Therapy With Young Men 16-24 Year Olds in Treatment

1. The Culture of Young Men

1. What’s it like to be a guy today?

1. What’s good
2. What’s not so good

2. What do guys value most?

2. What’s Going on Developmentally?

1. Erickson’s psychosocial stages

1. Identity vs. role confusion
2. Intimacy vs. isolation

2. Early adolescence and self-concept

1. Role of early adolescence in identity formation
2. Early wounds carried into later life

3. Important developmental considerations

1. A time of questions about identity
2. A time of need for more autonomy
3. A time of different culture and values

3. Are Men and Women Different?

1. Relational differences (research summary)
2. Gender differences (research summary)
3. Key differences in therapy

1. More behavioral problems
2. More alcohol and drug problems
3. Less relational skills
4. Less emotional awareness
5. More prone to "control and conquer"
6. More "systemizers" in life approach

4. Qualities of Great Therapists

1. Qualities of master therapists
2. 10 qualities of great therapists for young men

5. Prelude to Therapy

1. Effective therapy with young men

1. Focus on identity formation
2. Improve emotional intelligence
3. Reduce behavioral and substance problems
4. Develop relationship skills

2. Important theoretical influences

1. Motivational interviewing
2. Cognitive behavioral therapy
3. Positive psychology

3. Unique challenges in therapy with young men

1. Usually referred for what concerns others (usually parents) and not what concerns them
2. Typically less open to help initially
3. Once engaged, there is often a lack of alignment between their goals and the goals of those who referred them
4. There are often thorny confidentiality issues

4. Case example – Curtis

6. The Tone of Therapy

1. Setting the tone of therapy

1. Structured and directed
2. Fun and playful
3. Honest and straightforward
4. Smart and interesting
5. Inspiring and stirring

2. Therapeutic gift giving

1. At least one "gift" every session
2. Could be a skill, insight, encouragement, validation, etc.

3. Three types of therapeutic constructions

1. Too similar
2. Too unusual
3. Just right

4. Self-disclosure in therapy

1. Can be beneficial
2. Done well, can strengthen rapport and increase therapeutic effectiveness
3. Done poorly, it can detract from or even undermine therapy
4. Should be done sparingly, strategically, and for the good of the client

5. Therapy in the age of Facebook

1. Multiple issues to consider regarding technology and online contact
2. Emerging field of study and consideration

7. Creating a Context of Change

1. Change in treatment

1. Some people change without any treatment
2. Some people change with just a little treatment
3. Hopefulness predicts outcome
4. Accurate empathy is best predictor
5. Change talk predicts positive outcome

2. Conditions for change

1. People change when they feel discrepancies
2. Discrepancies between where they are and where they want to be
3. Discrepancies between who they are and who they want to be

3. Task of therapy – exposing discrepancies
4. Stages of change

1. Pre-contemplative
2. Contemplative
3. Preparation
4. Action
5. maintenance

5. What we can learn from therapy dropouts

1. Average dropout rate is 35%
2. Highest risk of dropout is in the pre-contemplation and action stages
3. Biggest factors in early termination

1. therapist rated alliance
2. client rated alliance
3. client motivation
4. client self-efficacy

6. Assessing ready, willing, and able

1. Don’t treat pre-contemplators or contemplators like they are ready to change
2. Need to resist the righting reflex
3. Ready – is it a priority right now?
4. Willing – is the issue to be changed important?
5. Able – is there the confidence to change?

8. Guiding Principles of Therapy with Young Men

1. Four general principles

1. Express empathy
2. Develop discrepancy
3. Support self-efficacy
4. Roll with resistance

2. Avoiding therapist pitfalls

1. Arguing for change
2. Assuming the expert role
3. Criticizing, shaming, blaming
4. Labeling
5. Premature focus
6. Being in a hurry

3. Fast is slow, slow is fast

9. Beginning Therapy

1. First session

1. Involve parents (if living with them)
2. Current concerns
3. Relevant history
4. Strengths
5. Preliminary goal setting
6. Confidentiality, information sharing

2. Working with parents

1. Involve early in process
2. Establish an agreed upon feedback loop
3. Explore their goals for therapy
4. Clarify who client is and whose agenda you accept
5. Discuss possible discrepancies between their goals and client goals
6. Explain motivational model
7. Clarify your role and their role
8. Clarify difference between acceptance of the person and endorsement of the behavior
9. Support their right to seek help from a different perspective
10. Have regular times to check in with them if client agrees

3. Interaction techniques

1. Open-ended questions
2. Reflective listening

1. simple reflections
2. amplified reflection
3. double-sided reflection

3. Affirmations
4. Summaries

4. Early assessment questions
5. Types of change talk

1. Disadvantages of status quo
2. Advantages of change
3. Optimism for change
4. Intention to change

6. Evoking change talk
7. Early motivational strategies

1. Typical day
2. Look back
3. Good and bad things
4. Stages of change discussion
5. Values exploration
6. Look ahead
7. Explore ready, willing, and able
8. Cost-benefit

8. Case example – Rick
9. Strengthening confidence for change

1. Evoking questions
2. Confidence ruler
3. Review past successes
4. Personal strengths and supports
5. Brainstorming
6. Reframing
7. Hypothetical change
8. Considering radical change

10. Going Deeper

1. Later stage cautions

1. Underestimating ambivalence
2. Overprescription
3. Insufficient direction

2. Developing an effective change plan

1. Setting goals
2. Considering change options
3. Arriving at a plan
4. Eliciting commitment

3. Collaborative Goal setting

1. Use goal wheel
2. Goal agreement

11. Helping Identity Formation

1. Happiness and identity

1. A philosophy of happiness
2. Research on young male happiness

2. Happiness paradigm
3. Interventions to improve happiness
4. Development of positive self-attributes

1. Personal inventory
2. Strength enhancement

5. Sexuality issues in therapy

1. Keep your voyeuristic tendencies in check
2. Development of personal sexual ethic and boundaries
3. Accurate information about sex
4. Pain of past sexual hurts and negative experiences
5. Issues of sexual orientation

1. continuum of sexuality
2. challenges of gay and bisexual young men

12. Improving Emotional Intelligence

1. Boys and emotion
2. A model for understanding and sorting out emotion

1. Primary emotions
2. Emotional roots
3. Emotions in time (past, present, future)

3. Improving stress coping

1. Using the stress analyzer
2. Teaching ways to cope with stress

1. reduce stressors
2. increase coping strategies
3. change meaning of stressors

3. Identifying poor coping and good coping strategies

13. Working on Behavioral and Substance Problems

1. Improving anger control steps

1. Triggers
2. Signals
3. Sequence
4. Strategies
5. Rehearsal

2. Managing risk areas

1. Risky situations
2. Risky thoughts
3. Risky feelings
4. Risky actions ("seemingly unimportant decisions")

3. Use of custom checklists
4. Improving decision-making skills

1. Series of questions about past, present, future
2. Self-cues to prompt
3. Rehearsal and practice

14. Improving Relationship Skills

1. The 4-T social skills

1. Talk about…
2. Track
3. Throw back
4. Tune in

2. Relating in intimate relationships
3. Helping others

Biography

David Verhaagen, PhD, ABPP, is a licensed psychologist and managing partner/CEO of Southeast Psychological Services. He is a well-published author and a frequent speaker; he is also one of fewer than 100 psychologists in the US to be board-certified by the American Board of Professional Psychology (ABPP) in Clinical Child and Adolescent Psychology.

"Drawing on more than 20,000 hours of treatment with young men, Dave Verhaagen has developed a comprehensive therapeutic strategy to engage young men – not only in therapy, but actually engage them in their own lives. This book is more than ‘useful’ – it’s vitally necessary." - Michael Kimmel, SUNY Stony Brook–New York, USA; author, Guyland: The Perilous World Where Boys Become Men

"Therapy with Young Men is an excellent book. Dr. Verhaagen describes a wide range of effective cognitive-behavioral interventions that can be implemented with adolescents and young adults with severe behavioral problems. For clinicians who want concrete tools that they can use in their practice to lower resistance and engage out of control adolescents, this is a must read." - Scott P. Sells, author, Parenting Your Out of Control Teenager; Treating the Tough Adolescent

"[This book] targets a narrow age and gender group, and this fills a gap in many clinicians' knowledge and skills base. It is clear that Verhaagen has a vast experience of working effectively with this client group, something that he is able to share in this very readable book." -Cheryl Bailey, Birmingham and Solihull Mental Health Foundation Trust, UK, in Child and Adolescent Mental Health