Dr. Guenther interviews Dr. Gordon MacNeil, retired professor of Social Work at UA, about the different types of therapy, most effective and most common. Original airdate: September 11, 2018.
Disclaimer: This show is not a substitute for professional counseling and no relationship is created between the show hosts or guests and any listener, if you feel you’re in need of professional mental health and are you a student, we encourage you to contact the UA counseling center at 348-3863. If you are not a UA student, please contact your respective county’s crisis service hotline or their local mental health agency or insurance company. If it is an emergency situation, please call 911 or go to your nearest emergency room.
Dr. BJ Guenther: Hey, it’s 6:00 and time again for Brian Matters, the official radio show, the UA counseling center, we are broadcasting live from the WVUA-FM Studio, 90.7 The Capstone on the campus of the University of Alabama. Good evening, my name is Dr. BJ Guenther, I’m the host of the show. This is our first show back from summer, so we might be a little rusty tonight, bear with us and be a little bit patient. We’ve got probably 12 shows scheduled for this semester and all of them sound really interesting and exciting, I’ve got actual in studio guests but also via telephone guests from all over the country. so stay tuned I’ll give you a heads up on some of our shows at the end of this show. In case you don’t know and I always make this announcement, this show’s about mental and physical health issues that affect college students, students and in particular UA students, and you can listen to us live each Tuesday night from 6:00 to 7:00 PM on 90.7 FM or you can listen online at wvuafm.ua.eu.
Dr. BJ Guenther: You can also download the Crimson White app and click on the 90.7 live streaming link. I’m asking for listeners to call in with any questions that you might have for our guests or for myself, or you can also email us questions, sometimes we’ll take email questions and I think people are more apt to send emails sometimes than actually calling in. If you want to call in, you can call in at 348-9070 or you can email me questions at brandmattersradio@wvua.ua.edu, and also if you have any ideas for upcoming shows, you can always email those to me also and I’ll consider the show topic. Tonight’s guest has been a guest on our show before, and we were trying to think of how long ago it was, I think it was over a year ago, I don’t think it was last year, but our topic tonight is types of therapy and there are many different types of therapy including those that are most effective with families or groups of people.
Dr. BJ Guenther: You can learn about your options by talking with people that you trust, like your family, doctor or clergy, or with people who have had experience with mental health conditions or have sought help for themselves, or you can also call us at the UA counseling center and we’ll give you some recommendations on therapy. You may get more out of therapy if you understand how the process is so that’s what we’re going to talk a little bit about tonight. My guest tonight is Dr. Gordon McNeil, Gordon has just recently from the university but he’s still very much involved. We were just talking about one of the classes that he’s involved with here on campus. It’s an online class actually, but Dr. McNeil was a professor of social work, so he has years of experience on this topic and you can probably carry the show yourself without even me sitting here. Yeah, you could.
Dr. Gordon McNeil: We’re not going to do that though.
Dr. BJ Guenther: Thanks for being on the show again. I really appreciate it and hopefully some people’s listeners will be able to take some information that we provide here and if you’re thinking about going to counseling, this might help you a little bit.
Dr. Gordon McNeil: That’d be great.
Dr. BJ Guenther: Tell us a little bit … tell the listeners, since it’s been a while since you’ve been on the show about yourself, your credentials, how’d you get here, how’d you social work, yadi, yada?
Dr. Gordon McNeil: I was a licensed social worker and I just retired and to be honest about it, I’m letting my license become inactive so I don’t do private practice. I’m intentionally trying to step back from that kind of work at this point, but my background has to do with mental health and counseling, that’s my masters in isn’t that. I’ve taught practice courses in social work for the last 25 years-
Dr. BJ Guenther: Both Undergrad and graduate.
Dr. Gordon McNeil: Mostly graduate, master’s and doctorate for sure.
Dr. BJ Guenther: Where are you originally from?
Dr. Gordon McNeil: From San Francisco Bay area, but a good part of my adulthood was in Arizona and I have degrees … I taught high school English for eight years.
Dr. BJ Guenther: Thank you, you may have told me that before.
Dr. Gordon McNeil: So I have a background in … so I taught for a while. Then I went back and got my master’s degree in social work and then doctorate in that and my research had to do with family therapy with adolescents and that led into caregiving networks, grandparents raising grandchildren, and the abuse of grandparents, oddly enough financial, emotional-
Dr. BJ Guenther: Physical.
Dr. Gordon McNeil: Physical, all kinds, yeah. So adult protective services kinds of things and then that led into caregiving and so, oh, for the last decade or more my research focused on resilience and caregiving, family caregiving, particularly when there’s mental illness problems and not dementia, but other things, psychotic kinds of problems, psychosis oriented.
Dr. BJ Guenther: The topic for the show tonight we’re featuring types of therapy and what I was doing research, you know, it’s been a long time since I’ve taken counseling theory courses where we talked all the different types of therapy so I really was surprised and the newer types of therapy that’s out there along with some of the stuff that I’m familiar with, like behavioral therapy or rational emotive therapy or existentialism. I mean I could go down the list, I was just shocked at how many new therapies, I don’t know if you … because you have been teaching all along. I don’t know how much you’ve researched that or talked about that or were aware of some of the newer forms of therapy that are being used by the younger therapists coming out of school.
Dr. Gordon McNeil: There aren’t any number of different kinds of therapy, I’m going to be glib about it and say there’s a therapy of the week. There’s something popping up-
Dr. BJ Guenther: That felt like what I was reading, yeah.
Dr. Gordon McNeil: All the time, but the truth of the matter is you can boil it down to about a dozen essential therapies and there’s actually a book called Essential Psychotherapies.
Dr. BJ Guenther: Is it a textbook that you use for-
Dr. Gordon McNeil: You could use it as a textbook.
Dr. BJ Guenther: Or it’s more like a self help.
Dr. Gordon McNeil: I wouldn’t say it’s a self help book. It’s more an overview of these various kinds of therapy, it’s pretty extensive in explaining each of them. The point of the matter is that there are well over 500 different kinds of therapy, but you can boil many of them down to about a dozen.
Dr. BJ Guenther: Right, go into the same route.
Dr. Gordon McNeil: Yeah, maybe getting back to your question about what’s new, so what do we add to this? I think the things that are kind of the new ones that have traction and look like they’re going to stick around and endure. One of them certainly is a greater emphasis on mindfulness.
Dr. BJ Guenther: Yeah. You’re hearing that a lot more, it’s a sexy term?
Dr. Gordon McNeil: Well, they had a special issue in time on it so there you go.
Dr. BJ Guenther: There you go.
Dr. Gordon McNeil: Mindfulness for dummies, you think about that? Mindfulness for dummies.
Dr. BJ Guenther: It’s hard to mess it up.
Dr. Gordon McNeil: That’s an interesting thought, yeah.
Dr. BJ Guenther: When I was in school and right after I graduated and maybe some students who graduate are graduating now feel the same way, but I was really excited to try some new techniques and new strategies. I wanted to be this kind of theorist and all that, but I always, for me personally, I always go back to cognitive behavioral therapy, which … can you give us the definition of that, in simple?
Dr. Gordon McNeil: I think cognitive behavioral therapy is the idea that there’s a connection between a stimulus, how we perceive that stimulus, the generated affect that comes from that and our behavioral response to us.
Dr. BJ Guenther: That’s right, it’s as simple as that.
Dr. Gordon McNeil: And the idea that any one of junctures, there’s an opportunity to create choice and when we take those opportunities to create choice, people have power. Choice equals power in our lives and so when we have the opportunity to not do something automatically, but rather step back and reflect on something, think about the options available to us and then make educated choices.
Dr. BJ Guenther: I think that’s … one of the reasons I enjoy working with individuals who are struggling with anxiety issues because CBT, I can see how it helps pretty quickly and in most setting at the counseling center. I think now you tell me what’s your opinion is, the setting sometimes sets the tone for what type of therapy you’re going to use, is that true?
Dr. Gordon McNeil: I think that’s true, but I think maybe what we need to do is step back a little bit. I think you’re absolutely right, the setting has an important part in setting some parameters about what’s possible. But maybe to start at the beginning of this, one of the things is the setting and the resources available. When I say resources, it partly has to do with the training of the individual who’s providing or administering and intervention, it has to do with the philosophy and resources of the agency, it has to do with, to be crass about it, who’s paying, whether there’s an insurance company involved with this or the individual or what not. The resources that are available have a great deal to say with what are the boundaries. So when we say that, one of the things I’m thinking is how we define the problem even is set within those parameters.
Dr. Gordon McNeil: Somebody may come in and say, “I’m really unhappy with my life. I’m distraught, I’m depressed,” and if you’re working in an agency that’s governed by a limit of 15 sessions and you know we’re going to identify a particular symptom or maybe a syndrome which is a group of science and symptoms and we’re going to focus on that, and we’re going to do that specific intervention to reduce those specific symptoms, and then we’re going to evaluate and perhaps terminate, that’s different than saying we’re going to work with you to address this core issue of your unhappiness. Woody Allen went to therapy for 30 years, well nice to have the money to do that and have somebody who’s willing to do that. So the context also has something to do with how we define the problem and what we might think of as an appropriate intervention to do that particular job.
Dr. BJ Guenther: Yeah, you’re making me think of some things because mentioning … at the counseling center in case you don’t know for listeners, we have a limit of 15 sessions so we do have to work quickly I guess you could say. But the majority of our students, I can say this don’t really need … most of them don’t really need more than six to eight sessions, most of them. But occasionally, you know, I had a student come in this week actually and she has many things going on, many things going on and personally I just don’t think … I think the issues are more long term and I don’t think she’s … I don’t think we’ll be able to get very far with just 15 sessions. So the procedure is usually to refer them out to someone that they can see in the community, that’s what I’m going to have to do. But a lot of times it makes the students mad because they don’t understand what you and I are talking about.
Dr. Gordon McNeil: Well, sure.
Dr. BJ Guenther: They think they’re getting rejected or abandoned.
Dr. Gordon McNeil: Many times people come in for help, let me put it a different way, most of the time when people come in, they’ve already burned through their personal resources. They’ve already tried to solve the problem, they’ve already worked with their friends, their family, perhaps their pastor to address the problem and it hasn’t worked. That’s why they’re coming in for professional help because they’ve already tried a number of things and it hasn’t gotten the job done. In a way that’s good because they already seen what kinds of things don’t work. But sometimes people come in because they’re overwhelmed. Most of the time they function pretty well, but they’ve tipped the balance and it’s becoming overwhelming circumstance for them and they need help.
Dr. Gordon McNeil: When I’ve talked with students, one of the things that I say is, as a social worker, our job is very much like being a spotter in weightlifting. I might be losing some of the readers, but when somebody is lifting weights seriously, they’re really stretching out, they’re really trying, they’re really using their muscles to the nth degree. The purpose of the spotter is to make sure that they can complete the task safely. In doing that, in spotting correctly, you don’t take the weight, you take enough of the weight so that the person can complete the wrap, they do the job. You’re there to help them-
Dr. BJ Guenther: And support them, yeah.
Dr. Gordon McNeil: As a social worker, I don’t want to solve somebody’s problems, I want to be there to help them solve problem. In many instances that means I want to help them and educate them in a process so that they can take that process and apply it to other problems. We may not solve every problem from somebody who’s overwhelmed, but if we give them the golden ticket, here is a process, here’s a mechanism, here’s a process that you can use to apply to many different problems, they can probably function independently without much assistance.
Dr. Gordon McNeil: So when somebody comes in and they’re wow, way over their heads with a lot of different things going on, sometimes the best thing we can do is say, yes, you have all these problems, we’re not going to work on all of those, but let’s work on one and learn how to do it and if you master this then you can solve most of your problems are. And here’s the key, if we take the burden off of you from most of these problems, then the others that are really tough, you’ll have more resources to devote to that and maybe you won’t even need outside help, you’ll figure it out yourself.
Dr. BJ Guenther: Gives them confidence.
Dr. Gordon McNeil: And tools.
Dr. BJ Guenther: And tools, not put you on the spot, but can you name some of them so people know what we’re talking about here? Can you name and give just a short definition of some of the most common types of therapies used by therapist?
Dr. Gordon McNeil: Listen, some of it … I almost want to get away from the word therapy sometimes because one of the things that I’m thinking about is something called task centered and task centered is really kind of problem solving model. The two names that we associate with this are William Reid, R-E-I-D, and Laura Epstein, Task centered practice comes out of social work, so I’m kind of staying close to my home base here, but the bottom line is it’s almost a way of helping do case management. Let’s identify the problems, We’re going to use a problem solving model, identify the problems, think about one that we’re going to focus on, Think about what an appropriate goal would be, what would be a reasonable and attainable goal?
Dr. Gordon McNeil: Then what are the possibilities. So brainstorming what are possible things that could be done, discarding or discounting some of them and then saying, okay, from those that remain what looks like it might have the most reasonable chance for success and the task centered part of it has to do with the client is to all right, what are you going to do? What are the specific things you’re going to do between now and when I see you again and as a worker, what am I going to do? It may be that I’m going to be working behind the scenes trying to get you an appointment with somebody or doing some other things like that, but there are specific tasks and then you come in, we’re going to evaluate what happened this week and it’s all time limited.
Dr. Gordon McNeil: So task oriented, you can do it on mundane problems like I don’t have a place to sleep tonight, you can do it on things involved with, depression, anxiety. Some of the things that are going to be done could include therapy so this is a broader model. If we think about Maslow’s hierarchy of needs, most people have some idea about that. Well, the idea is that there is some lower level needs like safety, security, food, shelter, that sort of thing.
Dr. BJ Guenther: Basics.
Dr. Gordon McNeil: Basic, people have to have those needs satisfied before they can think about the higher levels. So maybe we need to devote resources to taking care of the lower level as we also consider the higher levels. So yes, one of the issues we’re going to deal with is your anxiety, but we’re also going to deal with did you eat today, because you know if you didn’t eat today, you might be anxious.
Dr. BJ Guenther: Or sleep, that’s what I hear the most.
Dr. Gordon McNeil: All of these things.
Dr. BJ Guenther: How the sleep contributes to people’s anxiety.
Dr. Gordon McNeil: That’s one basic and you’re asking about some basic therapy. So let me just-
Dr. BJ Guenther: And are there some that are better than others, are these too broad questions?
Dr. Gordon McNeil: They’re wonderful questions, but the answers have to be a little bit obscure to. You wouldn’t go to a doctor, gave the same medication to everybody who walked in the door. Even if all of the people who walked in had a broken leg, you wouldn’t want the same treatment. What if one was a compound fracture and there’s a bone sticking out? Yeah, don’t set my bone, please. Different problems need different treatments, so I wouldn’t want to go to somebody who did the same therapy for everybody.
Dr. BJ Guenther: It’s boring.
Dr. Gordon McNeil: It’s not that it’s not appropriate.
Dr. BJ Guenther: It’s so boring, you know it is.
Dr. Gordon McNeil: That’s fine, but it’s also not appropriate.
Dr. BJ Guenther: No, it’s not. But it’s boring.
Dr. Gordon McNeil: That’s one thing is you want to go to somebody who has the ability to deliver a multitude of at least a range of interventions as required according to the problem and the person in the context. Another thing is the idea you can use multiple therapies to address a single problem. You just mentioned anxiety.
Dr. BJ Guenther: Yeah, a lot of people like to use the word eclectic.
Dr. Gordon McNeil: Oh, let’s not go there yet. Hang on, we’re going to get there. But the notion is, there are many different approaches or different therapies that can address a single problem, say anxiety, and one therapy can be used on lots of different kinds of problems. You mentioned anxiety problems and you said, “Oh, I gravitate automatically to a cognitive behavioral.” If I were dealing with somebody with an anxiety problem, depending on what the anxiety issue, I would say my number one is going to be exposure therapy. So different people have different forte and see the issue, the person, the client somewhat differently and can get where the client needs to in different ways but I think that there are a couple of things maybe that undergird a lot of this.
Dr. Gordon McNeil: A lot of this is based on, I think the inherent and the basic idea of fight or flight. When someone is approached with a challenge, a problem, they perceive it, they see it as a threat or something that’s not too big a problem and they decide, how am I going to respond to this? Am I going to run away from it as a protective coping strategy or am I going to be assertive and confront it and fight it, fight or flight? And so most of what we do when we are confronted with problematic situations is make a base level determination, am I going to fight or am I going to get away from this? One of the ways we might consider this is change what you can and cope with what you can’t change. So problem solving, if I can find shelter tonight, then I’m going to get a place to live, if I can’t do that, then I got to cope with not having a place to live.
Dr. Gordon McNeil: So a lot of these therapies are based on what are you going to do, are you going to be assertive or are you going to run away from something? It gets a little bit tricky because we’re talking about behavior patterns, characteristics so when we think about infants and we say, oh, this was an easy child, or this infant was hell on wheels, this one was rambunctious, I was an active child, they’re basic personality traits that we have. Sometimes we can act assertively and it’s actually a flight mechanism. If I put up a strong front, it’s the same thing I go to it automatically, it’s how I behave, it’s how I automatically respond to something, but what I’m doing is I’m avoiding thinking about it, I’m gravitating to an automatic response, flight, I’m distancing myself from the situation. So, we have to be careful to kind of be sensitive to what’s really going on.
Dr. Gordon McNeil: This fight or flight then has to do with the kind of strategies that we might use, I’m kind of maybe going full circle a little too soon-
Dr. BJ Guenther: No, you’re good.
Dr. Gordon McNeil: But consider this mindfulness. Mindfulness is kind of a philosophic orientation that says when you are in a challenging situation, when you feel stressed, pause, take a moment …
Dr. BJ Guenther: The here and now, be in the here and now.
Dr. Gordon McNeil: Be here, be now, be mindful instead of exiting, but don’t just focus on the issue that is problematic, think about everything. So when you’re feeling angry, note what is my heartbeat, what’s going on with my dilation in my eyes? And even things like how do my hands feel if I had choice and I had power, oddly enough, unclenching my hands makes it more difficult for me to be angry. If I know that I can use that as a tool, I can say I automatically want to be angry and feel angry, but if I’m in the moment, I can step back, take a deep breath, consider not only the thing that is kind of making me feel this way, but if that way of feeling is accurate or not, I might have power to feel other ways if I just give myself the opportunity.
Dr. BJ Guenther: I like to describe it as making yourself aware.
Dr. Gordon McNeil: Yep.
Dr. BJ Guenther: That’s like the first step that a lot of people and a challenge. I talked to a student this week and I challenged her to start thinking about how many times she thinks negatively about herself. I said, because when you come back in here next week, you’re gonna be shocked at how many times it has been because you have not really paid attention or made yourself aware.
Dr. Gordon McNeil: Well, I told you that some of my research has to do with resilience and caregiving, caregivers get burned out emotionally. Most of the interventions that are available for caregivers are focused on immediately after they have become caregivers, the first year. Well, that’s fine, the information that’s provided in these kinds of programs is useful, but my concern has to do with what if somebody’s been a caregiver for 10 years, they’re just flamed out. They know as much about schizophrenia as you do as a therapist, they know all about this, they know what to do, but it’s draining. So I came up with an intervention and it has to do … It was called banking positives that used to banking metaphor, but the idea is we tend to identify negative happenings. We tend to focus on them and as long as that’s what we focus on, we tend to have kind of a negative feeling or attribution about things.
Dr. Gordon McNeil: If you want to change the behavior of a child behavior therapy now, if you identify negative things and penalize them, if you find ways to reinforce the negatives by circumventing that, et cetera, the response that you get is going to be very extreme, but also short lived. Think about smacking somebody, you swat them, they stopped the behavior, but it doesn’t last very long and they often go back and repeat it and we find this negative cycle. Reinforcing positive behavior lasts a lot longer, people want attention, kids want attention, they’re going to get it, bad or good. So if you want to invoke change in kids, catch him in the act of being good and reinforce positive behavior.
Dr. BJ Guenther: That’s true with anybody.
Dr. Gordon McNeil: It is true with anybody.
Dr. BJ Guenther: Yeah, it’s true with anybody.
Dr. Gordon McNeil: What about the idea of mindfulness, what about not waiting until a crisis, what if you were proactive and started taking an assessment of how you’re doing and finding out you’re okay most of the time and you’re dealing with things appropriately most of the time, but you’re focusing on or remembering the few things that are the exception to the rule. So if we came full circle and we’re more aware, more mindful, we might have a little bit better self esteem, more tools to address problems, et cetera.
Dr. BJ Guenther: Sounds good. We’re up on a break, it’s been a while. Let’s take a break. When we come back, I want to ask you, do you have any advice for people on how they can get the most out of their therapy, out of their counseling?
Dr. Gordon McNeil: When we return.
Dr. BJ Guenther: When we return.
Drew Holcomb: Hi, this is Drew Holcomb and you’re listening to 90.7 The Capstone.
Disclaimer: This show is not a substitute for professional counseling and no relationship is created between the show hosts or guests and any listener, if you feel you’re in need of professional mental health and are you a student, we encourage you to contact the UA counseling center at 3-4-8-38-6-3. If you are not a UA student, please contact your respective county’s crisis service hotline or their local mental health agency or insurance company. If it is an emergency situation, please call 911 or go to your nearest emergency room.
Dr. BJ Guenther: Hey, you’re back listening to Brain Matters on 90.7 The Capstone, and we’re talking tonight about different types of therapy and Dr. Gordon McNeil is my guest. Dr. McNeil has taught social work for the university of Alabama, mainly graduate courses for the past 25 years would you say?
Dr. Gordon McNeil: Yup.
Dr. BJ Guenther: So you know a little bit about what you’re talking about?
Dr. Gordon McNeil: And I can guess the rest.
Dr. BJ Guenther: Tell us a little bit … before we wenT to break, I wanted to talk about how someone could get the most out of their, their counseling sessions or their therapy, any ideas?
Dr. Gordon McNeil: I do have some ideas about that, one of the things I would say is I think that people do well when they are prepared. Many times people come in because they’re overwhelmed and I get that and …
Dr. BJ Guenther: Go ahead.
Dr. Gordon McNeil: It’s really kind of interesting how quickly somebody who’s overwhelmed with a little bit of outside perspective can get a grasp on what’s going on, so being overwhelmed doesn’t have to last a long time. Moving in the proper direction, moving in a positive direction, can go a long way toward helping someone get over the emotional element of being overwhelmed. The problems may not be resolved, but the feelings involved with being overwhelmed can dissipate pretty quickly
Dr. BJ Guenther: Because I work on a college campus, sometimes when you’re talking about that, sometimes I feel like it’s a little more common with this age group. Do you think it is or do you think it’s across the board?
Dr. Gordon McNeil: I think everybody has these issues, I think that life in some ways is happening a whole lot quicker these days. When you think about sound bites and oddly enough, when I look at movies now, I’m an old guy. I like stories and movies and I like editing of movies where I focus on one person, one character for a few seconds before they cut away, but a lot of movies these days are quick cuts between people and a camera that revolves around somebody. Makes me dizzy, but it seems very natural for young people.
Dr. BJ Guenther: Yeah, I know. It’s some of the new.
Dr. Gordon McNeil: Yes, and so I think that the number of problems and ability to balance those is somewhat different for people who are younger, but it’s easier therefore to feel overwhelmed if you’re not doing the job very well. Now, the truth of the matter is too, our society, even the university expects people to be able to perform and multitask successfully, I think there’s a catch 22 there. I think there’s a problem because there are a lot of studies that have shown that people don’t multitask nearly as well as they think they do. We see that with driving, it’s a real easy way to see it, right?
Dr. BJ Guenther: Yeah, it’s a dangerous way to see it too.
Dr. Gordon McNeil: How many times have you been on the phone with somebody and it’s very apparent that you only have half of their attention? They’re doing a number of other things and you wait for an answer from them and it’s kind of I’ll get back to you, you’re third in line. It doesn’t feel very courteous, I don’t think, but I also think that it’s not a really good strategy for solving problems. You asked how can someone get the most out of a therapeutic experience, first is focus, pay attention, leave your phone at the door so to speak, don’t try to multitask, be there, be authentic, be optimistic that the process can be helpful. That’s sometimes a challenge, I recognize that, but the idea is that I don’t think that people come in because they want to talk, I think they come in because they have a problem that they want to solve.
Dr. BJ Guenther: Exactly, and sometimes it is hard, difficult to get someone invested.
Dr. Gordon McNeil: Right, that’s what I’m getting at here is if you really have a problem and you really want help, then work with the professional to address that problem. Focus in, be prepared, be authentic, be honest, be communicative, be willing to carry your share of the relationship load.
Dr. BJ Guenther: Yes, speaking of the relationship, in your opinion, how important is it for someone to click with their therapist, that’s what I call it?
Dr. Gordon McNeil: Well, a good working relationship is important, but it doesn’t mean that you have to be friends.
Dr. BJ Guenther: No, in fact that’s inappropriate.
Dr. Gordon McNeil: No, we wouldn’t want that. We want people to be able to communicate well and to work toward a common goal. If you feel that there’s opposition based on personality, then that can be a problem, but it’s something that you have to be open about and communicate about. If you just carry it as a resentment, then it’s hard to have a positive experience, so being open and willing to make yourself vulnerable to say I’m not feeling the love from you and it’s not a friendly thing, it’s a matter of working on this problem in a positive way.
Dr. Gordon McNeil: I think that relationship is absolutely tantamount, it’s kind of the bedrock for things moving forward. I’m a metaphor guy, I’m a person who tells stories, I have this image that I use with my students and there’s a dentist office and there’s a young dentist who’s attractive and here’s this space, age, dental suite, right?
Dr. BJ Guenther: Yes, it’s sounding familiar.
Dr. Gordon McNeil: Then image number two and the machinery is from like the 1971s and here’s the old geezer kind of thing so it’s a question about which dentist are you going to go to? Well, most people are going to say, you know, I at least want the good machinery. I want the guy or the person who knows what they’re doing with it.
Dr. BJ Guenther: I want the experience.
Dr. Gordon McNeil: I want somebody who knows what they’re doing. You can have the greatest tools in the world, but if you don’t know how to use them, you’re not going to be able to help me but-
Dr. BJ Guenther: That’s a good metaphor.
Dr. Gordon McNeil: But why not have the best tools and that also goes with knowledge, why not keep up to date with current therapies and that sort of thing too?
Dr. BJ Guenther: I know people and you do too, other counselors, social workers, therapists who, who don’t keep up with the latest so you know and it and it passes them by.
Dr. Gordon McNeil: Let me answer a question that you haven’t asked yet, but your audience is going to be attentive to, why would I need different therapies? Because our problems come in many shapes and forms and the solutions come in many shapes and forms. There are some kinds of problems where if I give you knowledge, the problem is solved. If there’s a problem between two people and perhaps it has to do with somebody is just too close to me, they are breathing down my throat, they’re in my face, sometimes it might be as simple as something like there’s a cultural difference, someone has a different frame of reference, a different contexts. They’re not trying to be in your face inappropriately, but from their background, this is an appropriate thing so there can be a misreading.
Dr. Gordon McNeil: All I have to do is tell you your perception is incorrect and this is what the other person really means. Guess what, the problem mostly gone, knowledge gets the job done. There are other times when knowledge isn’t the whole thing. Sometimes it means that you have to go through an experience to appreciate something. Think about doing a relaxation exercise, having somebody tell you what it is, informing you about it is nice, but it is not the same as experiencing a relaxation exercise. To have benefit from it you really have to experience it, you have to do it. Then there’s another kind of problem solving. Let’s say that somebody needs to learn how to ride a bike, I give them a manual and I say, here is everything you need to know in order to ride a bike, read it. They read it-
Dr. BJ Guenther: They’re not going to be able to ride a bike.
Dr. Gordon McNeil: They come back a month later and I say, “Did you read it?” And they said, “Yes, I did.” I hand them a bike, what happens?
Dr. BJ Guenther: They don’t know what to do with it.
Dr. Gordon McNeil: They’re going to fall down, aren’t they?
Dr. BJ Guenther: Mm-hmm (affirmative)-
Dr. Gordon McNeil: Anybody who has watched the video or seeing people dancing and then said, I want to learn how to dance, if you look in the mirror, you’ll quickly find out-
Dr. BJ Guenther: It’s not going to look like-
Dr. Gordon McNeil: It’s not that easy.
Dr. BJ Guenther: It’s not that easy.
Dr. Gordon McNeil: It takes practice, it takes exposure, it takes maybe critique, it takes something else to understand how to behave, so there are some problems giving you knowledge. Some? If you know what’s going on and you experienced something, it can change your reality and others you have to actually engage in behaviors that are different and master them in order to overcome a problem. Now, let me go a step further, we’re talking about this from the client’s perspective. What if I said the same thing holds true for a therapist, sometimes it’s enough to know about a therapy. Sometimes it’s enough to have witnessed it or experienced it, but sometimes you need to do it.
Dr. Gordon McNeil: You’ve got to learn how to ride that bike, you need to know about, all right, if I want to do exposure therapy, how do I do exposure therapy? So when we talk about the training and the background for somebody, different therapies require different backgrounds and different kinds of-
Dr. BJ Guenther: Specialized training?
Dr. Gordon McNeil: Yeah. But you don’t want to be the first patient for a doctor.
Dr. BJ Guenther: How would you know, right?
Dr. Gordon McNeil: Yes, but it’s one of those-
Dr. BJ Guenther: I know what you’re saying, because when you first come out of school, you really are kind of thrown to the wolves.
Dr. Gordon McNeil: And it’s why you’re not allowed to practice independently for a couple of years, so these are the kinds of things. There isn’t a simple answer, but there are best fits. If you are a person who is very emotionally driven, emotionally governed, you rely on your emotions a lot, working with someone who’s a cognitive person isn’t going to be a very good fit and it can still work. There’s no reason it can’t be successful, but You have to be aware that both of you are going to have to understand this gap and make efforts to close the gaps.
Dr. BJ Guenther: To make it work, right.
Dr. Gordon McNeil: But you might find that you’re working with somebody who has a very similar orientation to you and it’s a better fit and it feels more comfortable and more natural. So eyes on the prize, remember why you’re there, I’m here to solve a problem. Can that person solve my problem? Part of it has to do with does it seem like this person has an understanding of what the problem is and how to solve it?
Dr. BJ Guenther: We consider ourselves at the counseling center generalists, but many times we’ve had students come to the counseling center and ask for specific therapies whether they have come from a therapist back home who they knew were doing DBT for instance, dialectical behavioral therapy, and they’ll come and ask for that, but even though some of us may have training in that, we still don’t … We try to stay away from that and just practice generally since we are a counseling center for a college campus.
Dr. Gordon McNeil: One of the things I’d say is, okay, where’s your medical degree kind of if you’re going to tell the doctor what treatments you’re going to get?
Dr. BJ Guenther: It is weird, yeah.
Dr. Gordon McNeil: I think the idea is to have a good dialogue. The person may have read up and be very knowledgeable about it.
Dr. BJ Guenther: It happens a lot.
Dr. Gordon McNeil: And their idea may be really sound, but from my perspective-
Dr. BJ Guenther: And experience.
Dr. Gordon McNeil: And experience, the process should be collaborative and it needs to fit the worker, the agency, the problem, a client.
Dr. BJ Guenther: There’s a lot of factors.
Dr. Gordon McNeil: It’s like a Rubik’s cube, trying to find a best fit with all of these dimensions to it, but ultimately the client is going to decide if something is acceptable to them or not and they’ll vote with their feet. They won’t come back if it’s not an appropriate fit, but I think they come to us because of our professional knowledge and experience and I think that’s where we have to be assertive as workers and say, my background and experience says that this would be a good choice and here’s why. Agree, disagree, okay, but you came to me because of my clinical knowledge and expertise, so let’s take-
Dr. BJ Guenther: They’re going to get it.
Dr. Gordon McNeil: They’ll take advantage of it.
Dr. BJ Guenther: Before we wrap up, we’ve got a few more minutes, but before we wrap it up, with some of the talking points that you would like to address and we still haven’t really gotten to the eclectic part. I don’t know if you want to touch on that before we leave.
Dr. Gordon McNeil: I can do it pretty quickly.
Dr. BJ Guenther: Yeah, it is what it is.
Dr. Gordon McNeil: There are two things we can talk about, there are mainstream and kind of more extreme kinds of therapies. The truth of the matter is there are only a few basic ones. When we talked about those that have more evidential support, maybe there’s been research done on them to a greater extent. Well, that means that people have looked at them carefully and know something about when they have some effects and when they don’t, so they’re better studied. It doesn’t mean that other things can’t be useful, but it means you’re taking more of a gamble and using them.
Dr. BJ Guenther: What do you think about … do you think there’s such a thing as regional therapies? Do you know what I mean by that?
Dr. Gordon McNeil: Yes.
Dr. BJ Guenther: Like if you go to Sedona, Arizona and those counselors, therapists, they might use a different type of therapy, whatever, but it wouldn’t fly here.
Dr. Gordon McNeil: There are some more holistic kinds of things, therapies that are available.
Dr. BJ Guenther: It doesn’t mean it’s not good or it’s not effective, it’s just-
Dr. Gordon McNeil: No, but you’re taking a chance on some of them. Some of them … well I’m showing my age here, but I’m talking about things where people were being rebirthed and beings and-
Dr. BJ Guenther: Or screened therapy, do they still do that?
Dr. Gordon McNeil: Yeah, I mean, yeah.
Dr. BJ Guenther: Primal therapy.
Dr. Gordon McNeil: Yeah, some of those things. I think of them as being pretty extreme and some of them can be pretty dangerous. You know, some of the rebirthing, wrapping people on a blanket and making them fight their way out of it and, some people died.
Dr. BJ Guenther: It sounds ridiculous, but it was really happening.
Dr. Gordon McNeil: Yes and there are things like that are happening as well. You know, conversion therapy is something that I don’t particularly agree with and yet it’s done and sometimes it becomes politicized. I think as a starting point, it’s nice to start with something that has a little bit more support and is a little bit more dependable, you kind of have an idea of why it’s supposed to help.
Dr. BJ Guenther: And it’s a good idea for a person who’s searching for a counselor to do their research a little bit.
Dr. Gordon McNeil: Yeah, so that gets us into this idea about if you’re going to say you’re going to do CBT, you got to make sure that you’re doing CBT and not a diluted version of it, you know, to say CBT didn’t work for me. Well here are two things, number one, CBT is a label for maybe a 100 different therapies. There are lots of different variations on a theme. Everything you mentioned REBT, which is rational emotive behavioral therapy, there’s a model called behavioral activation, there’s a model that’s becoming very popular with kids, trauma focused CBT. The evidence is really good for kids using it with kids who have been traumatized, but the evidence isn’t there yet for using it with adults. Sometimes the evidence just isn’t there yet. Eye movement decent or-
Dr. BJ Guenther: EMDR.
Dr. Gordon McNeil: EMDR, Eye movement desensitization reprocessing by Francine Shapiro was kind of out there for a while and one of the reasons was she held great control over it, wouldn’t let anybody do it unless she had trained them personally. Well, she ran into problems because insurance companies thought, how do I know if somebody is adequately trained in this or not? There’s no evidence, she Wasn’t doing research, so then the next wave hit and okay, now the people that I’ve trained can train other people and eventually, okay, we’ll allow some research to be done. Long story short, it took a long time, but there is pretty good evidence that EMDR can be very useful for certain kinds of cases, certain kinds of problems, trauma focused in particular.
Dr. Gordon McNeil: But because it’s been out there so long now the question is, is EMDR a unique and separate intervention or is it a series of techniques within CBT, so as we move forward there have come these issues. One of the issues you mentioned, dialectical behavioral therapy, DBT, one of the issues for a long time was its originator, Marsha Linehan had a strong hand in the research that was done, so there was quite a bit of research, but Marsha Linehan was a coauthor on all of the writing, so it made people really suspect about jeez if she’s in on it. How objective is this? Does she have a dog in the fight, so to speak? Research is good, but you have to be a good critical consumer about it. That gets us to eclectic.
Dr. BJ Guenther: Luckily enough here. You said you could get to it fast, let’s see.
Dr. Gordon McNeil: Eclectic simply means a combination of things. So when I said earlier, if you’re going to do CBT, make sure you get a full dose of CBT, not a diluted version, it’s the same thing with eclectic, eclectic means I’m using a kind of a mishmash of at least two different things. That’s not bad as long as how these two things fit together is really considered. It’s not something that’s by happenstance or by accident that somebody really considers how do these two things fit together?
Dr. BJ Guenther: I just always thought that if somebody says they’re doing eclectic therapy they don’t know what they’re doing.
Dr. Gordon McNeil: Well, it depends. They might know very well, but they have to be able to articulate what they’re doing. Just a real quick example of it, one of the forms of therapy historically that we’ve talked about is human centered or person centered, Carl rogers stuff, and this is based on the unconditional acceptance of the individual. It’s the idea that you know what’s right and wrong and certain things in our culture and our society and our situation, our society have caused you to stray from what you know is right, but if we uncluttered that, if we get all of that away, you’ll know what to do. We just have to be supportive and provide a laboratory setting session for you to experiment with being authentic, so that requires that the therapists not be very directive. Just be accepting, showing the person how to bring out their authentic self.
Dr. Gordon McNeil: Cognitive behavioral requires that the worker be very directive, I’m going to tell you what I think are irrational thoughts.
Dr. BJ Guenther: That would be me, at a therapy session.
Dr. Gordon McNeil: So I’m going to judge you, so you can see-
Dr. BJ Guenther: You can call it judging, I call it bluntness.
Dr. Gordon McNeil: Well, it serves a purpose, but the idea that I wanted to somehow combine person centered and CBT, well now you have to show me that there’s some way to combine these because from the client’s perspective, you’re telling me that I know the answer and you’re not going to judge me, and then in the next session you’re judging me and you don’t trust me to have the answer, these don’t fit together naturally.
Dr. BJ Guenther: Sending mixed signals.
Dr. Gordon McNeil: So it’s possible for me to use those together. If I were to say I’m going to use a person centered approach to build rapport, to establish a relationship that’s a working relationship, to get this person to accept, I do honor and trust that you have innate goodness at your core. Then switch and say, now I do hold that to be true, but in order to solve a specific problem, I’m going to serve as a kind of an outside sounding board and tell you what isn’t making sense when you tell me about how you approach problems. These two can be reconciled if you know what you’re doing, but if somebody-
Dr. BJ Guenther: There’s the magic mystery question.
Dr. Gordon McNeil: Well that’s it. So when somebody says eclectic, I don’t think that is in itself a sufficient answer.
Dr. BJ Guenther: That’s my point. I kind of feel like it’s a mask.
Dr. Gordon McNeil: Well, somebody should know and be able to articulate more specifically what they do.
Dr. BJ Guenther: Hey, thanks for being on the show again.
Dr. Gordon McNeil: It was a pleasure.
Dr. BJ Guenther: I really appreciate it.
Dr. Gordon McNeil: Well, I hope it’s useful to you and to your listeners.
Dr. BJ Guenther: I think it is, I think a lot of people have questions when they come to counseling if they’re afraid, if they’ve never been, they don’t know what to expect, they don’t know what’s going to be like if it’s really going to help them, there’s just a lot of questions.
Dr. Gordon McNeil: It’s a helping profession, isn’t it? Your job is to help, to help people solve their problems so that they learn skills to negotiate their lives, so if somebody is aware of that, ours is a helping center. Our job is to help and facilitate you solving your problem.
Dr. BJ Guenther: Like a weightlifting spotter, right?
Dr. Gordon McNeil: Yeah.
Dr. BJ Guenther: Hey, I want to make some announcements before we go. Don’t forget, our shows are recorded and podcast it on audioboom.com. Just type in Brain Matters and you’ll find some of our pastures and there’s also a link to audio boom on the counseling center’s website and that’s @counseling.unc.edu. I want to make an announcement about an event we’ve got coming up in October, October the 1st through the 7th is the University of Alabama suicide awareness week, and during that week there will be daily activities held around campus to promote prevention and awareness of suicide while also promoting mental wellbeing.
Dr. BJ Guenther: As the anchor of the US suicide awareness week, the counseling center will host the ninth annual Tuscaloosa out of the darkness community walk, which will be held on Sunday, October the seventh from 1:00 to 4:00 at the Ferguson center plaza, and the mission of the walk is to promote prevention and provide support to family and friends affected by loved ones’ death due to suicide. If you want to register for the walk, please visit afsp.org\tuscaloosa, or to learn more about the counseling center, suicide prevention programs and activities during suicide awareness week, visit counseling center website @counseling.ua.edu so we hope to see you there in October.
Dr. BJ Guenther: I want to thank a few people who always make this show possible. First of all, the executive director of the counseling center, Dr. Lee keys, Terry Sayers of the office of student media, my production assistants tonight, Catherine Howell, who came in late because she helped me out with some of the on call duties that I have, Lizzie Zamon who helped us out last year and she’s back this year, of course, my colleagues at the counseling center, especially Dr. Nori Dow, and Carey Marsh, the WVUA staff and my guest tonight, Dr. Gordon McNeil.
Dr. BJ Guenther: Join us next week for the show, this is going to be an interesting show, the interview’s going to be via telephone, but our guest is Tim Bono and we’re going to talk about how the internet affects our mental health. Thanks again for listening to Brain Matters on 90.7 The Capstone, goodnight.
Disclaimer: Views, opinions and conclusions expressed by the show hosts or their guests are their own and not necessarily those of the University of Alabama, it’s officers or trustees. Any views, opinions, or conclusions shared on the show do not create a relationship between the host or any guest and any listener and such a relationship should never be inferred. If you feel you’re in need of professional mental health and are a UA student, please contact the UA counseling center at 348-3863. If you’re not a UA student, please contact your respective county’s crisis service hotline or their local mental health agency or insurance company. If it is an emergency situation, please call 911, or go to your nearest emergency room.
