A Peek Inside the Mind of a Therapist:
- Emily Fry
- Oct 25, 2024
- 13 min read
Counseling Lloyd Dobler from the film
Say Anything
I thought it might be helpful for me to look at a character in a movie and develop a treatment plan, protocol and interventions, so that I can share a inside glimpse at counseling. It also gives me the opportunity to be transparent with you about what the counseling relationship looks like from a therapist’s perspective and specifically how I show up in the counseling relationship without breaking confidentiality nor does ignore the fact that when it comes to humans, mental health professionals, should never diagnose someone with whom they have not personally seen in their practice.I look forward to your thoughts and comments!
On April 14 in 1989, Say Anything, introduced the world to somewhat directionless, but lovable Lloyd Dobler and his crush and eventual girlfriend valedictorian, Diane. I chose to add the qualifier ’somewhat’ because in the classic scene with Diane’s father Lloyd responded to his question about his future plans with the following:
I don't want to sell anything, buy anything, or process anything as a career. I don't want to sell anything bought or processed, or buy anything sold or processed, or process anything sold, bought, or processed, or repair anything sold, bought, or processed.
Following is an overview of what counseling with Lloyd might look like as he and Diane’s life together unfolds.
Psychoeducation: Adolescent and Young Adult Development
Adolescence and young adulthood are periods of development that come with continued growth and development in the brain. Additionally, during both of these periods individuals are individuating and independence, identity development and social relations are one of the central concerns. While young adulthood is marked with a slowing of physical growth adolescence is marked by continued physical growth and puberty (Boyd & Bee, 2019).
Based on our legal system’s definition of an adult, a common misconception is that at 18 years-old we are done growing and our brains are fully developed. But in fact, there are two growth spurts that occur in the brain between ages 17 and 22 and again in the mid to late 20s (Boyd & Bee, 2019). During young adulthood cognition continues to develop in order to address and manage the problems of adulthood which are often complex and multi-layered. Formal reasoning ability no longer suffices as a means to manage the complex issues and decisions adults face. Developmental and cognitive theorists have labeled this a fifth stage in cognitive development where one develops the ability to accept and manage uncertainty, duality, ambiguity and contradiction in decision-making and life in general (King & Kitchener, 2004).
Therapeutic Application
Background Story
Llyod Dobler, the male lead in Say Anything, is an optimistic and lovable underachiever. To pick up where the movie left off with Diane and Lloyd on a plane flying to England together where Diane’s has been accepted into a prestigious university program. After living blissfully in England together for over a year, Diane gets news that her father is terminally ill. The pair return to the United States and Diane enrolls at a local university and emerges herself in her studies and caring for her father. Llyod’s transition back to the States, however, was not as smooth. Feeling depressed, Lloyd reaches out to his physician. He is diagnosed for the first time with ADHD, but does not want to take mediation, thus he is then referred to me for individual counseling (Sawamura et al., 2021).
Personal Reflection – Why Lloyd?
I chose Llyod Dobler for a handful of reasons. Like myself, especially at that age Llyod is an underachiever with a huge heart. Many, many years ago in 1994, when I first attended college, I really began to struggle. I stopped completing assignment and eventually stopped going to class all together. After the first semester of my sophomore year, at 19 years-old, I returned home deflated, defeated and depressed. I began counseling and was subsequently diagnosed with ADHD. As I began reading about ADHD, I could immediately identify with the symptoms and I found much alleviation of my shame and guilt regarding my lackluster or rather non-existent academic performance.
The juxtaposition of Lloyd’s lack of direction and discipline with Diane’s drive and ambition is exacerbated upon their return. Diane is easily able to learn from Lloyd and take risks to expand and explore her own identity and well-being. This is evident from the start of their relationship as she decides to attend the graduation party despite her reserved social nature. Conversely, Llyod is not so easily able to learn from Diane and the diagnosis of ADHD helps to explain his struggles and the resulting depression he is experiencing. Diane remains a constant source of support and Lloyd, too, is Diane’s rock and teddy bear. From all accounts, their relationship remains a bright spot in his world and hers.
Following our initial session and assessment, Lloyd completed the VIA Character Strength Survey, which identified his character strengths in order from greatest to least (Peterson & Seligman, 2004). I chose the strength-based assessment for two reasons. First, with a new diagnosis of ADHD alongside depression, strategies that lean on the individual’s strengths helps to reframe the previous and current struggles and the new diagnosis (and any shame that may be present around being diagnosed with ADHD) as neurological difference. Of additional note during the assessment process, Lloyd was identified at an early age as gifted, scoring in the 99th percentile on IQ testing at age 11. However, his academic performance throughout most of his middle and high school years was abysmal and was certainly not a reflection of his intelligence. This nugget is especially important considering his late diagnosis and the many years of underachievement in school. Addressing this issue will mean that Lloyd reflects upon this time in his past and how it has affected his self-efficacy and self-concept and we will examine his thoughts and feelings about being diagnosed with ADHD now. I am curious to learn how receiving this new diagnosis during the dawn of his adulthood has affected his self-concept and identity.
Lloyd is passionate about kickboxing, but since returning to the U.S., he has been unable to re-engage with the sport as competitor. Upon returning, he reports that he began teaching children’s kickboxing classes at the same gym at which he trains, but still has not engaged in any competitive matches. He is concerned that at his current age, now 20 years-old the window to become a professional in mixed martial arts (MMA) is quickly closing. While training and competing was always a place Lloyd excelled despite that it required great discipline, focus and tenacity. However, it, too, eludes him, now. Currently, he is struggling to motivate himself and to maintain consistent effort and drive in his pursuits.
Following our initial session and assessment, Lloyd completed the VIA Character Strength Survey, which identified the his character strengths in order from greatest to least (Peterson & Seligman, 2004). I chose the strength-based assessment for two reason. First, with a new diagnoses of ADHD alongside depression, strategies that lean on the individual’s strengths helps to reframe the previous and current struggles. I will provide a safe space for Lloyd to better understand his new diagnosis and express any and all emotions, frustration or shame that may be present around being diagnosed with ADHD, especially later in life. I believe reframing ADHD as neurological difference that has its benefits as well as challenges will be important, as well (Sawamura et al., 2021)
Of additional note during the assessment process, Lloyd was identified at an early age as gifted, scoring in the 99th percentile on IQ testing at age 11. However, his academic performance throughout most of his middle and high school years was abysmal and was certainly not a reflection of his intelligence. This nugget is especially important considering his late diagnosis and the many years of underachievement in school. Addressing this issue will mean that Lloyd reflects upon this time in his past and how it has affected his self-efficacy and self-concept and we will examine his thoughts and feelings about being diagnosed with ADHD now (Galvez-Contreras et al., 2022).
Treatment Plan Including Orientation of Techniques
Following are the therapeutic techniques initially employed while working with Lloyd along with the theoretical orientation from which they were derived and excerpts from our conversation during session (Neukrug, 2019):
VIA Character Strengths — Positive Psychology & Strengths-Based Counseling
Hope
Humor
Hope
Perspective
Appreciation of Beauty & Excellence
Honesty
Spirituality
Love of Learning
Gratitude
Fairness
Sparkling Outcomes/ Exceptions — Narrative Therapy & The Miracle Question — Solution-Focused Brief Therapy (SFBT)
Utilizing the techniques from narrative therapy and SFBT, I inquire about a time in Lloyd’s life where he felt the most focused and driven. Was there a time in his life where he did not struggle with discipline and drive? An excerpt of the conversation follows:
Me: Lloyd, can you think of a time during your life, when you felt the most focused and driven?
Lloyd: Hmmm,…well, my sophomore year in high school I transferred to a new school. I had joined the wrestling team for the first time and it felt like everything was coming together, like maybe the fresh start helped…but, I was not just focused on training, but was also in the zone at school.
Me: Can you tell me a little bit more about what was going on in your life at the time? What was the reason for the transfer?
Lloyd: I was at my home school and I got in a fight with this asshole who was constantly picking on and making fun of this other kid, who was a family friend with severe learning problems. I was able to stay in the district and transferred to another high school.
Me: At 15 years-old trying to protect and stand up for your friend against someone who was preying on him, because of his learning differences, only to be expelled must have been confusing and disheartening. How did you manage to recover from this to go on and have the most focused and driven period in your life?
Lloyd: I know, that when I transferred from Lakewood High School, I went in trying to see it as a fresh start…I remember reading a lot and always having a book with me…Just prior to the fight and expulsion, I had done something that I have done multiple times usually only to turn around and purchase another, I sold my X-Box. So, yeah, when I started at the new school I did not have an X-Box but I had wrestling training and competitions to fill my time. Oh,…I just remembered that during the fight my phone was crushed and completely inoperable to the point I threw it away, so I didn’t have a phone at the time either. Don’t get me wrong, I do like to read, but I think the book initially was more about having something to do while everyone else was on their phone.
Me: Wow, there is a lot there for us to unpack there! Knowingly or unknowingly you employed some strategies then that were extremely effective. You reframed the situation in your mind, so that you could in turn, behave and feel differently in this new environment. Very insightful, Lloyd.
Lloyd: Yeah, I guess so. I never looked at it like that before.
Me:Additionally, what stands out to me is your decision to completely remove of certain distractions all together, like your cell phone and X-Box. Can you tell me more about coming to that decision?
Lloyd: Yeah, um,…I never thought about that. I was just committed body and mind, you know?
Me: Yes, exactly! I wonder what your training regiment and competitive efforts might look like in the future, if you were to eliminate certain distractions that may be competing with and/or deterring your focus and drive?
Lloyd: Maybe more like it did my sophomore year…
Me: Over the next week, could you spend sometime, just noticing where your time is spent. I can provide you a blank hourly worksheet to document your activities until our next session. Understanding first, where your time is spent and then examining the benefits or detriments of those activities will help you to become more intentional with how you spend it and to what ends.
Mindfulness Meditation & Urge Surfing — Dialectical Behavioral Therapy (DBT), Existential Therapy, Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Cognitive Therapy (MBCT)
Mindfulness meditation and urge-surfing are techniques that run counter to CBT’s efforts at changing one’s thoughts to change one’s behavior. Rather, mindfulness meditation and urge-surfing are about accepting one’s thoughts as merely that, just thoughts. The concept of urge-surfing applies the concept mindfulness to the sensation of an urge. Allowing oneself to sit with urges without responding to them and noticing the feelings emotions and thoughts that come up diminishes the power the urges have on one’s behavior (Neukrug,. 2019). Following is an excerpt regarding mindfulness meditation and the practice of urge-surfing:
Me: I know you are very familiar with Eastern traditions through you study of mixed martial arts.
Lloyd: Yeah, its fascinating.
Me: Have you ever meditated or engaged in a meditative practice.
Lloyd: Actually, yes, some of my teachers throughout my training had us meditate at the beginning or end of class and I had a coach once that always made me do what he called breath work every time before I stepped into the ring.
Me: Say a little more about your experience with breath work and meditation, how was it for you in the moment?
Lloyd: Hard,…impossible almost when I was younger. It used to drive my instructor up the wall, because I couldn’t sit still much less meditate, but when I worked with Master Takashi, the breath work really centered me.
Me: I wonder what your thought are on re-engaging in that practice.
Lloyd: I am totally open to that and I think that would be really helpful.
Me: Does five minutes a day seem like a good starting place or would you prefer to start with two minutes a day? I am more interested in you doing it everyday than how long you do it, so make it something you feel is relatively easy to begin.
Lloyd: Okay, that makes sense. How about three?
Me: You tell me.
Lloyd: Three it is then!
10-Minute Rule (Ramsey & Rostain, 2015; Otto et al., 2011) — Cognitive Behavioral Therapy (CBT)
During the assessment and also in the sessions that followed, issues with procrastination and initiating or beginning activities.. After exploring any possible underlying causes and identifying the task or activity that Lloyd currently found most abhorrent thus experienced the most difficulty when attempting to engage in or begin the task, I employed a technique common to CBT by asking Lloyd the following (Ramsey & Rostain, 2015; Otto et al., 2011):
Me: Even though it may be difficult and uncomfortable feeling may arise, how much is the minimum amount of time you commit to being at the sparring and competition gym?
Lloyd: Since we’ve been back, I have yet to set foot in that gym…I know it’s crazy,…or kinda sad, but I am fine in the main gym. I workout and teach in the main gym, but the SAC (sparring and competitive) gym…?
Me: Tell me what could or will happen if you were to spend any amount of time in the SAC gym?
Lloyd: (Sighs) Someone will ask me to spar or get in the ring with them. and it’s been over a year since I have been gone from here, the gym, my team and the sport in general….(silent pause)
Me: I hear you voicing concern about the level in which you can or will perform, having been on somewhat of a hiatus for a year. Tell me more, have you been approached by anyone who has asked you to get in the ring with them and how did you respond?
Lloyd: Nope, why do you think I avoid the SAC like the plague? I mean, before, I would go in the ring anytime someone asked me. But, now,…I just don’t know.
Me: I noticed you looking down and your posture has changed. Can you talk about what is going on emotion-wise right now? (Attending to the Here and Now — Existential Therapy)
Lloyd: I dunno, I feel like a failure,…a fraud.
Me: Okay, that’s a good start…how does feeling like a fraud and a failure effect you emotionally?
Lloyd: I am ashamed. It is just not who I am or who I thought I was.
Me: That is huge, Lloyd. And those thoughts and the resulting feelings sound painful and difficult to carry.
Lloyd: Yeah, for sure. And I am sick of feeling this way!
Me: You have made a huge leap in addressing this issue and together I think we can tackle it. Our time is almost up, so how about this week you journal about what comes up for you when you think about competing and how the thought of training and sparring sits with you. Lastly, start thinking about what the minimum amount of time you think that you could commit to being at the SAC gym and we will look it again together.
Future Sessions and Moving Forward
For Lloyd, social media could act as a support or a distraction. As he shared in the sessions, which is also consistent with his recent ADHD diagnosis, his most sustained focus time was when he did not have a cell phone or gaming device. Limiting distractions will be very important to Lloyd productivity and discipline. Tools and applications like setting focus times, Pomodoro timers and digital planners that build-in structure, organization and boundaries to support times of sustained focus. Strategies like being extremely intentional and selective about which apps he downloads on his phone and committing to only productive ones can help support his efforts.
Lloyd comes to therapy with many strengths and an openness to the therapeutic process. There is much to build upon and his commitment to he and Diane’s future is solid and backed by his actions and care on a daily basis. While living with his sister in his last year of high school, his schoolwork may have been lackluster, his devotion to caring for his young nephew was evident in how big of a role he played as caregiver to him. His kind and loving spirit and his innate optimism will serve him well in counseling and life in general. I look forward to our continued work together.
References
Boyd, D. R., & Bee, H. L. (2019). Lifespan development (8th ed.). Pearson.
Boyer, B., Geurts, H., Prins, P., & Oord, S. (2016). One-year follow-up of two novel CBTs for adolescents with ADHD. European Child & Adolescent Psychiatry, 25(3), 333–337.
Galvez-Contreras, A., Vargas-de la Cruz, I., Beltran-Navarro, B., Gonzalez-Castaneda, R. E., & Gonzalez-Perez, O. (2022). Therapeutic Approaches for ADHD by Developmental Stage and Clinical Presentation. International Journal of Environmental Research and Public Health, 19(12880), 12880.
Neukrug , E. (2018). Counseling Theory and Practice (2nd ed.). Cognella, Inc.
Otto, M. W., Simon, N. M., Olatunji, B. O., Sung, S. C., & Pollack, M. H. (2011). 10-Minute CBT: Integrating cognitive-behavioral strategies into your practice. Oxford University Press.
Peterson, C., & P., Seligman M. E. (2004). Character strengths and virtues: A handbook and classification. American Psychological Association.
Proți, L. E. (2016). Aspects of Existential Psychotherapy in Cognitive Behavioral Approach. Romanian Journal of Cognitive-Behavioral Therapy & Hypnosis, 3(3),11–18.
Ramsay, J. R., Rostain, A. L., & Ramsay, J. R. (2015). The adult ADHD tool kit: Using CBT to facilitate coping inside and out. Routledge.
Sawamura, Y., Hirokawa-Ueda, H., Kawakami, T., Sakane, H., Teramoto, K., Yamamoto, A., Taketani, R., &; Ono, H. (2021). Increased prefrontal cortex activity on near-infrared spectroscopy after interpersonal counseling in individuals with attention deficit hyperactivity disorder. Journal of Physical Therapy Science, 33(9), 668–671.
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