I’m just writing you all on this beautiful fall afternoon in Montana to let you know about a FREE 20ish minute video titled, “Working Online with Suicidal Clients in the Age of COVID.” The video features Victor Yalom of Psychotherapy.net and me discussing issues related to suicide and distance counseling.
In honor of national Suicide Prevention Awareness Month, Psychotherapy.net is offering this video free (n.b., to access the video, you’ll need to enter your email address). Note: I used “n.b.” in my previous parenthetical comment to stick with the “Yalom” theme, because I learned to use n.b. (along with a plethora of new vocabulary words, like solipsistic, amnestic, servility, internecine, and sacrosanct), from reading Irvin Yalom’s group psychotherapy textbook.
This morning I had the honor of spending two hours with counselors from the Western Tidewater Community Services Board in beautiful Virginia. Unfortunately, I wasn’t in Virginia, but the magic of Zoom made the connection and collaboration possible.
The presentation focused on how to integrate assessment and relational factors into an initial clinical interviews. The powerpoints are here:
Before signing off, I want to emphasize how much I enjoyed the short and Zoom-based interactions I had with the Western Tidewater clinicians. They were focused, interested, and engaged. Being with them (over 120 people) increased my belief that there are good people in the world. Thanks!
Rita and I get to be the guests for tomorrow’s online ACA Town Hall. The topic for the day is suicide, but more generally, the Town Hall, moderated by ACA President Dr. Kent Becker, is designed to be a community event for ACA members. The suicide discussion will be brief and there will be several other break-out groups in the Zoom format.
For many counseling students, September brings with it the question, “What’s my theoretical orientation?” This is a big question . . . and its bigness is probably the reason why many of our old “theoretical orientation” blog posts suddenly get hot this time of year.
Below, I’ve excerpted a section from the end of chapter 1 of our Counseling Theories textbook. If you’re exploring your theoretical orientation, reading this section might be useful.
Here’s the excerpt
If you want to be an excellent mental health professional, then it makes sense to closely study the thinking of some of the greatest minds and models in the field. This text covers 12 of the most comprehensive and practical theories in existence. We hope you absorb each theory as thoroughly as possible and try experiencing them from the inside out. As you proceed through each chapter, suspend doubt, and try thinking like a practitioner from each theoretical orientation.
It’s also important for you to discover which theory or theories are the best fit for you. You’ll have opportunities reflect on the content of this text and hopefully that will help you develop your own ideas about human functioning and change. Although we’re not recommending that you develop a 13th theory, we are recommending that you explore how to integrate your genuine self into these different theoretical perspectives.
Some of you reading this book may already have considerable knowledge and experience about counseling and psychotherapy theories. However, even if you have very little knowledge and experience, you undoubtedly have some preexisting ideas about what helps people change. Therefore, before reading chapters 2 through 14, we encourage you to look at your own implicit ideas about people, and how they change.
Your First Client and Your First Theory
Pretend this is the first day of your career as a mental health professional. You have all the amenities: a tastefully decorated office, two comfortable chairs, a graduate degree, and a client.
You also have everything that any scarecrow, tin man, or lion might yearn for: a brain full of knowledge about how to provide therapy, a heart with compassion for a diverse range of clients, and courage to face the challenge of providing therapy services. But do you have what it takes to help a fellow human being climb from a pit of despair? Do you have the judgment to apply your knowledge in an effective way?
You walk to the waiting room. She’s there. She’s your first client ever. You greet her. The two of you walk back to the office.
In the first 20 minutes, you learn quite a lot about your client: She’s a 21-year-old college student experiencing apathy, insomnia, no romantic interests, carbohydrate cravings, an absence of hobbies, and extremely poor grades. She’s not using drugs or alcohol. Based on this information, you tentatively diagnose her as having some variant of clinical depression and proceed with counseling. But how do you proceed? Do you focus on her automatic thoughts and the core beliefs about herself that might be contributing to her depressive symptoms? Do you help her get a tutor, thinking that improved grades might lift her depressive symptoms? Do you recommend she begin an exercise routine? Do you explore her childhood, wondering if she has a trauma experience that needs to be understood and worked through? Do you teach her mindfulness skills and have her practice meditation? Do you have her role play and rehearse solutions to her problems? Do you focus on listening, assuming that if you provide her a positive therapy environment, she’ll gain insight into herself and move toward greater psychological health? Do you help her recast herself and her life into a story with a positive ending more adaptive identity? Do you ask her to sit in different chairs—speaking from different perspectives to explore her here and now feelings of success and failure? Any or all of these strategies might help. Which ones seem best to you?
You have many choices for how to proceed, depending upon your theoretical orientation. Here’s our advice: Don’t get stuck too soon with a single theoretical orientation. It’s unlikely that all humans will respond to a single approach. As suggested in Putting it in Practice 1.3, experiment and reflect before choosing your preferred theory. (Complete the ratings in Table 1.2 and then look through Table 1.3 to see which major theoretical perspectives might fit best for you).
On September 24, I’m doing a full-day online-only Strengths-Based Suicide Assessment and Treatment Planning workshop. The workshop is on behalf of the Association for Humanistic Counselors . . . a cool professional organization if there ever was one.
Just in case you want two-days of Strengths-Based Suicide Training or you want to come to the U of Montana or you need some college credit, we’ve got a full two-day version of the workshop happening in Missoula on November 19 and 20. In addition, if you’re wanting a continuing education smörgåsbord, this link also includes two day trainings with the fabulous Dr. Kirsten Murray (Strong Couples) and the amazing Dr. Bryan Cochran (LGBTQI+ Clients). Here’s that link: https://www.familiesfirstmt.org/umworkshops.html
There’s more happening too . . . but for now, this is probably enough for one post.
Have a fantastic week, and don’t be afraid to be the early bird.
Fall semester is quickly approaching. For some of you, it may have already arrived.
This post includes my usual free offer of theories resources. Even though Rita and I have our own Theories textbook, and we would love for you use it, the resources below are free and will work for you regardless of whether you use our textbook. My general philosophy on textbooks is that I’d rather be helpful than try to coerce people to buy books.
I’ve got a set of theories lab activities. I tried posting them here, but technology wasn’t helping. If you want them, email me and I’ll send them out as an attachment. email@example.com
You can access several theories-related counseling demonstration videos through my YouTube page. Also, I’ve posted a bunch of links previously, and you can access them with brief descriptions here: https://johnsommersflanagan.com/2020/03/14/free-video-links-for-online-teaching/ If you want access to the complete set of all of our theories videos, you have to use the text, but the preceding link has several potentially useful videos.
Theories is my favorite course to teach. I hope these resources will help you have a fun, engaging, skills-based, and inclusive theories teaching experience.
In our Counseling and Psychotherapy Theories in Context and Practice book, we include short sections on spirituality for each of the major theories. Previously, I’ve posted all the others (just search spirituality on this blog to find them), but discovered this evening that I forgot to post the Gestalt one. Maybe I forgot because it’s especially short and enigmatic . . . meaning, I didn’t find much out there on the crossroads between Gestalt theory and spirituality. If you know of something, please enlighten me!
Here’s the very short excerpt:
Although not always visible or palpable, Gestalt theory and therapy have deep spiritual roots. Laura Perls studied with Martin Buber and had interests in Taoism. Fritz Perls studied Zen Buddhism. Paul Goodman had interests in Taoism, and Gestalt writer, Dave Mann (2010) contended that Goodman’s book, Nature heals, is consistent with his Taoist beliefs about living with nature in accordance with nature. It may be that Gestalt experiments are consistent in style with the Zen Buddhist koan, a puzzle orriddle designed to open Zen novices to deeper levels of consciousness. At the very least, Zen Buddhism and Gestalt therapy share an attitude of acceptance of the now and an exploration of experience.
There are, of course, differences between Gestaltists regarding the role and nature of spirituality in Gestalt theory and practice. For some, the I-Thou connection is where the transcending and spiritual contact happens. Boundaries dissolve and deeper connections and insights blossom. This may have been what led Jesse Thomas (1978) to publish an early Gestalt-spiritual work titled, “The youniverse: Gestalt therapy, non-western religions, and the present age.” Spirituality, from the Gestalt perspective, is both personal and universal (or youniversalJ).
At the other end of the continuum are individuals who don’t see spirituality as warranting a place in Gestalt theory and practice (Mann, 2010). Mann (2010) recommended that Gestalt therapists, like clients, need to decide where they stand on religion and spirituality, recognizing, at the same time, that where they stand may well change. This brings us to perhaps the most famous words Fritz Perls ever wrote, the Gestalt prayer:
I do my thing and you do your thing.
I am not in this world to live up to your expectations,
And you are not in this world to live up to mine.
You are you, and I am I,
and if by chance we find each other, it’s beautiful.
As most of you know, I recently published an article in Psychotherapy Networker on my long-term experience of coping with the death of a client by suicide. In response to the article, I’ve gotten many supportive responses, some of which included additional published resources on coping with client death by suicide.
This blog post has two parts. First, I’m promoting the Networker article again to get it more widely shared as one resource for counselors and psychotherapists who have lost a client. Below, is an excerpt from the article. . . followed by a link. Please share with friends and colleagues as you see fit.
Second, at the end of this post I’m including additional resource articles that several people have shared with me over the past two weeks.
Here’s the excerpt . . .
The Prevention Myth
I’d worked with Ethan for about 20 sessions. Stocky, socially awkward, and intellectually gifted, he often avoided telling me much of anything, but his unhappiness was palpable. He didn’t fit in with classmates or connect with teachers. Ethan felt like a misfit at home and out of place at school. Nearly always, he experienced the grinding pain of being different, regardless of the context.
But aren’t we all different? Don’t we all suffer grinding pain, at least sometimes? What pushed Ethan to suicide when so many others, with equally difficult life situations and psychodynamics, stay alive?
One truth that reassures me now, and I wish I’d grasped back in the 1990s, is that empirical research generally affirms that suicide is unpredictable. This reality runs counter to much of what we hear from well-meaning suicide-prevention professionals. You may have heard the conventional wisdom: “Suicide is 100 percent preventable!” and, “If you educate yourself about risk factors and warning signs, and ask people directly about suicidal thoughts or plans, you can save lives.”
Although there’s some empirical evidence for these statements (i.e., sometimes suicide is preventable, and sometimes you can save lives), the general idea that knowledge of suicide risk, protective factors, and warning signs will equip clinicians to predict individual suicides is an illusion. In a 2017 large-scale meta-analysis covering 50 years of research on risk and protective factors, Joseph Franklin of Vanderbilt University and nine other prominent suicide researchers conducted an exhaustive analysis of 3,428 empirical studies. They found very little support for risk or protective factors as suicide predictors. In one of many of their sobering conclusions, they wrote, “It may be tempting to interpret some of the small differences across outcomes as having meaningful implications, . . . however, we note here that all risk factors were weak in magnitude and that any differences across outcomes . . . are not likely to be meaningful.”
Franklin and his collaborators were articulating the unpleasant conclusion that we have no good science-based tools for accurately predicting suicide. I hope this changes, but at the moment, I find comfort in the scientific validation of my personal experience. For years, I’ve held onto another suicide quotation for solace. In 1995, renowned suicidologist Robert Litman wrote, “When I am asked why one depressed and suicidal patient dies by suicide while nine other equally depressed and equally suicidal patients do not, I answer, ‘I don’t know.’”
Here are the additional resources people have shared with me:
Ellis, T. E., & Patel, A. B. (2012). Client suicide: what now?. Cognitive and Behavioral Practice, 19(2), 277-287.
Jorgensen, M. F., Bender, S., & McCutchen, A. (2021) “I’m haunted by it:” Experiences of licensed counselors who had a client die by suicide. Journal of Counselor Leadership and Advocacy. DOI: 10.1080/2326716X.2021.1916790
Knox, S., Burkard, A. W., Jackson, J. A., Schaack, A. M., & Hess, S. A. (2006). Therapists-in-training who experience a client suicide: Implications for supervision. Professional Psychology: Research and Practice, 37(5), 547-557.
Ting, L., Jacobson, J. M., & Sanders, S. (2008). Available supports and coping behaviors of mental health social workers following fatal and nonfatal client suicidal behavior. Social work, 53(3), 211-221.
As always, thanks for reading, and have a great day!
Yesterday, Rita posted a free rooster to give away on a local Facebook page. She was surprised that no one claimed him. I waxed empathic, “I don’t understand,” I said, “people always want free things. Getting a free rooster would make the right person very happy.”
We’ve been studying happiness, but not the smiley sort of happiness. We’re into Aristotelian eudaimonic happiness (of course we are). You know, the sort of happiness you experience from living your life in ways that honor others and consistent with your deep values. That just might involve high-quality daily interactions with a free rooster. Think about it.
I was so puzzled by not having our rooster snapped up for immediate adoption that I took to the streets. Really, it was just one street. We’re living in Absarokee for the summer; there are streets, but not very many, and I only spent time on one street.
I cleverly wove the rooster opportunity into my banking business. With only two employees left in the bank on a late Friday afternoon, I asked with great cheer, “Would either of you like a free rooster?” They both quickly said “No thanks,” but I got my transaction processed in record time.
Rita was still in the grocery store (we were dividing and conquering our errands). I marched in, offered to carry her beer, and announced, “Hey. Anybody want a free rooster?” The cashiers avoided eye contact. The bagger started talking about his pigs; they made him happy. He didn’t need a rooster. I guess that proves it’s possible to have too much happiness.
Despite repeated rejections, I’m still convinced that our rooster could bring free happiness to someone. In fact, I think our failed transactions are evidence that happiness is in the eye of the beholder. When I was a teenager, our neighbors got a rooster. We woke up every morning to fantasies of murdering the neighbor’s rooster. I started plotting a late-night abduction. After all, roosters are the mother of opportunity. [I know that’s a wrong and terrible butchering of the saying “necessity is the mother of invention,” and I know that butchering must be the wrong word here, but I’m typing fast and consequently it’s impossible for me to suppress or repress my aggression and mother issues when free associating at this pace. Freud would be happy. But then Freud had his own peculiar tastes regarding what made him happy, which is, of course my point.
The famous Peanuts cartoonist, Charles Shulz, wrote a book titled, “Happiness is a warm puppy.” Although warm puppies likely bring happiness for many people, they’re certainly not the recipe for happiness for everyone. If I recall correctly, for Linus, happiness was a warm blanket.
And I can’t stop myself from thinking that, perhaps, for some lucky person out there . . .
. . . happiness is a warm, free, pet rooster.
If you’re that person, contact me, because right now, for me, happiness is giving away a free pet rooster.
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