The fall semester is in full swing at the agency where I supervise graduate students in family counseling. As usual, we have a number of international students. I have one from Malaysia and one from Korea. Both of them are quite brilliant and have a genuine gift for counseling, so it really is a joy to help train them. It is also quite challenging, sometimes hilariously so, as we navigate the cultural chasms between their native countries and the USA. This is particularly true when dealing with adolescents and their families. Sometimes our client families take advantage of the grad student interns’ obvious uncertainty when addressing matters of the not-so-secret lives of American teenagers. Elizabeth, the Korean intern, is a soft-spoken, thoughtful woman with a number of graduate degrees to her name. Ready to believe the good in her clients, she has been snowed a couple of times. First, a 14-year-old nearly convinced her that it is customary in American families for the oldest son to tell his father to “fuck off” from time to time. (This may be true, but not outloud.)
Elizabeth and I were discussing this same family the other day. Like many modern families, they don’t interact as much as they claim to want to. They often go their separate ways with little more than the occasional obscenity exchange that passes for conversation. Elizabeth has been trying to introduce more routine, more stability into their daily lives, starting with a homework assignment to eat dinner together as a family at least once a week. This is part of our supervision session earlier this week:
E: The mother said they can’t do that. They can’t eat at the table because the boys [ages 14 and 9] eat better when she feeds them on trays in front of the TV.
S: Eat better?
E: Yes, she says they’ll eat their vegetables in front of the TV, but they won’t eat them at the table.
S: laughing loudly That’s a new one. OK, it very well may be true that they shovel food into their faces mindlessly while watching TV, and that they are unaware of eating the vegetables during that process, so they don’t object to them . . . but . . . NO.
S: OK, let me back up a minute. Are they malnourished? Any sign of rickets . . .
E: smiles No . . .
S: OK. Double check this, to make sure they’re not suffering from any nutritional deficit. And by all means, if they have scurvy, we’ll sit them in front of the TV with a big ol’ bag of oranges . . .
S: But short of that, we don’t give a rat’s ass what they eat, or even whether they eat. They’re not here because they need better nutrition, they’re here because they have no family relationships. They will sit at the table together and make some attempt at conversation. If they can also manage to eat without the aid of television, God bless ’em. If they can’t . . . we don’t care.
E: We don’t care?
S: Not a bit. I have no concerns about these boys starving. I have a lot of concern about there being no relationship, no communication in this family.
We continued the supervision session, and Elizabeth had a plan for the next few sessions by the time we concluded. The first thought I had when Elizabeth told me about the mother saying her kids had to be fed in front of the TV was, “That’s crazy talk!” This has been one of my favorite expressions for a while now. And believe me, in my line of work, I get to use it a lot. At least in my head. Thinking about this reminded me of a “diagnostic manual” that the staff and I joke about writing some day. We make entries into it from time to time. I’m going to share with you some of my contributions over the past year or so.
Please read with the understanding that I work my butt off and my heart out, and I really am considered quite good at what I do. In order for the preceding to remain true, though, sometimes I just have to find the dark, politically-incorrect, shockingly inappropriate humor in the whole process:
It has come to our attention that the agency has been criticized for not adequately teaching diagnostic skills as part of our internship experience. In an effort to remedy this shortcoming on our part, we offer the following tips for assessment and intervention:
· It is often advisable to include the client in the diagnostic process. This is done through the use of “leading” questions, as follows:
“What are you — NUTS?”
“Are you CRAZY?”
“What is WRONG with you?”
“Have you gone BATSHIT?” (“APESHIT” is also acceptable in this form.)
· For those who prefer a more direct approach, a statement can be made, followed by a pause during which the client may agree or disagree:
“You’re crazy as hell.”
“You’re freakin’ nuts.”
“You’re a wacko.” Or the related, “You’re wack.”
· The following are some brief diagnostic labels that are acceptable:
Jackass, Freakshow, Wingnut, Loon
Clients have also supplied the following diagnostic categories: Bi-polo, “somewhat mental,” and “triflin’.” The latter two are usually reserved for in-laws.
· Following the example of Jesus, it is important to talk to our clients in language they can understand — using metaphors from the context of their everyday lives. Observe:
One might assess the mental status of an obese client as, “a few sandwiches short of a picnic.” The client will quickly grasp the gravity of the situation.
A self-mutilating client will immediately understand the concept of being, “not the sharpest knife in the drawer.”
Assessments like the preceding may appropriately be followed by, “You know’m sayin’?” in order to ensure that the client has understood the counselor’s assessment.
· It is important to use contemporary language when confronting a client with maladaptive behavior. For example, “in denial” is an antiquated phrase, whereas “reality” is a more progressive term.
So, instead of suggesting that a client is “in denial,” one might reflect, “So . . . if I hear you correctly, you and reality are not on speaking terms.”
Another example of contemporary vernacular: When a client makes a statement which you find difficult to believe, replace the meek and outdated, “Really?” with the more modern, emphatic, “OH NO YOU DI’INT!”
Similarly, replace, “That is a cognitive distortion,” with “Now, that’s just CRAZY TALK!”
· On occasion, it may become necessary to exclude a particular client from the counseling process. (Often, this will be “mom’s boyfriend.”) When that time comes, the most efficacious way of removing the uncooperative, non-compliant client is to say to that client, kindly but firmly, “You’re dead to me.” (More experienced counselors may use this intervention with its accompanying hand gesture for emphasis: as you say the previous sentence, raise your right hand in a saluting fashion, but instead of saluting, draw it sharply across the front of your throat, mimicking a quick and decisive severing of the carotid artery.)
There you have it. Anyone want to come see me? MWAHAHHAHHAAA!
(Oh, and contributions to “the book” will be gladly accepted.)