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Instructor’s Manualfor

COGNITIVE-BEHAVIORAL THERAPY

WITH

JOHN KRUMBOLTZ, PHD

from the series

PSYCHOTHERAPY WITH THE EXPERTS

with hosts

Jon Carlson, PsyD, EdD & Diane Kjos, PhD

by

Randall C. Wyatt, PhD

&

Eileen Flanagan, MA

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COGNITIVE-BEHAVIORAL THERAPY WITH JOHN KRUMBOLTZ, PHD

The Instructor’s Manual accompanies the DVD Cognitive-Behavioral Therapy with John Krumboltz, PhD (Institutional/Instructor’s Version). Video available at www.psychotherapy.net.

Copyright © 2009, Psychotherapy.net, LLC. All rights reserved.

Published by Psychotherapy.net 150 Shoreline Highway, Ste 1 Mill Valley, CA Email: [email protected] Phone: (800) 577-4762 (US & Canada) / (415)332-3232

Teaching and Training: Instructors, training directors and facilitators using the Instructor’s Manual for the DVD Cognitive-Behavioral Therapy with John Krumboltz, PhD may reproduce parts of this manual in paper form for teaching and training purposes only. Otherwise, the text of this publication may not be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the publisher, Psychotherapy.net. The DVD Cognitive-Behavioral Therapy with John Krumboltz, PhD (Institutional/Instructor’s Version) is licensed for group training and teaching purposes. Broadcasting or transmission of this video via satellite, Internet, video conferencing, streaming, distance learning courses or other means is prohibited without the prior written permission of the publisher.

Wyatt, Randall C., PhD, & Flanagan, Eileen, MA

Instructor’s Manual for Cognitive-Behavioral Therapy with John Krumboltz, PhD

Cover design by Sabine Grand

Order Information and Continuing Education Credits:For information on ordering and obtaining continuing education credits for this and other psychotherapy training videos, please visit us at www.psychotherapy.net or call 800-577-4762.

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Instructor’s Manual for


Table of ContentsTips for Making the Best Use of the DVD 4

Krumboltz’s Approach to Cognitive-Behavioral Therapy 8

Krumboltz’s Reflections on the Session 9

Reaction Paper for Classes and Training 11

Suggestions for Further Readings, Websites and Videos 12

Discussion Questions 14

Complete Transcript 16

Krumboltz’s ApproAch 16

psychotherApy session 26

Group Discussion 49

Video Credits 69

Earn Continuing Education Credits for Watching Videos 70

About the Contributors 71

More Psychotherapy.net Videos 73

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Tips for Making the Best Use of the DVD

1. USE THE TRANSCRIPTSMake notes in the video Transcript for future reference; the next time you show the video you will have them available. Highlight or notate key moments in the video to better facilitate discussion during the video and post-viewing.

2. DISCUSSION QUESTIONSPause the video at different points to elicit viewers’ observations and reactions to the concepts presented. The Discussion Questions provide ideas about key points that can stimulate rich discussions and learning.

3. LET IT FLOWAllow the session to play out some so viewers can appreciate the work over time instead of stopping the video too often. It is best to watch the video in its entirety since issues untouched in earlier parts often play out later. Encourage viewers to voice their opinions; no therapy is perfect! What do viewers think works and does not work in the session? We learn as much from our mistakes as our successes and it is crucial for students and therapists to develop the ability to effectively critique this work as well as their own.

4. REFLECT ON KRUMBOLTZ’S REFLECTIONSAfter showing the video, hand out copies of Krumboltz’s Reflections on the Session, giving participants an opportunity to read Krumboltz’s own summary of his intentions for the session and his reflections on how it went.

5. SUGGEST READINGS TO ENRICH VIDEO MATERIALAssign readings from Suggestions for Further Readings and Websites prior to viewing. You can also time the video to coincide with other course or training materials on related topics.

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6. ASSIGN A REACTION PAPERSee suggestions in Reaction Paper section.

7. ROLE-PLAY IDEASAfter watching the video, organize participants into pairs. Assign each pair to role-play a therapy session using Krumboltz’s Cognitive-Behavioral Therapy approach. The clients may resemble the client in the video, or you can create different scenarios, and you may have players switch roles if time permits. As a basic instruction, suggest to the therapists that they begin by establishing ground rules for the session with the client. After clarifying the client’s concern, therapists may want to problem-solve with the client to identify constructive actions the client can take. Encourage therapists to focus on instilling hope in the possibility of learning and change. See Krumboltz’s Approach to Cognitive-Behavioral Therapy in this manual for a brief review of how he works. After the role-plays, have the groups come together to discuss the exercise. First have the clients share their experiences and then have the therapists talk about what the session was like for them. What did participants find exciting and/or challenging about this way of working? Finally, open up a general discussion on what participants learned about Cognitive-Behavioral Therapy.

An alternative is to do this role-play in front of the whole group with one therapist and one client; the entire group can observe, acting as the advising team to the therapist. Before the end of the session, have the therapist take a break, get feedback from the observation team, and bring it back into the session with the client. Other observers might jump in if the therapist gets stuck. Follow up with a discussion that explores what participants found exciting and/or challenging about this way of working.

8. WATCH THE SERIESThis video is one in a series portraying leading theories of psychotherapy and their application. Each video in the series presents a master therapist working with a real client who has real problems. By showing several of the videos in this Experts series (See the More

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Videos section for a complete list of the videos in the series), you can expose viewers to a variety of styles and approaches, allowing them an opportunity to see what fits best for them.

More Videos with this Client: In this video, Dr. Krumboltz works with a client named Robin. Robin is featured as a client in several other videos in this Experts series:

–Integrative Therapy with Allen E. Ivey, EdD;

–Mind-Body Therapy with Ernest Rossi, PhD;

–Person-Centered Therapy with Natalie Rogers; and

–Solution-Focused Therapy with Insoo Kim Berg, MSSW.

It can be particularly enlightening for viewers to watch some or all of these five therapists work with the same client to see how their styles, personalities and theoretical orientations play out differently. If you have viewers write a Reaction Paper – see the guidelines in this manual – you can ask them to address what differences they notice in how Berg, Krumboltz, Rossi, Rogers and Ivey work with Robin, and how these differences affect the outcomes of the sessions.

Other videos in the series use different therapeutic models. We can reflect upon the differences among these models by exploring the following questions:

• How does the model explain the therapeutic process?

• What assumptions does the model imply about the purpose of therapy?

• How is theory translated into practice in real-life situations?

• What is the role of the therapist?

• What outcomes are associated with successful therapy?

9. PERSPECTIVE ON VIDEOS AND THE PERSONALITY OF THE THERAPISTPsychotherapy portrayed in videos is less off-the-cuff than therapy in practice. Therapists or clients in videos may be

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nervous, putting their best foot forward, or trying to show mistakes and how to deal with them. Therapists may also move more quickly than is typical in everyday practice to demonstrate a technique. The personal style of a therapist is often as important as their techniques and theories. Thus, while we can certainly pick up ideas from master therapists, participants must make the best use of relevant theory, technique and research that fits their own personal style and the needs of their clients.

*A NOTE ON PRIVACY AND CONFIDENTIALITYBecause this video contains an actual therapy session, please take care to protect the privacy and confidentiality of the client who has courageously shared her personal life with us.

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Krumboltz’s Approach to Cognitive-Behavioral Therapy

A leader in the practice of cognitive behavioral therapy, John Krumboltz, PhD describes his work as a learning approach to counseling. Whether the goal is learning to think, learning to feel, or learning to act, Krumboltz advocates for an education based model.

In his counseling sessions, Krumboltz considers himself a coach and a teacher. The therapeutic relationship provides hope, and supports the client in formulating and accomplishing goals. Cognitive problem-solving techniques are an important aspect of the process. In the course of the session the client will typically have the opportunity to practice new attitudes and behavior. The counselor provides positive reinforcement and helps the client devise tasks that will reinforce new behavior and transfer these attitudes onto other aspects of experience.

Krumboltz finds this approach useful across cultures, and he applies it effectively with individuals, groups, families and couples. For Krumboltz, therapy is successful when clients change in the way they want to change.

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Krumboltz’s Reflections on the Session

I think that the most important goal of counseling is to help clients learn how to take the next action step in the real world toward dealing effectively with their problem. Active listening is certainly important, but it is not enough.

So in this case with Robin I had seven goals:

1. Let Robin know the local ground rules including the fact that we were making a movie that could last no more than 40 minutes;

2. Discover Robin’s concern and let her know that I understood her feelings about it;

3. Offer some hope that constructive action could be devised;

4. Allow her to propose potentially satisfactory solutions;

5. Provide a model of one way in which some action could be taken;

6. Have her actually practice the action in a role play; and

7. Get her to agree to try the proposed action in her real world.

I think the counselor should be of maximum help in the shortest reasonable amount of time. She wanted to know how much history of the problem I wanted to hear. I asked her to tell me what was going on now. Every problem has a long history, but the crucial issue is what can be done about it NOW.

Robin came to counseling alone. She could have brought her husband, but she didn’t. She could have brought her mother-in-law, but she didn’t. If other people had been included, I would have wanted to solicit their views too, and the counseling might have taken a quite different direction.

I believe people do what they think is the best thing to do at each moment given all their circumstances. Even Robin’s mother-in-law was doing what she thought was best, and I wanted Robin to see that her mother-in-law’s behavior was understandable even though it was not acceptable to Robin.

Cultural values are an important part of counseling. Robin wanted to

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operate independently without unwanted intrusions by her mother-in-law. As one of the audience members pointed out, this view would be unacceptable in other cultures where respect for one’s elders is highly valued. However, Robin was my client. I accepted her values. If I had not, I probably would not have been able to help her and would have referred her to a more suitable counselor.

What would I have done differently now that I have had more time to think about it? Not much, given the short time we had. I thought the counseling session was reasonably successful. I only wish I had not used the word “ugly” to describe the mother-in-law’s behavior. That was too harsh a word. Now I think the word “inappropriate” would have been better.

If I had been her regular counselor and could have seen her subsequently, I would have asked her if she would be willing to email me a brief report about the action she had agreed to take. And I would have asked her to name the date and time by which I should expect to receive her email. It is too easy to assume that counseling is over when the client leaves the office, but the crucial action is still ahead. Will the clients actually do what they have promised to do? Asking for email reports increases the probability that they will actually take the promised action.

What if the client does not fulfill a promise? My rule is never blame the client. I would engage the client in a discussion about their thinking. Maybe the task was too difficult. Maybe some other task would be better. Maybe there are some questions that need to be considered first. But still the bottom line is this: What can the client try to do in the real world as a next step toward resolution of the problem?

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Reaction Paper for Classes and Training

Video: Cognitive-Behavioral Therapy with John Krumboltz, PhD

• Assignment: Complete this reaction paper and return it by the date noted by the facilitator.

• SuggestionsforViewers: Take notes on these questions while viewing the video and complete the reaction paper afterwards, or use the questions as a way to approach the discussion. Respond to each question below.

• LengthandStyle: 2-4 pages double-spaced. Be brief and concise. Do NOT provide a full synopsis of the video. This is meant to be a brief reaction paper that you write soon after watching the video—we want your ideas and reactions.

What to Write: Respond to the following questions in your reaction paper:

1. Key points: What important points did you learn about Cognitive-Behavioral Therapy? What stands out in how Krumboltz works?

2. What I found most helpful: What was most beneficial to you as a therapist about the model presented? What tools or perspectives did you find helpful and might you use in your own work? What challenged you to think about something in a new way?

3. What does not make sense: What principles/techniques/strategies did not make sense to you? Did anything push your buttons or bring about a sense of resistance in you, or just not fit with your own style of working? Explore these questions.

4. How I would do it differently: What might you have done differently than Krumboltz in the therapy session in the video? Be specific in what different approaches, strategies and techniques you might have applied.

5. Other Questions/Reactions: What questions or reactions did you have as you viewed the therapy in the video? Other comments, thoughts or feelings?

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Suggestions for Further Readings, Websites and Videos

BOOKSEllis, A. (2001). Overcoming destructive beliefs, feelings, and behaviors:

New directions for rational emotive behavior therapy. Amherst, NY: Prometheus Books.

Krumboltz, J.D. & Levin, A. S. (2004). Luck is no accident: Making the most of happenstance in your life and career. Atascadero, CA: Impact Publishers.

Meichenbaum (2002). Cognitive behavior modification: An integrative approach. New York, NY: Springer.

Reinecke, M.A. & Clark, D.A. (Eds) (2003). Cognitive therapy across the lifespan: Evidence and practice. Cambridge, UK: Cambridge University Press.

WEB RESOURCESJohn Krumboltz’s web pages at Stanford University www.stanford.edu/~jdk

www.stanford.edu/group/adolescent.ctr/Research/ krumboltz.html

Psychotherapy.net online interviews with Albert Ellis and Donald Meichenbaum www.psychotherapy.net

Association for Behavioral and Cognitive Therapies www.aabt.org

National Association of Cognitive-Behavioral Therapists www.nacbt.org

The British Association of Behavioural and Cognitive Psychotherapies www.ocdaction.org.uk

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RELATED VIDEOS AVAILABLE AT WWW.PSYCHOTHERAPY.NETMixed Anxiety and Depression: A Cognitive-Behavioral Approach

-Donald Meichenbaum, PhD

Cognitive-Behavioral Child Therapy

-Bruce Masek, PhD

Couples Therapy for Addiction: A Cognitive-Behavioral Approach

-Barbara S. McCrady, PhD

Integrative Therapy with Allen E. Ivey, EdD*

Mind-Body Therapy with Ernest Rossi, PhD*

Person-Centered Therapy with Natalie Rogers, PhD*

Solution-Focused Therapy with Insoo Kim Berg, MSSW*

* additional videos that feature the same client and therapists from different theoretical orientations.

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Discussion Questions

Professors, training directors and facilitators may use a few or all of these discussion questions keyed to certain elements of the video or those issues most relevant to the viewers. On-screen minute markers are noted to highlight related points in the video/transcript.

KRUMBOLTZ’S APPROACH1. LearningApproachtoCounseling: How do you relate to the

idea of the learning approach to counseling? In your clinical work, do you consider yourself a coach and a teacher? Why or why not? If not as a coach or teacher, how do you see your role?

THE PSYCHOTHERAPY SESSION2. Understanding the Client: (2-2:2-9) Early in the session,

what do you notice Krumboltz doing to let Robin know that he understands her problem? Do you think he is successful? What do you think Krumboltz accomplishes with this focus on understanding the problem?

4. Interesting Dilemma: (2-9) What is your response to Krumboltz telling Robin she has an interesting dilemma? How do you think his framing her dilemma as “interesting” affects Robin and the work they do together? How is this intervention consistent with Krumboltz’s learning approach?

5. Emotional Abuse: (2-28) What do you notice in yourself when you observe Krumboltz telling Robin that she is being emotionally abused by her mother-in-law? Do you agree with Krumboltz’s assessment? Does his approach seem to further the therapy or slow it down?

6. Role-Play: (2-30) How did Krumboltz’s role-play interventions affect Robin’s therapy? For example, his choice to exaggerate Robin’s mother-in-law when it is his turn to play her part? What guides your use of role-plays?

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7. Interventions: Which of Krumboltz’s interventions in this session seem most effective to you? What do you think of the way he encouraged Robin to first reflect on a recent experience before going into the history of the problem (2-3)? Or, asking Robin why she thinks her mother-in-law behaves as she does (2-9)? What about his approach to problem-solving with Robin (2-20:2-30)? How might you have intervened differently if you had been the therapist here?

8. Therapeutic Relationship: How would you characterize the therapeutic relationship in this session? Do you think Krumboltz developed a working alliance with Robin? In what ways was the therapeutic relationship significant in this particular course of therapy?

GROUP DISCUSSION9. Values (3-37): What do you think of Krumboltz’s assertion that

all therapy is value laden and that the values of the counselor come into play particularly around the issues of contract? In thinking of this session, were there any moments where you became aware of Krumboltz’s values? How do you see your own values coming into the work you do with clients?

10. Uncomfortable Techniques (3-43): Krumboltz asserts that we have to serve the public using the best techniques we know, even if they are uncomfortable to us. How does that idea sit with you? What do you think of his analogy comparing counseling to treating a patient with appendicitis? What do you do when you find yourself trying out clinical techniques that feel uncomfortable to you? Does this seem like an ethical issue to you?

11. Personal Reaction: How would you feel about being Krumboltz’s client? Do you believe he could create an alliance with you and that the therapy would be effective? How so?

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Complete Transcript of Cognitive-Behavioral Therapy with John Krumboltz, PhD

Note to facilitators: You will find chapter markers on the DVD at five-minute intervals so that you may easily skip to desired points in the video. Throughout the transcript below, we indicate on-screen minute markers that correspond with those that appear at the bottom right corner of the DVD on screen. In the transcript of the psychotherapy session itself, use the numbered entries to draw attention to desired points within the dialogue.

KRUMBOLTZ’S APPROACH1–1Carlson: I’m just wondering: What’s your sense of what cognitive behavioral therapy is?

Kjos: I see it as a structured, systematic approach to therapy that’s based on scientific principles. Basically the therapist applies his or her scientific knowledge about human behavior to helping the client solve a problem.

Carlson: Oh, okay. It’s my understanding that it’s based upon two underlying beliefs, and the first is that a person is both a product and a producer in their environment. And secondly, that if someone can change their thoughts, or their cognitions, or their behavior, or actions, then they can actually bring about a change in their life. How does this relate to other theories?

Kjos: Well, I think it’s probably what you would call a cognitive theory, although often when you watch a person work in this area, you see them doing things that you would call person-centered as they build the relationship with the client, because that’s a key part of it.

1–2But the therapist acts in a way as a teacher, a coach, maybe an expert in terms of how to accomplish the client’s goals, in some cases.

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Carlson: Well, let’s find out some more about cognitive behavioral therapy from our guest, John Krumboltz. John? Welcome.

Dr. Krumboltz: Thank you.

Carlson: Thank you for joining us today.

Krumboltz: Thank you.

Kjos: John.

Krumboltz: Hi.

Carlson: John, can you tell us a bit about cognitive behavior therapy, and just how it works?

Krumboltz: Well, first I should mention that cognitive behavior therapy is not my favorite word in the world. It’s too much of a mouthful to say, for one thing. And the other thing is that its, well, it doesn’t describe the entirety of what we’re doing as well as a phrase such as “a learning approach to counseling,” because learning, to me, encompasses the entirety of what we are about. Learning to think, learning to feel, and learning to act.

1–3Carlson: So you’d see this cognitive behavioral approach, then, as a learning-focused or a learning-centered approach.

Krumboltz: Absolutely.

Carlson: Um-hmm. How do you make an intervention and make it work, though? What is the underlying principles of change, then, in this learning model?

Krumboltz: The underlying principle of change is an educational model. We are educating people. That’s what the… The counselor is an educator. The metaphor that I think may be most useful is to sort of think of yourself as a coach. What does a coach do? Suppose you want to improve your golf strokes. So you go to a golf coach and you say, “Help me.” Okay, well the coach doesn’t start off by giving you a lecture about golfing or the history of golf.

1–4The coach will say, “Let’s see you swing. What do you do? Starting

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with the way you are right now.” And then begins to help you figure out ways to improve. “Why don’t you try standing this way? Why don’t you grip the club this way? And experiment with some different alternatives and see if it makes any difference in where the ball goes.” See, it’s very much an educational model.

Carlson: So it sounds like the counselor observes and then provides feedback?

Krumboltz: Uh, it doesn’t have to be the counselor who observes and provides feedback. The client can observe and provide feedback. The client can elicit observations and feedback from other people, too. The counselor can also add to it, but is not the sole provider of such guidance.

Kjos: The counselor, then, serves somewhat as an expert?

1–5Krumboltz: Well, the counselor is an expert, but an expert in the sense of helping the process. Not an expert in deciding what the goal ought to be. I mean, if you said, “Oh, I’m not interested in improving my golf game,” the coach is not going to teach you how to hold a golf club.

Carlson: So you’re not going to manipulate or make somebody do something that they don’t want to do.

Krumboltz: Well, of course not, of course not.

Kjos: How did this therapy get developed, or what was the process of development of this approach?

Krumboltz: Well, you know, there is no one guru of the learning approach to counseling. I think thousands of people have contributed to it. But one could identify a few people who made some notable contributions.

1–6In a sense, Albert Ellis was one of the early proponents of an approach. He called it Rational Emotive Therapy, but he clearly contributed an important cognitive development. B.F. Skinner, of course, is a notable proponent of a behavioral approach. I don’t know whether those two

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ever met. They may have. But I don’t think they ever cooperated on doing anything. But lots of other people. Meichenbaum, of course, has contributed a lot. Aaron Beck.

1–7And thousands of other people have made contributions to our understanding of how to help people by applying a learning approach. So it has evolved over the decades until we sort of have an accumulation of techniques that seem to be very effective in helping people accomplish what they want to accomplish.

Kjos: How do these techniques or this theory as it has evolved apply to the many different cultural types of clients that we now see, the sort of multicultural characteristics?

Krumboltz: Well, you see, everybody from every culture learns. I mean, that’s how they apply their culture is by learning. So the basic principles apply to everybody. But the specifics of how you help a person might be quite different depending upon their cultural background.

1–8See, now one feature of this learning approach is that we don’t deal just with remediation of problems that already occurred but we also do preventive work and developmental work. And one example of that is a study that was done by Steven Schinke and Beverly Singer. They were working with Native American adolescents on helping them develop better nutrition habits and preventing them from starting to smoke. They set up some groups; they arranged for indigenous personnel to be the leaders of these groups and trained these leaders.

1–9They used Native American folktales to illustrate the traditional American Indian values of health, of pure mind, of pure body, of pure spirit. They used models from the American Indian heroes who illustrated the principles of good health. And so the technique of helping people learn was tailored to the culture of the people who are trying to learn, to maximize the learning that occurs. But the basic principle of learning is still the same, no matter who you’re trying to help.

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Kjos: What about someone who sees themselves as being constrained by external forces, such as racism or sexism?

1–10Krumboltz: Everybody is constrained by external forces: racism, sexism, ageism, regionalism. Part of the problem is to help people figure out ways to cope with these. I mean, these are pressures that are exerted from the outside, judgments that are made about you from the outside, and everyone faces some of them. Now some people face a lot more, and much more severe, as in the case of sexism and racism. One needs to… And see, in a sense part of it is trying to overcome this thing on a political front, but another part of it is how do you help each individual deal with it in his or her own personal life? And again, it’s a learning process. How are you going to learn to cope with this?

1–11What do you do when someone makes a racist or sexist remark to you, or tells a racist or sexist joke in your presence? What kind of a response do you want to be able to make? Can you make it? Do you need some practice in making it? And again, you design what would be the best thing for that person to do.

Carlson: So you’d see these as learned behaviors and needing to learn different responses…

Krumboltz: Exactly.

Carlson: …in this basic learning program. Is there a kind of client that behavior therapy really works well with? Or maybe one that it doesn’t work so well with?

Krumboltz: It works very well with anyone who is capable of learning. We have had absolutely no success with people who are dead.

Kjos: What about couples, or groups, families?

1–12Krumboltz: Couples, groups, families, absolutely. There has been lots of good work done in group counseling. Lots of good preventive work.

Carlson: Is there research that points to the effectiveness of this model, this learning or cognitive behavioral model?

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Krumboltz: There are mountains of research, mountains of research. One of the best books that summarizes this, I think, is a book by Frederick Kanfer and Arnold Goldstein called Helping People Change. I find it very useful because it not only summarizes the research but it writes it up in a way that enables people to actually apply it. and gives examples of how it can be applied in practice.

1–13Carlson: One of the things that I’ve been really interested in, and I’d be remiss if I didn’t get a chance to ask you this question. Early in your career you were identified as a behavioral counselor, and you wrote books and articles and actually even participated in a famous debate in which you took the behavioral counseling point of view and you debated C.H. Patterson, the famous client-centered theorist. How did you make that transition from this strictly behavioral approach to this more of a learning or cognitive behavioral approach?

Krumboltz: Well, in my history I’ve tried out lots of different approaches. Originally I was fascinated with Sigmund Freud, and I thought psychoanalysis was the answer to every problem. And I used to provide interpretations about how anal retentive some of my friends were. And then I got trained in what was then called nondirective counseling—Carl Rogers—now called client-centered or person-centered counseling. And you know, for awhile I thought, well, that was the answer. And then I got hired as a high school counselor and I tried to apply client-centered counseling…

1–14Carlson: Hmm, I bet that was interesting.

Krumboltz: …in a high school setting. That was disaster city. It was clearly not doing any good. Of course, I thought it was my fault because I wasn’t doing it well enough, but now I think it’s simply insufficient. I mean, good ideas, helpful ideas, but insufficient by itself to do everything that needed to be done. And you know, then I moved to a psychometric approach and failed that for awhile, and then sort of a self-understanding approach, and a phenomenological approach.

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1–15And then I got intrigued with B.F. Skinner and I thought¬ that the behavioral approach would have a great deal to offer because of its specificity of goals, specificity of techniques for accomplishing goals. That was good, and so it was true that I was sort of identified as a behavioral counselor for a number of years. And my feeling is that I still am. I mean, but the reason that I prefer a little broader way of thinking about it now is because the phenomenon of human behavior is so complex that the behavioral approach by itself did not really encompass enough of the thinking process of human beings: the way in which we process information, the way we solve problems. And that there’s a lot to be added by looking at human behavior through a cognitive lens as well as the behavioral lens.

1–16So it’s not that I have switched. It is that I have broadened my view to take into account the complexity of human behavior.

Carlson: It’s interesting that you mentioned when you were the high school counselor you felt that you didn’t do it right, this person-centered or client-centered approach, and I noticed in a book that you wrote called Behavioral Counseling that you talked about the client-centered concepts of developing a relationship, and you devoted one paragraph to that in this entire text and really said that it was an important thing for a counselor to do, and then really went on to talk more about the behavioral change. How important is that in your approach, this notion of creating a relationship?

1–17Krumboltz: Well, it’s very important, it’s very important. The reason that we didn’t devote more than a paragraph to it was because, at the time, there were people devoting books and books and books to it, and it didn’t seem necessary to repeat what everybody else was saying, because we wanted to add something new, but at the same time acknowledge the importance of really understanding where the person is coming from. So it was not in any way intended to diminish the importance of it. It was just, let’s spend the few pages that we have to devote to this topic to something that hasn’t been said before.

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Carlson: Kind of on a different stage of therapy, the first stage maybe being the relationship. The first step.

1–18Krumboltz: Well yeah, see, I think that, in any counseling, that you have to begin by finding out where the client is. What is the problem? What are you concerned about? And you have to indicate to the client that you understand where the client is. And the client has to know, “Oh, my counselor understands me. Phew, what a relief. I feel understood.” I mean, I think that is a very essential beginning point. But, you see, some people might say, “Well, that’s enough,” you see. I don’t think that’s enough. That’s where you start, but now how are you going to help this person take steps to accomplish their goal?

Carlson: So the conditions aren’t sufficient for change. You have to go beyond that.

Krumboltz: Oh, absolutely.

Kjos: Making a change, what would you say to a student who would be interested in pursuing a career in this area? What future do you see in cognitive behavior?

1–19Krumboltz: Oh, I see a big future. Interesting question, Diane. I guess I’d want to say, “Do you want to be a guru? Do you want to be seen as omniscient? Somewhat mysterious? Sort of like the Wizard of Oz? Sort of manipulating things behind the scenes and projecting this big image of omniscience? If that’s what you want then you’d better go somewhere else, because cognitive behavioral approach, the learning approach, is not mysterious. It is very sensible. It’s very down to earth. There’s no mumbo-jumbo to it. You’re helping people learn. You’re a coach, you’re a mentor, you’re an educator. If you don’t like that view of it, well, why don’t you go into something where there’s more mumbo-jumbo. Read Rorschach cards or tea leaves.

1–20So that’d be a way of sort of screening out people who want to be the omniscient guru. But then they might say, “Well, what kind of people do you want?” Well, I’d say, uh, “Are you interested in helping people

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prevent problems from occurring?” For example, we have, on the Stanford campus, a program in sexual assault prevention. Now the way it used to be done was, women who were concerned about this would take courses in how to ward off sexual assault. Don’t go to these places. Don’t dress in this way. Be sure you say this or that.

1–21But a bigger way of looking at the problem is to say, “Why does this behavior occur anyway? Who are the people who perpetrate it?” So Stanford University has sort of a sexual assault training program. And it’s not just the women who get trained, but the men, also. So there’s an… And there are policy statements made about how this is totally unacceptable behavior and the people who perpetrate it will be dealt with severely. Announcements from the administration.

Carlson: So changing the whole system.

Krumboltz: Changing the whole system.

Carlson: Okay.

Krumboltz: You see? Now to me that’s a cognitive behavioral approach. It’s educating the whole community about a problem and preventing it from happening rather than waiting for it to happen and then dealing with the victims.

Carlson: Next we’re going to watch you work with a young woman in counseling. What were your goals in working with this person as a cognitive behavioral therapist?

1–22Krumboltz: Well, uh, I knew that we only had one interview that was to be 40 minutes long, and so, in the first interview, and in this case the only interview, I wanted first of all to make sure that we understood what the ground rules were. I wanted to make sure that we all recognized that we were making a movie, that we had only 40 minutes to make it, and that this movie would be seen by thousands of people. I wanted to make it sort of on the public record what the ground rules were. And see, I think in any first interview you want to somewhat, sometime, somewhere, make clear what the ground rules were.

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1–23And then the second thing I wanted to accomplish was to make sure that she knew that I understood her problem. And the third thing I like to do is to offer hope, hope that something can be done. That it is not hopeless. That it’s possible to make progress toward solving the problem, if indeed I think it is, and for the most part I always do.

Carlson: So ground rules, clear goals. We want to develop some understanding of the problem. Instill some hope or encouragement.

1–24Krumboltz: Yes, and the fourth thing is to have some sort of a task to be done, some sort of action to be taken, so that when the client leaves, there is something to be done. All counseling does not occur in an interview setting. In fact, some of the most important activities occur outside of the interview setting.

Carlson: And the task would be a behavioral task, or a thinking task?

Krumboltz: It could be. It could be a behavioral task, it could be a thinking task, it could be a monitoring task. It could be, you know, keeping a record of how often you do such and such.

Carlson: Okay.

Kjos: What kinds of things should we watch for in this video? Anything in particular that we should be watching for as we’re watching the video, a segment of the interview?

Krumboltz: Well, you might watch it and see whether what I have just said is what I did.

Kjos: Okay, okay.

Krumboltz: And there may be some other things, too. There may be some other things that you…

Carlson: Would you like our viewers to particularly pay attention to, then, the way that you structure the counseling session? You develop understanding of the problem, instill some kind of hope and encouragement, and then let the counselee leave with a specific task that she’s going to be working on?

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1–25Krumboltz: Yes, and in this particular case, we also practiced the task right here in the counseling session.

Carlson: So there was another step in there that might ensure the likelihood that the task would be carried out by a rehearsal?

Krumboltz: By a rehearsal of it if possible, in the counseling session, yes.

Carlson: I can’t wait to see this.

Krumboltz: Let’s go.

Kjos: Okay. Thank you.

PSYCHOTHERAPY SESSIONKrumboltz 1: Robin, you and I have just met, and uh, we, are here making a film, and we have camera people around and three cameras going, and, uh, this film is going to be seen by thousands of people in the years ahead and, uh, the ground rules here are that you and I have 40 minutes to work together, and we are going to see if we can accomplish whatever we can accomplish in 40 minutes.

Robin -1: Okay.

Krumboltz–2: And I am looking forward to doing that with you. And, uh, I understand that you have something on your mind, and I would like to know what it is.

2–2Robin–2: Well, I guess, I’m having trouble in, uh, relationships are complicated with people. Um, but I am having specific problems right now with my in-laws, and I know that that’s common, that everybody, you know, you always hear all the mother-in-law jokes and things like that, but, um, uh, I’m having some real difficulty knowing what my boundaries are, how much should I give, how far should I bend, uh, how much should I really care, should I let it bother me, should I not? Um …

Krumboltz–3: It does bother you, though.

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Robin–3: It does.

Krumboltz–4: Yeah. Okay.

Robin–4: It very much does.

Krumboltz–5: I, I hear that. I hear that.

Robin–5: Um. My husband is an only child, and for a long time everything that my mother-in-law said I took personally. Now I know it’s just, it’s because who her son married, it has nothing to do personally, but accepting that is extremely difficult for me. Um. Anything she says, anything she does, I still take personally, even though I shouldn’t.

Krumboltz–6: What do you mean you shouldn’t? Why shouldn’t you take it personally?

Robin–6: Because it’s not against me personally. It’s against the person that married her husband.

Krumboltz–7: Yeah, but you are that person.

Robin–7: Or her son.

Krumboltz–8: You are that person.

Robin–8: Yeah, but …

Krumboltz–9: And so, tell me more about the specifics of this. What, what exactly, um, happens?

2–3Robin–9: Well, I mean, I could start from the very, I mean, there is so much history between us. Um, I don’t know how far to go back, um …

Krumboltz–10: Well, why don’t we not go back too far. Why don’t we start with more recent.

Robin–10: Okay.

Krumboltz–11: What’s the most recent thing that’s happened?

Robin–11: The most recent thing was this past weekend. (What had led up to the point was, um, I have a son who is 14 months old. When he was born, I really thought that this would be a time for his parents to become more involved in our lives and want to have some thing to

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do with their grandchild. They never showed any interest whatsoever. Um, they live locally where I do, and they only visited maybe 5 times within that year. That was very disturbing to me. Um, this past weekend they came down for a visit completely unexpected. I was not prepared. I don’t like surprises.

2–4Um, my husband immediately dropped all our plans and catered to everything that they did, and the fact that the holidays are approaching, I’ve already made my holiday plans. Normally we don’t do anything with them because they don’t want to be involved with us. Well, all of a sudden now , they want my husband to go to Tennessee with them to visit their family for Thanksgiving, and, um, I wasn’t invited and neither was my son.

Krumboltz–12: Oh my! Mmmm.

Robin–12: So, um …

Krumboltz–13: That hurts.

2–5Robin–13: It hurts, but I mean, I know that it causes some conflict with my husband and I, but my husband’s not one of those ones to stand and tell his mother, you know, don’t, don’t say anything against her, blah, blah, blah. Because he knows that she doesn’t come around much. But the ridicule that she gives me, she also gives to him. But he’s been raised in that type of environment, so he can ignore it. He doesn’t let it bother him.

Krumboltz–14: Tell me about this ridicule.

Robin–14: Um, well, I’ve been told that I’m not good enough for her son, that I don’t take care of him enough, um …

Krumboltz–15: Told to your face?

Robin–15: Yes.

Krumboltz–16: Uh-huh. In just those words, “You’re not good enough for my son”?

Robin–16: Yeah. When I, um, when we were planning our wedding, I

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wanted to include her and offered her, you know, if she had anything she wanted, and she said “No, I’m sorry I just can’t, I can’t be involved in it because I don’t think you’re good enough for my son. You don’t, you don’t treat him the way you should.”

Krumboltz–17: Hmm!

Robin–17: I mean …

Krumboltz–18: Hmm! Wow, that is really cruel.

2–6Robin–18: Well, she’s the only woman I’ve ever encountered that can’t like me. I think I have one of those personalities that I’ve never met a stranger …

Krumboltz–19: Yes, I, I sense that about you, too. I mean, you have a very friendly,

outgoing nature, and I image everyone you meet would just love you.

Robin–19: Uh-huh. And she’s the only one that doesn’t. And that hurts so much and I…

Krumboltz–20: Of course.

Robin–20: I can’t gain her approval. They’re, they’re, I mean, I’ve tried. Um, I’ve tried to kill her with kindness, you know, remembering her birthday, holidays, things like that. I’ve, I’ve tried it all.

Krumboltz–21: Uh-huh, and what happens when you do that. I mean, you remember her birthday–what does she say when you…

Robin–21: She talks specifically to my husband, Ed, and says, “Oh, thank you for that card”, or “Oh, thank you for that gift. You picked it out so well”, and my husband will immediately say, “Well what did you get? I don’t know what you got because Robin bought it,” you know, that type of thing. But she never acknowledges.

Krumboltz–22: She won’t acknowledge that you did it.

2–7Robin–22: No, no. Everything comes from her son. But yet, before I came along, he never did anything for his parents. You know, but,

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that’s…

Krumboltz–23: I can, I can see that would be very, very difficult to take.

Robin–23: It is. And it’s a relationship that’s, that for most people is difficult anyway, but I guess when I, when I look at my son and know that someday if he decides to marry, I’m going to be a mother-in-law, and I think to myself, no way am I going to even think about mistreating, you know …

Krumboltz–24: Your, your daughter-in-law.

Robin–24: Yeah. Just because it’s almost inhumane.

Krumboltz–25: It is not almost inhumane. It is inhumane. It is, it is.

2–8Robin–25: But I don’t want, I mean, it has, it has caused problems in the past with, with my husband. Now, we’ve basically come to terms that, when they come around, we try to just be friendly and, you know, and then if they don’t come around, that’s okay too. Uh, but, and it doesn’t cause problems, but yet the underlying current is still there, you know, because it, one time I did confront her that I didn’t feel part of the family. Uh, it, it doesn’t register with her. It goes in one ear and out the other. I mean, she immediately changes the subject. So, there, there is nothing I can do or say to her to get her to understand. It’s something that I have to learn to accept how to do that and still keep my sanity. It’s like …

2–9Krumboltz–26: Uh-huh. Uh-huh. Well, that’s, that’s an interesting dilemma that you are in right now. Let’s, let’s, so, let’s kind of concentrate a little bit on how you might work on this. Your mother-in-law is not going to change.

Robin–26: No. The only person who can change is me.

Krumboltz–27: That’s right. That’s right, the only person who can change is you.

Robin–27: Uh-huh.

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Krumboltz–28: Your husband probably cannot change.

Robin–28: Nope.

Krumboltz–29: And, so you and I have this rare opportunity right now to see if we can’t think of a way to deal with this situation so that you will not feel so devastated when you get these cuts.

Robin–29: Uh-huh. Yeah.

Krumboltz–30: So, let’s, let’s, let’s first, uh, kind of think now, why, why do you suppose your mother-in-law does this? I mean, can you, can you put yourself in her shoes for a moment and…

Robin–30 : Yeah, I’ve taken her son away.

2–10Krumboltz–31: Yes, you have. Her only son.

Robin–31: Her only son, yeah.

Krumboltz–32: And you, Robin, have stolen her only son. And your husband loves you maybe even more than he loves …

Robin–32: Her.

Krumboltz–33: His mother.

Robin–33: Uh-huh, uh-huh, yeah. The, the, it goes without saying there is an intimacy between a husband and wife that is not with a parent, uh, uh, that’s why I sometimes think that she’s got a problem because she, she had an unhealthy relationship to begin with, with her son. She was very possessive with him.

Krumboltz–34: Oh, she, oh, she was.

Robin–34: Yeah.

Krumboltz–35: Uh-huh. And now her possessiveness is really challenged by your presence.

Robin–35: Uh-huh. Definitely.

2–11Krumboltz–36: She must feel absolutely threatened.

Robin–36: I think she does.

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Krumboltz–37: At a, at a very deep level she is, she is, uh, so insecure in, her, uh, herself that, that she sees what is, to anybody else a normal happy marriage, as a threat to her.

Robin–37: Uh-huh, uh-huh. But see she feels insecure, so how she responds is to make me insecure.

Krumboltz–38: Exactly, exactly. That’s … well, what a wonderful way to do it. What a wonderful …

Robin–38: She succeeds very well.

2–12Krumboltz–39: Well, I hear that. She’s, she’s a master at this art of making you feel bad. But she is doing it because she herself is threatened by the loss, what she perceives, as the loss of a son. Now, it’s, it’s a sick way to look at it. I mean, a normal healthy individual would say, “Oh, how wonderful. Now, not only do I have a son, but I have a daughter and a grandson, and wonderful. What a terrific pleasure to have our family increase so delightfully.”

Robin–39: Right.

Krumboltz–40: That would be a healthy way to look at it.

Robin–40: Right, and she doesn’t.

Krumboltz–41: She’s not a healthy, she’s not a healthy person.

Robin–41: No.

Krumboltz–42: And the more you try to cater to her, the more you try to please her, what’s going to happen?

2–13Robin–42: It doesn’t affect her. It just makes me more frustrated because I feel that I can’t accomplish anything.

Krumboltz–43: Uh-huh. Exactly, exactly. And do you think that she might even know that at some level?

Robin–43: Her? No. No, not her. I don’t think so.

Krumboltz–44: You don’t think she even knows that?

Robin–44: No, I’ll be honest. I don’t think she smart enough to

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understand any of that.

Krumboltz–45: Yeah. But at an emotional level. Intellectually, she probably doesn’t.

Robin–45: Emotional level she knows she can get to me.

Krumboltz–46: Yeah, exactly.

Robin–46: Yeah.

Krumboltz–47: Exactly. And if she gets to you enough, I’m, I’m looking at this from her point of view now, or let’s you and I both look at it from her point of view. She gets to you enough at her emotional level, may be she can …

Robin–47: Get Ed back.

Krumboltz–48: Get him back.

Robin–48: Yeah.

Krumboltz–49: Get him away from you.

2–14Robin–49: Uh-huh. Oh, she’s tried.

Krumboltz–50: She has? What do you mean?

Robin–50: Uh, we had, we were building a new home. And we sold our home. We had to find a, temporary housing for six weeks. Uh, my parents could not hold the two of us. His mother refused to let me live with them for six weeks. So, we just went ahead and decided and went our separate ways. I stayed with my parents, and he stayed with his parents for six weeks, and, it, it took us probably three months after that six weeks for us to come to terms with what had happened.

Krumboltz–51: Uh-huh. I can see … Now, can, can you and your husband talk about this situation.

Robin–51: Uh-huh, very, very well.

Krumboltz–52: And what is his, what is his attitude about it?

2–15Robin–52: He tries to tell me, and this is what bothers me the most,

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he says that she and I are a lot alike, and that’s why we can’t see eye to eye on a lot of things, that we, in other words, we both want the best for him. He, he really believes that his mother wants the best for him, and that’s okay if that’s what he wants to believe. Uh, but he thinks that I just need to let whatever she says go in one ear and out the other because that’s what he’s done. She will put him down, and it doesn’t even register with him as a put-down.

Krumboltz–53: What, what does she say to him that puts him down?

Robin–53: Uh, that he’s overweight. That he’s lazy. He’s too picky about his house, Uh…

Krumboltz–54: Uh-huh. Does she, does she ever praise him? Does she ever…

Robin–54: Never.

Krumboltz–55: Never.

Robin–55: Never.

Krumboltz–56: Has she ever praised you?

2–16Robin–56: Never. Well, she did one time. On my wedding day, she told me that I looked very beautiful. That was it. That’s the only compliment I’ve ever received. You know, so, when you get them, you remember them. But, she, she, it’s, it’s sort of like, you know, my mother told me if you don’t have anything nice to say, don’t say anything at all. Well, she’ll say. She’ll speak her mind.

Krumboltz–57: She is just the other way around.

Robin–57: Uh-huh.

Krumboltz–58: If she has something bad to say, she’ll say it. If she has some thing good to say…

Robin–58: She won’t.

Krumboltz–59: She won’t say a word.

Robin–59: Uh-huh.

Krumboltz–60: Uh-huh. So, you are in this dilemma of, uh, of, of

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really being all alone in this situation. Because your, your husband doesn’t quite understand…

2–17Robin–60: No, he’s a lot like my father-in-law. My father-in-law told me the same thing when I tried to talk to him, that that’s just the way she is. You just accept her the way she is. Uh, he never says anything. I mean, he’s got a heart of gold. He would do anything and everything for us. But he will never disagree with her.

Krumboltz–61: He won’t confront her.

Robin–61: No, never.

Krumboltz–62: And, and, your, your husband doesn’t confront her.

Robin–62: No. Never. So, so, my situation is, you know, to what extent do I try to have a relationship with them for the sake of my son? That’s his grandmother, but yet, eventually, he is going to know and be able to see that there is a difference in her, and he is going to see that.

Krumboltz–63: Oh, of course he will.

2–18Robin–63: Uh, at what point do you, do you say, we are only going to allow certain things to happen, or, we are only going to get together occasionally or, you know. The one thing that I have said, regardless, is that if she wants to have anything to do with my son, I will be included. That’s just a given.

Krumboltz–64: Good for you.

Robin–64: Just because it’s my son. You know, I went through the nine months, and I went through the labor and…

Krumboltz–65: Exactly.

Robin–65: You want to enjoy him, you’ll enjoy him with me.

Krumboltz–66: That’s good, that’s good. So you, you have asserted yourself in that way.

Robin–66: Uh-huh.

Krumboltz–67: By making your boundaries clear, right?

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Robin–67: Yeah, because when I really thought that there might be a change in her when, when he was born, she would call and ask how her boy was, referring to my son, and I just laid the law down. I said he is your grandson. He’s my son, he’s your grandson.

Krumboltz–68: Good for you.

Robin–68: Yeah, but I didn’t feel comfortable doing that.

Krumboltz–69: Well, but good for you. You did it.

2–19Robin–69: No, but, I don’t like, because to me that’s almost being, uh, rude.

Krumboltz–70: Uh, well, yes, but you… I, I, I, for anybody else, I can understand. That would be sort of, yeah, kind of rude. Because you, you know, someone else might have meant something different by it, or a slip of the tongue or something. But you knew full well what she was saying.

Robin–70: Oh yeah.

Krumboltz–71: You knew full well, and you confronted her on it.

Robin–71: Yeah, but I didn’t like it.

2–20Krumboltz–72: Well, but you did it. You did it. Yeah, I think, I think that the thing that maybe we could do for a few minutes right here is to think about what are the alternatives that, uh, you face here. I mean, let’s, let’s just kind of list the possible things that you could do in this situation, okay? I’m sure you’ve thought about this a lot, so why don’t you just kind of list what they are.

Robin–72: The one that I’d love to do is just no relationship with them at all. But I know that’s not possible.

Krumboltz–73: Okay, let’s list that. That’s, that’s the first alternative. Okay. If you don’t mind, I’ll just make a few notes here.

Robin–73: Okay.

Krumboltz – 74: Of these things. Okay, first thing is just, no

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relationship at all.

Robin–74: Uh, the second would be setting the ground rules. If she calls me, it has to be at my convenience. It has to be, you know, okay with me. In other words, no dropping by unexpectedly. Planned, planned visits.

Krumboltz–75: All right, so you would set the ground rules. Planned visits only where you have agreed to it in advance.

Robin–75: Right.

Krumboltz–76: All right.

Robin–76: You know, like a phone call.

Krumboltz–77: Yeah, a phone call.

2–21Robin–77: Or just let things go the way they are. I mean, uh…

Krumboltz–78: The way they are? That’s a third alternative. Just let things go the way they are, huh?

Robin–78: Uh-huh.

Krumboltz–79: Okay, which means that they’d pop over whenever they feel like it?

Robin–79: Uh-huh, yeah. We used to live in the same town, and they used to do that very frequently, and I put a stop to that, too.

Krumboltz–80: Oh you did?

Robin–80: I just told her, I said, and sometimes you have to be very rude and crude with her. But I just told her. She, she used to do it a lot right after we got married. And I didn’t appreciate it, because I’m one of those people that if I know somebody’s coming over, I’d like the house to be at least presentable. Uh, and finally, I just told her, well, you know, we are a young couple, we might be doing something, so I would appreciate it if you would call before you came over. Because we had given her a key.

2–22My husband thought she should have a key, and she would just help

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herself right on in. In other words, there was no respect of our home.

Krumboltz–81: Hmm. Does she still have a key?

Robin–81: Nope.

Krumboltz–82: Ha, ha! The way you said that indicates that you must have done something.

Robin–82: Yeah, well, we moved. That was one of the reasons why we moved was mainly to isolate ourselves a little bit. We put 30 miles between our parents.

Krumboltz–83: Oh, okay.

Robin–83: just to give us a little bit more, uh…

Krumboltz–84: a little more distance.

Robin–84: Uh-huh. That helped a lot.

Krumboltz–85: Okay, all right, all right.

Robin–85: That has helped a lot.

Krumboltz–86: Good.

Robin–86: Uh, I’m trying to think if there is anything else.

Krumboltz–87: Well, okay, having no relationship at all is one. Setting some ground rules is the second. Leaving things as is, is the third. Um, okay. Anything else that you’ve thought of?

2–23Robin–87: Well, one thing that I would love to happen but it will never happen is for my husband to lay the law down.

Krumboltz–88: Uh-huh, uh-huh. Okay. But, but since your husband is not here to talk to us, we can’t control his …

Robin–88: And he’s not going to.

Krumboltz–89: And you know he’s not going to anyway, uh, but, but one thing that it does suggest is that you could have a heart-to-heart talk with him about this.

Robin–89: Uh-huh. Which I have.

Krumboltz–90: Which you have had, but you are afraid that would

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never do any good anyway.

2–24Robin–90: Yeah, it, it probably wouldn’t. Uh, uh, well, you know, one of the things, another thing that bothers her, and I don’t, I thought about it a lot, I have a large family. My family is very involved with me and my son. You know, big extended family. She has always been intimidated by that also. So, I mean, like a couple of, like, when my son had his first birthday, I invited all the family. They came, gave him his gift, he opened up his gift. When he had finished opening up that gift, they left. She wouldn’t stay with the rest of the family for the rest of the party.

Krumboltz–91: Oh, she left early.

Robin–91: Yeah.

Krumboltz–92 After she had done her thing?

Robin–92: Uh huh. Yeah. But yet they came over the next day when nobody else was there.

Krumboltz–93: Ahh, interesting.

2–25Robin–93: So, I, I sometimes think, okay, she’s intimidated by my family. Maybe I need to make sure that she has her own time. That if I do have a family event, that I do one thing for my side of the family and one thing for his side, which his side is only his parents. But that’s more work for me. But yet it caters to her.

Krumboltz–94: It does, doesn’t it?

Robin–94: Uh-huh.

Krumboltz–95: It does. You know, what, what occurs to me is, uh, maybe there is a way of using your family as a, a, a buffer. That is, uh, uh, the only time that you, you have certain, say, family gatherings, uh, his family and your family come at the same time. Now she’s not going to like that.

Robin–95: Right, right

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2–26Krumboltz–96: We already know that. Okay. But, that’s the family gathering time. And if you had some sort of a ground rule that, that she only came over when it was agreeable with you, then you could control when she appeared. And, and if you wanted to, I mean, just, just to list another alternative here, you could say, we are not having a family get together until next month, the 29th of next month, and, uh, so we are going to invite you and your husband and my family over then. And we certainly hope that you will be able to come.

Robin–96: Well, then I’d never see them.

Krumboltz–97: Well, uh, does that bother you?

Robin–97: Uh, yes. But it doesn’t bother me as much as it bothers me to see that my husband then doesn’t get to see his parents. See, I guess that’s why regardless of what a horrible person she is to me and really is to my husband, my husband still loves her because he’s her son.

Krumboltz–98: That’s right.

2–27Robin–98: And I have to be respectful of his feelings. And I, I couldn’t do that.

Krumboltz–99: Okay.

Robin–99: Uh, because I would hate it if he ever limited me to when I could see my mother. See, that’s where we are drawing the fine lines, is where, I mean, cause …

Krumboltz–100: But now, wait a minute. You are not limiting him as to when he can see his mother. I mean, he can go see his mother any time.

Robin–100: No, no, no, see, he never goes to see his mother. His mother comes to see him. That’s where…

Krumboltz–101: Well, but, he could go see his mother.

Robin–101: That’s true. He could.

Krumboltz–102: He could.

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Robin–102: Then it still frees me. I just don’t want to end up being the, whatever decision I decide to make, I just don’t want to turn out to be the bad guy.

2–28Krumboltz–103: I hear you. That’s right. No, you don’t want to be the bad guy. But you also don’t want to be abused.

Robin–103: Right.

Krumboltz–104: You are being emotionally abused right now.

Robin–104: Right.

Krumboltz–105: By her.

Robin–105: Uh-huh. Uh-huh. Yeah. But the, it’s so hard. My parents taught me so much to give other people respect. And it’s hard to, uh… sometimes I don’t feel like I’m an adult, uh, that I’m still a child and that I still have to respect her. It ‘s hard to stand up on my own two feet a lot.

2–29Krumboltz–106: I hear you, I hear you. Uh, but, now, we’ve actually sort of talked about, uh, five alternatives now. Let’s just see if we could quickly just try out uh, uh, uh, a narrowing down. One alternative is no relationship at all, and you’ve already said, that’ s not going to, so we cross off number one. Okay, possibility number two is setting some ground rules for planned visits. That’s a possibility.

Robin–106: That’s a possibility.

Krumboltz–107: Okay. And number three is leaving things as is.

Robin–107: And that’s not…

Krumboltz–108: No, that’s not a possibility. And number four is persuading your husband to change his behavior. And you think that’s really impossible.

Robin–108: To confront this. Yeah.

Krumboltz–109: And alternative number five is using your own family as sort of a buffer and having them over at the same time you

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have her over.

Robin–109: Uh-huh. That’s… I would probably use a combination of those two.

2–30Krumboltz–110: Of, of those two? Okay, okay. Now, what, what, so let’s, let’ s for a minute then go with these two possibilities. Uh, setting the ground rules for planned visits, and, and, which could include your family if you decided to do it that way. You wouldn’t have to every time.

Robin–110: Right.

Krumboltz–111: I mean, it’s always your choice.

Robin–111: Right.

Krumboltz–112: Okay. Now, would you find it hard, I mean, I sense you would find it hard, to set up these ground rules.

Robin–112: Oh, yeah.

Krumboltz–113: Uh, what, what would be the ground rules that you would like to set up?

Robin–113: Well, probably one of the, the biggest one is that they call beforehand.

2–31Krumboltz–114: Okay. Let’s just work, let’s just work with that one for a minute. Let’s , let’s, let’s have a little fun here together. Let’s, uh, l et’s see. Why don’t you be your mother-in-law for a minute. Try, try to put yourself in her role. I am going to try to be you for a minute.

Robin–114: Okay.

Krumboltz–115: And I’m going to try, I’m going to try to see if I can’t talk to

your mother-in-law in a way that might be helpful. And you try to be your mother-in-law. You got it?

Robin–115: Yeah.

Krumboltz–116: Now, how do you address her?

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Robin–116: Dori.

Krumboltz–117: Dori, okay. Now, let’s, uh, shall we make this on the phone, or shall we make it in person?

Robin–117: On the phone.

Krumboltz–118: All right, on the phone.

Robin–118: I’m more confident. “Hello?”

Krumboltz–121: Uh, Dori, how are you feeling today?

2–32Robin–121: Oh, it’s been another one of those days.

Krumboltz–122: Yeah, yeah? Not so good, huh?

Robin–122: No, I’m down on my back again.

Krumboltz–123: Oh, that’s too bad, that’s too bad. Dori, listen, there is something I want to talk to you about.

Robin–123: Uh huh.

Krumboltz–124: And, uh, it’s kind of hard for me to, to say, but, uh, it’s really quite important for me to, uh, to be able to discuss this with you.


Krumboltz–125: Uh, one of the things that my husband and I need to do is to, is to be able to plan our time together. And, uh it’s sometimes hard for us to do this, uh, when we have guests that, who drop in unexpectedly, and, and I was wondering if you would be willing, uh, when you are thinking about coming over, uh, to call us in advance and see whether or not it is a convenient time, or, or see if we couldn’t negotiate a good time for us to get together.

2–33It would really be a much more helpful way for it to happen. Do you think that we could do it that way?

Robin–125: Am I a guest?

Krumboltz–126: Well, in our house you certainly are a guest. And we

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would like you to be a welcome guest when it’s mutually convenient.

Robin–126 : Well, I, I can’t believe you just feel that way.

Krumboltz–127: Well, Dori, it is the way I feel. I’m being very honest with you. And it’s hard for me to say this to you, uh, but, it, it really is important to me that we have control of our own time and that we can talk to each other in advance so that we can plan mutually convenient times to get together.

Robin–127: Well, if that’s the way you want it.

Krumboltz–128: Well, it is the way I want it, and, uh, so I hope you understand.

Robin–128: Bye.

Krumboltz–129: Great. That’s wonderful. Thanks Dori.

Robin–129: Mm hum.

Krumboltz–130: Talk to you later.

2–34Robin–130: Bye. That’s exactly how she’d be.

Krumboltz–131: Terrific. All right. Now, what, what, uh, uh, let’s, let’s re verse the process. You be you, and I will be your mother-in-law. I’m probably going to be more ugly than your mother-in-law is. Just to give you a hard time.

Robin–131: (laughter) Okay.

Krumboltz–132: Okay?

Robin–132: All right.

Krumboltz–133: All right, so, call me up.

Robin–133: Ring, ring, ring, ring, ring.

Krumboltz–134: Hello?

Robin–134: Dori?

Krumboltz–135: Yeah, yeah. Who’s this?

Robin–135: This is Robin.

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Krumboltz–136: Robin who?

Robin–136: Your daughter-in-law.

Krumboltz–137: Oh, my daughter-in-law?

Robin–137: Yeah, you know the one that’s married to Ed?

Krumboltz–138: Oh, oh, oh, uh, oh yeah. Oh, Ed, oh yeah. Hi. Yeah, what’s up?

Robin–138: Well, uh, I wanted to talk to you. Wondered if you had a minute.

2–35Krumboltz–139: Well, I’m pretty busy right now. My back’s paining me, and I’m awfully busy. I don’t really have too much time to talk to you.

Robin–139: Well, you know this is really important, and Ed wanted me to give you a call.

Krumboltz–140: Oh, well, if Ed wanted it, then what is it?

Robin–140: Well, we’ve been talking, and you know, family time’s real important to us, and you know, with Ed putting in all the extra hours and stuff, we very seldom get to see one another, and weekends are our only time, and it, it just seems like you’re coming over, you know, quite often, and you sometimes forget to, uh, give us a call to let us know you’re coming.

Krumboltz–141: Well, so, so what. I mean, what am I some kind of a guest or something?

2–36Robin–141: Well, yeah, in essence you are, you know. Because we make plans and we want to do stuff, and when you come over, it just sort of messes up our whole schedule, and I was just wondering if you could possibly start giving us a call. That way we can make arrangements to make sure that we’re free and, could spend some time with you then.

Krumboltz–142: Well, I am totally offended. I think this is just a terrible way to treat one’s mother-in-law. It’s just awful. I mean, just,

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I, I, I told you before, that you are just not good enough for Ed. I just think it’s awful that you treat me this way. I just, I just can’t believe that you would call me up and say something so cruel and rude as you just said.

Robin–142: Well, you know, Ed and I talked about it, and he was in agreement with me, but he just didn’t feel comfortable calling you. I said that I would call because he doesn’t have much time.

Krumboltz–143: Well! I just, I just, I just can’t believe that you would say this. I just, I just am really shocked. And,uh, good-bye.

Robin–143: (Laughter)

Krumboltz–144: All right, now I was, I was maybe worse than she would have been.


Krumboltz–145: You think so?

Robin–145: Yeah.

2–37Krumboltz–146: Yeah, yeah, okay. Good, okay. So, now, now that I was just as bad, that’s just probably the worst it could be, right?

Robin–146: Uh-huh.

Krumboltz–147: So, how do you feel now?

Robin–147: I’d be like, I would feel like, that I probably ruint [sic] it.

Krumboltz–148: You probably what?

Robin–148: That I ruined it.

Krumboltz–149: Ruined … ?

Robin–149: Ruined it.

Krumboltz–150: Ruined what?

Robin–150: Ruint [sic] it. That, that’s the southern word. That they probably wouldn’t have anything to do with it and it’s probably going to all come back in my face, and Ed’s going to say that I hurt his mother ‘s feelings and, uh, I shouldn’t have done that. Even though

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we had talked about it. He can sometimes, she’ll sometimes turn it around to say that I said something different than what I actually did. Which is one reason why if I confront her, I like to do it over the phone, but I like to have Ed listening on the other end.

Krumboltz–151: Oh, that would be good, wouldn’t it?

2–38Robin–151: Yeah. So that he hears the whole conversation to know …

Krumboltz–152: That would be good. That would be good. And now he wouldn’t say a word, then?

Robin–152: No.

Krumboltz–153: He wouldn’t say a word?

Robin–153: No.

Krumboltz–154: But he would hear everything?

Robin–154: Right.

Krumboltz–155: And you would have talked with Ed in advance so that he knew that it was a planned conversation?

Robin–155: Right, right, yeah.

Krumboltz–156: And, and so if she did come back and twist it around on you, which I’m sure she will, he at least would know.

Robin–156: Right.

Krumboltz–157: You know, you know, one of the things that sometimes is a good idea on these kinds of things is to tape record the conversation.


Krumboltz–158: And then you and Ed can play it back when she begins to distort it, and say…

Robin–158: Oh, that’s a good idea. That’s a really good idea.

2–39Krumboltz–159: Yeah, yeah. What really took place here? And you can get little, little, uh, devices from places like Radio Shack that you

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can attach to your phone and hook it up to a tape recorder and tape, tape both sides of the conversation just clear as a bell.


Krumboltz–160: And then you will have evidence in your pocket.

Robin–160: Yes.

Krumboltz–161: Ever after. Exactly what happened.

Robin–161: Yes. Uh-huh. That’s a, that’s a really good idea. Never thought about that.

Krumboltz–162: Well, what do you think about it? Do you think you could do something like that?

Robin–162: You mean far as going ahead and calling her and setting the ground rules?

Krumboltz–163: Yeah.

Robin–163: Yeah. I would probably discuss them with my husband and make sure that he was in agreement. He doesn’t necessarily have to be the one to call her and tell her because that’s not what he is going to do.

Krumboltz–164: That’s not it, that’s not it.

2–40Robin–164: But if he was in agreement with them, yeah, I could probably give her a call and just say you know, we’ve talked about it, you know and we understand that you do want to have something to do with us, but it, it’s difficult for us.

Krumboltz–165: Uh-huh, uh-huh. I think you can do it. I mean you just did it with me, and I was, I was more ugly than even your mother-in-law would be. And you did, you did a perfect job. A super job.

Robin–165: Well, see, I always try to pass the buck and say that it was Ed’s idea.

Krumboltz–166: That’s all right. But it is going to be Ed’s idea. It’s going to be Ed’s and your idea. Because you are going to agree on it in advance. He, he just doesn’t want to do it himself.

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Robin–166: Right.

Krumboltz–167: But he would support you in doing it. And it’s clear to me that you know how to do it. Because you just did it right here. I want you to try to do it, I think you can do it. And I think, I think that once she gets over the shock of it, she will shape up. She’ll never, she’ll never approve of you.

2–41Don’t ever hope that that’s going to happen, but she will respect you because you are not kow-towing to her bully tactics.


Krumboltz–168: She will respect you.

Robin–168: Well, that’s probably all I want.

Krumboltz–169: Yup.

Robin–169: Yeah, that’s true. That’s very true.

Krumboltz–170: I think you can do it.

Robin–170: I’ll try.

Krumboltz–171: All right! Let’s do it! And I think our time is up for right now.

Robin–171: Good, good.

Krumboltz–172: Okay?

Robin–172: Mmmmm

GROUP DISCUSSION3–1Carlson: John, I was very impressed with this interview. Is this a typical example of what cognitive behavioral therapy is like?

Krumboltz: Hard to answer whether it’s typical. I think it represents fairly a way in which it is done, yeah.

Carlson: If we were to look at this video, how did the theory work in terms of the way that you operated with this client?

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Krumboltz: Well, the way I looked at it was that Robin needed some help in learning how to deal with this dilemma that she was faced with. She didn’t know exactly what to do, how to deal with it. We had to consider with her, we had to run through some cognitive processes of problem-solving, one of which is to list alternatives.

3–2After we sort of understood what the problem was, we had to list some alternative solutions that might work, and we did so, and then we narrowed them down to a couple that she was willing to try. But she still didn’t know quite know how to do it, so I wanted to give her some practice. So what she needed to learn to do was to do it. So we did that in two ways: First I… We role-played in one way, where she was the mother-in-law and I was doing her part, and then we did it the other way where she could do it herself and I was the mother-in-law. And so she got some practice both ways—really some modeling the first way and then some practice the second way—and then I wanted to give her some positive reinforcement for her success because she did a super job. And I wanted to let her know about that. And then I wanted her to generalize this practice that we did in the session with what she would do on the outside.

3–3So I would say the theory was applied rather consistently.

Kjos: So sort of step-by-step as you had talked about it earlier.

Krumboltz: Uh, it seemed to work very well.

Carlson: Very clearly, learning was at the root of this intervention.


Carlson: I was impressed with the number of techniques that you used, and I went through my notes and I looked at this and I saw techniques and skills such as empathy and respect, reinforcement and encouragement and support. You were using restatement and reframing. You placed the locus of control directly on the client. You used a little bit of logical persuasion and you overstated the obvious. You used problem-solving procedures and role-playing, and even got a commitment to change at the end. You used many, many of the

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techniques. I expected to see more of an emphasis, though, on logic and reason, kind of like Aaron Beck might, or Albert Ellis did, and you passed up opportunities, such as talking about “shoulds” or that she was not good enough.

3–4Can you explain your thinking, what was going on, or how you might differ from these people?

Krumboltz: Well, I didn’t feel it was necessary to give her a lecture on the “shoulds.” She didn’t need that. I did respond to it.

Carlson: It sounds like that’s almost disrespectful, from your point of view, to give somebody a lecture.

Krumboltz: Well, if it would have done any good, I might have done it. I like to be very results-oriented. I want to do what helps the client, not simply adhere to some theory. A theory is just a template, just a filter for kind of helping you think where you’re going. It’s not a command. It’s not a set of orders that you have to follow.

3–5It’s just designed to be kind of a helpful reminder of where you’re going.

Kjos: One of the other things that you did that I was fascinated by was what we kind of call a Columbo technique, where you’d sort of start and then you’d back off, and she’d have to finish it. And that worked very well with her, so that you would sort of imply that there must be at least one more alternative and she’d come up with it. And that was a neat way that you used that, and it worked well with Robin, I thought.

Krumboltz: I think you’re right, Diane. I think one of the most useful techniques in counseling is silence. A well-timed silence can be very effective if… Because what it does is put the ball in the court of the client.

3–6Carlson: This is especially effective with a client like Robin, who is more dependent and maybe a little bit more submissive. How would you work with a client who had a different personality structure?

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Maybe somebody who was more resistant, or maybe even mandated, who didn’t even want to be here?

Krumboltz: Those circumstances could change things drastically. I probably wouldn’t be able to do it the same way with a resistive client as I was able to do it with Robin, who was so cooperative. Might be a totally different way to approach it.

Carlson: Would it work with somebody who maybe didn’t want to learn?

3–7Krumboltz: Would it work with someone who didn’t want to learn? Well, I’m not sure that there’s anyone who doesn’t want to learn, but there may be some people who don’t want to learn what I want to teach. We would first have to arrive at some contract, some sort of agreement of what it was that we were trying to achieve.

Kjos: Some basis of understanding.

Krumboltz: Some basis of understanding of why we were both there, and if we couldn’t arrive at a contract, why, we couldn’t make any progress.

Carlson: So it might not work if you couldn’t come to an agreement.

Krumboltz: Well, absolutely. If a person doesn’t want counseling, you can’t force them to undergo a process that they are refusing to do. This is still a free country, thank goodness.

Carlson: So if somebody were mandated to come to see you by the court system and really didn’t want help, you might just accept that fact and…

Krumboltz: No, no, I think what I would say was, “Look, let’s face facts here. You’re here because if you don’t come here, you’re going to spend time in jail. I know that and you know that. Now the question is, do you want to work together on this situation?”

3–8Carlson: Um-hmm.

Krumboltz: If the guy says, “No, I don’t. Screw you.” Okay, that takes

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care of it. Go back to jail.

Carlson: Okay.

Krumboltz: But if he says, “Yeah, as long as I’m here, let’s deal with it.” Okay, then we can start getting down to brass tacks and start to deal with it. But we’ve got to have that initial agreement.

Kjos: Somebody said that the counselor is not mandated. The client is.

Carlson: Yeah. Okay. Well, why don’t we bring our audience in to our discussion period and maybe begin with some specific questions about the interview that we just saw.

Audience Member #1: I’d like to go back to your original question, Jon. Before you got into the cognitive process you really dealt with the affective domain and the kinds of concerns that she was having. And I was wondering if that’s a typical kind of preparation to get into the cognitive awareness.

3–9Krumboltz: Well, absolutely. I think the first thing that has to happen is I have to understand what the problem is. And I have to let her know that I understand what the problem is. And I can’t do anything before that. So I’m not sure that I would separate the affective from the cognitive. I think the affective and the cognitive permeated the entire process. But in a sense I first was doing this understanding before I could know how to begin a different type of intervention.

Audience Member #2: I thought you did a really nice job of conveying your understanding and your warmth toward the client, and I thought that the problem that she stated in the beginning was that she needed to not take it personally, what her mother-in-law was saying and doing.

3–10And I thought that wasn’t addressed very much. You got almost to it at the end. And I think that what you conveyed was, by taking the side of…her view of her mother-in-law, a win-lose situation rather than creating a win-win situation.

Krumboltz: See, I don’t think that she was put in a win-lose situation

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at all. I think this approach puts her in a win-win situation because I think it gives her a technique for asserting herself and gaining the respect of her mother-in-law. You see, the technique of catering to her mother-in-law, she’s tried, for a long time, and it did not work. She made that very clear.

3–11But what I did try to do, along the line that you’ve suggested, was to try to get her to put herself in her mother-in-law’s shoes. And see that this mother-in-law is a very insecure, inadequate, unhealthy individual. So I didn’t want Robin to feel that she, Robin, was the bad guy or should be feeling bad because of the kinds of treatment she was getting, because it was actually the doings of this rather sick individual who was in fear of losing her son. So in a sense I was trying to get her to see a bigger picture, with the hope that that might contribute toward… So even when they do get together, she’s still going to get these insults. So it was an effort to sort of buffer her so when she gets them, she’s says, “Oh well, this is the response of this rather inadequate human being, and too bad, but ah…” So in that sense I think I did address her concern in that way.

3–12But I didn’t want to just say, I didn’t want… See, I was not willing to accept her initial premise that what I need to do is learn to accept this bad treatment.

Carlson: So you changed her thinking…

Krumboltz: I…I…I… I don’t know if I changed her thinking. She changed her thinking. But I was unwilling to agree, you know: “Yes, you’re going to be treated badly and you should learn to accept that.” That’s not my goal at all. I wasn’t willing to buy that, see? So once again, we had to make a contract. We had to agree on something to do. And we figured out something to do, and she seemed to like it. And she did it.

Audience Member #3: John, I just want to get into how you think and conceptualize. Do you consciously, in your mind, think about positive reinforcement, negative reinforcement, even punishment, when you’re

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processing a case? This would be helpful, I think, for those of us that are training, because these are important basics. Can you kind of share with us how you conceptualize and think in these terms? Or do you?

3–13Krumboltz: Well, I do use those terms in my thinking, yes, but I’m not sure that I am…I don’t think I do it quite…in going to the abstraction and then to the specific. I don’t think, “Now it’s time for a positive reinforcement statement.” No, I don’t do anything like that. If I think that, uh, you know, if Robin did something really effective and good, I spontaneously say, “Wow, that was good. That was great. You did it. Nice going.” Those are positive, reinforcing statements. They come from the heart. But I know that they’re positively reinforcing. They’re, uh…I want her to be encouraged and supported for doing them.

3–14But they’re not contrived in any sense. So I don’t know if I’m addressing your question. I know that I’m doing it. But they come from the heart.

Audience Member #3: But you would say that in teaching people this technique in your work, that they should have some awareness of how…

Krumboltz: Oh, absolutely, absolutely. I mean, I think counselors need to be aware of what they are doing and what they are saying while they are being genuine with their client.

Audience Member #4: John, at what point in the counseling process would you help Robin with identifying who owns the problem?

3–15Krumboltz: Well, in a sense, Robin—we were fortunate here because I think Robin knew full well who owned the problem. She said so herself. She said, “It’s up to me. I can’t change my mother-in-law, I can’t change my husband,” basically is what she said. So I had an easy job of it there. See, some clients will say, “The reason I came to get help from you is because I want my husband to behave differently.”

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And at one point I said to her, “But your husband isn’t here now. So we can’t help him change because he’s not here.” I could have said, “Maybe you and your husband would like to come in together next time and we can work on this, the three of us.” But you see, one of the ground rules was that I’m only here now and we only have 40 minutes. And so that’s part of the limitations, what we’re working with. But that would have been an alternative way to go.

Audience Member #5: I very much respect the piece of work you did, and I think it was appropriate in these limits, but I was concerned about some ways that, if this were continued work, and she will continue work, that it set up some barriers to some work that needs to be done: specifically, that you helped her label her mother-in-law and even her husband, at one point, as unchangeable.

3–16Not just not changeable here, since they’re not here. You helped… you fed into perceiving the situation as good guy, bad guy, and the mother’s the bad guy. And my sense is that she has a lot of ways she is like her mother-in-law, including projecting the problem, or the badness, outside herself, and none of that stuff that you could do later in role-play or empty chair is set up here.

3–17Krumboltz: Well, interesting point. There are a lot of things that could have been done, in addition to what was done. We had 40 minutes to work. My judgment was that we needed to make some progress now. We needed to do something constructive now. So it was the first step. And remember in the tape, she started to say, “Well, one of the things that would help would be if she would call in advance.” Now I cut her off at that point. I didn’t say, “Well, what’s another thing that you want to do, and what’s a third thing, and a fourth thing?” I cut her off because… I said, “Let’s just work on this one thing now, and see if we can make some progress on it. And if we can, then we can work on these other things later.”

Audience Member #6: I think the presenting problem here was with the in-laws and the upcoming holidays. In terms of cognitive behavioral therapy, what specifically did you feel needed to be learned

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or unlearned in regard to this presenting problem?

3–18Krumboltz: Yes, she talked about the holidays and the fact that her husband was invited to go to Tennessee, and she and her son were not invited. And we didn’t deal with that problem at all. I didn’t quite see that as the presenting problem. It was not the problem that she chose to focus on for this session. It could have been, but we focused on how she could confront her mother-in-law about these surprise visits. That was the thing we focused on. This other problem is a good one, too. I don’t know what she’s going to do about the holidays. I hope she has a chance to talk to you. I mean, it’s another dilemma.

3–19Audience Member #7: I was wondering about helping a person who comes from another culture like I do, where we have an extended family system, and the family dynamic is very different. As I was listening to her and you supporting her, or reinforcing her, treat the mother-in-law like a guest. This would be extremely offensive and hurting in my culture, because my way is your way, too. We have our way, not my way or your way. And this is a very deeply ingrained belief system and value system we have in our culture. How would you deal with a client who comes from that family dynamic?

3–20Krumboltz: Ah, see, that’s a great question. This very clearly was an American problem in an American setting. In another culture, where the extended family values are much more important, or even in this country, where extended family values are much more important, there would be other considerations. See, but my job was to help Robin figure out what to do in her situation, with her mother-in-law, in the state of Illinois, in the United States of America this year, right now.

Audience Member #7: Can I respond to that?

Krumboltz: Yes.

Audience Member #7: I think even in an American family, the mother would feel offended to be treated like a guest by her own son.

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3–21Krumboltz: Well, you know, being treated like a guest is really not such a bad thing. I mean, guests are often treated better than family members in many homes. And, you see, under normal circumstances, this is not a thing you would say to your mother-in-law or your mother or anybody else. But these are not normal circumstances. Robin was being emotionally abused, and had been for a long time. And it was getting intolerable for her. And she needed to figure out some action that she needed to take. She felt it was rude. I mean, she said so herself. So it’s not that different here than it is from where you come from. She felt it too. And yet she felt it was necessary to do because of the certain circumstances that exist right here, now.

Audience Member #4: John, do you feel this form of therapy sort of reinforces the quick fix mentality that our society seems to be permeated with presently?

3–22Krumboltz: Does it…oh, boy, I don’t know. But yeah, there’s something about a quick fix that…It sounds like you’re against quick fixes. You see, I’m not against quick fixes if they work. I think the quicker the fix, the better, if it’s a good fix. I don’t believe in extending…I don’t believe in having long-term therapy just because it’s long-term. I mean, as far as I’m concerned, the shorter we can do it, the better. The only reason we want it to go longer is because it takes longer in order to accomplish our goals. If we can do it in one session, let’s do it in one session. If it takes three, let’s do it in three. But the shorter, the better. So I’m not against a quick fix. Um, it’s only if the quick fix is a bad fix, then we’re in trouble. But in this particular case, I don’t think it was a bad fix. I think it was taking steps toward a good fix.

3–23Carlson: The research literature, John, talks about psychodynamic approaches as yielding long-term changes and says cognitive behavioral really do provide quick fixes. What do cognitive behavioral therapists do to make sure the treatment is adhered to, that there won’t be a relapse over time?

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Krumboltz: Well, several things. One is that the process by which it takes place can be made explicit. So you help a person learn how to confront, and you give them support, for example, in doing it. See, I would hope that Robin learned some—will learn, by her experience—some skills.

Carlson: So the skills would be transferable.

3–24Krumboltz: The skills would be transferable to other situations. Sometimes it takes longer. I mean, Robin was a very quick learner. Some people take a lot longer to acquire some of these skills. Some people are much more trouble than Robin. I mean, Robin is a pretty together person, so it didn’t take very long with her. I think there is some obligation to follow through and follow up and make sure that these learnings stick. It takes a little cooperation on the part of the client with the counselor to follow through on that.

Carlson: Especially if the research is true for cognitive behavioral work, that the gains are lost over time.

Krumboltz: Well, I don’t think that there’s any evidence that that’s true at all. I’m sorry, I don’t agree with that. And I don’t agree that long-term therapy is better than short-term therapy.

Carlson: The research that I was referring to is research out of the University of Washington that Neil Jacobson has done, in which he’s shown that there is a 50 percent relapse rate after two years.

3–25Krumboltz: Relapse in what?

Carlson: That the clients are performing at the same levels that they were at pre-treatment after having undergone successful treatment.

Krumboltz: Well, that may be in…He’s been doing work in marriage therapy.

Carlson: That’s behavioral and cognitive behavioral and marital therapy.

Krumboltz: Yeah, yeah, well, if that’s the case, then the question,

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see…One of the absolute advantages of a cognitive behavioral approach is that it is self-correcting. That if whatever technique Jacobson is using is not working, and he’s getting this relapse rate, and he’s not happy with it, he might say, “Well, hmm, I wonder why? What am I doing wrong? How could I change my procedures? What can I do better? Let’s do…let’s try something different and do another research study and see if it works any better.

3–26So, we’re constantly trying to improve the process. Cognitive behavioral approach does not have a set formula for accomplishing anything or everything, at all. It’s constantly being improved by people trying new things, doing research on it, adding to the literature. Ten years from now we’ll know a lot better how to do it than we know today.

Carlson: It’s a research-based approach, though…


Carlson: …so that you keep using this empirical data to refine techniques and intervention strategies?

Krumboltz: Absolutely. We are results-oriented. We want to help people improve, and we want to do it as quickly and as easily as possible. And we want to keep learning how to do it better and better.

Audience Member #8: So how do you know then if counseling is successful?

3–27Krumboltz: We know that counseling is successful if the client changes in ways that the client wants to change. So sometimes it takes some reports from the client. Sometimes it’s self-reports, sometimes it’s observations from other people, sometimes it’s various kinds of assessments, psychometric assessment instruments. But there are lots of ways to observe whether people have changed in the way they want to change.

Audience Member #8: John, long ago in another life, when you were a behaviorist, I had a chance to see you run a group, and I’m wondering

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if Robin were in a group and you were the facilitator, how you might have dealt with her differently, or the same, or how you would use the group to deal with Robin?

3–28Krumboltz: I’m a firm believer in group counseling. I think it’s a very effective way to help people, and a very efficient way. If Robin were in a group of people who also had mother-in-law problems, let us say, or marital problems, what I would want to do is to use the group as a sounding board and as a feedback mechanism, so that members of the group could say things to her perhaps even more frankly than I did about what they saw going on and how they had done it in their family. It would be a sharing of ideas for how other people handle this similar situation. And there’s something about…I think it would help…The other thing about group therapy that I like is it helps people feel not so lonely. To some extent, Robin may have felt she was all alone in this problem that she had, and the group would alleviate that problem because she’s not alone.

3–29Everybody knows what it’s like to have problems with in-laws. So I’m much in favor of the group approach. I’m glad you mentioned that.

Carlson: We certainly want to open up questions to the general theory now as well as specifically on the video.

Audience Member #9: John, getting back to people not being alone. Obviously Robin was not alone in her problems, but also not alone in dealing with the problem. Clearly, the husband was going to be an integral part of the solution to this problem. Now she, at the end, brought him in, saying, you know, “We have talked about this. I’ve talked to Ed about this,” and when they did the role-playing, making it clear that he was involved. Now if she hadn’t brought that up, when would you have brought the idea of bringing him into consulting on the solution to the problem, and in similar cases where you have an adolescent who may be describing a very different situation at home, when do you bring the other parties involved in solving the problem?

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3–30Krumboltz: You mean, when do I bring them into the counseling situation, or when do I bring them into, I mean bring them the office where we talk about it? Or you mean bring them into the conversation.

Audience Member #9: Not necessarily, but even bringing the person, saying, you know, “This is a good solution but there are other people involved, Would you consider…When are you going to talk to Ed about the solution?”

Krumboltz: Oh.

Audience Member #9: You know, either way. Either bringing them in or at least getting the person to say, you know, “You’re not alone in this situation. There are other people that need to be involved.”

Krumboltz: I see. Oh, absolutely, and it’s a good point. I think I definitely would have, in this case, if she had not made it clear that she did talk with her husband about this and that they were agreed that something like this needed to be done, I would have, uh…I would have suggested…In fact, maybe the role play would have been, how is she going to talk with Ed, rather than how is she going to talk with her mother-in-law.

3–31That might have been a necessary precursor to what we did.

Audience Member #9: Okay. Uh, following up on another question, getting back to dealing with an adolescent. I understand the need to empathize and relate to the presenting problem that the person has. However, in adolescence they may describe a situation or a parent’s overbearing in an artificial way and exaggerated manner. And going along and confirming that may cause more difficulties and hinder the solution to the problem, and may mask some other possible alternatives. When do you confront their description of the situation as to whether that is an actual, accurate description?

3–32Krumboltz: Well, I think you’ve put your finger on a really serious

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problem. And that is that, uh, in dealing with adolescents, and of course many adults are still adolescents at heart, what you get is a one-sided picture of what’s going on. And if we were to, uh…in the case of Robin, if we were to have the mother-in-law present, we might get a quite different story about what’s going on here. And if Robin and the mother-in-law had come in together to work on this, I would have worked in a completely different style. I would have wanted to find out, well, what’s the mother-in-law’s position on this? How does she feel about this? But the mother-in-law was not here, so I had to deal with what existed. Now you’re talking about adolescents. My wife, Betty, is a middle school counselor, and she sees, uh, she deals with these adolescents and their parents and the teachers and the principals and the school psychologists.

3–33And she sees these problems from many different points of view, and she sees how these kids will distort a story. And if the kid goes to a psychiatrist and tells the psychiatrist the story, the psychiatrist—and that’s all the psychiatrist knows—the psychiatrist is likely to take some actions that are not optimal and healthy. I think it is often necessary to get people together who are sharing some stake in the problem. I think family systems approach is very useful when it gets together the people who are involved and who have to interact with each other and interrelate. And the therapist can be in the middle of it and see what’s going on. So that’s another reason why group counseling is helpful.

3–34That’s why I think marital counseling is optimally helpful when both members of the couple are present, not just one. So I am all in favor of getting all the stakeholders involved, if you can. But sometimes you can’t. And then you have to do what you can with what you have.

Audience Member #1: Just one comment about what you just suggested. I would also like to add the possibility of parents and teachers distorting the position. It’s not just the teenagers.

Krumboltz: Very good point. In a sense, everybody distorts the situation. Everybody sees it from their own point of view.

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Audience Member #1: Their own truth.

Krumboltz: They do.

Audience Member #4: But as a follow up to that, what would be easier to work with, then, a population of adolescents whose belief system isn’t that long in the making, or the adults in the system whose belief system may in fact be generations in the making?

Krumboltz: What’s your answer to that one?

Audience Member #4: I prefer the adolescents.

3–35Audience Member #5: It seems to me that one way we can open up that both the systems work and the intrapersonal work is to not make statements that confirm their good/bad or black/white thinking, and that’s what I was trying to indicate. You did it very well when you were talking about, “Well, the husband isn’t here right now so we can’t work on that piece.” But when you were talking about the mother-in-law, you almost label her a demon.

Krumboltz: Well, maybe I did, maybe I did. Maybe I went a little bit too far on that. I’ll consider that as a very legitimate consideration here. I was trying to be empathic with her and how she was seeing the situation. But at the same time, I was trying to get her to see that the mother-in-law was that way for very good reasons at an emotional level.

3–36Audience Member #5: She’s…

Krumboltz: But…

Audience Member #5: I’m sorry.

Krumboltz: But you’re right. I mean, I did kind of paint it in rather dichotomous terms.

Audience Member #5: Her recognition, or your recognition that she felt abused, if it were handled at a feeling level, leads to, “So you need some better boundaries.” So that the total direction seemed to be right, but I would have kept it, this is her subjective experience. She

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feels abused.

Krumboltz: Well, it’s possible that… The totality of the situation as she described it was not just that she felt abused. I felt that she was abused. And I said so. And I might have been wrong.

Carlson: So you entered her world.

3–37Krumboltz: But it wasn’t reflective of her view of it, but it seemed to me that the whole thing held together and made sense that way. But I take your suggestion with respect. I appreciate it.

Audience Member #3: I’m impressed by the fact that you take that position on it. I think that’s a good modeling for other counselors and it’s greatly appreciated. And I guess this is something that we’re getting into. Allegedly behavioral therapy is supposed to be “value-neutral” or “value-free.” And I’m just wondering. Do you buy into that, and what would your value base be for when you provide therapy services?

3–38Krumboltz: I do not buy into that at all. All counseling is value-laden, from beginning to end, and we might as well face it. My values… The values of the counselor come in when you agree to what the contract is. What are we going to accomplish here? And maybe other counselors would not have agreed to the same things that I agreed to. But it’s a contract. It’s a contract, an agreement. And it takes two people to arrive at that agreement. And once it’s agreed to, then we work on it together.

Audience Member #10: She mentioned several times that she had spoken with her husband, that her husband supported her, but yet I kept getting the feeling that, although the husband said he supported her, she still felt very alone when confronting the mother-in-law. At what point would a cognitive behaviorist address this issue, if at all, and how would they go about doing that?

3–39Krumboltz: Now address the issue of what?

Audience Member #10: Being alone and unsupported; out there by

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herself.

Krumboltz: I could have said that. I could have said the—I don’t know if I did. I guess not—I could have said, “You feel very much alone in this situation.” And I think that would have been an accurate reflection of probably how she did feel. Because, you know, she did say that the husband was supportive of her but he wasn’t willing to do anything. It sounded to me as if the husband was intimidated by his own mother. But he was willing to, you know, apparently to listen on the phone to the whole process.

3–40Kjos: And you had said that you had made a choice not to deal with her talking to her husband about supporting her versus calling the mother-in-law. I think that was sort of one of those choices one makes in a session: which way do we go?

Audience Member #1: John, I’d like to ask a theoretical question. Going back somewhat to Jon Carlson’s question in reference to research. One of the elements of mischief in some of the research is that one solution does not necessarily apply to another situation. What do you do in terms of transferring generalization of learning experience for the client?

Krumboltz: Well, in this particular case, we didn’t really address it explicitly. But sometimes, more often sometimes in career counseling, we’ll talk about, you know, “Let’s take a look at the process that you went through to arrive at this decision. Now, you’re going to probably be making many career decisions in the years ahead.

3–41What have you learned from this that you might want to use again if you need to make another decision?” And get the client to kind of verbalize the process that we went through. There, that’s a way of trying to promote some generalization.

Audience Member #4: John, given that cognitive behavioral therapy is a more directive teaching kind of model, would there be a student profile that might best fit this model in the teaching arena, as far as training counselors?

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Krumboltz: Uh, a student profile? You mean, a…

Audience Member #4: A type of student who might adhere well to that kind of approach.

3–42Krumboltz: Well there’s a premise in your question here that I want to challenge. You see, I don’t think that counseling techniques should be adhered to on the grounds that they are comfortable for the counselor. I think counseling techniques are used because they are helpful to the client. You see, I would want to be, I would want to be training counselors who would be maximally helpful to their clientele. And it might be that initially, they might feel a little bit uncomfortable trying out some techniques. I don’t really know why. I mean, I don’t think these are particularly uncomfortable techniques. But let’s say they are. So part of the training program is to help them learn how to do these techniques effectively, but not to say, “Oh, well, you’re not very comfortable using positive reinforcement, so you don’t have to do that.

3–43You just go ahead and do your whatever thing.” No, that’s not the way. This is a profession. Our job is to serve the public, and we have to serve the public using the best techniques we know how. You know, what if a doctor, you go to a doctor and say, and you yell and you’ve got appendicitis, and he says, “You know, I’m not really comfortable with operations. I think what I’ll do is I’ll give you some aspirin. Well, I’m really comfortable giving aspirin. That’s what I’ll give you.”

Audience Member #4: I know that doctor.

Krumboltz: No, no. We’ve got to use the best techniques we know how.

Carlson: John, we’re nearing the end of our time. Are there any comments or any concluding remarks that you might want to make for our audience?

3–44Krumboltz: Well, yes. I just want to say one thing, and that is that, you know, we have to be very careful about all of these theories that

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we throw around. You know, there’s a tendency to, uh, somehow deify these theories and make them more important than they really are. You know, a theory is just a simplification. It’s a way of looking…I mean, human life is so complicated that we can’t understand it. We can’t understand it. So a crutch that we go to is a theory, a way of sort of…Well, if I can’t…If I can just kind of put my finger on a few labels, it would help me get hold of it. So okay, here are a few labels that we can use to kind of put it in order. But when we do that we are simplifying it, oversimplifying it. And so, we ought to keep remembering that it’s an oversimplification that we’re using, and that real life is much more complicated, and we should never forget that. And therefore…

3–45See, one of the advantages of the cognitive behavioral approach is that it is perfectly willing to steal techniques from anybody. No limit, no limit. The question is, does it work? Does it help the client? That’s the important thing. That’s what we’re all about.

Carlson: Well thank you, John. We all learned a lot about cognitive behavioral therapy and appreciate you being with us today.

Kjos: Thank you.

Krumboltz: My pleasure.

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Video Credits

SPECIAL THANKS TO:The clients Gina, Juan, Robin and Phil for their time and the courage to share their personal stories so that others may learn.

Barbara Milton, Project Coordinator, for her dedication to the success of this project.

Faculty and students in the Psychology and Counseling division of the College of the Education at Governors State University for their participation.

Addison Woodward, Chair, Division of Psychology and Counseling for his support, participation and encouragement.

LeonZalewski,former Dean, and LarryFreeman, Acting Dean, College of Education for their support and encouragement.

A very special thank you to Ray Short, Editor, Allyn & Bacon, for his courage and vision.

A production of Communications Services, Governors State UniversityVideo copyright © 1997, Allyn & Bacon DVD released by Psychotherapy.net, 2009; VHS version by Allyn & Bacon, 1997.

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About the Contributors

VIDEO PARTICIPANTSJohn Krumboltz, PhD, Featured Therapist, is Professor of Education and Psychology at Stanford University with a specialty in counseling psychology. He helps counselors learn how to help their clients take actions to create more satisfying lives for themselves. His research covers tracing the roots of academic, career, and personal problems, as well as studying the emotional outcomes of learning experiences, and the use of multimedia in simulating occupational activities. Dr. Krumboltz is also a leader in the theory of career counseling. His social learning theory postulates that career transitions result from an uncountable number of learning experiences made possible by both planned and unplanned encounters with the people, institutions and events in each person’s particular environment.

Dr. Krumboltz is a Fellow of the American Psychological Association and the American Association for the Advancement of Science. He has received a Guggenheim Fellowship and spent a year as a Fellow at the Center for Advanced Studies in the Behavioral Sciences. On three occasions he has received the Outstanding Research Award from the American Personnel and Guidance Association. In 1990 the American Psychological Association’s Division of Counseling Psychology gave him the Leona Tyler Award, the nation’s foremost award in the field of counseling psychology.

Dr. Krumboltz is co-author of Luck Is No Accident: Making the Most of Happenstance in Your Life and Career and Changing Children’s Behavior.

Jon Carlson, PsyD, EdD, Host, is Professor of Psychology and Counseling at Governors State University and a practicing clinical psychologist. He has authored 40 books, 150 journal articles, and developed over 200 videos featuring leading experts in psychotherapy, substance abuse treatment, and parenting and couples education.

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Diane Kjos, PhD, Host, now retired, was a professor at Governors State University in Illinois for twenty-two years, and past-President of both the Illinois Counseling Association and the National Career Development Association. She is co-author, with John Carlson, of two textbooks, Theories of Family Therapy, and Becoming an Effective Therapist, and co-host of the video series Psychotherapy with the Experts, Family Therapy with the Experts, and Brief Therapy Inside-out.

MANUAL AUTHORSRandall C. Wyatt, PhD, is Director of Professional Training at the California School of Professional Psychology, San Francisco at Alliant International University and a practicing psychologist in Oakland, California.

EileenM.Flanagan,MA,LMFT, is a practicing psychotherapist practice with offices in Oakland and San Francisco, California. Email: [email protected].

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