The Delight of Scientific Discovery

Art historians point to images like John Henry Fuseli’s 1754 painting “The Nightmare” as early depictions of sleep paralysis.

Consensus among my family and friends is that I’m weird. I’m good with that. Being weird may explain why, on the Saturday morning of Thanksgiving weekend, I was delighted to be searching PsycINFO for citations to fit into the revised Mental Status Examination chapter of our Clinical Interviewing textbook.

One thing: I found a fantastic article on Foreign Accent Syndrome (FAS). If you’ve never heard of FAS, you’re certainly not alone. Here’s the excerpt from our chapter:   

Many other distinctive deviations from normal speech are possible, including a rare condition referred to as “foreign accent syndrome.” Individuals with this syndrome speak with a nonnative accent. Both neurological and psychogenic factors have been implicated in the development of foreign accent syndrome (Romö et al., 2021).

Romö’s article, cited above, described research indicating that some forms of FAS have clear neurological or brain-based etiologies, while others appear psychological in origin. Turns out they may be able to discriminate between the two based on “Schwa insertion and /r/ production.” How cool is that? To answer my own question: Very cool!.

Not to be outdone, a research team from Oxford (Isham et al., 2021) reported on qualitative interviews with 15 patients who had grandiose delusions. They wrote: “All patients described the grandiose belief as highly meaningful: it provided a sense of purpose, belonging, or self-identity, or it made sense of unusual or difficult events.” Ever since I worked about 1.5 years in a psychiatric hospital back in 1980-81, I’ve had affection for people with psychotic disorders, and felt their grandiose delusions held meaning. Wow.  

One last delight, and then I’ll get back to my obsessive PsycINFO search-aholism.

Having experienced sleep paralysis when I was a frosh/soph attending Mount Hood Community College in 1975-1976, I’ve always been super-delighted to discover old and new information about multi-sensory (and bizarre) experiences linked to sleep paralysis episodes. Today I found two articles stunningly relevant to my 1970s SP experiences. One looked at over 300 people and their sleep paralysis/out-of-body experiences. They found that having out-of-body experiences during sleep paralysis reduced the usual distress linked to sleep paralysis. The other study surveyed 185 people with sleep paralysis and found that most of them, as I did in the 1970s, experienced hallucinations of people in the room and many believed the “others” in the room to be supernatural. I find these results oddly confirming of my long-passed sleep insomnia experiences.

All this delight at scientific discovery leads me to conclude that (a) knowledge exists, (b) we should seek out that knowledge, and (c) gaining knowledge can help us better understand our own experiences, as well as the experiences of others.

And another conclusion: We should all offer a BIG THANKS to all the scientists out there grinding out research and contributing to society . . . one study at a time.

For more: Here’ a link to a cool NPR story on sleep paralysis: https://www.npr.org/2019/11/21/781724874/seeing-monsters-it-could-be-the-nightmare-of-sleep-paralysis

References

Isham, L., Griffith, L., Boylan, A., Hicks, A., Wilson, N., Byrne, R., . . . Freeman, D. (2021). Understanding, treating, and renaming grandiose delusions: A qualitative study. Psychology and Psychotherapy: Theory, Research and Practice, 94(1), 119-140. doi:https://doi.org/10.1111/papt.12260

Herrero, N. L., Gallo, F. T., Gasca‐Rolín, M., Gleiser, P. M., & Forcato, C. (2022). Spontaneous and induced out‐of‐body experiences during sleep paralysis: Emotions, “aura” recognition, and clinical implications. Journal of Sleep Research, 9. doi:https://doi.org/10.1111/jsr.13703

Romö, N., Miller, N., & Cardoso, A. (2021). Segmental diagnostics of neurogenic and functional foreign accent syndrome. Journal of Neurolinguistics, 58, 15. doi:https://doi.org/10.1016/j.jneuroling.2020.100983

Sharpless, B. A., & Kliková, M. (2019). Clinical features of isolated sleep paralysis. Sleep Medicine, 58, 102-106. doi:https://doi.org/10.1016/j.sleep.2019.03.007

Checklists from the Forthcoming 7th Edition of Clinical Interviewing

Textbook writing is a particular kind of writing that requires a variety of ways to present relatively boring material to students and aspiring professionals. Although we pride ourselves on writing the most entertaining textbooks in the business, our efforts to entertain are all part of a reader-friendly delivery system.

Another (less humorous) reader-friendly delivery strategy is the checklist. We intermittently use checklists to summarize essential information in our Clinical Interviewing text. Below, I’m including links to three checklists. Please note, these checklists are in process, and so if you see any typos or missing information or have some excellent feedback to share with me . . . post your feedback here on this blog or email me: john.sf@mso.umt.edu. I will greatly appreciate your feedback!

From Chapter 10: A Checklist on Suicide Assessment Documentation:

From Chapter 12: A Checklist on Strategies and Techniques for Working with Client Ambivalence or Natural Client Resistance.

From Chapter 13: A Checklist on Getting Prepped for Your First Session with a Child or Adolescent Client

For those of you who are still reading (and I hope that’s everyone), I’m still looking for someone who can write me a short (400 word) case or two on working with LGBTQ+ youth. A transgender case would be especially nice. If you’re interested, send me an email: john.sf@mso.umt.edu

Update on the Wright Stuff on Happiness

Several weeks ago, Dylan Wright (of Families First Learning Lab in Missoula) and I had a successful, albeit (speaking for myself) embarrassing fundraiser for his show, The Wright Stuff on Happiness, at the Missoula Public Library. At that time, we didn’t have the schedule for the show’s debut and season. Now we do . . . and so I’m happily sharing it here with you, so you can tune in and then share it with the world (or vice versa). 

The release of The Wright Stuff on Happiness has been scheduled to air, beginning December 12, on MCAT’s TV, channel 189 (Spectrum Cable) or https://mcat.org/watch/  on Mondays at 4:00 PM and Wednesdays at 6:00 PM! The schedule is below. You will also be able to watch the show anytime after it airs by going to The Montana Happiness Project YouTube Channel. We will post each episode as they air. To re-watch or share the teaser that we showed at the release party, please use the following link – https://youtu.be/t3YfBmjzqUo

Feel free to reach out if you have any questions, and here’s THE SHOW SCHEDULE! 

Dec 12th (4:00 PM) & Dec 14th (6:00 PM) – Dr. Dan Salois

Dec 19th (4:00 PM) & Dec 21st (6:00 PM) – Dr. Emily Sallee

Dec 26th (4:00 PM) & Dec 28th (6:00 PM) – Dr. Jayna Mumbauer

Jan 2nd (4:00 PM) & Jan 4th (6:00 PM) – Lillian Martz

Jan 9th (4:00 PM) & 11th (6:00 PM) – Dr. Nancy Seldin 

Jan 16th (4:00 PM) & Jan 18th (6:00 PM) – Dr. Sidney Shaw

Jan 23rd (4:00 PM) & Jan 25th (6:00 PM) – Hana Meshesha

A Free Video on Collaborative Safety Planning for Suicide Prevention

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.

Victor Yalom of psychotherapy.net has given me permission to offer this video clip to everyone as a free resource to guide and inspire you as you work to develop your skills for collaborative safety planning. You can find a glittering array of videos, including the previously mentioned, three-part 7.5 hour classic at: https://www.psychotherapy.net/ and https://www.psychotherapy.net/video/suicidal-clients-series

Here’s the video link: https://youtu.be/jd7PM9HFDO4

Have a great holiday week.

JSF

Using Reframing as a Counseling Intervention and What to do When They Fail

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.

Advanced Mental Health for the Jackson Construction Group

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.

Here is a one-page summary handout:

Here are the ppts:

Talking to MOLLI About Eudaimonic Happiness

Last night I had the honor of helping facilitate the World Premiere of “The Wright Stuff on Happiness” along with Dylan Wright and Hannah Zuraff and the Families First Learning Lab staff. Hannah posted a short video clip of the event on LinkedIn: https://www.linkedin.com/feed/update/urn:li:activity:6995246199964413952/?commentUrn=urn%3Ali%3Acomment%3A(ugcPost%3A6995246199159095297%2C6995248345623527425)&dashCommentUrn=urn%3Ali%3Afsd_comment%3A(6995248345623527425%2Curn%3Ali%3AugcPost%3A6995246199159095297)

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.

Here are the ppts for today’s talk:

I’m looking forward to spending time with the good folks and folx of MOLLI

Happy Monday!

Today: CBT Conference in Helena — Powerpoints

Happy Friday!

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

Using a Strengths-Based Approach to Suicide Assessment and Treatment in Your Counseling Practice

To Tweet or Not to Tweet: The Question of Quitting Twitter

Photo, courtesy of @rksf2/twitter

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?

We shall see.  

Advocating for Children’s Mental Health

Hi All,

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: bpe@mt.gov.

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.

Sincerely,

John Sommers-Flanagan

The place to click if you want to learn about psychotherapy, counseling, or whatever John SF is thinking about.