All posts by johnsommersflanagan

Love One Another

Last week I was dancing and singing in India at my nephew’s wedding. This week I’m jet-lagged in Missoula. But the afterglow continues.

Being at a wedding, it was hard not to think of my mother. She loved weddings and always wished for everyone to find love.

My sisters had similar thoughts. We reminisced and projected my mother into the scene of my nephew marrying an Asian Indian woman in a Hindu ceremony. We wished she could pop back into the world and join in.

Mostly, my mother was shy and insecure. She didn’t learn to drive until age 34. I often wished she had more confidence.

But there was one place where my mom found her voice, early and often. For mysterious and obvious reasons, she became anti-racist in the 1950s, before anti-racism was a thing. She delighted in visits from my father’s Japanese friend, Carl Tanaka. When a Black family moved onto our all-White dead-end suburban street, she was the first to greet them with welcome gifts. She then sat my sisters and I down, and told us with piercing clarity that we would ALWAYS treat every member of that family with nothing but respect and kindness. They quickly became our friends. I have great memories of hanging out with my friend Darrell, who was the closest to me in age and in school.

What I didn’t understand about my mom’s anti-racism—until last week—was that she also had a solution. My sisters told me that my mother’s favorite solution to all that ails the world was inter-racial, inter-cultural, and inter-religion marriage. Of course, I’m not naïve enough to think that any single strategy could solve racism, but last week, during a three-day Hindu marriage ceremony, I returned home transformed and preoccupied with the idea that we can and should love one another.

The internet tells me that love one another has Christian Biblical origins . . . and more. Here’s an excerpt from a site that discusses “love of neighbor” in Hinduism.

Love of the neighbor or the “other soul” is a fundamental requirement for a functioning Hindu who aspires for final liberation from this world. Any injury or insult inflicted upon the other soul is ultimately injury inflicted on oneself—or worse still, the higher being. Neighborly love is integral for one’s social existence in this world. The Anusana Parva (113:8) in Mahabharata encapsulates this wisdom and dictates that one should be unselfish and not behave toward others in a way that is disagreeable to oneself. [From: http://what-when-how.com/love-in-world-religions/love-of-neighbor-in-hinduism/]

The facts were that Stephen Klein married Sahana Kumar last week, in a beautiful coastal setting just south of Chennai, India.

In a marvelous stroke of luck, I happen to be Gayle Klein’s brother and Stephen’s Uncle John. Along with the dancing singing (which I may have overdone), I was completely taken by the intercultural love and acceptance. The Kumar family welcomed Stephen and all of us to be with them not only in the celebration, but in relationship. At the Sangeet, we were invited to dance a Bollywood and a Hollywood dance. We were terrible AND we were completely accepted. To be immersed in another culture, to learn about Hinduism, to experience glimpses of the Southern Indian cultural ways of being . . . was AMAZING.

In love and in relationship, we often fall short. It’s hard to love our politically different family members. It’s hard to love when we feel annoyed. Sometimes, as I heard the famous Julie and John Gottman say, it’s even hard to find the time and timing to love our romantic partners. But love is big and, thanks to my sisters and Stephen, Sahana, and the Kumars, I understand love a little better this week. The intent to love people who are different than us; the invitation to be in relationship across cultures and generations; the desire to be as loving as we can be . . . those are the ways of being my mom might be shouting from the heavens.   

Istanbul Tomorrow

In 90-minutes, Rylee and I fly out of Seattle to Istanbul. Upon our arrival, the amazing Dr. Umit Arslan will pick us up from the airport, and then we’ll have three days of Umit, Turkish coffee, Turkish breakfasts, and tours of Istanbul with him (thank you, Umit!). As part of the trip, I’ll be offering a talk (translated live and in-person by Umit) at Yildiz Technical University (motto: “The ever-shining star”) in Istanbul. For those of you interested in such things, here are the ppts for the presentation, titled, Skills and Strategies for Conducting Excellent Clinical Interviews:

Peace, love, and virtual hugs,

John S-F

Neurogenesis and Ideas for Training Your Brain to Listen with Empathy

To start, I should say that I generally dislike pop-psych articles and promotional efforts that include cute sayings like, you can “Train (or re-wire) your Brain.” Most of you know this about me, partly because I like to make pithy comments about how, in fact, our brains actually don’t have any wires.

Despite overuse of the “wiring” analogy, I’m all-in on the principle that our behavior influences our brain structure, function, including a vast array of neurochemicals, hormones, and yada, yada, yada. In the following excerpt from our forthcoming Clinical Interviewing text, we provide a brief scientific commentary and recommendations for what we might oversimplify as “empathy training.”

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Neurogenesis refers to the birth of neurons and is one of the biggest revelations in brain research. Although neurogenesis primarily occurs during prenatal brain development, humans and other mammals generate new neurons (brain cells) throughout the life span (Jenkins et al., 1990). When adult neurogenesis occurs, new neurons are integrated into existing neurocircuitry.

Over 30 years ago, researchers demonstrated that repeated tactile experiences produced functional reorganization in the primary somatosensory cortex of adult owl monkeys (Jenkins et al., 1990). This finding and subsequent research supporting neurogenesis underscore a commonsense principle: Whatever behavior you practice or repeat is likely to stimulate neural growth and strengthen skills in that area. This is our explanation and prescription for how you can become more like Carl Rogers.

Multiple brain regions are activated during an empathic experience. Kim and colleagues (2020) summarized the complexity of what’s happening in the brain during empathic or compassionate responding, “Our analysis of sixteen fMRI studies revealed activation across seven broad regions, with the largest peaks localized to the Periaqueductal Grey, Anterior Insula, Anterior Cingulate, and Inferior Frontal Gyrus” (p. 112). In a similar review, Sezer and colleagues (2022) wrote:

Mindfulness-mediated functional connectivity changes include (1) increased connectivity between posterior cingulate cortex (DMN) and dorsolateral prefrontal cortex (FPN), which may relate to attention control; (2) decreased connectivity between cuneus and SN, which may relate to self-awareness; (3) increased connectivity between rostral anterior cingulate cortex region and dorsomedial prefrontal cortex (DMN) and decreased connectivity between rostral anterior cingulate cortex region and amygdala region, both of which may relate to emotion regulation; and lastly, (4) increased connectivity between dorsal anterior cingulate cortex (SN) and anterior insula (SN) which may relate to pain relief. (https://doi.org/10.1016/j.neubiorev.2022.104583)

If we focus in (somewhat inappropriately) on a particular brain structure, the anterior insula or insular cortex, a small structure residing deep within the fissure that separates the temporal lobe from the frontal and parietal lobes, seems particularly linked to empathy experiences, self-regulation, and other compassionate counseling-type responses (Chen et al., 2022).

Compassion meditation (aka lovingkindness meditation) is also associated with neural activity and structural development (or thickening) of the insula. Individuals who engage in regular compassion meditation have thicker insula, and when they view or hear someone in distress, they show more insula-related neural activity than individuals without compassion meditation experience (Hölzel et al., 2011). Other researchers have conducted meta-analyses and written reviews indicating that several brain structures are activated during cognitive-emotional perception, regulation, and response, and the relationships among them are highly complex (Kim et al., 2020; Pernet et al., 2021).

To oversimplify a complex neurological process, it appears generally safe to conclude that compassion meditation and other human activities related to empathy may contribute in some way to the thickening of the insula and development of other brain processes that enhance empathic responsiveness.

Although our knowledge about what’s actually happening in the brain is limited, these findings imply that you should engage in rigorous training to strengthen and grow your insula—as well as some of its empathic and self-regulating buddies like the posterior cingulate cortex, dorsolateral prefrontal cortex, rostral anterior cingulate cortex region, and dorsomedial prefrontal cortex (Sezer et al., 2022). This “training regimen” might contribute to you becoming more empathic and therefore, more therapeutic. In addition to practicing mindfulness or lovingkindness meditation, such a regimen could include:

  1. Committing to the intention of becoming a person who listens to others in ways that are accepting, empathic, and respectful.
  2. Developing an empathic listening practice. This would involve regular interpersonal experiences where you devote time to using active listening skills described in this chapter. As you practice, it’s important to have listening with compassion as your primary goal.
  3. Engaging in the active listening, multicultural, and empathy development activities sprinkled throughout this text, offered in your classes, and obtained from additional outside readings.
  4. When watching videos/television/movies, reading literature, and obtaining information via technology, lingering on and experiencing emotions that these normal daily activities trigger.
  5. Reflecting on these experiences and then… repeating… repeating… and repeating them over time and across situations

Rogers wrote in personal ways about his core conditions for counseling and psychotherapy. Contemplating his perspective is part of our prescription for developing an empathic orientation toward the variety of individuals with whom you will work.

“I come now to a central learning which has had a great deal of significance for me. I can state this learning as follows: I have found it of enormous value when I can permit myself to understand another person. The way in which I have worded this statement may seem strange to you. Is it necessary to permit oneself to understand another? I think that it is. Our first reaction to most of the statements which we hear from other people is an immediate evaluation or judgment, rather than an understanding of it. When someone expresses some feeling or attitude or belief, our tendency is, almost immediately, to feel “That’s right”; or “That’s stupid”; “That’s abnormal”; “That’s unreasonable”; “That’s incorrect”; “That’s not nice.” Very rarely do we permit ourselves to understand precisely what the meaning of [the] statement is to him [or her or them]. I believe this is because understanding is risky. If I let myself really understand another person, I might be changed by that understanding.” (Rogers, 1961, p. 18; italics in original)

As always, send me your thoughts on this content, as well as any ideas for improvement. Thanks and happy Friday!

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.

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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.  

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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!