narrative. In discussing this pattern, they discovered that the client no longer wanted to let his responsibilities be an excuse for shying away from conflict. So, they worked together to determine how the client handled conflict currently, how the client wanted to handle it in the future and how the client’s role models handled conflict.

“Guided imagery is a way of projecting that hero data onto a future career decision or a career transition. And it makes it more lifelike in the session for the person. It begins to allow them to purposefully imagine and really begin to apply that self-concept to the next step in their career,” Stoltz says.

Stoltz uses narrative data from the career construction interview to develop individualized scripts, including ones focused on supporting client identity, meaningfulness of work and aspects of adaptability and skills. “The narrative approach is always about writing the next chapter, and this is a way of applying the next chapter to an imagined world, a daydream,” he explains.

Pictures worth a thousand words

Words can sometimes fail clients. If clients cannot or will not articulate their stories with words, counselors must be creative and find another way for clients to express themselves, Redmond says. “The more versatile a counselor can be, the better,” he adds.

Sawyer works with some clients who possess limited vocabularies because they have lived on the streets from an early age and haven’t been exposed to higher levels of language. For example, a child might say, “I’m really mad,” but that statement is insignificant compared with what he or she is actually feeling.

When children don’t have all the words they need to express their thoughts, Sawyer relies on pictures. She asks clients to draw pictures, find pictures on the Internet or even go out and take pictures that support the deeper level of emotion in their personal stories. Often, she will take a series of pictures into the counseling session and ask clients if any of the pictures express how they feel that day and why that image best exemplifies what they are feeling.

Technology is providing yet another avenue for clients to communicate their stories. Sawyer finds that children and adolescents are often more comfortable texting than talking, so she has started using technology as a tool in storytelling. She creates digital narratives by typing the clients’ stories into PowerPoint slides. Then, she gives clients the option of adding music, images or art to depict how they feel. For example, one client added a picture of his father’s death certificate, and another client added a picture of a pair of shoes she was going to send her sister before her sister was murdered.

Redmond also combines technology and narrative therapy. At Mercer University’s CSN, counseling students interview people in the community and then convert these interviews into digital narratives (approximately five-minute videos) by selecting pictures, art and music to complement each person’s narration of his or her own story. One woman whom Redmond interviewed painted and sang to express her story, and both aspects were incorporated into her digital narrative. Pairing descriptions of her artwork with actual images of it captured her essence more fully than if she had been only interviewed, he adds.

These digital narratives allow individuals not only to rewatch their stories but also to share their stories with others. In fact, one of Redmond’s goals for CSN is to create a digital library that will help individuals going through a difficult time to realize that they aren’t alone.

Taking a back seat

Narrative therapy falls under postmodern theory. “One of the hallmarks of the postmodern approach is embracing the fact that there is subjectivity with an individual’s perception and what they’ve been through and not having the counselor come in and be the expert,” Redmond says. With narrative therapy, he explains, clients are the ones verbalizing the new or modified narrative of their lives, and counselors only paraphrase or mirror what clients are saying.

Because narrative therapy is client driven, it is more important for clients to understand how they are feeling than for the counselor to understand it, Sawyer says. “[Counselors are] the tool that [clients are] using, the base that they’re using, to tell their stories for themselves,” she explains. Clients must be provided with a safe space where they can share their stories and learn to express their feelings about what happened.

As a volunteer with Bikers Against Child Abuse, Sawyer often attends court cases involving children who have been abused, and she has observed children’s frustration when lawyers interrupt or guide their stories in answer to a specific question. For Sawyer, this observation further underscores the importance of allowing clients, not counselors, to direct and narrate their stories. As she points out, counselors are facilitators for the client’s story, so their job is to listen and help the client structure the order of the story, not the content.

Stoltz has found that the process of deconstructing and reconstructing the elements of a client’s story is often challenging, particularly for counseling students. To demystify this process, in 2015, Stoltz, along with Susan Barclay, published a guidebook, The Life Design ThemeMapping Guide, that provides counselors with a process for deconstructing narrative data, developing specific themes for the career construction interview and helping clients reauthor their stories. For the past five years, Stoltz has used this technique to train students to deconstruct and theme elements together.

Taking a back seat and allowing clients to guide the session can be particularly difficult for new counselors because they want to feel that they are accomplishing something, Stoltz says. They want to sense that the client has made a decision and is moving in a direction. Drawing on James Prochaska and Carlo DiClemente’s Stages of Change model, Stoltz reminds counselors that they’re “raising awareness now. You’re in the beginning of the change model. You’re in the contemplation stage or precontemplation stage. You’re not looking for movement. You’re looking for insight or awareness, the aha moment.”

A voice for marginalized, multicultural populations

With narrative therapy, clients inform counselors about their world, values and beliefs. In fact, early recollections provide counselors with an inside view of the client’s culture, Stoltz says.

Within this dynamic, a counselor’s culture and values may differ from the client’s, but counselors should not place cultural judgment on what clients have done, Sawyer says. For example, clients might disclose that they have offered sex in exchange for food, or they may use profanity in telling their story, but counselors must refrain from passing judgment, even if they think this act or language is hideous or immoral based on their own cultural perspective. Clients must feel safe to use their own language and words to freely tell their stories, Sawyer adds.

Redmond agrees that narrative therapy is compatible with cross-cultural environments because narrative counselors do not presume to know and tell clients about their problems. He also realizes that too often, the stories of marginalized individuals remain unheard. One of Redmond’s inspirations for creating CSN was StoryCorps, an oral history project that allows people to record their stories in a studio by having a family member or friend interview them. The recordings are then archived at the Library of Congress. Through CSN, Redmond expanded the project to include marginalized populations (e.g., people who are homeless, refugees) who do not readily have someone available to interview them and record their stories.

Redmond believes the community plays a significant role in narrative therapy. Therefore, CSN’s purpose is both to allow counselors to practice their listening skills and to provide a service to the community by letting people who are marginalized know that they are valued. Even though the CSN interviews are not considered official therapy, most people would agree that the simple act of telling one’s story can be therapeutic, Redmond says.

Redmond’s personal story also played a role in the creation of CSN. Besides the fact that he has always enjoyed stories, Redmond had two professional experiences that strengthened his belief in the power of narrative therapy. First, in his role as a supervisor at Hillside in Atlanta, a facility that serves children with severe emotional behavior disorders, he discovered that the children with the most severe behaviors and who had been at the facility the longest also possessed the most strengths. This observation made an impression on him, especially considering all the negative messages directed at these children, many of whom had been abused and were in and out of foster care.

The second experience occurred when Redmond was an access clinician at a community services board. Many individuals were at this facility under court order or because they were dealing with mental health issues. While conducting intake interviews, Redmond amused himself by writing down the clients’ strengths (e.g., intelligent, strong work history, sense of humor, family support). At the end of the interview, he would tell the clients the strengths he had jotted down and then would ask if they wanted to add anything. He often witnessed powerful reactions from the clients, including those who cried and said no one had ever told them that they had strengths.

These two experiences reinforced Redmond’s belief that “people start creating negative self-stories, and they start to only believe the negative images, and then they forget about the strengths that they have.” Therefore, Redmond advises counselors never to forget to account for the strengths of their clients, no matter the difficulty of the case.

The cultural awareness gleaned from narrative therapy also applies to clients, allowing them to question their own cultures. Often, Stoltz says, the difficult part is relating the memories and stories back to the client’s present life. Some clients grasp this concept more easily than others, and some struggle to understand how childhood events are still affecting them as adults. The latter scenario is challenging. “Early memories really are a good tool to have to be able to talk to people from different cultures because [there are] stories in every culture. … Memories are a story, and [they are] a way of relating that whole story back to the person,” he says.

Validating narrative therapy

Critics of narrative therapy often question how counselors objectively measure narrative techniques, which are subjective. “I think we’re in the infancy of starting to measure these kinds of things. I think we’re just beginning to rediscover some of the things that have been helpful in mental health counseling, and we’re applying those as new techniques to the career narrative area,” says Stoltz, who served as chair of the research committee for the National Career Development Association, a division of ACA. At conferences, counselors are discussing how the narrative approach works, and they are doing outcome research that says it works, but they are not yet validating the process, he adds.

“You cannot quantify emotion,” Sawyer acknowledges. She and her colleagues attempted to measure narrative approaches by administering a pretest and posttest to children who had suffered trauma. They found a valid instrument and administered it in the children’s native language, but the formality of the instrument and the fact that the counselors had not yet established a relationship with the clients caused some clients to leave prematurely. Based on this experience, Sawyer decided not to administer the posttest and concluded that sometimes narrative therapy is not about research; it is about clients and their needs.

The best method Sawyer has found for measuring the success of narrative therapy involves having clients point to shapes (e.g., small, medium and large circles) to indicate how big their problems are both before and after counseling sessions. Using this method, she has found that narrative therapy has a positive effect because for most children, the representative shape decreases in size at the end of the counseling sessions. However, because counselors cannot account for all variables — if court is over, if the client is living in a home with 14 other children, if the client has learned to speak English and so on — it is impossible to know whether clients have improved strictly because of narrative therapy, she points out.

Redmond is a proponent of mixed-methods research because quantitative research (e.g., a Likert-type scale) provides more breadth than depth, whereas qualitative research provides the depth. In addition, they complement each other: Quantitative research can provide counselors with great ideas for qualitative research and vice versa. Redmond recommends first using quantitative research, such as a survey, because clients find it less threatening and less personal, but it will still get clients thinking about their experiences. Then, counselors can ask clients the magic question: “Is there anything you haven’t discussed that you would like to talk about?”

Stoltz has discovered that finding thematic codes for categorizing narrative data is one way to measure narrative techniques. For example, people who engage in storytelling about traumatic events in their lives tend to integrate these life events into meaningful stories and report higher life and career satisfaction.

“Preliminary evidence is beginning to show that when trained people read these stories, they come to the same conclusions,” Stoltz says. “That’s an important first step in validating …
this process.”

In addition, digital narratives may provide opportunities to quantify narrative interventions in the future, Redmond says.

Integrating narrative practices

Narrative therapy is not for the lightweight, and it is not as easy as it sounds, Sawyer says. In fact, self-doubt can prevent counselors from using narrative techniques, she points out. To avoid this, counselors need practical experience. Just taking one course or workshop or reading a book on the topic won’t mean that counselors will know how to use the approach correctly. Instead, Sawyer argues that counselor training should involve a holistic approach in which counselors expose themselves to the topic not only through courses, books and articles but also by practicing under supervision and processing all along the way.

Also, some counselors are hesitant to incorporate mental health-based approaches if their training is in another specialty such as career counseling. Stoltz, however, stresses the importance of taking an integrated perspective because people have multidimensional experiences that are not mutually exclusive. “Career counseling is often seen as limited to the career dimension, but it is really counseling with a career goal in mind,” he says.

For Stoltz, it makes sense to apply narrative therapy to career counseling because there is always a story behind one’s career. Furthermore, many people spend eight to 10 hours working every day, and work stress is a significant contributor to a person’s well-being or absence of well-being, he says. Despite this, counselors are generally not incorporating work aspects into mental health, he points out.

Thus, Stoltz argues that counselors “need to rethink [their] specialization construct.” Unfortunately, it is easy for counselor educators to design courses that address a certain standard (e.g., a career counseling course, a trauma course, a multicultural course). However, when counselor educators create stand-alone courses, students often move from one course to another without integrating those courses, Stoltz says. To avoid this, he incorporates basic counseling skills alongside career counseling because students must learn to respond to content and meaning before they can help a client deconstruct a story.

Sawyer’s counseling program at Houston–Clear Lake integrates narrative therapy into the curriculum by introducing narrative therapy as a counseling tool and working narrative techniques into multiple courses. “It is not the only way to counsel but … like how everybody knows how to do Rogers, everybody knows how to do Gestalt … all of my students know how to do CBT [cognitive behavior therapy] and trauma-focused CBT, and they all know how to do narrative counseling,” she says.

Stoltz agrees with expanding counseling areas, but he also worries that as counseling training becomes broader, counseling programs are finding it difficult to retain depth. Counseling students need to understand both the academic jargon and the practical training associated with those terms, he stresses. “Re-storying needs to be accompanied with a practical, pragmatic application of what that looks like and what that process is,” he says.

Stoltz is helping to bridge this gap by incorporating experience work in his classroom, which is a technique modeled after Mark Savickas’ pedagogical practice. For example, a counseling student might do a case study and follow someone through a career intervention, or a career story, and present this constructed story to the class.

Redmond finds that counseling students infrequently have many opportunities to train specifically in narrative therapy or narrative studies. Currently, students in his program are introduced to narrative therapy under the umbrella of postmodern approaches in a counseling theories course, but his goal is to have students do more specialized work in narrative therapy in the future. As a step toward achieving this goal, he will be working this fall on a proposal for a narrative certificate program.

Authoring the next chapter

Stoltz acknowledges that misinterpretation or a unitary interpretation of a client’s story is one of the pitfalls of narrative therapy. “[Counselors] feel like [we’ve] got the inside track on this because [we] have this psychological knowledge, this counseling knowledge, and [we] have to be careful with that,” he warns.

Often, counselors will make up their mind about what the story means to the client. But the counselor’s job is to test, not to interpret, Stoltz says. Counselors should make the client aware of what they see and test that theme or theory with the client while still respecting that it is the client’s story, he explains. The client is the one who has to live the life and rewrite the story; the counselor’s job is to help the client accomplish this.

Adichie reminds us that “stories can break the dignity of a people, but stories can also repair that broken dignity.” Narrative therapy provides clients with a safe space to tell their stories. With a counselor’s guidance, clients can slowly reject the negative stories and stereotypes that create an incomplete or inaccurate representation of who they are as individuals and replace them with stories that empower them to take control of their lives and regain their humanity.

Stories are powerful, but the person holding the pen is the one who controls the story. Revision is key when writing a novel, and this holds true in narrative therapy as well. People first have to understand and narrate their stories in order to rewrite them and become the authors of their next chapter.

 

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Narrative approaches

As explained in the fifth edition of Counseling and Psychotherapy: Theories and Interventions, edited by David Capuzzi and Douglas R. Gross and published by the American Counseling Association, narrative therapy is based on the following beliefs:

1) Clients are not defined by problems they present in counseling.

2) Clients are experts on their lives, so in counseling, judiciously seek their expertise.

3) Clients have many skills, competencies and internal resources on which to draw when impacting change and growth.

4) Therapeutic change occurs when clients accept their role as authors of their lives and begin to create a life narrative that is congruent with their hopes, dreams and aspirations.

 

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Lindsey Phillips is a freelance writer and UX content strategist living in Northern Virginia.
She has 10 years of experience writing on topics such as health, social justice and technology. Contact her at lindseynphillips@gmail.com or through her website at lindseynphillips.com.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The Counseling Connoisseur: The canvas of counseling

By Cheryl Fisher August 17, 2017

“My life has been a tapestry of rich and royal hue, an everlasting vision of the ever-changing view.” ~ Carole King

Summertime often brings opportunities to gather with family and friends. Over grilled goodies and cold beverages, we wallow away the hours, reminiscing of old and fabricating new visions and ventures. It was during one such event that the conversation turned toward the topics of careers, financial advisers and retirement.

My husband and I have differing views around the idea of retirement. He has wanted to live a life of leisure from the time I met him in his early 30s. I, however, have fallen madly and hopelessly in love with my vocation and can’t imagine a life without a clinical practice … or academic appointment … or literary presence … or speaking opportunities … or … Well, you get the idea. I am smitten.

When asked why I am so devoted to the cause, however, I fumble and stammer. “Well, we help people! And there’s never a dull moment. And …” — I finally concede — “I don’t actually know.”

After meditating on the question, I have arrived at six possible answers (beyond the obvious altruism of the craft):

 

1) Diversity. My counseling career extends over several decades and has taken me from work in geriatrics to hospice care and bereavement. As a young counselor, my elderly and terminal clients offered me wisdom around aging well and examining life fulfillment. I have made midnight runs, pumping with adrenaline, as I responded to survivors of rape and we attempted to untangle the multiple violations they had experienced, both from their perpetrators and the systems designed to help survivors. I have gone into school systems and witnessed an entire faculty and administration rally around young children whose home lives left an abysmal track of trauma and abuse. I have watched couples choose to remain together despite a breach of vows. I have witnessed the selfless act of a young mother relinquishing her parental rights in an attempt to offer her newborn baby a life that she could not provide while struggling with addiction. I have counseled in clinics, hospitals and hospices and, over the past decade, have settled into a more routine private practice. Each placement offered me rich and varied clientele, experiences and life lessons.

2) Flexibility. Counseling requires flexibility. Agendas are fluid and cocreated with the client. And let’s face it … you never know what your client will present in session. So we wait in anticipation, realizing that counseling is a dance perfected between therapist and client, but that each client brings her or his own footwork to the session. The counselor must be versed in a variety of dance steps and be willing to freestyle when it is appropriate.

In addition to the flexible nature of the counseling session, counseling hours are rarely 9-to-5. Instead, being a counselor often requires evening or weekend availability. It’s hardly a banker’s workday; we must be prepared to navigate inconsistent schedules that may include a crisis call or hospitalization. At the same time, not being locked down by a set schedule also allows for an occasional two-hour lunch with an old friend, a midday stroll, a hair appointment or even a nap.

3) Contemplative practice. I don’t know of any other career that promotes (requires) reflexivity. We are encouraged to “do our own work” and continue to examine the dynamics that occur in the counseling session. We process our feelings and thoughts not only in relation to our clients but also around our personal experiences that are occurring simultaneously. Is our countertransference therapeutically employed or hindering the therapeutic alliance? Have we devoted time to our own processes?

I remember coming home one night following a very long day and beginning a processing session (de-identifying my clients, of course) with my husband the engineer. We have been married long enough for him to know that he is not being asked to FIX anything when I process. However, at the end of my discourse, my husband just shook his head and asked, “Doesn’t all this thinking tire you out?” I laughed and responded, “No, it’s actually one of the things I love most about my work!” As Irvin Yalom wrote in his novel The Spinoza Problem, “[Counseling] is a strange field because, unlike any other field of medicine, you never really finish. Your greatest instrument is you, yourself, and the work of self-understanding is endless.”

4) Community. It is true: We counselors are a curious people. As such, we benefit from other similar-minded and like-hearted folks. We seek each other out through conferences, workshops and supervision. Through the years, our practices and the clients we serve also become extensions of our community. After all, we journey with our clients during their most vulnerable times, including in the aftermath of cancer diagnoses, struggles with substance abuse, marital affairs, deaths, divorces and other instances of devastation. We create community in the most unlikely of places through our work on disaster teams and travel to locations where unspeakable traumatic events have occurred. We are experts at building community.

5) Creativity. The field of counseling is broad enough to embrace the creative in practice. Counselors welcome the creative, as evidenced by the fact that I will be presenting workshops on “Superhero Therapy 101” and “Homegrown Psychotherapy: Nature-Enhanced Counseling” at the Association for Creativity in Counseling’s national conference in September. (The Association for Creativity is a division of the American Counseling Association.)

In addition to a slew of creative practices, our clinical canvas includes other modalities of service to the field that may include mentoring and supervising neophyte counselors. It is a privilege to be part of the skill-building of hope-generating newbies whose desire to help others supersedes their own discomfort around presenting their clinical work in class.

Furthermore, opportunities exist to contribute to the field through research, writing and presentions at conferences. And if that isn’t enough, there is a plethora of administrative and advocacy roles to serve the many affiliations that support the counseling field. This profession offers endless creative avenues for practice and service.

6) Mystery. Psychologist, researcher, author and educator Kenneth Pargament, in his book Spiritually Integrated Psychotherapy: Understanding and Addressing the Sacred, wrote, “Spirituality is an extraordinary part of the ordinary lives of people. … It manifests in life’s turning points, revealing mystery and depth. … It is interwoven into the fabric of the everyday. We can find it in music, the smile of a passing stranger, the color of the sky at dusk or a daily prayer of gratitude upon awakening.”

Although counselors employ strong evidence-based standards of practice, pastoral counselors (in particular) are cognizant of the mystery in our work and in the therapeutic process. That mystery can be found in the experience of when, having exhausted all tools in the clinical toolbox and feeling incredibly ineffective, a random question pops into your head. Having nothing to lose, you pose the question to your client, which results in a flood of emotional release (or an epiphany of sorts) that propels the session toward healing.

The counseling experience is filled with the unknown and the sacred — mysteries of interaction between human and divine. It is that experience of mystery that I have trusted when positioned with a client in the cesspool of tragedy and despair, knowing that the light will shine … eventually … again.

 

Conclusion

Image via Flickr https://flic.kr/p/9U6ha2

Counseling has served me well over the past 25 years. I embrace counseling and counselor education as vocations filled with integrity, diversity, flexibility, community and creativity. Counseling is a field that promotes continued personal growth as well as professional competence and humility. Counseling recognizes the beautiful mystery that at times transcends logic.

A colleague described her experience as a counselor as “a quilt of many shades and hues that converge together in a beautiful tapestry.” It is a tapestry of many threads, woven over time and accommodating the varied fabrics of a lifetime — of my lifetime. Retirement? I think not, for I have only just begun!

 

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Why do you enjoy being a counselor? Let me know. And don’t forget to stop by the Association for Creativity in Counseling 2017 Conference, Sept. 8-9, in Clearwater Beach, Florida, and visit me at “Superhero Therapy 101” and “Homegrown Psychotherapy: Nature-Enhanced Counseling.”

 

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Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is affiliate faculty for Loyola and Fordham Universities. Her research interests include examining sexuality and spirituality in young women with advanced breast cancer, nature-informed therapy and geek therapy. She will be presenting “Superhero Therapy 101” and “Homegrown Psychotherapy: Nature-Enhanced Counseling” at the Association for Creativity in Counseling Conference in September. Contact her at cyfisherphd@gmail.com.

 

 

 

 

 

 

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The Counseling Connoisseur: Feminist psychology and the Amazonian mystique

By Cheryl Fisher July 13, 2017

She wanted a hero…so that’s what she became! –Anonymous

 

Clad in her patriotic unitard and silver arm bands, her dark mane cascading as she twirls her golden lasso of truth, Wonder Woman has become an icon of beauty, physical strength and moral character. Her conception in 1941 has taken her from her Amazonian haven of Paradise Island into the land of patriarchy as she is committed to help humans end violence and suffering in the United States. From her 1940s pinup persona to her 1970s Lynda Carter television series and this summer’s blockbuster movie, Wonder Woman continues to wrestle with the underpinnings of injustice in a society plagued with inequity. In creating Wonder Woman, psychologist William Moulton Marston hoped to “set up a standard among children and young people of strong free courageous women and to combat the idea women are inferior to men, and to inspire girls to self-confidence and achievements in athletics, occupations and professions monopolized by men.”

Harvard professor Jill Lepore suggests in her book The Secret History of Wonder Woman that Wonder Woman acted as a bridge for feminism, highlighting the first cover of Ms. magazine in 1972 with the headline ‘‘Wonder Woman for president.’’ Yet, not everyone was convinced of this superheroine’s positive influence on young and impressionable minds.  In his 1954 book The Seduction of the Innocent, psychiatrist Fredric Wertham described Wonder Woman as “…always a horror type. She is physically very powerful, tortures men and has her own female following, is the cruel, ‘phallic’ woman. While she is a frightening figure for boys, she is an undesirable ideal for girls, being the exact opposite of what girls are supposed to be.”

While Wertham lost his argument declaring comics a contributing factor to delinquency, it wasn’t until 2010 that evidence of the manipulation of data supporting his theory was fully revealed.  Nevertheless, Wonder Woman remains a constant iconic figure in the history of feminism.

Feminist psychology: History

In an attempt to counter Freud’s male-centered theory of identity formation, Karen Horney and other female psychologists developed theories that did not exclude the female experience. It was believed that rather than experiencing penis envy, what women desired was the status and opportunity afforded to men. Rejecting Freud’s theory in 1926, Horney introduced the concept of womb envy, or the desire around women’s ability to create and connect to their children.

The first wave of feminism occurred between 1900 and 1920 and included the suffrage movement, which ultimately won women the right to vote. Simultaneously, the field of psychology was emerging with theories of learning and intelligence. Women who were instrumental to the early conceptualization of psychology included Mary Whiton Calkins, the first female president of the American Psychological Association (APA) and Margaret Floy Washburn, who was the first woman to earn a doctorate in psychology and was the second woman, after Calkins, to serve as APA president.  Women were generally excluded from academia and (ironically) Elizabeth “Sadie” Holloway, the wife of William Moulton Marston (the creator of Wonder Woman) earned a PhD in psychology but was forbidden to attend college with men.

Marston, a psychologist and inventor of the polygraph, produced a paper in 1928 that declared that human emotions came from four factors: dominance, compliance, submission and inducement. According to Marston, inducement was the most powerful of forces, encouraging one to submit – and producing pleasantness in the induced. This was a trait that Marston identified in women, on which he based his 1937 proclamation that women would establish a matriarchy in 100 years because they have the biological advantage with “twice the love-generating organs” as men.  It was from this theoretical framework that Marston introduced his Wonder Woman in 1941.

Biology or social learning and gender prescription

Early psychology and first wave feminism emphasized the biological differences between the binary assignments of male and female-ness. Philosopher, psychologist and Harvard University professor William James denounced women as leaders because of their “tender-minded nature.”  However, second wave feminists of the 1960 to 1980s repealed the androcentric approaches to gender identity and research began to identify greater similarities between men and women.

Many theorists agree that most noted gender differences result from social learning and rewards or punishments for desired socially prescribed behavior. In essence, the theory posits that boys and girls are rewarded for different behaviors and therefore, learn what behaviors are appropriate for their gender. Social structural theory builds on social learning theory by addressing the secondary skills learned as a result of the learned primary behaviors. For example, if a girl is rewarded for domestic skills, a secondary learned behavior may be communal skills. This may result in the stereotyping of domestic work and promote the continued disenfranchising of women.

Wonder Woman attempted to dispel gender differences and employed an internal locus of control. She attributed her successes to commitment and training and valued mental and moral strength, in addition to physical conditioning.

Cultural identity

In addition to gender identity, cultural and ethnic identity contribute to one’s overall sense of self.  Cultural identity involves actively learning about one’s culture (beliefs, values and customs) and developing a clear understanding of the meaning of culture in one’s life. This includes the development of positive feelings toward one’s cultural group membership. Cultural identity in younger children is viewed in terms of physical characteristics. As they mature, culture takes on more social and membership implications.  Research appears to suggest an increase in cultural identity formation during middle adolescence. Furthermore, researchers Timothy Smith and Lynda Silva found evidence to suggest that cultural identity is a predictor of wellbeing among minority adolescents. Wonder Woman identifies as a member of the Amazons living in Paradise Island. While she is fluent in most languages, she is unfamiliar with the rules that accompany an androcentric world. She is abruptly thrown into a society that does not value women as equal [to men] and forces women to bind themselves [in clothes] “restricting their ability to be free to battle.” She wears her arm bands as a reminder that she will never be bound by anyone again. She must learn to acculturate in a way that honors her past and helps her function in the present. She must find membership and belonging in this new land, [which are] tasks that resonate with individuals migrating from other countries.

Conclusion

Wonder Woman has been described as complicated and dichotomous. According to researcher and social work educator Paige Averett, Wonder Woman “is feminine, sexual, submissive and dependent. She is also strong, capable, independent, fierce and ultimately a warrior. Unlike so many other female role models, she does not promote a one-dimensional view of the lived experience of being a woman. Wonder Woman is not just a sexy, attractive woman or just a strong kick-ass heroine or just a nurturing daughter and girlfriend or just a hardworking, justice-loving and world-changing working woman. She is all these things. Wonder Woman does not have to choose.”

Maybe this is the mystique of the Amazon princess that has remained strong for more than 75 years. While she is clearly not free from bias as a light-skinned, blue-eyed, dark haired, slender, more-than-able-bodied demigod, the idea of Wonder Woman poses the vision to engender life without prescription, to capitalize on individual strengths and to promote endless possibilities … for all persons.

 

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Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is affiliate faculty for Loyola and Fordham Universities. Her research interests include examining sexuality and spirituality in young women with advanced breast cancer; Nature-informed therapy: and Geek Therapy.  She will be presenting Geek Therapy 101 at the Association for Creativity in Counseling conference in September.   She may be contacted at cyfisherphd@gmail.com.

 

 

 

 

 

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Related reading: See Counseling Today’s July cover story on the intersection of pop culture and counseling: wp.me/p2BxKN-4Lb

 

Letters to the editor: CT@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

‘Cultured’ counseling

By Laurie Meyers June 22, 2017

Pop culture has long exerted an influence on our lives, but some might argue that this overlap has unofficially reached its peak. After all, in November, a former reality TV star was elected president of the United States. And, of course, it is now possible for us to play computer games, listen to music, watch movies and stream live TV on a single device that is rarely out of arm’s reach for many of us. Some decry this confluence, stating that (among other things) people have become addicted to the internet and their smartphones and that video games glorify and encourage violence.

But rather than view pop culture as the ruination of society, some counselors say that elements of popular entertainment can actually be used strategically to enhance client-counselor communication and the therapeutic relationship. These counselors — many of whom are enthusiastic consumers of “geek” culture themselves — are turning comic books, TV shows, movies and video games into vital therapeutic tools.

For Steve Kuniak, a licensed professional counselor and private practitioner in Greensburg, Pennsylvania, the idea of using elements of pop culture in practice formed early, inspired by the words of a professor in his introduction to counseling class. “He said that counseling is one of the few — if only — professions where the professional uses themselves as the tool, and so we as professionals should bring everything we are into our counseling in order for it to be most effective,” Kuniak recalls. “That resonated with me, and what I am at my core is a gamer/geek.”

Not very long ago, the term geek had negative connotations and was used to belittle those who were viewed as being “different” in some way — often because they were out of step with popular culture. But now many of the interests formerly associated with geeks are routinely celebrated in mainstream culture, making it hard to define what today’s “geek culture” embodies. Kuniak says that, broadly, geek culture includes a love of video games, comic books, other types of games (tabletop games, board games, collectible card games) and the science fiction and fantasy genres.

For Kuniak, however, what truly qualifies someone as a geek (in the most positive sense) is the enthusiastic degree of interest that he or she shows in something. “It’s not just enough that I watch Star Wars,” he explains, “but rather that I need to know all of the characters’ back stories, I need to understand the philosophy of the Jedi … While I’m at it, maybe I should know how to build a lightsaber.”

Kuniak believes that being a self-described geek enhances his practice. “It helps me to create meaning with my clients,” he says. “If I’m talking to someone about the difficulties of their addiction, they might understand what I’m saying generally, but if I start talking about the ‘One Ring’ from Lord of the Rings and how Gollum ‘hates and loves the Ring, as he hates and loves himself,’ my client might get that imagery more and relate to it better. I can talk about feeling like no one can possibly understand me, and [how] I try to help people, but in my fear of doing something wrong, I end up hurting them, and the client might relate. However, I can relate this to the story of Darth Vader in Star Wars, and now the imagery is more solid.”

Kuniak likes to use clips from The Lord of the Rings and Star Wars as conversation starters in his group sessions, particularly with clients who are struggling against substance abuse issues. “The idea of the journey to destroy the evil Ring, and to have the Ring itself attempt to pull people back into darkness, resonates with this population,” he says.

Another film Kuniak likes to use is The Avengers, which he finds particularly useful in family therapy. “As we see in the film, the Avengers all have unique superpowers and don’t get along because they all want to be the individual hero of the story. Once they put their differences aside, they are more able to stop the bad guys and save Earth. Similarly, I’ll have each family member design their own superhero, [and] we talk about real strengths and weaknesses they’re experiencing. Then we go through The Avengers story, with clips if needed … and we work out how all of their powers work together. We explore how those powers and their weaknesses relate to their real strengths and struggles in the home, and how they can work together like the Avengers to build a stronger family.”

Playing in the virtual sandbox

Kuniak also frequently uses video games such as Minecraft in session as a kind of “virtual sandbox” for play therapy. “I find that video games have such a universal appeal right now that my client population tends to have at least some familiarity with them, and many are full blown gamers” (individuals who regularly plays interactive games). “This isn’t any specific age group either, which is what’s nice. I have clients from 4 to 40 and beyond who make gaming a part of their regular routine.”

“I’ve helped my clients build characters and improve goal setting by making smaller goal steps like they find in their games,” Kuniak continues. “I’ve also used some games that require voice input to help illustrate the point that when you don’t say things well — like when you’re inconsiderate to your parents — you don’t get what you want.”

Gaming proved particularly instrumental in helping one of Kuniak’s clients, a young boy with autism, move forward with therapy. At first, Kuniak says, the boy “was very resistant, and we struggled at getting any headway in his sessions.” Kuniak talked with the boy’s mother, and together they worked out a plan.

Kuniak learned that the boy was particularly a fan of the video game Halo, which requires players to build virtual worlds. Kuniak asked the boy to bring his Xbox video game system to sessions, and they began creating virtual worlds together.

“He was able to begin to talk to me [while engaged in the process],” Kuniak recounts. “Through helping him design a stage in the game, he began to trust me more, and we worked together. He very quickly began talking to me about the game and what he liked about it. He was able to identify that he didn’t like Halo [and other video games] because he got to shoot people or because he liked violence. Rather, he felt like he didn’t fit in at school, and characters like Master Chief in Halo made him feel like he was doing something good by saving the galaxy.

“When we eventually finished our treatment experience, he was able to use his … world at home. I heard back from his mom a few years later that he’d still go into that world and play around when he was having a hard time with things. She seemed to think, and I’m hopeful, that he was using it to remember all the sessions we worked through and the progress we made.”

Graphic examples

Lauren Calhoun, a doctoral student in counselor education and supervision at the Chicago School of Professional Psychology and a crisis counselor at Lutheran Social Services of Illinois’ Project Impact and Welcoming Center, thinks comic books can be a powerful tool in therapy.

“Graphic novels [and] comic books … resonate with us [because] they give examples of what we can be,” she says. “While we may never wear costumes and have superpowers, we can see how these heroes overcome obstacles, much like [we do]. They show that one has a choice on how to respond. They also deal with real issues like grief and loss, trauma, injury and belonging. Comic books also give us an escape, but it can be meaningful and aid us in learning about ourselves.”

Calhoun, a member of the American Counseling Association, recently used a graphic novel featuring Batman to explore issues of grief and loss, belonging and feeling “different” with a group of clients who were struggling with serious mental illnesses. She made copies of some of the novel’s chapters and brought them to the group, asking members to either journal about their responses to the chapters or to add their own comic book page.

Group participants were also asked to consider the actions of the characters and to talk about how they might respond in a similar situation. About four weeks into group therapy, participants began creating their own comic books, making themselves heroes or villains and identifying an antagonist. Calhoun says that just envisioning themselves as heroes was extremely helpful, whereas others portrayed their presenting problems as villains that they could then vanquish.

ACA member Emily Dennis thinks that characters such as Batman might prove especially appealing in areas such as college counseling. When she was working with students at the Counseling and Human Development Center at Kent State University, Dennis and a colleague tossed around the idea of creating a group counseling experience based on the iconic superhero.

“We discussed it being focused on increasing social skills and ‘coming out of your bat cave,’” Dennis says. “We even brainstormed a curriculum based on various behavioral levels for group members to advance toward earning a cape. Unfortunately, it never progressed further than our imaginations. … However, I think there’s potential in using characters that clients can connect to as examples in counseling. Batman is one of those characters. There are many interpretations of Batman’s mythology, but in the most basic sense, his is a story of resiliency and the duality of public and private personas, which can be important themes in counseling.”

Batman isn’t the only hero who has inspired Dennis. “Another example of a popular culture character whose story can be meaningful to clients is Harry Potter,” says Dennis, who also worked as a doctoral intern and clinical resident at Child Guidance and Family Solutions in Akron, Ohio. “A few years ago, I had an insightful teenage client who was reading the Harry Potter series during the course of our work together. Luckily, I had read the books previously, and our sessions adopted a sort of unexpected bibliotherapeutic approach. As she progressed in the seven-book series, we processed the themes of love, loss and believing in yourself, and she identified parallels in herself [and] Harry Potter. Despite the magical or supernatural aspects of these stories and characters, the essence of these examples is very human and relatable. It’s why I believe they may be of value in counseling.”

Screen savers

Dennis and Calhoun are also proponents of using television shows and movies as adjuncts to traditional counseling approaches. With one of her groups and in some individual therapy, Calhoun has used Star Wars and the TV show Doctor Who to explore issues of right and wrong and feelings of loneliness and loss.

“I would show an episode or section of the movie, then ask questions for them to journal about and share if they wanted to,” she says. In addition to using favorite characters from TV shows and movies to address major themes in counseling, this approach can provide clients with a safe avenue to talk about challenging issues in their life, she adds.

Dennis has found that TV shows can also make excellent teaching tools in the classroom. Currently a temporary faculty member in the counseling department at Indiana University of Pennsylvania, Dennis recently taught a course on counseling and consulting within systems.

“When I was designing the class, I thought about showing a film that demonstrated some of the complicated dynamics that occur within systems, as well as giving my students a chance to practice creating genograms with the fictional family,” Dennis says. “I remembered that when I was a master’s student, we watched Ordinary People, which is a family therapy classic, but I wanted to push it further and match what I showed them with each of the systems theories we were learning from week to week. Sitcoms provided excellent examples of many of the systems theory concepts I was teaching. I liked that sitcoms were available through the various streaming subscriptions I had, they were 22 minutes or less and not nearly as heavy as some of the content featured in full-length feature films.”

Dennis used shows such as Black-ish, The Goldbergs, Roseanne and Everybody Loves Raymond to explore systems therapy concepts such as differentiation, triangulation and transgenerational patterns. “I created conceptualization worksheets for the students to work on in groups after we watched the episodes,” says Dennis, a doctoral candidate in counselor education and supervision. “My students reported enjoying the viewing and conceptualization activities. I think it encouraged them to think systemically, and we laughed as a class.”

Dennis cautions, however, that not all elements of pop culture can be considered therapeutic. Her school counseling students have been discussing the Netflix TV series 13 Reasons Why, which has become a ubiquitous presence in the lives and conversations of teenagers across the U.S. The show revolves around the suicide of a high school girl. Although Dennis has yet to see the show, she notes that suicide prevention experts are concerned that it might encourage copycat behavior and promotes the idea of suicide as a solution to problems and a weapon for revenge.

“I think it is important to be aware of what our clients and students are viewing or reading and the popular culture characters they idolize, celebrate or fear, especially with younger clients, who have a harder time differentiating reality from fiction,” Dennis says. “I’ve encouraged my students to research some of the popular culture references that their young clients talk about in counseling sessions. Most of the characters, shows and movies are benign, but fear and fascination provoked from characters like those in the video game Five Nights at Freddy’s or the internet meme of Slenderman are worrisome and worthy of addressing in counseling.”

The positive power of pop culture

As a whole, however, the professional counselors interviewed for this article view pop culture as a largely positive influence. Kuniak believes it even has therapeutic value for society at large.

“With all the exposure to heroic belief systems, there may be some transference of resilient ways of thinking and behaving. Because we expose ourselves to so many self-sacrificing individuals in fantasy, we can’t help but learn a little about being good people,” he explains. “Additionally, our individual areas of fandom provide us joy. There’s nothing like that. Just being able to sit down and indulge in something that provides such positive vibes can be great therapy all in itself. After that, we [counselors] need to help people use it all responsibly and take the next steps with it.”

Licensed professional counselor Josué Cardona is a proponent of “geek therapy” and a big believer in the power of pop culture. His website, Geek Therapy (geektherapy.com), started as a place to gather articles about geek culture being used in positive ways, and it now hosts six different podcasts that explore connections between pop culture, mental health and psychology.

“I see geek and pop culture as a celebration,” says Cardona, a former private practitioner in North Carolina who is currently working as a personal and professional coach in New York City. “There is a lot of positivity in communities that rally around their love of something. At a time of such polarized politics, with people itching to fight and so much negativity online, fandom and fan culture is still all about celebrating something. The reason why I enjoy comic and pop culture conventions is because everyone there is celebrating something. There is nothing but positive energy, mostly. So especially today, when so many things seem negative, imagine how beneficial it is to be a part of a group that is celebrating something, anything.

“These groups also help us feel less isolated, and thanks to social media and online communities, we can find people who like something we do, even if the people closest to us do not. In general, this … is beneficial in that it allows for social interaction and healthy relationships.”

Kuniak thinks that all counselors can — and probably should — learn how to use pop culture as a tool in their work with clients. “Most folks are acquainted in some way with the material we’re talking about … and are gaining some of the benefits of exploring geek culture — like the transference of heroic belief systems — without even knowing it,” he says. “The trick is that, at times, we need someone to guide us through that transference process, which is why I think that counselors need to be better acquainted with the medium. The culture is already laying the groundwork. If we speak the language, there’s a potential goldmine for linking in with our clients, building rapport, having a common language and helping them to make change.”

Cardona is planning to publish a “geek therapy playbook” in which he recommends several ways for counselors to integrate pop culture into their sessions. One common-sense approach is simply embracing what clients like and trying to see the world through their interests, he says. Counselors can do this by asking clients about fictional characters that they relate to or even just asking them about their current passions.

“The best insights here come from clients relating to characters and stories, seeing themselves in them and opening up about how they feel,” Cardona says. “It is often easier for a client to explain how they feel or how they see themselves by giving an example, real or fictional.”

Counselors can also use their own passions as a means of helping to explain or demonstrate a concept, Cardona says. “Think using a sports metaphor, [or] using Spider-Man to explain anxiety, or comparing a gaming mechanism to a real-life situation,” he says. “Here, although the client may not be a fan, the excitement and knowledge of the therapist can be more clearly understood and more engaging.”

When counselors use pop culture references in session, they may find that clients enjoy some of the same things, which can create a kind of shared language between them, Cardona says. For instance, when Cardona referenced Spider-Man in a session with a client, it inspired the client to talk about his own love of the X-Men — a passion that Cardona just so happens to share.

“The client was struggling with anxiety, and he said he liked comic books, so I used Spider-Man to explain anxiety,” Cardona shares. “Spider-Man is my go-to for anxiety and comic book characters because his spider-sense is a warning system, much like anxiety, and Spider-Man is one of the most popular comic book characters. I was surprised when [the client] told me he didn’t really know much about Spider-Man, but he loved the X-Men, so I asked him if there were any X-Men characters he really liked and why. He then used his own examples of X-Men characters and events that he thought represented what I was trying to explain about anxiety with Spider-Man. He continued to do this until he found a character — I believe it was Professor Xavier — whom he felt had been through a similar experience as what he was going through.”

Once Cardona was able to tap into that interest, the client went from barely speaking to becoming fully engaged in the sessions. “We shifted to discussing his symptoms in the context of the X-Men and made progress very quickly,” he says.

For counselors wishing to dive deeper into the world of comics, Calhoun recommends the website Comicspedia (comicspedia.net). “It lists several different books by topic or character as well as some ideas of how to incorporate comics into therapy,” she explains. She also suggests querying local comic book store employees if a counselor is searching for a fitting character or comics series to use with a particular client. “I have asked my local shops for suggestions, and most have been helpful,” she says.

Some counselors may like to have clients try creating their own comic books as a therapeutic tool. Helpful apps are available for creating comic books on a computer, but Calhoun says these tend to work best with individuals. In groups, she finds it easier to provide participants with blank comic strips on which to create their stories.

Says Cardona, “I see geek therapy as a mindset, and if I had to simplify it, I would say: Care about what your clients care about. We don’t have to care about gaming, for example, but it is beneficial to the therapeutic relationship that it matters to us that it matters to our clients. This enhances the counseling process in many ways: Counseling is more fun, it helps with rapport, and it can lead to insights more quickly.

“The insights are for everyone involved because I believe that the best way to understand someone is through the things that they love. So when a client talks to you about their favorite things, the things they enjoy doing, the reasons for that can include very telling insights about having related with characters or experiences in those stories.”

 

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Additional resources

Read more about how counselors are using pop culture in their work with clients:

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editorct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.