Becoming a Reality Therapist: The Reality Therapy Lab

Let’s say you want to practice reality therapy. Maybe more than any other approach, you’ll need to use reality therapy on yourself to become a reality therapist. Here’s what I mean.

You could consider channeling a little William Glasser, because he’s the developer of reality therapy. Then again, you might not want to channel Glasser, because, as Robert Wubbolding has written, to become a reality therapist, “You need not imitate the style of anyone else.”

The point is that you get to do the choosing . . . and a great start is to choose to use Wubbolding’s summary of the delivery system of reality therapy. Wubbolding used the letters, WDEP to summarize reality therapy, and these letters also happen to appear on Wubbolding’s car license plate. If you’re getting the feeling that Wubbolding is committed to reality therapy principles, you would be absolutely right. WDEP stands for Wants, Doing, Evaluation, and Planning. The following four questions capture WDEP:

What do you want?

What are you doing?

Is what you’re doing working? [Evaluation]

Should you make a new plan?

Before enacting reality therapy, you’ll need to adopt a positive, engaged, courteous, enthusiastic, counselor demeanor. You also need to be ready to use your excellent active listening skills. Avoiding toxic relational strategies like arguing, blaming, and criticizing is crucial. Think of yourself as a mentor or coach, and then practice the following strategies to see if they fit for you.

Begin by helping your client (or role-play partner) identify what he/she/they want. You could use any of the following questions:

If we could work on something that feels important to you, what would that be?

What do you want from our meeting today?

This is a big question, but I’m going to ask it anyway: What do you want from life?

If we have a good session and accomplish something that feels good to you, what will we have accomplished?

After you’ve gotten a sense of what your client is wants, you can move onto an inquiry about how your client is currently trying to get those wants. Questions like the following might help:

How are you currently trying to get what you want?

What have you tried?

I imagine you’ve tried various strategies for getting what you want to happen in your life. Tell me about all those things you’ve tried and how they’ve worked.

You can see from this last question, that asking about what clients are doing naturally leads to what Wubbolding considers to be the most important step in reality therapy: Evaluation. Wubbolding hypothesizes that many clients don’t get taught how to self-evaluate and/or may not have much practice at self-evaluation. He uses questions like the following to prompt client self-evaluation.

Is what you’re doing helping or hurting?

Is want you want realistic and attainable?

Does your self-talk help or hinder you in your efforts to get what you want?

Wubbolding has many additional questions about how to help clients self-evaluate in his book, Reality Therapy for the 21st Century. Check it out.

This brings us to the final question: Should you make a new plan? I think one of the most important insights that reality therapy brings to the counseling table is its emphasis on active and smart planning. Although SMART plans originated in the business world, Wubbolding has an extensive guide for how to help clients make effective plans. In my experiences doing counseling and psychotherapy, I’ve been astonished at how often clients go off in search of goals with either no plans or bad plans. For Wubbolding, client plans should be: Simple, Attainable, Measurable, Immediate, Involved, Controlled, Committed, and Continuous (Wubbolding’s acronym for planning is SAMI2C3). For more information on how to create SAMI2C3 plans, see Wubbolding’s book or the chapter in our Counseling and Psychotherapy Theories in Context and Practice textbook.

All planning that happens in counseling should be collaborative planning. Your job, as you engage in this important planning step, is to come alongside clients, brainstorm small tweaks or big changes in how clients might attain their goals, and to give them constructive feedback about whether their plan is a smart plan while providing encouragement and collaboratively evaluating the plan’s effectiveness. I have no doubt that reality therapy can be effective, partly because the first three reality therapy questions are so central to human functioning, but also because a good plan is a beautiful thing.

Note: the content of this blog is primarily adapted from the section that Robert Wubbolding wrote for our theories textbook.

My Birthday Wish (and Request)

Yesterday, in anticipation of my 63rd trip around the sun, I started feeling a slow creep of melancholia. At my age, because all movements are slower than frozen molasses, I now have the luxury of spotting doom early on, as its ambling my way. Last night’s gloominess was mostly about aging, but amplified by my nightly dose of watching the evening news. As usual, the news inevitably featured Donald J. Trump being Donald J. Trump, and saying things that can’t—without the aid of a delusional disorder—be framed as anything other than mean, nasty, and dangerous. After yet again witnessing Mr. Trump’s malevolence, I turned to Rita and murmured, “I think he might be evil.”

As soon as the word evil escaped my mouth, I immediately thought of Carl Rogers. Rogers was an amazing American psychologist who, from the 1930s to the 1960s, developed a profoundly empathic way of working with people. Rogers was raised in a rigid fundamental conservative Christian family. He wasn’t allowed to dance or play cards. During college, at age 20 (the year was 1922), Rogers took a sharp ideological left turn while on a slow boat to China. He stepped away from his fundamentalist roots, and began embracing a broad and encompassing belief in the goodness of all people. Rogers stepped so far away from judgmentalism, and believed so deeply and persistently in the innate goodness of all humans, that many philosophers and psychologists in the 1950s and 1960s (like Rollo May and Martin Buber), viewed Rogers as dangerously naïve.

After realizing back in the 20th century that I would never be “Like Mike” (Michael Jordan), I started fancying myself as being like Carl Rogers instead. The match seemed perfect. Just like Rogers, I believe in everyone’s positive potential. Also like Rogers, I don’t really believe in evil. However, after four years of listening to someone with immense power mock the disabled, disparage the military, demean women, remorselessly lock migrant children in cages, stoke hate, division, and conspiracies, and threaten to blow up our democratic process . . . I’ve begun reconsidering my naïve Rogerian perspective on evil. Last night’s news snippet included Mr. Trump’s continued attack on the Michigan governor. As far as I can tell, the only times Mr. Trump manages to use his words to show empathy is when he’s reading—rather haltingly—off of a teleprompter.

Rogers might blanch at my judgment of Trump, but I think not. He wrote a book “On Personal Power” and his bottom line was that you should give it away. And when I interviewed his daughter, Natalie Rogers, in 2006, she made it clear that her dad was in favor of accepting and prizing all human feelings, but that he could be quite firm when people (and his children) behaved in unacceptable ways. I’m pretty sure that Carl Rogers, one of the most profoundly influential psychologists of all time, would be horrified by Mr. Trump’s behavior, and he would use his power to bring back civility, decency, and empathy.

A couple years ago I had the honor of meeting Joe Biden, face-to-face. He greeted me with flourish and enthusiasm. He oozed empathy, compassion, kindness, and a commitment to service. He spoke and acted without a whiff of arrogance. I’m convinced that he’s the sort of person who will use his power for good.

Here’s my birthday wish (and request). Instead of sending me all the lavish gifts you had planned to send me, just go out and spread the word that decency, empathy, respect, kindness, and love are making a HUGE comeback. And if you know someone whom you think isn’t voting, consider this: reach out with respect and kindness and ask them to vote for Joe Biden. That would be amazing . . . a little frosting on my birthday wish.

Thanks for reading this and for helping make my birthday wish come true.

Essential Information about Counseling and Psychotherapy Theories

A good summary is a beautiful thing. But summaries are always unfair and limited representations of that which is bigger. Nevertheless, below, I’ve tried to summarize the primary listening focus and the primary change mechanisms for each of 13 theoretical orientations included in our textbook, Counseling and Psychotherapy Theories in Context and Practice (John Wiley & Sons, 2018). In addition, yesterday I filmed myself using a memory-palace strategy while describing all 13 perspectives below. You can read the summary below and/or watch me try to pull off this 15 minute theories overview on YouTube: https://youtu.be/VJFK6cCHCU8

TheoryWhat to Listen For. . .Change Mechanisms
Psychoanalytic PsychodynamicOld maladaptive intrapersonal conflicts and repetitive, unconscious, and dysfunctional interpersonal patterns.Make unconscious conscious, catharsis, and working through new intra- and interpersonal dynamics.
AdlerianBasic mistakes imbedded in the style of life, including excess self-interest and inferiority/superiority.Awareness, insight, and encouragement (courage) to face the tasks of life.
ExistentialAnxiety over and avoidance of core existential life dynamics like death, isolation, meaninglessness, and freedom.Feedback and confrontation to help clients gain awareness and face life’s ultimate existential demands.
Person-CenteredEmotional distress, incongruence (discrepancies between real and ideal selves), and conditions of worth.A relationship characterized by congruence, unconditional positive regard, and empathic understanding.
GestaltUnfinished emotional and behavioral baggage from the past that blocks awareness or disturbs self-other boundaries.Guidance on using here-and-now experiments to deal with unfinished emotional and behavioral experiences.
BehavioralDisturbing emotions (e.g., anxiety), maladaptive behavior patterns, and environmental contingencies.New learning or re-learning via operant, classical, and social processes.
CBTDisturbing emotions (e.g., anxiety, anger), maladaptive thinking, maladaptive behaviors, and triggers/contingenciesCollaborative and empirical tasks that modify maladaptive or distorted cognitive information processing.
Choice Theory/Reality TherapyWhat clients want, what they’re doing, whether that’s working, and planning.Commit to and enact adaptive plans that are aligned with quality world goals.
FeministWhere is the client experiencing anger or dissatisfaction due to gender-based limits or oppressive situations?Relational connection and empowerment to actively seek personal goals and mutually empathic emotional relationships.
ConstructiveWhere clients are stuck and how existing client strengths, exceptions, and solutions can fuel change.Re-shaping, reframing, and reconsolidating old narratives and problem-based patterns through solutions and sparkling moments.
Family SystemsFamily dynamics, transactions, hierarchy, roles, and boundaries that contribute to personal or systemic dysfunction.Shift family dynamics and transactions via in-session and outside session assignments.
MulticulturalWhere is the client experiencing distress due to limiting or oppressive socio-political factors?Cultural acceptance, empowerment, and culturally-based rituals.
IntegrativeWhat are the client’s unique problems, strengths, and consistent ways of thinking, acting, and feeling?Match a therapeutic process to the client’s unique problems and strengths.

My Cache of Unprofessional Counseling and Psychotherapy Theories Videos

In a surprising turn of events, this semester, I’ve decided to make a series of unprofessional theories videos to accompany my counseling and psychotherapy theories course (and text). When I say surprising, I mean surprising in that I’m surprised about feeling open to spontaneously video recording myself and making it available via YouTube. Could it be that as I grow older, I care less about how I look and sound, and care more about showing myself openly to others as an imperfect being who’s just trying to offer up something that might be educational? Alternatively, maybe I just caught the narcissistically-leaning, reality television, constantly-make-videos-of-myself, YouTube, Instagram, Facebook, Tiktok, virus that’s infecting so many people. We may never know.

And I say unprofessional because I’m filming these all by myself, not using a script, and making side comments and using props that might involve embarrassing myself as I talk about counseling and psychotherapy theories. One form of these unprofessional videos includes me doing “dramatic readings” and commentary from the works of Freud, Adler, and other original theories thinkers and writers. Although I intended these readings to be dramatic, I can see how they also might just be dull.

With my explanations and caveats out of the way, here are the offerings, thus far, for this semester.

Week 1 – An Intro to Counseling and Psychotherapy Theories

Hypnosis for Warts: A Story – https://youtu.be/9FR4PyTcsKw

Psychotherapy Math – https://youtu.be/ZqMW0SNekY0

Week 2 – Psychoanalytic Approaches

Freud Dramatic Reading – https://youtu.be/L-fkveRk7B0

Week 3 – Individual Psychology and Adlerian Therapy

Adler Dramatic Reading, Take 1 – https://youtu.be/_sVysgm1UiY

Adler Dramatic Reading, Take 2 – https://youtu.be/xCQd6i_CWAI

Week 4 – Existential Theory and Therapy . . . coming soon!

Although this post focuses on my unprofessional videos, that doesn’t mean I’ve completely stopped behaving professionally. For example, recently, I was a guest on the podcast, “A New Angle” hosted by Justin Angle and Bryce Ward (both of the University of Montana College of Business). In this podcast, we talk about COVID, suicide in Montana, happiness, and why the College of Business supports the teaching “Essential” interpersonal and psychological skills. It’s a pretty cool (and professional) podcast, even if I do say so myself. You can find “A New Angle” on Apple Podcasts at:

https://podcasts.apple.com/us/podcast/i-i-happiness-with-john-sommers-flanagan/id1336642173

Or at: anewanglepodcast.com

I hope you’re all having a great run-up to the weekend.

Understanding Suicide – A Video/Podcast Interview with Paula Fontenelle

The word suicide, all by itself and regardless of context, can elicit anxiety, grief, anger, and other raw emotions. One of my goals as a mental health professional, is to advocate for open discussions of suicide. Why? Because I want to actively role model how facing, embracing, and discussing suicide directly can shrink the threatening nature of the word—and also shrink the anxiety, grief, and anger that people feel when they hear the word.

Just yesterday, Paula Fontenelle, author of “Understanding Suicide” (see Amazon: https://www.amazon.com/Understanding-Suicide-Living-loss-prevention/dp/1691504831), posted a podcast and video of her and I discussing suicide. As always, when I look at and listen to myself, I feel a bit shy about sharing this. The mirror (or video recording) is never as flattering as I wish it to be. However, I love that Paula is so dedicated to this topic and that she was willing to have me as a guest on the 1st anniversary and 40th episode of her show.

You can access a video of the show here: https://www.youtube.com/watch?v=RDmY8kgf6Zc

You can access the audio (podcast) of the show here: https://bit.ly/3muZ2eD

If you want to know more about Paula and her interests and expertise, you can link to her in all of the methods listed below:

WebsitePodcast | YouTube | LinkedIn | Facebook | Instagram

Thanks for reading, listening, and watching. I wish you all the best this weekend and beyond!

John

Why Everyone loved the Quiet and Powerful Paula Sommers . . . and why we so Desperately miss her

On Monday, August 31, 2020, Paula Ann Sommers passed on to the place where only the kindest and most loving people on the planet go after death. We don’t know the exact location, but she’ll be there, sharing her angelic love and kindness. Paula was 91 years old, living in a small family group home in Woodinville, WA. She was suffering from dementia and had recently tested positive for COVID-19.

Paula was born to Angelo and Lucille Costanzo in Portland, Oregon. She had two older brothers, Robert (Bob) and Lawrence (Larry) Costanzo. Paula loved her parents and her older brothers, often telling stories of their years together growing up on the Oregon coast. Paula’s stories of Seaside and Arch Cape made these locations mystical and magical to the 13 cousins (children of Bob, Larry, and Paula).

After graduating from Seaside High School in 1948, Paula worked at Patty’s Fountain. In the summer of 1948, Max Sommers walked into the restaurant with a mutual friend. The friend, knowing Paula already had a boyfriend (or two), bet Max that Paula wouldn’t accept a ride home with him. Max took the bet. Not long after Paula saw Max—and his new yellow convertible—Max won the bet. In Max’s words, the bigger prize was to be with the love of his life. Last November, 2019, was Paula and Max’s 70th wedding anniversary. 

In 1949, with the help of a VA loan, Paula and Max purchased City Shade Company in Vancouver, Washington. She worked at City Shade with Max for over 44 years. Paula regularly confessed to stealing cash from the company’s cash-box. Having absolutely no ability for stealth or deceit, she confessed to her so-called crimes, just as openly as she shared her heart and love with everyone who entered the doors at City Shade. Among her many remarkable gifts, Paula exuded warmth, genuine caring for others, and unmitigated kindness; she created moments in time and space that made people feel loved, accepted, and prized. In the days following her death, we (her children) have heard dozens of stories of how she unselfishly provided comfort to others. Around Christmas, virtually anyone who entered her home received a gift. For several years she gave out gym bags; other years there were shirts, sweaters, and blouses; still other years, games, toys, and fudge. Her kindness and generosity had no bounds.

As the daughter of an Italian American immigrant, Paula experienced discrimination. Then, as a Catholic, she met, fell in love with, and married a Jewish man. These experiences fueled her determination to reject all forms of prejudice and discrimination with an intensity that might have been labeled as hate (but Paula was philosophically opposed to using the word hate for anything). Instead of railing in negativity against racism, sexism, and homophobia, Paula simply lived her values, welcoming everyone into her bubble of love and kindness. The Christian family next door, the Jewish relatives, the Black family up the street, the lesbian daughter of friends, people on the street living in poverty, Muslims she had never met, children at restaurants . . . to be in proximity of Paula put everyone in danger of a hug, a gift, a smile, an empathic ear, and her unwavering love and acceptance. 

Children from the neighborhood came to the Sommers home just as much to be with Paula as to see her children. There was only one Black family in the neighborhood. Paula loved that family with all her heart, soul, and spirit. When they were hungry, she fed them. If the boy who was struggling to understand his sexuality needed to talk, he wandered down the street and sought out Paula. Like moths to a flame, children were instantly attracted to “Mrs. Sommers,” because they saw her for what she was, an oasis of love and acceptance in a world of judgment. Despite this, Paula was nearly oblivious of her popularity. As is true with other Catholic saints, Saint Paula walked humbly in the world, never overestimating herself, while quietly living out her deep values of love, acceptance, kindness, and generosity.

Along with her talents for customer service, listening, and parenting, Paula was also an excellent cook. Every meal was an event that didn’t start until everyone was seated. Special guests got the coveted lace tablecloth, but everyone got food and comfort that would linger in their memories. Paula especially loved desserts. Everyone who knew anything knew that if fresh cookies weren’t on the counter, they could find a cache of snickerdoodles, chocolate chip cookies, banana bread, pumpkin bread, or lemon poppyseed bread in the third drawer on the south end of kitchen. If you came for dinner, it was advisable to “save room in your stomach” for Paula’s pies of the lemon meringue, pumpkin, pecan, apple, and other varieties. Her cheesecakes were to die for. Paula had a mathematical formula for calculating precisely how many pies (or cheesecakes or cakes) were required for a particular meal. She took the number of guests, and divided by two. If eight people were expected, she made four pies. Despite being teased by her children for constantly overestimating dessert needs, in the end, rarely did any of Paula’s desserts exist after noon the following day. Either Paula sent generous servings away with happy recipients, or her naysayers ate all the leftover desserts for breakfast.

In the Sommers family, there were very few rules, because when everyone feels loved and prized for their unique personalities, very few family rules are needed. She never yelled at her children. She never hit her children (although she did chase one child around with an eggbeater until they both dissolved in laughter). One of Paula’s most famous rules was, “We never use the word hate in our family.” She offered an alternative, “You can say you dislike something very intensely.” The word hate was simply the opposite of everything Paula believed in and stood for. In rare cases, when one sibling insulted another, Paula would counter, “If John’s dumb, you’re dumb too, because you’re both in the same family.” To this day, the Sommers children have no memory of sibling rivalry. The Sommers family was a team; Paula gently guided us away from conflict and toward love. When angry, she vacuumed and cleaned the house until everything was spotless and her anger had diminished. Freudian sublimation was never so complete. No one went to bed angry. Everyone was valued. No one doubted Paula’s love.

For many years, Paula mailed out so many greeting, sympathy, and birthday cards that we believe she single-handedly drove up the stock price of Hallmark Cards. Consistent with her character and values, she signed every card the same way: “Love always, Paula.”

For Valentine’s Day, 2010, Regence BlueShield of Oregon made a video recording of Paula and Max talking about their relationship and marriage. During the recording, Max said “Paula is the most unselfish person you ever saw, and you can’t help but take on some of those traits for fear of looking bad if you don’t.” This was the essence of Paula Ann (Costanzo) Sommers. Whenever she was, through kindness, love, and generosity, she inspired everyone to be better, lest they not keep up.

Paula is survived by her husband, Max (Vancouver, WA), her children Gayle (Vancouver, WA and Surprise, AZ), Peggy (Kirkland, WA), and John (Absarokee/Missoula, MT), and her grandchildren Chelsea Bodnar (Missoula, MT), Jason Lotz (Chino Hills, California), Patrick Klein (Vancouver, WA), Aaron Lotz (Seattle, WA), Rylee Sommers-Flanagan (Helena, MT), and Stephen Klein (Los Angeles, CA). Paula is also survived by eight great grandchildren, nieces, nephews, and friends of the family, many of whom who refer to her as their “Favorite Aunt,” or “Quite possibly the kindest person I have ever met.”

Memorial plans for Paula are to be arranged. The family is considering online and face-to-face alternatives. Paula was a staunch supporter of people with limited incomes and resources. Memorial donations can be made in honor of Paula Sommers to whatever charity you believe would fulfill her desire to help those in need. More importantly, she would want all who read this to live in ways to spread happiness, unity, and love. In the spirit of Paula’s life and values, we hope—in her honor—you will take a day, a week, a month, a year, or the rest of your life to intentionally share kindness, acceptance, and generosity with others. And, as Paula would say, “Love always.”

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Treating and Preventing Suicide: Follow-Up and Resources

On Wednesday, we had about 3,000 people register for the ACA-sponsored webinar, “Treating & Preventing Suicide.” That was a fantastic turn out and I owe a BIG THANKS to Zachary Taylor of PESI for skillfully moderating the event and to Victoria Kress (Distinguished Professor from Youngstown State University) for sharing her insights about suicide assessment, prevention, and non-suicidal self-injury. Questions and comments from participants were excellent; it would have been great to have more than only one hour.

During the webinar we promised I would post additional suicide and NSSI resources on my blog. Other events have conspired (as they will) to delay this posting to this particular moment in time. Because we’re posting this content after the event, I’m aware that we may not efficiently get this out to everyone who was online and interested. Consequently, if you get this post and you know someone who’s not following this blog, but who might want this information, please feel free to forward or share.

The following content is from Victoria:

An article on self-harm published in Psychotherapy Networker:

https://www.psychotherapynetworker.org/blog/details/1313/treating-self-harm

Vicki also co-authored the following two publications:

Kress, V. E., & Hoffman, R. M. (2008) Non-suicidal self-injury and motivational interviewing: Enhancing readiness for change. Journal of Mental Health Counseling, 30, 311-329.

Stargell, N. A., et al., (2017-2018). Student non-suicidal self-injury: A protocol for school counselors. Professional School Counseling, 21, 37-46. Click here for the pdf.

Vicki also shared this document on suicide assessment:

My top resources include:

Sommers-Flanagan, J. (2018). Conversations about suicide: Strategies for detecting and assessing suicide risk. Journal of Health Service Psychology, 44, 33-45.

Sommers-Flanagan, J. (2018). Suicide assessment and intervention with suicidal clients [Video]. 7.5 hour training video for mental health professionals (produced by V. Yalom). Mill Valley, CA: Psychotherapy.net — https://www.psychotherapy.net/video/suicidal-clients-series

Sommers-Flanagan, J. (2019). Suicide assessment for clinicians: A strength-based model. ContinuingEdCourses.net

Sommers-Flanagan, J. (2019). Suicide interventions and treatment planning for clinicians: A strength-based model. ContinuingEdCourses.net

Because Rita and I just turned in our ACA book manuscript (coming in Feb), I’ve got a huge list of suicide-related citations. Below, I’m listing a few highlights related to our discussion on Wednesday. Books and articles about the top evidence-based approaches have an asterisk (*).

Ahuja, A., Webster, C., Gibson, N., Brewer, A., Toledo, S., & Russell, S. (2015). Bullying and suicide: The mental health crisis of LGBTQ youth and how you can help. Journal of Gay & Lesbian Mental Health, 19(2), 125-144. https://doi.org/10.1080/19359705.2015.1007417

Binkley, E. E., & Liebert, T. W. (2015). Prepracticum counseling students’ perceived preparedness for suicide response. Counselor Education & Supervision, 54(2), 98-108.

Bryan, C. J., Bryan, A. O., & Baker, J. C. (2020). Associations among state‐level physical distancing measures and suicidal thoughts and behaviors among U.S. adults during the early COVID‐19 pandemic. Suicide and Life Threatening Behavior, e12653, 1-7. https://doi.org/10.1111/sltb.12653

*Bryan, C. J., & Rudd, M. D. (2018). Brief cognitive-behavioral therapy for suicidal prevention. Guilford Press.

Cureton, J. L., & Clemens, E. V. (2015). Affective constellations for countertransference awareness following a client’s suicide attempt. Journal of Counseling & Development, 93(3), 352-360. https://doi.org/10.1002/jcad.12033

Erbacher, T. A., Singer, J. B., & Poland, S. (2015). Suicide in the schools: A practitioner’s guide to multi-level prevention, assessment, intervention, and postvention. Routledge.

Finn, S. E., Handler, L., & Fischer, C. T. (2012). Collaborative/therapeutic assessment: A casebook and guide. Wiley.

Freedenthal, S. (2018). Helping the suicidal person: Tips and techniques for professionals. Routledge.

Granello, D. H. (2010a). A suicide crisis intervention model with 25 practical strategies for implementation. Journal of Mental Health Counseling, 32(3), 218-235. https://doi.org/10.17744/mehc.32.3.n6371355496t4704

Granello, D. H. (2010b). The process of suicide risk assessment: Twelve core principles. Journal of Counseling & Development, 88(3), 363-371. https://doi.org/10.1002/j.1556-6678.2010.tb00034.x

Healy, D. (2009). Are selective serotonin reuptake inhibitors a risk factor for adolescent suicide? The Canadian Journal of Psychiatry/La Revue Canadienne De Psychiatrie, 54(2), 69-71. https://doi.org/10.1177/070674370905400201

Hedegaard, H., Curtin, S.C., & Warner, M. (2020). Increase in suicide mortality in the United States, 1999–2018. NCHS Data Brief, 362. National Center for Health Statistics.

*Jobes, D. A. (2016). Managing suicidal risk: A collaborative approach (2nd ed.). Guilford Press.

*Joiner, T. (2005). Why people die by suicide. Harvard University Press.

Large, M. M., & Kapur, N. (2018). Psychiatric hospitalisation and the risk of suicide. The British Journal of Psychiatry, 212(5), 269-273. https://doi.org/10.1192/bjp.2018.22

Large, M. M., & Ryan, C. J. (2014). Suicide risk categorisation of psychiatric inpatients: What it might mean and why it is of no use. Australasian Psychiatry, 22(4), 390-392. https://doi.org/10.1177/1039856214537128

*Linehan, M. (1993). Cognitive behavioral therapy of borderline personality disorder. Guilford Press.

*Linehan, M. (2015). DBT® skills training manual (2nd ed.). Guilford Press.

Maris, R. W. (2019). Suicidology: A comprehensive biopsychosocial perspective. Guilford Press.

*Stanley, B. & Brown, G. K (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256–264. https://doi.org/10.1016/j.cbpra.2011.01.001

Wenzel, A., Brown, G. K., & Beck, A. T. (2009) Cognitive therapy for suicidal patients: Scientific and clinical applications. American Psychological Association.

Suicide Assessment Should be Therapeutic Assessment

This morning (or afternoon, depending on your time zone), I’ll be participating on a panel discussion titled, “Treating and Preventing Suicide.” Although the event has reached maximum capacity, the link for more information is here: https://catalog.pesi.com/sq/pn_001386_essentialstreatingpreventingsuicide_panel_aca-139059?fbclid=IwAR2QYfDxVFjdnnDHV1JwKUYh54JqKzvhpneB98FF-yNrk5fcbFfPMdtyuWs

As a resource to complement the panel discussion, I’m posting some information on suicide assessment. Below is the opening from the suicide assessment chapter in our forthcoming book with the American Counseling Association. We emphasize that suicide assessment isn’t purely data collection. Instead, professionals need to simultaneously keep their eye on how to be therapeutic. Here’s the excerpt:

Suicide assessment integrates science and art. Assessment science helps practitioners determine what information is most important during a clinical interview and how to best obtain reliable and valid assessment data (Sommers-Flanagan et al., 2020; Wygant et al., 2020). The art of assessment includes how and when to ask questions, relational methods for offering empathy, and how clinicians can partner with clients to explore symptoms and strengths in ways that facilitate trust and stimulate honesty (Ganzini et al., 2013). Because suicide is a painful and provocative topic, advanced assessment skills are essential.

When clients or students experience suicidality, exposure to an assessment process can feel threatening. As a consequence, we believe counselors should embrace principles of therapeutic assessment (Fischer, 1970, 1985). Therapeutic assessment originated in the late 1960’s, when Constance Fischer began practicing and publishing about a radical new assessment approach. Unlike traditional objective and unilateral approaches to assessment, Fischer (1969, 1970) began viewing clients as “co-evaluators.” Stephen Finn has extended Fischer’s ideas; the approach is now called therapeutic assessment (Finn et al., 2012).

Therapeutic assessment principles are consistent with the professional counseling paradigm (Capuzzi & Stauffer, 2016); they include collaboration, compassion, openness, honesty, and a commitment to valuing clients as ultimate experts on their lived experiences. Although information gathering remains important, relationship connection during assessment interviews takes priority. Every assessment finding needs to be validated and understood within each client’s unique personal context. Collaboration is the cornerstone; assessments are done with clients, not on clients (Martin, 2020; Sommers-Flanagan & Sommers-Flanagan, 2017). As Flemons and Gralnik (2013) wrote, when conducting suicide assessments, “Our goal is not to remain objectively removed but, rather, to become empathically connected” (p. 6).

There are several “therapeutic” strategies for suicide assessment interviewing. Jobes’s (2016) book is a great resources, as is Freedenthal’s (2018). You can also check out our Clinical Interviewing suicide assessment chapter, or read this free blog post on using a mood scaling method: https://johnsommersflanagan.com/2018/05/25/suicide-assessment-mood-scaling-with-a-suicide-floor/

Obviously, there’s not enough time and space to go into great depth on suicide assessment in a little blog like this. And so, if you looking for depth, check out the video series I did with Victor Yalom and Psychotherapy.net. You can even watch a short demonstration video clip: https://www.psychotherapy.net/video/suicidal-clients-series

I wish you all the best as you face the challenge of engaging with and treating clients who are suicidal with the therapeutic respect they deserve.

That Time When Sara P. Punk’d John SF during Filming of the Counseling and Psychotherapy Video Series

Over the past decade or so, Rita and I have been involved in some better and worse video production experiences. When I say better and worse, mostly I mean more embarrassing and less embarrassing.

Once, back in 2012, Sara Polanchek volunteered to help me do a psychoanalytic video demonstration. In honor of Freud, I suppose, the videographer begins by over-handling my tie. Then, we officially start the session with me asking Sara to free associate, and Sara takes over. Late in the clip, the other voice you hear in the background is Rita, whom I suspect collaborated with Sara on trying to embarrass me (even more than I would have been naturally embarrassed simply be trying to demonstrate a psychoanalytic session).

I tried posting this clip several years ago, but somehow the version didn’t actually include Sara’s opening disclosure. . . which was the whole point. So here’s the full 1 minute and 55 seconds: https://www.youtube.com/watch?v=SeihJqtenyc

Counseling Theories — Week One — Hypnosis for Warts

Theories III Photo

Being holed up in our passive solar Absarokee house made an interesting venue for blasting off this semester’s University of Montana Counseling Theories class. I’m mentioning passive solar not to brag (although Rita did design an awesome set-up for keeping us warm in the winter and cool in the summer using south-facing windows and thermal mass), but to give you a glimpse of our temperature-related passivity: we have no working parts (as in air conditioning). And I’m mentioning holed up because we’re in a stage 1 air pollution alert from California smoke and consequently weren’t able to use our usual manual air conditioning system (opening up the windows in the night to cool off the house). Our need to keep the windows shut created a warmer than typical room temperature and, based on my post-lecture assessment of the armpits of my bright yellow shirt, yesterday just might have been my sweatiest class since 1988, when I was teaching at the University of Portland, and started sweating so much during an Intro Psych class that my glasses fogged up. In case you didn’t already know this about me, I’m an excellent sweater. You haven’t seen sweat until you’ve seen my sweat. Top-notch. The sort of sweating most people only dream about. I’d rate myself a sweating 10.

Aside from my sweating—which I’m guessing you’ve had enough of at this point—the students were pretty darn fantastic. Attendance was virtually perfect, which, given that everything was virtual, exceeded my expectations.

Speaking of expectations, because I’m teaching online via Zoom, one thing I’m adding to the course are a few pre-recorded videos. Yesterday’s pre-recorded video featured me telling my famous “Hypnosis for Warts” story. My goal with the pre-recorded video—aside from letting my students see me and my yellow shirt in a less sweaty condition—was to break up the powerpoints. I could have told the story live, but instead, I clicked out of the powerpoints, told my students we were going to watch a video, and then showed a video of myself . . . telling a story I could have been telling live. I thought I was hilarious. However, mostly, the sea of 55 Hollywood Squares faces just stared into the sea of virtual reality, and so I couldn’t see whether the students appreciated my pre-recorded video of myself teaching strategy. I know I’ve got too many “seas” in that preceding sentence, but redundancy happens. Really, it does. I’m totally serious about redundancy.

Back to expectations . . .

One of Michael Lambert’s four common factors in counseling and psychotherapy is expectancy. He estimated that, in general, expectation accounts for about 15% of the variation in treatment outcomes. But, of course, treatment outcomes are always contextual and always variable and always unique, and so, as in the case of “Hypnosis for Warts,” sometimes the outcome may be a product of a different combination or proportion of therapeutic ingredients. If you watch the video, consider these questions:

  • What do you think “happened” in the counseling office with the 11-year-old boy to cause his eight warts to disappear?
  • Do you think the therapeutic ingredients that helped the boy get rid of his warts were limited to Lambert’s extratherapeutic factors, relationship factors, technical factors, and expectancy factors (his four big common factors) . . . or might something else completely different have been operating?
  • What proportion of factors do you suppose contributed to the positive outcome? For example, might there have been 50% expectancy, instead of 15%?

Here’s the video link to the Wart story: https://www.youtube.com/watch?v=9FR4PyTcsKw

That’s about all I’ve got to share for today. However, if you happen to know of some nice 1-5 minute theories-related video clips that I can share with my students, please pass them on. I’d be especially interested if you happen to have video clips of me, but relevant videos of other people would be nice too. Haha. Just joking. Please DON’T send video clips of me. My students and I—we already have far too much of the JSF video scene.

Be well,

John SF

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