Engaging clients in a collaborative safety planning process is an evidence-based suicide intervention. The typical gold standard for safety planning is the Safety Planning Intervention (SPI) by Stanley and Brown (2012). You can access free material on the SPI and learn how to obtain professional training for using SPIs at this link: https://suicidesafetyplan.com/
As a part of the 7.5-hour Assessment and Intervention with Suicidal Clients video published by psychotherapy.net, I did a short (about 7 minute) demonstration of safety planning with a 15-year-old cisgender female client. The demo comes at the end of the session and naturally, I already know lots of information that can be integrated into the safety plan. Nevertheless, introducing and completing the safety plan is an excellent organizing experience.
In part, safety planning emerged as an alternative to what were called “No-suicide contracts.” No suicide contracts fell out of favor in the mid-to-late 1990s, because many clients/patients viewed them as coercive and liability-dodging behaviors by clinicians, and because they focused on what NOT TO DO, instead of what clients/patients should do, when feeling suicidal. Safety planning involves proactive planning for what clients can do to effectively cope during a suicidal crisis.
Reframing, as a counseling and psychotherapy intervention, involves nudging clients toward viewing their thoughts, emotions, behaviors, and life situations from a different or new perspective. Reframing is an especially popular technique among cognitive, existential, and solution-focused therapists. In the following excerpt from our book on the strengths-based approach to suicide assessment and treatment, we discuss reframing . . . and what to do when it fails.
Framing Pain and Suicidality as Evidence of a Normal Self-Care Impulse
Another reframe involves viewing suicidality as coming from a place of self-care or self-compassion. Using your own words, you might try a reframe like this:
As you talk about wanting to die, I’m struck that your wish for death also comes from your wish to feel better . . . and your wish to feel better is normal, natural, and healthy. What I’d like to do for now, is to partner with you on the healthy goal of feeling better. I need your help on this. For now, we can put your wish to die on the sidelines, and focus on feeling better. We can’t expect immediate positive results. Will you work with me to battle your pain, and little by little, to help you feel better?
This reframing message is intentionally repetitive, and almost hypnotic. The purpose is to engage with and activate the healthy part of the self that wants to feel better. When clients respond to this message, hope for positive outcomes may increase. If clients reject this reframing message, suicide risk may be high.
Framing Pain as Meaningful
Victor Frankl (1967) used reframing to address depressive symptoms in the following case.
An old doctor consulted me in Vienna because he could not get rid of a severe depression caused by the death of his wife. I asked him, “What would have happened, Doctor, if you had died first, and your wife would have had to survive you?” Whereupon he said: “For her this would have been terrible; how she would have suffered!” I then added, “You see, Doctor, such a suffering has been spared her, and it is you who have spared her this suffering; but now you have to pay for it by surviving and mourning her.” The old man suddenly saw his plight in a new light, and reevaluated his suffering in the meaningful terms of a sacrifice for the sake of his wife. (1967, pp. 15–16)
Consistent with Frankl’s existential perspective, his reframe involves viewing suffering as meaningful. If clients view suffering as meaningful, life can feel more bearable.
When Reframes Fail
Reframing and redefining client emotional distress takes many forms. But, sometimes reframes don’t fit and don’t work. Reframes may be ineffective due to: (a) cultural insensitivity, (b) symptom severity, (c) inadequate rapport or alliance, and (d) countertransference (Lenes et al., 2020; Parrow et al., 2019). When your efforts to reframe fail, clients may withdraw or become agitated and you may risk a relationship rupture (Safran & Kraus, 2014). If the reframe doesn’t fit, process the issue (e.g., “Based on your reaction, it doesn’t seem like the idea I shared fits well for you”). After listening to your client’s response, you might need to proceed with strategies for rupture repair (see Sommers-Flanagan & Sommers-Flanagan, 2017). Relationship repair might include a direct apology and further processing. For example,
I’m sorry my idea for how to think about your pain wasn’t a good fit. But I’m glad you let me know it doesn’t fit. Lots of counseling is like an experiment. Sometimes we discover something doesn’t work. If you think something doesn’t fit or work for you, I will always want to know. Thank you for telling me.
When it comes to using reframing and redefinitions, your theoretical foundation is less important than the pragmatics of finding something that works for your client. The process involves: (a) identifying a potential reframe, (b) asking clients permission to try it out; (c) sharing the reframe; (d) observing client reactions, (e) verbally checking on client reactions and goodness of fit; (f) continuing to collaboratively experiment with the reframe or collaboratively discard it as a bad idea; and (g) addressing the relationship rupture—if one occurred.
If you’re interested in our suicide book, give it a Google. Given the our unique hyphenated last name, it’s not hard to find.
Three years ago (2019) I had the honor and privilege to be the first outside person to speak at a Jackson Construction retreat. The topic was suicide prevention. During our time at the Jackson retreat at Big Sky, Rita and I were touched by the kindness, authenticity, and engagement of the Jackson community.
On this rather frigid Montana day, I’m back with 130 Jackson employees at Fairmont Hot Springs. Once again, I’m honored and humbled to have the chance to speak. Knowing how hard it is to gain and maintain positive mental health, I deeply appreciate the chance to speak, and I hope the words and experiences I share are of use to the Jackson community.
After watching the video last night, I experienced an unplanned two-hour bout of insomnia wherein I replayed all the ways in which my behavior at the event (singing as a part of a group name that tune trivia contest) was embarrassing and regrettable. The good news is that I’ve studied insomnia and negative cognitions in the night enough to know that the middle of the night is a particularly easy time to exaggerate and negatively evaluate oneself. I (mostly) pushed out the cognitions with some mindfulness meditation, three good things, and music from David Bowie’s “Changes” (which had randomly or unconsciously gotten stuck in my brain).
This morning I’m presenting on the Art and Science of Happiness with the University of Montana’s Osher Center for Lifelong Learning. One core message from last night woven into today is that that we’re not striving toward unreflective toxic positivity, but instead, we’re working toward an awakened eudaimonic happiness, in the Aristitotean sense of living a balanced and meaningful life.
I’m in Helena today, learning and presenting at the Montana CBT Conference. This is a very cool event, organized by Kyrie Russ, M.A., LCPC, and including about 35 fantastic Montana professionals interested in deepening their knowledge of CBT principles and practice.
I’m presenting twice; below I’ve included links to my two sets of ppts (which may be redundant/overlapping with ppts I’ve posted here before).
Exploring the Potential of Evidence-Based Happiness
Last week, I tweeted that I was quitting Twitter, “For obvious reasons.” In response, several of my Twitter friends (you know who you are AND I appreciate YOU) noted that staying on Twitter and having a positive voice might be a better option than retreating to a location under Zuckerman’s umbrella. Hmm. Point taken. And so instead of completely quitting Twitter, this past week I put myself in Twitter time-out.
Over the past couple years, I’ve come to mostly like Twitter. There’s lots of aversive stuff, but following selected news outlets, researchers, a few Twitter-friends, and various renowned individuals helps with cutting edge news and perspective; it also contributes to me feeling “in the loop.”
Problems with Twitter, however, are legion. There’s an odd plethora of so-called mindfulness practitioners engaging in self-promotion. That’s ironic, but my understanding (and experience) is that Twitter is very much about self-promotion. That’s probably why the former guy (TFG) used it so prolifically. But only so many voices can fit into a Twitter feed, which leads to INTERMITTENT YELLING IN HOPE THAT SOMEONE WILL HEAR YOUR TWITTER-VOICE. Even TFG did lots of ALL CAPS. There may be no better means for getting your perspective “out there.” Whether the perspective is worthy of public viewing, that’s harder to discern.
Part of my current conundrum stems from the fact that I have a small sense of a small “Twitter community.” I enjoy liking and being liked by them. I can find cutting edge suicide-related research straight from several academics. But, along with the benefits, two days prior to the Musk takeover, my Twitter feed became suspiciously littered with so-called republican politicians. I saw despicable Unamerican, divisive posts from Marsha Blackburn, Marco Rubio, Kevin McCarthy, Lauren Boebert, Jim Jordan, and others whose names I’m conveniently suppressing. It was a line-up of political partisan trash the likes of which couldn’t have been better designed to push my buttons.
Of course, as someone close to me accurately observed (I’m paraphrasing now), perhaps rather than living in my own partisan echo-chamber, I should be more open to hearing messages from the “other side.” Not surprisingly, my buttons were pushed, yet again.
Maybe it’s already obvious to everyone else, but MY biggest problem with Twitter (and mainstream media and other social media and political debates and any opinion other than my own) is more about me than anything else. My inability to self-regulate and manage my own emotional buttons make the best case for exiting Twitter. If I can’t read antivaxxer Twitter posts without feeling the need to slap them upside the head with a rolled-up copy of the latest edition of the New England Journal of Medicine or bash them in the face with David Quammen’s “Breathless,” then maybe it’s time to stop tweeting. On the other hand, if I can recognize that all Twitter disagreements end the same way—with elevated animosity and mutual disgust—and instead, focus on being the most positive voice I can be, then maybe Musk won’t dysregulate me into quitting something I enjoy.
This past week without Twitter has been fine. I found plenty of alternative ways to agitate myself (haha). But I didn’t feel any Tweet-generated-angst. I also was out of the news loop. My wife had to tell me Lula won the Brazilian election. Woot-woot! If I’d been Twittering, I’d have known right away. I also missed following my daughter’s non-profit, social justice Upper Seven Law firm. Her tweets are awesome and she—along with other people in the habit of consciousness-raising and justice give me hope.
Here’s my new plan. I’m returning to Twitter this week, with adjusted expectations, and will closely monitor myself. Can I be a positive voice? Can I accept the reality that some people (and Bots and Trolls) are purposely spreading misinformation (without feeling agitated and unhappy)? Can I accept that I’m mostly powerlessness and irrelevant in the fight against racist, sexist, ableist, and classist forces seeking to inhibit growth in the lower and middle class, while sowing fear and hate? Can I add my voice (and Tweets) to the social media soup and stay mostly positive, while managing my expectations and NOT FEELING THE URGE TO YELL?
This letter is primarily directed to Montana residents, although concerned out-of-state individuals may also participate or use this information to advocate for children’s mental health in your state or province.
As many of you may know, Montana State Superintendent of Schools Elsie Arntzen has recommended the elimination of the state requirement that Montana Public Schools have a required minimum number of 1 school counselor for every 400 students. Obviously, this number is already too high; the national recommendation is for 1 school counselor for every 250 students. During this time of urgent student mental health needs, we need more school counselors, not fewer.
I just wrote and sent my letter to the Montana Board of Public Education in support of retaining the school counselor to student ratio in Montana Public Schools. Please join me. Email your letter to support retaining (or increasing) the current school counselor to student ratio to: email@example.com.
The public comment period ends on November 4th, so please launch your emails soon!
If you’re not sure what to write, but you believe school counselors are important for supporting student mental health, then just write something simple like, “Please support Montana students and their mental health by retaining or increasing the current school counselor to student ratio in Montana Schools.”
If you want to write something longer, the Montana School Counselor Association has provided the following bullet points to guide public comment.
Keep your talking points clear and concise. Make sure to state that you are in support of keeping the school counselor to student ratio
It’s ok to provide a few talking points, less may be more. If you’re not sure what to write, you could simply send a statement asking them to retain the School Counselor to Student ratio
Professional and polite messages are received better
Provide examples as to why the ratio is important. Share your experiences within your school (maintain confidentiality), about your program, the multiple hats that you wear, any changes you have experienced over recent years, data that supports increased student needs, etc
We acknowledge that there is a shortage of school counselors in Montana. Eliminating the ratio will not solve the shortage of school counselors, but could exacerbate the shortage, especially when tough budget decisions need to be made
Students could miss out on the proactive and responsive services our communities have come to expect from us including A) attendance and graduation rates, B) school climate and bullying prevention, C) social and emotional learning, and D) students having a professionally trained safe person to talk with
Thanks for considering this and for doing all you can to support children’s mental health and well-being.
On Sunday, November 6 from 6pm to 7:30pm on the 4th floor of the Missoula Public Library (the recent winner of the International Library of the Year award) Dylan Wright and I will co-host the brief and fantastic world premier of “The Wright Stuff on Happiness.”
You may be wondering, “What is The Wright Stuff on Happiness?”
The Wright Stuff on Happiness is a new Missoula Community Access Television show featuring Dylan Wright discussing, interviewing, and pontificating on individual, family, and community happiness. The Wright Stuff on Happiness is a program of Families First Learning Lab and is one of the initiatives of the Montana Happiness Project, L.L.C. (specifically, the Happy Media initiative).
At the World Premier, Dylan and I will introduce the show and Dylan will present a short series of video clips of never-before viewed footage. And then, we will engage the group with a never-before hybrid version of “Name That Tune” and Pub Trivia wherein Dylan and I sing songs and participants work in teams to win prizes by identifying the song title and artist.
Although the World Premier is a fundraiser for Families First Learning Lab and the Happy Media Initiative, you can also attend to learn and participate in the highly acclaimed and world renowned Name That Tune trivia competition.
When I was the executive director of Families First Missoula, one of my favorite topics was “Wishes and Goals.” The point—especially salient for parents experiencing separation and divorce—was that wishes are things outside our control that we pray and wish for, while goals should always be within our circle of control.
Given that today (October 18) is my birthday, wishes are in order. And given that I’m temporarily giving into my impulse to wish, my wishes will be palpably outside my control.
In honor of Aladdin and the Magic Lamp, I am officially awarding myself three wishes.
Wish #1: Create equity, social justice, and Adlerian Gemeinschaftsgefühl. For anyone not familiar with Gemeinschaftsgefühl, it refers to developing empathy, a community orientation, and compassion for and interest in working with others for the common good. Technically—and I would argue this point with the Genie—this wish includes two sub-wishes:
Wish 1a: End racism. Not much explanation needed here. Yes, we have cultural and ethnic differences, but that’s mostly a good thing. Differences should be celebrated or embraced or, at least tolerated. We should approach others who are different from us with an attitude of kindness, curiosity, and compassion.
Wish 1b: End poverty. At Chelsea’s graduation from Harvard Medical School, I remember listening to the famous guy who had a plan to end poverty. Maybe it was Jeffery Sachs. His ideas were fabulous, but we keep drifting the wrong direction. Why it is that trickle-down economics never works to do anything but create greater income disparity, but the American electorate continues to believe in the myth that “republicans are better on economic issues?” Not true. Never been true. Which brings me to my second wish.
Wish #2: Promote truth-telling in politics and the media. Although wishing to end racism and poverty is unrealistic, my second wish might be even more unrealistic. . . which is why I’m asking for your help here. We need to stop tolerating lies and misleading statements in the media. Sadly, even National Public Radio and National Public Television can’t stay on point and represent truth. Just yesterday we heard interviews on NPR and PBS wherein an interviewee was allowed to make statements about republicans being better on economic issues. And then a professional journalist/commentator (who used to unfairly rail against Hilary Clinton) paid far too much positive attention to DJT’s continued whining, complaining, and bidding for attention. Seriously? Why can’t the media JUST STOP REPEATING his lies and abusive comments??
Would you join me this year in becoming more diligent about holding people responsible to the truth? Election deniers should get no oxygen to spread their deceit. Covid deniers and antivaxxers should pay their own medical expenses. Yes, I know we live in a post-modern world and I know that means much is subjective. But have anti-vaxxers even bothered to read things like David Quammen’s Spillover? I just did as a part of a book club, and I’m clearer than ever on the long and dedicated history of medical scientists, epidemiologists, and virologists at trying to keep us safe from the next Zoonotic disease outbreak. After a detailed description of the influenza virus, Quammen wrote: “Having absorbed this simple paragraph, you understand more about influenza than 99.9 percent of the people on Earth. Pat yourself on the back and get a flu shot in November. [Rita and I are scheduled for ours on Nov. 3, in Bozeman, where we hope to bump into David Q.]
Wish #3: Out of respect for the several hundred pre-teens and teens I’ve worked with in counseling, I’m compelled to spend my third wish as balm to my unmet power and control fantasies. . . you know, it’s the only and best wish #3: “I hereby declare my 3rd birthday wish as a wish for unlimited wishes.”
I hope you all have a great and glorious October. And thanks to everyone for the fantastic birthday wishes.
IMHO, usually parents spank their children for one (or more) of several reasons.
They have come to believe that spanking “works.”
They have been told or educated about reasons for spanking, such as the old “spare the rod, spoil the child” message.
They experienced spanking themselves and have concluded, “I got spanked and I turned out okay.”
They are unaware of other discipline strategies they can use to get positive results, without hitting their children.
Each of these reasons are myths or the results of misinformation. If I wanted to get into a debate with parents who spank their children, I could easily win the argument based on logical and scientific reasoning. But, ironically, in winning the argument, I would lose the debate . . . principally because most parents who spank aren’t open to logical argument about whether or not spanking is a good thing. Instead of winning the debate, I’d be rupturing my relationship with the parents.
Over the years, I’ve learned to avoid rational argument and scientific evidence, and tell parents about these 7 “secrets” instead:
Acknowledge that parents and child development researchers agree on one point: Spanking is usually effective at stopping or suppressing misbehavior in the moment.
If you have spanked your child in the past, you are not a bad person; you’re just a parent who’s trying to make a positive difference.
Most parents who spank their children have mixed feelings about hitting their child before, during, and after the spanking.
I’ve never met a parent who wants to spank their children more; nearly all parents are looking for ways to spank their children less
Even though it’s hard for some parents to believe, from the scientific perspective, spanking is linked to far too many negative outcomes to justify its use. In particular, spanking has adverse effects on mental health, emotional well-being, and child, adolescent and adult behaviors. The science on this is very one-sided in that there’s lots of science indicating spanking has negative long-term effects and very little evidence linking spanking to anything positive in the long run.
If you want to spank less, you’ll need to identify, practice, and implement alternative discipline strategies. . . and that will be hard; it will take time, energy, and patience.
It might help to think about learning to spank less as a sacrifice you make because you love your children. No doubt, learning and practicing alternatives to spanking won’t be the first or last sacrifice you make to be a parent. But, using alternatives to spanking might be the most long-lasting contribution you can make to your child’s future well-being and success.
Medical and scientific organizations, including the American Academy of Pediatrics, the American Psychological Association, and nearly every professional group on the planet, advise against using corporal punishment (including no spanking). However—and this is incredibly important—the recommendations are NOT anti-discipline. In fact, mainstream scientific views are consistent with parents as leaders, authority figures who set limits and deliver natural and logical consequences to help children learn what’s acceptable and what’s not acceptable. Children need their parents to set limits, because children (including teenagers) are not very good at setting healthy limits for themselves.
As my former doctoral students would attest, I’m passionate about teaching parents not to spank their children. I’m also passionate about teaching parents how to use constructive and educational approaches to discipline.