Essay Grade

JOHN SOMMERS-FLANAGAN:
Welcome to our clinical interviewing DVD. In this video, we describe anddemonstrate a wide range of different clinical int
erviewing responses. Our goal is to help you further developyour clinical interviewing repertoire. The material in this DV
D is based on our textbook, cleverly titled clinicalinterviewing.
RITA SOMMERS-FLANAGAN:
In our life as professors, we really have come to believe in that old kindergartenactivity called show and tell. So in this vid
eo, we’re obviously going to be telling you about clinical interviewingskills, but we also will be showing you video clips th
at illustrate these. And we really hope that together they’llcombine to help you become excellent clinical interviewers.
JOHN SOMMERS-FLANAGAN: And
we begin with a focus on very basic interviewing and listening skills, skillsthat everyone needs to do a really good clinical i
nterview. These skills include attending behavior, nondirectivelistening, directive listening, and action responses, as well as the skill the use of questions. Later, we move todem
onstrating more complex assessment interviews, including intake, mental status, and suicide assessmentinterviewing.
RITA SOMMERS-FLANAGAN: You know, our overall goal in
this DVD is to help you become aware of how to dothe skills and when to do the skills. Awareness isn’t undergirding. That’s very important in conductingprofessional clinical interviews and in being a mental health professional.
JOHN SOMMERS-FLANAGAN: You
know, just a few years ago, Rita, although I might be underestimating that,we had a clinical supervisor who used to always
say, don’t fly by the seat of your pants. You need to know whatyou’re doing and why you’re doing it. You need to know w
here you’re going, basically.
And I think what he also was saying is that as clinical interviewers, we need to become more intentional. Andso that’s ano
ther goal that we have for this video. And that is we hope that it can move you in that direction soyou become a little bit m
ore intentional in your clinical interviewing activities.
In the next four parts of this interviewing DVD, we focus on what we call the continuum of listening responses,beginning
with the less directive, almost nondirective listening approaches and extending to the morecomplex and directive interviewing or even action skills.
RITA SOMMERS-FLANAGAN:
I think it’s important before we actually talk about the techniques that we take aminute to think about a couple of things t
hat are across techniques in interviewing. One is that because there’sa power differential in the relationship, and we can n
ever not communicate, the interviewer can be seen asdirective even when they’re not doing anything. It’s just associated
with the authority.
JOHN SOMMERS-FLANAGAN: Yeah. Rita, that reminds me. And it goes without saying, but you know me, I’mgoing
to say it anyway, that culture and the individual characteristics of the client are very important in theclinical interviewing
process. For example, if you don’t consider race, sex, ethnicity, and many other backgroundfactors, it may be that you’ll be
tuned out and insensitive to things that you’re doing that might be off putting tothe client.
For example, if you’re listening closely, and leaning forward, and nodding vigorously, making great eye contact,but your cl
ient is sort of leaning backwards, and looking awkward, and uncomfortable, it’s your problem. It isdefinitely not the client’
s problem. And you need to make some changes in your approach.
I also find that there’s a little subjectivity in how I respond personally to interviews. And for example, when yousaid, I und
erstand, I just really kind of don’t like that at all. Because I think technically you can’t reallyunderstand the deep experienc
e of another person, especially if the person’s from another race or anotherculture.
RITA SOMMERS-FLANAGAN:
Yeah, yeah, you’re right. It’s very subjective. And there are, I think, some bad orineffective ways of listening that aren’t just
ineffective. I think they are harmful. I think looking at your watch,glancing around, yawning-JOHN SOMMERS-FLANAGAN: Or maybe interrupting, interrupting could be one of those negative behaviors.
RITA SOMMERS-FLANAGAN: Yeah,
I agree. I think that across cultures, people have some kind of awareness orradar that tells them when they’re not being lis
tened to and they’re not being respected, yeah.
JOHN SOMMERS-FLANAGAN:
So I guess the bottom line is listen well, listen authentically for you, but also tryto calibrate or adjust the way you’re listeni
ng for the specific individual who you’re with in the room.
RITA SOMMERS-FLANAGAN:
Yeah, I think too I want to underline something I tell my students over and overagain. Listening is a gift. Listening in our c
ulture, being listened to very, very well, is really a rare and a helpfulgift.
Let’s talk about some of these listening techniques, the least directive set of interviewing skills, nondirectivelistening responses.
JOHN SOMMERS-FLANAGAN: Right.
RITA SOMMERS-FLANAGAN: So the first one is Allen
Ivey’s attending behaviors. And these include eye contact,body posture, voice tone, and verbal tracking.
JOHN SOMMERS-FLANAGAN:
And Ivey wrote about those as basic micro skills that are always present in theinterviewing interaction. In addition to thos
e, there are also some non-directive listening responses. Theseinclude silence, clarifications, paraphrasing- and there’s several different kinds of paraphrases people can use– reflection of feeling, and summarization.
RITA SOMMERS-FLANAGAN:
Silence can be a very compassionate response. Just sitting quietly aftersomebody has shared their pain or their story can b
e difficult but very powerful. The important thing is, John,you’ve got to have your body, and your mind, and your face all r
eally connected to the client, really saying, I hearyou. I’m right here in the room with you. I can handle this.
JOHN SOMMERS-FLANAGAN: You know, I
think that’s a great point. Almost every student I’ve ever worked withhas wished that they had exactly the right thing to s
ay at the right time.
RITA SOMMERS-FLANAGAN: Right.
JOHN SOMMERS-FLANAGAN:
And sometimes silence is exactly the right thing to say. Although, I thinkespecially for beginning interviewers, five or 10 s
econds of silence can seem like an eternity. And so they canfeel like they need to say something. And even myself, at times,
I noticed I should put my hand over my mouthand try to stop myself from talking too much.
RITA SOMMERS-FLANAGAN:
Verbal output, yeah, so silence certainly is a skilled tool and an important one.But of course, we also need some other nondirective techniques that we can use.
JOHN SOMMERS-FLANAGAN: Tell me more about that.
RITA SOMMERS-FLANAGAN: Well, that was one, and verbal prompt.
JOHN SOMMERS-FLANAGAN: Mmhmm.
RITA SOMMERS-FLANAGAN:
Mmhmm. And also we can use paraphrasing, which means just reflecting backthe content that you’ve heard. Although, I h
ave to say something about that. When paraphrasing is done in aclumsy way, I think it can seem like you’re mimicking the
client. It can seem kind of robotic.
JOHN SOMMERS-FLANAGAN:
So what you’re saying is that although you think paraphrasing is very important,you really don’t like it when it’s done in k
ind of a mimicky or robotic way.
RITA SOMMERS-FLANAGAN: Thank you, John Carl Rogers Sommers-Flanagan. I hate when you do that. Sowhat
you’re saying is you really don’t like it when I talk like Carl Rogers.
RITA SOMMERS-FLANAGAN: Well, I like Carl
Rogers, but so let’s move on. How about this. How about you saysomething, and I’ll demonstrate a clarification.
JOHN SOMMERS-FLANAGAN:
Sounds good. You know, one of the things that is I think true for me is thatsometimes in my students, I have observed the
m having naturally good listening skills. It’s like they seem to beborn to listen, while other students, it’s more of a challeng
e for them.
And they need to work at it
a little harder. But what I found is that the virtually everyone is able to increase orimprove their listening skills. And so th
at kind of gives me hope for everyone.
RITA SOMMERS-FLANAGAN:
So what I think I hear you saying is that listening skills and abilities can besomething someone naturally has, more or less
of. But in the years you’ve worked in this area, you’ve realizedthat everyone can learn to be a better listener. Did I get that
right?
JOHN SOMMERS-FLANAGAN:
Absolutely right, and it feels good to be heard. And so now let’s watch the magicof listening skills in action. Now this video
clip begins a couple of minutes into a session where the client,Jessie, is talking about a roommate problem. The therapist,
Megan, has a very gentle and accepting style,which allows Jessie to explore her concerns in depth.
Early on, you should especially watch for Megan’s paraphrase about Jesse having no time for herself. Becausethere’s not e
ven a hint of a robot in the room.
JESSIE: I just, I can’t. I feel like she uses me as like a sounding board, and I get nothing in return.
RITA SOMMERS-FLANAGAN:
You said several times while talking that she doesn’t listen to you or doesn’t evengive you the opportunity to talk. It seems
like she just talks, talks, talks.
JESSIE: Yeah.
MEGAN: And then you’re listening, and that’s exhausting. Or you’re kind of getting angry and irritated by it.
JESSIE: Yeah, yeah, I do. It’s just frustrating when somebody comes and they talk to you for like half an hourabout all
of their problems. And then it’s like once they’re done, they’re like, OK. I don’t care about how you are,what you’re doing.
So she’ll go off and do whatever, or watch TV, or something. And
whenever I do try to talk to her, she’s likeeither playing a video game or
on her phone. Or she’ll just start in with oh, did that happen to you? Thathappened to me. And it’s just like, oh my gosh.
MEGAN: Then she’ll go on into it.
JESSIE: Yeah, and then she’ll
just go off about her own story. I care about our friendship, because it’s been likea five or six or something yearlong friendship. And so I would like to continue that. And so I think we could stillbe friends, if we
didn’t live together. But the whole not living together part has to be crucial. Yeah.
MEGAN:
Yeah, it seems like you’ve talked a lot about the different things that you’re dealing with within thisrelationship with her, i
n terms of not being heard and not enjoying, just not enjoying, being around her anymoreand not wanting to go home.
JESSIE: That’s the worst part.
MEGAN: And feeling frustrated by it, but also just it almost seems like you’re not sure what to do about it.
JESSIE:
Yeah. I guess I’m just not sure how to bring up not living together anymore. I’ll be gone for the summer,so part of me think
s that would be a way. Because like she has to find a new place or continue to pay rentwhere we are.
And I don’t want to have to do that. And so part of me wants
to be like, well, I’m just not going to be here. So wecan’t live together because of that.
Because you need to get into a place and start paying before I’ll even be here. And so I kind of want to
justapproach it that way. But that’s definitely not confronting the real reason of why I don’t want to live with her.
MEGAN: What’s hard about that, about confronting her?
JESSIE:
Because I like confrontations. And I don’t like making people feel upset. And I’m pretty sure that shewould cry, and get def
ensive, and angry.
And we couldn’t continue a friendship. It would be like I’m a horrible person for this, and she wouldn’t want tobe my frien
d. I would just imagine her getting defensive and blame me or something.
MEGAN: So when you think about confronting her, you think that it would end the relationship. Am
I getting thatright? Or that it would kind of lead to that?
JESSIE:
Yeah, that’s what I’m afraid of. Because honestly, I want to say I can’t stand your dogs, and I can’t standyour attitude. And I
am so exhausted with you. And I can’t continue to live with her. That’s how I feel.
RITA SOMMERS-FLANAGAN: That was really nice. You
know, we showed that video, we didn’t really talk aboutsummarizing or summarization. Summarizing can really be a grea
t technique to use, partly because it forcesyou to listen so well. Because you’re going to list the main points that you’ve jus
t heard.
JOHN SOMMERS-FLANAGAN: Yeah, and
I think Megan did a great job of that. Especially because for myself,and I think many people I know, it’s so easy for the poin
ts that you’re listening to kind of evaporate in your mindas you’re trying to formulate the summary. And she did a great jo
b. She identified that the client was feelingvery unhappy in the roommate situation, that she was not wanting to come ho
me, that she didn’t feel heard,that but she really didn’t even like her roommate anymore.
RITA SOMMERS-FLANAGAN:
Yeah, that was a great summary. One warning is probably not to number theitems that you’re going to say. Because you ca
n get to number two and suddenly have no idea what numberthree was. So John there’s one last skill that I think maybe w
e should talk about before ending this segment.And that is called the reflection of feeling.
JOHN SOMMERS-FLANAGAN:
Absolutely, and I’m really glad that you remembered that. I find myself just aswe go through this production process, it’s s
ort of nerve wrecking. I feel nervous. I feel anxious.
I try to keep an external composure. But on the inside, I feel pressure. I’m worried that we’ll make mistakes, andthat mayb
e it’s going to be not hopeful, or even worthless, or even the worst possible scenario that I would justterribly embarrass m
yself.
RITA SOMMERS-FLANAGAN: Yeah, so lots of feelings there– you feel anxious. You want this to go well. You
have kind of this calm veneer, but underneath there’s anxiety. There’s a kind of worry that this won’t go well.And it just sp
irals down to the point where we might be wasting people’s time and really might just beembarrassed.
JOHN SOMMERS-FLANAGAN: That is very nice. You did
a great and accurate job of identifying a range ofdifferent emotions that I’m feeling. And I have to say I really appreciate th
e fact that stayed with the basic nondirective reflection of feeling. You didn’t interpret anything. You didn’t try to go for my deep-seated neuroses.
RITA SOMMERS-FLANAGAN:
Right, well no, it was tempting. And in the next sections, we’ll have opportunitiesfor that. But our time’s up for this section
. And we’ll move on to more directive listening and action responses.
JOHN SOMMERS-FLANAGAN:
Previously on this video, we focused on listening skills and techniques that helpthe interviewer stay less directive. And ou
r therapist on the proceeding video clip, Megan
Hopkins, she is amember of the Sioux Assiniboine tribe. And that particular tribe has strong values and deep beliefs about
theimportance of listening to one another respectfully. And the extent to which you as a professional clinicalinterviewer v
alue listening may also depend on your cultural background and even on your personalexperiences.
RITA SOMMERS-FLANAGAN: That’s true. You know, being able to stay nondirective and nonjudgmental is animportant part of interviewing. But we also have to learn how to use more directive inte
rventions and actions ina way that maintains the therapy relationship.
JOHN SOMMERS-FLANAGAN:
Absolutely. In this next section, we begin moving further along the continuumtoward more complex and more directive lis
tening responses. These responses are referred to as directivelistening responses, because they still primarily focus on list
ening. But they also include components that areprogressively more directive.
And so they involve lots of listening, and a little bit of directing, or pushing clients to see or think about things abit differen
tly. Directive listening responses are more judgmental. And they include guidance or validation fromthe interviewer.
For example, you might use a feeling validation like, I can sure see why you would feel angry about that. Andthat’s sort of
a validating response. It’s no longer non-directive.
RITA SOMMERS-FLANAGAN:
Right, and you might do an interpretive reflection of feeling, which takes it a littlepast the feeling that has been stated. And
you might take a guess at a feeling that might actually be implied orjust underneath what the client is saying.
JOHN SOMMERS-FLANAGAN:
Some people, Rita, refer to that as advanced empathy, because it goes beyondthe client’s words. And speaking of going bey
ond the client’s words, from the psychoanalytic perspective, aneven more directive listening response is interpretation. In
terpretations are designed to put two differentobservations together and along with
an attentive statement about how they might be related or what theymight mean. These meanings that the interviewer pi
cks up on might relate to earlier life experiences of theclient or perhaps to some kind of unconscious processes.
RITA SOMMERS-FLANAGAN:
Right, and of course that is sort of theoretically laden. And some people are littleresistant to that kind of interpretation. Bu
t another way of thinking about it is when you take information theclient is giving you and you link that to a different reali
ty or different way of seeing reality, and we call that a re-frame. It’s also quite directive.
JOHN SOMMERS-FLANAGAN: Yeah, and you might even do a gentle confrontation. At least I
prefer gentleconfrontations. Because confrontations simply involve pointing out inconsistencies or discrepancies betwee
nwhat clients are saying they want and what they’re actually doing.
RITA SOMMERS-FLANAGAN:
In this next set, we’re going to see John working with Trudy, who’s struggling inher marriage with her husband named Ja
mie. And it’s also important to notice that they have a son namedRoss who has a disability. And Ross is still living with the
m. It may be subtle, but notice the difference in toneand style when the interviewer’s being slightly more directive than th
e previous segment with Megan.
TRUDY:
And I keep telling him, he doesn’t have to do it all today. But then I think he thinks that I’m trying tosabotage his good heal
th. I don’t know. It’s just like everything that I do that I think is going to be a good thing, apositive thing, doesn’t turn out t
hat way.
JOHN SOMMERS-FLANAGAN:
Yeah, you mentioned before you feel a little bit scared at the idea of really beingout there kind of on your own. But also I h
ear maybe some sadness and some frustration in the relationshipnow and that you’re not even sure where to start.
TRUDY:
You know, I don’t. I sit and think about how our relationship has been in the past. And I realized that itwasn’t just since Ja
mie’s first heart attack that things have been different.
I just remember a time when this friend of mine that I was telling you about that is concerned about me, shecalled me for l
unch one day. And so we made arrangements go to lunch. And you know what? I took Ross withme.
And I remember her looking at me like, I invited you to lunch. And Ross was 17 years old. And so consequently,we never t
alked about girl things that we might have talked about or anything like that. It was just about kind ofabout Ross and tryin
g to keep him in the conversation, which isn’t always easy because he has some autismproblems. And I don’t know why I d
id that.
JOHN SOMMERS-FLANAGAN: Is it OK with you, Trudy, if I just share with you
a thought that I have about one ofthe dynamics that I think might be going on.
TRUDY: Sure.
JOHN SOMMERS-FLANAGAN:
I hear you saying that sometimes Jamie says or wonders if you’re trying tosabotage some of his exercise.
TRUDY: Yeah.
JOHN SOMMERS-FLANAGAN:
But I also hear you maybe sometimes actively sabotaging the possibility ofintimacy with him. And I
just wonder what your reaction is when I say that.
TRUDY:
It’s very possible. And you know, this is one thing, John. This just really upsets me about myself when Ithink about it. I don
‘t think I even know how to be intimate anymore. It would
seem so foreign to me to spendtime with just Jamie and to talk about our feelings.
JOHN SOMMERS-FLANAGAN: Yeah.
RITA SOMMERS-FLANAGAN: So in that last section, we saw two interesting things. We saw
an interpretation offeeling, and we saw confrontation. The first, the interpretation of feeling, led Trudy to go into deeper
material.And that’s often an indicator that the interpretation was accurate.
And then we saw the confrontation, which of course was very gentle. We asked the client’s permission, thenoffered the int
erpretation, and then asked her what she thought about it. And again, we saw Trudy just go for it.And that’s an indication t
hat the confrontation was OK with her.
JOHN SOMMERS-FLANAGAN:
One of the reasons I think I like to ask client’s permission to do a confrontationis because I’m kind of naturally averse to c
onfronting people. So it’s a hard thing for me. And I also think ithelps to engage them in a more collaborative way. The oth
er
thing I noticed about that clip was that althoughTrudy was talking about sabotaging a lunch with a friend, I brought it bac
k with the confrontation to herpresenting complaint, which was intimacy with her husband.
RITA SOMMERS-FLANAGAN: Yeah, so in this next little clip, we’re going to watch John work with TJ. TJ is a 22-yearold young man with issues around anger, aggression, and social skills. This clip that you’re about to seefocuses on TJ’s ang
er and aggression. And you’ll see a paraphrase, then
an attempt, and an interpretivereflection of feeling, which TJ corrects, and then a reflection of feeling, and
a clarification. You’ll see Johncreating a context for interpretation and then offering the interpretation.
TJ: –fights with family that don’t fully escalate physically, but kind of break you down.
JOHN SOMMERS-FLANAGAN: So you’ve had some fights with
your family that have been emotionally prettypainful, maybe lasting emotional effects, not so much physical. OK. And whe
n I hear you say that, it sounds likeone of the costs of that is you feel some regret. Have I got that right? Or is it something
else?
TJ: Not completely, more like sympathy.
JOHN SOMMERS-FLANAGAN: Tell me about that.
TJ:
Well, I think emotions are a weakness. And if I have emotions that make me vulnerable, when people feelsympathetic of it,
it doesn’t help me at all.
JOHN SOMMERS-FLANAGAN:
OK. So it is painful to you emotionally to be seen as having a weakness. And sowhen your family or people have some sym
pathy for you, that actually is something you don’t like?
TJ: No.
JOHN SOMMERS-FLANAGAN: No.
TJ: No, because it’s like they feel like they have to do something to make you feel better to get you out of it.
JOHN SOMMERS-FLANAGAN: OK. I’ve heard you use the word weakness at least three times.
TJ: Yup.
JOHN SOMMERS-FLANAGAN: And sometimes when we talk about anger and
anger management stuff, one ofthe things we do is we talk about what are the triggers or the buttons they get pushed that
bring that anger up.And it makes you wonder if maybe one of the buttons or the triggers for you is a sense of feeling weak.
Wouldyou say at that might make you pretty pissed sometimes?
TJ: Yeah.
RITA SOMMERS-FLANAGAN:
So John, you were really working with TJ with his emotions and the triggers thatare associated with his aggression. And y
ou did have that attempt to do an interpretation of feeling, and hewas able to say, not quite right. Yeah. He also, I think, aft
er you corrected, was starting to get some awarenessthat even the slightest whiff of weakness was going to be a trigger fo
r him.
JOHN SOMMERS-FLANAGAN:
Yeah, I do think it’s good to follow the client’s lead on interpretive material inparticular. And so when he clarified or told
me that it wasn’t quite right, I wanted to go with his direction ratherthan mine. And you know, I think that’s really import
ant, partly because interpretations when they go well arecollaborative. And Otto
Fenichel said this over 60 years ago, and that is, that we have to prepare clients forinterpretations and
that interpretations are really a way of us working on the edge of our client’s consciousnessor awareness.
RITA SOMMERS-FLANAGAN: Yeah, there’s nothing mysterious or woo-woo about interpretations. They’re
notlike mind reading. They really involve a lot of listening and a lot of work. So directive listening responsesobviously dep
end more on the view of the interviewer, and the direction is this a little bit more related to where
the interviewer wants to go than the client.
JOHN SOMMERS-FLANAGAN: Yeah, directive listening responses are more advanced responses by clinicalinterviewers.
RITA SOMMERS-FLANAGAN:
Well, I agree with you in one sense. But I also think that actually listening really,really well is as hard as some of the more
directive responses.
JOHN SOMMERS-FLANAGAN: Well, you
know, actually I totally agree with you. You’ve convinced me. And reallywhat I was trying to say is I
was trying to make the point that interviewing in a directive way is sometimes verytempting.
And it’s very natural. It’s similar to the way we behave socially in social environments. And so I do think that todo it well, i
t really requires awareness of your goal. It requires sensitivity to the client, and it requires practiceand probably some wis
dom as well.
RITA SOMMERS-FLANAGAN:
So in this section, we’re going to be talking about directives and actionresponses, which actually move us a little further al
ong the continuum of directive listening skills.
JOHN SOMMERS-FLANAGAN: Directives are really sort of like prescriptions in that they push or move clients a
little bit toward acting, feeling, or thinking in certain particular ways. And so it’s really important when usingthese kinds o
f approaches that we weave back and forth or we integrate into the approach some less directiveor nondirective listening skills– so a non-directive listening skill like
a paraphrase, and then a directive actionresponse, and then a check in or paraphrase to follow it.
RITA SOMMERS-FLANAGAN:
And you know we’re talking a lot it about the continuum as if it’s a linear sort ofprocess. But actually, it’s sort of dimensio
nal. Because something that seems very non-
directive can be done ina way that was experienced as pretty directive. Raised eyebrow, a tone of
voice, choice of words, posture thosekinds of things can be experienced is as a pretty directive or not attractive.
JOHN SOMMERS-FLANAGAN: I know, I’ve seen some people raise one eyebrow. And I’ve never been able to dothat.
RITA SOMMERS-FLANAGAN: Can you raise one nose nostril?
JOHN SOMMERS-FLANAGAN: I don’t want to try, especially not on video.
RITA SOMMERS-FLANAGAN: OK, fine. So in general, I think the truth is that nondirective things can be directiveand directed things can come off as non-directive, really depending on how you use them.
JOHN SOMMERS-FLANAGAN:
Yeah, when interviewers start sharing information, or making suggestions, orexpressing agreement, or disagreement, or a
pproval or disapproval-RITA SOMMERS-FLANAGAN: Or giving advice-JOHN SOMMERS-FLANAGAN: Self-disclosing-RITA SOMMERS-FLANAGAN: Yeah, self-disclosing, urging-JOHN SOMMERS-FLANAGAN:
When those kinds of things are happening, it’s obvious that the interviewer ismoving toward action. And we’re trying to c
hange in those situations the client’s way of thinking, or way ofbeing, or behaving. We are in the realm of the directive, wh
ich may be one reason why directives are mosteffective with clients who are in Prochaska and DiClemente’s action stage i
n the transtheoretical model. Theseare people who are ready to engage and work hard toward change.
RITA SOMMERS-FLANAGAN:
Right, right, well, being directive is not a bad thing. It’s just that it comes verynatural to some bossy firstborn people. And t
hey might need, like you’ve been talking about, to tone it down, tobe aware of when to use it. On the other hand, there are
people who are very passive and the idea of offeringsomething directive can be sort of terrifying.
So in this next clip, we see John using agreement, suggestion, and he provides psychoeducational materialeffectively and a
ppropriately. Watch how he engages his client Lisa with the information and the ideas heoffers.
LISA: Well, I don’t want to take drugs. I’ve tried a couple of glasses of wine at night, doesn’t seem to help.
JOHN SOMMERS-FLANAGAN: That doesn’t help either.
LISA:
No. I’ve tried a good book, and that’s fine until I turn off the light. And then my mind starts racing again. Ijust feel overwhe
lmed and behind. All my life there have been times like that, but I’ve been able to see the bigpicture and know that it’s just
a bump in the road. Now I’m swallowed up.
JOHN SOMMERS-FLANAGAN:
Yeah, that does sound really intense. Now let’s focus on the sleep just for a littlewhile. There are three kinds of insomnia,
mainly. One is difficulty falling asleep. And that’s when you lay there,oftentimes with racing thoughts, but you can’t get to
sleep often for hours.
The second type is early morning awakening. And that’s when you go to sleep, and you sleep most of the night.But maybe
2:00 or 3:00 in the morning, depending on when you went to bed, but way earlier than you want towake up, you wake up
and then you can’t get back to sleep. And so that’s early morning awakening. And thefirst one is difficulty falling asleep.
And the third one is a thing called choppy sleep or intermittent insomnia. And that’s when maybe you havesome difficulty
falling asleep. You go to sleep. You wake up.
You go to sleep. You wake up. And you kind of wake up intermittently through the night. Which do
you think isthe best description of the troubles you’re having?
LISA: The first one.
JOHN SOMMERS-FLANAGAN:
OK. Are you interested if I might suggest to you a few ideas about how toapproach the sleep issue?
LISA: Sure.
JOHN SOMMERS-FLANAGAN:
I know that there are other things that we could and will talk about. But it seemslike if we focus on the sleep for a little wh
ile that that might be useful. Is that OK?
LISA:
Yes. I think it’s all magnified by the fact that I have such a sleep deficit. And if I can sleep better, I’ll handlethings better.
JOHN SOMMERS-FLANAGAN:
Yeah, I think that might be true for everybody. The lack of a good night’s sleepcan make all of us a little less able to cope w
ith things. And anything else you’ve tried to maybe push thethoughts aside or to speed the onset of sleep for you?
LISA: No.
JOHN SOMMERS-FLANAGAN: OK. Have you ever heard of mindfulness meditation or have you ever triedmeditating?
LISA: No, I never have.
JOHN SOMMERS-FLANAGAN:
No? OK. I’m just going to describe one approach to that. And actually I’llprobably describe several approaches. And what I’
m going to do is I just want you to think about them and trythem on as I’m talking. OK?
LISA: OK.
JOHN SOMMERS-FLANAGAN:
So there’s a guy who did some research long ago. And he identified four thingsthat people need to experience a relaxed sta
te of mind. They need a comfortable position.
I’m guessing in your bed it’s comfortable. They need a quiet place. Is it more or less quiet?
LISA: More or less.
JOHN SOMMERS-FLANAGAN:
OK. Then they need a mental device. And what that means is a thought. It couldbe an image to focus on. It could be a word.
You’ve tried counting sheep. That’s an example of a mental device. And we’ll talk more about that in a moment.And then t
he fourth thing you need is passive attitude. And a passive attitude, do you know what I mean bythat?
LISA: Well, go back to the one before.
JOHN SOMMERS-FLANAGAN: Mental device.
LISA:
Yes, at some point I hope you’ll explain that one to me. And no, I’m not sure exactly what you mean by apassive attitude.
JOHN SOMMERS-FLANAGAN: OK, well, let
me try to explain both. Mental device, the sort of Zen people whoare into meditation would say that your mind is like a ba
rking dog– bark, bark, bark, bark, bark. And it barkswhen you stop reading, and you lay down.
And they sometimes say yapping, you know? But a barking or
a yapping dog, and then in order to get that mindto stop barking at you, you need to give it a bone. You need to give
it something to chew one.
And that is what we refer to as a mental device, mental device being sometimes a mantra. People who do sortof Buddhist s
tuff might say the word ohm over and over. People who are religious, I know a guy who isreligious, and he likes to say so
mething they feels sort of spiritually right to him.
And his mantra is to say, I am here. Here I am. So with his in breath he says, I am here.
With his
out breath, he says, here I am. And that sort of got some spiritual meaning for him. And so he findsthat very soothing, and
he can stick with it.
RITA SOMMERS-FLANAGAN:
So Lisa is obviously happy to get some information and