All posts by johnsommersflanagan

Eight Core Conditions that Often Contribute to Suicide

Rainbow 2017Many professionals and media sources have proclaimed that suicide is a 100% preventable problem. Although I completely disagree with that message—and find it terribly offensive—I also believe that we should do what we can to prevent suicide.

Recently I was asked to write a journal article summarizing the conditions or dimensions that commonly contribute to suicide. To give you a flavor of these dimensions, below I’ve included brief descriptions of each one. However, I also want to emphasize that suicidologists and suicide researchers agree that death by suicide is nearly always unpredictable. Suicide is unpredictable despite the fact that, afterwards, many people and professionals will feel as though they should have “seen the signs” and done something more to prevent the death.

Knowing the following eight dimensions is useful when they’re used to enhance your compassion and capacity to collaborate with individual clients and persons. They’re not designed to be used as suicide risk factors or predictors.

Here are the eight dimensions.

Unbearable Psychological/Emotional Distress (Shneidman’s Psychache)

Shneidman (1985) originally identified “psychache” as the central psychological force leading to suicide. He defined psychache as negative emotions and psychological pain, referring to it as “the dark heart of suicide; no psychache, no suicide” (p. 200). In more modern patient-oriented language, psychache is aptly described as unbearable emotional distress. Unbearable distress can involve many factors, or center around one main trauma, loss, or other psychologically activating experiences; it may be accompanied by distinct cognitive, emotional, or physical symptoms.

Problem-Solving Impairment (Shneidman’s Mental Constriction)

Depression or low mood is commonly associated with problem-solving impairments. Originally, Shneidman called these impairments mental constriction, and defined them as “a pathological narrowing of the mind’s focus . . . which takes the form of seeing only two choices: either something painfully unsatisfactory or cessation” (1984, pp. 320–321). Researchers have reported support for Shneidman’s original ideas about mental constriction (Ghahramanlou-Holloway et al., 2012; Lau, Haigh, Christensen, Segal, & Taube-Schiff, 2012).

Agitation or Arousal (Shneidman’s Perturbation)

Agitation or arousal is consistently associated with death by suicide (Ribeiro, Silva, & Joiner, 2014). Shneidman (1985) originally used the term perturbation to refer to internal agitation that moves patients toward suicidal acts. When combined with high psychological distress and impaired problem-solving, agitation or arousal seems to push patients toward acting on suicide as a solution to their distress. Trauma, insomnia, drug use (including starting on a trial of serotonin-reuptake inhibitors), and many other factors can elevate agitation (Healy, 2009).

Thwarted Belongingness and Perceived Burdensomeness

Joiner (2005) developed an interpersonal theory of suicide. Part of his theory includes thwarted belongingness and perceived burdensomeness as contextual interpersonal factors linked to suicide. Thwarted belongingness involves unmet wishes for social connection. Perceived burdensomeness occurs when patients see themselves as flawed in ways that make them a burden to others.

Hopelessness

Hopelessness is a broad cognitive variable related to problem-solving impairment and linked to elevated suicide risk (Hagan, Podlogar, Chu, & Joiner, 2015; Strosahl, Chiles, & Linehan, 1992). Hopelessness is the belief that whatever distressing life conditions might be present will never improve. In many cases, patients hold a hopeless view—even when a rational justification for hope exists.

Suicide Desensitization

Joiner (2005) and Klonsky and May (2015) have described how fear of death or aversion to physical pain is a natural suicide deterrent present in most individuals. However, at least two situations or patterns can desensitize patients to suicide and reduce natural suicide deterrence. First, some patients may be predisposed to high pain tolerance. This predisposition is likely biogenetic, as in blood-injury phobias (Klonsky & May, 2015). Second, patients may acquire, through desensitization, a numbness that reduces natural fears of pain and suicide. Chronic pain, self-mutilation, and other experiences can be desensitizing.

Suicide Plan or Intent

In and of itself, suicide ideation is a poor predictor of suicide. Nevertheless, ideation is an important marker to explore with patients; exploring ideation can lead to asking directly about whether patients have a suicide plan. Suicide plans may or may not be associated with suicide intent. Some patients will keep a potential suicide plan on reserve, just in case their psychological pain grows unbearable. These patients do not intend to die by suicide, but they want the option and sometimes they have thought through the method(s) they might employ.

Lethal Means

Access to a lethal means is a situational dimension that substantially contributes to suicide risk. Firearms are far and away the most lethal suicide method. Specifically, Swanson, Bonnie, and Appelbaum (2015) reported that firearms result in an 84% case fatality rate. Although firearms can quickly become a politicized issue in the U.S., researchers have repeatedly found that access to firearms greatly magnifies suicide risk (Anestis & Houtsma, 2017).

 

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Parenting in the Age of Trump . . . and other Parenting Challenges

John and Paul with Fish

This past week, Donald Trump posted another name-calling Tweet about Kim Jong Un being short and fat. Before that, he was famously recorded by Access Hollywood saying it was okay to grab women by the pussy. Somewhere in between, he tweeted about shooting Muslims with bullets dipped in pig’s blood and referred to “firing those SOBs.”

This blog isn’t designed to be political. I don’t mean to be picking on Donald Trump. However, the extraordinary number of provocative statements he generates every day makes him a ready example of a poor media role model. His statements are often of the ilk that republicans, democrats, and independents would all rather not have their 12-year-old children hear, much less repeat. The point is that sometimes politicians, news reporters, comedians, musicians, athletes, and other celebrities make statements that are incompatible with mainstream American family values. This isn’t new. For those of us who were parents back then, about 20 years ago President Bill Clinton made a statement about oral sex that—at the very least—constituted horrid advice for teenagers. The other point is that somehow parents have to figure out how to best deal with provocative statements that leak out of the media and into our children’s brains.

In this week’s episode of the practically perfect parenting podcast, Dr. Sara Polanchek and I take on the contemporary Trump phenomenon, as well as the equally challenging phenomenon of comedians who try to make a joke out of holding a picture of a severed Trump head. How should parents deal with this stream of objectionable content?

Not surprisingly, Sarah and I have a thing or two to say about Parenting in the Age of Trump. We encourage you to contemplate, in advance, how you want to address revolting media-based material to which your children will be inevitably exposed. Our hope is for you to identify your personal and family values and then learn how to stimulate your children’s moral development. Bottom line: we can’t completely control the objectionable media discourse, and so we might as well use it for educational purposes.

You can listen to the Practically Perfect Parenting Podcast on iTunes: https://itunes.apple.com/us/podcast/practically-perfect-parenting-podcast/id1170841304?mt=2

Or you can listen to it on Libsyn: http://practicallyperfectparenting.libsyn.com/

You can follow and like us on Facebook: https://www.facebook.com/PracticallyPerfectParenting/

And just as soon as I gain better control of my Twitter finger, then you’ll be able to find us on Twitter too.

 

Building Better Counselors

JSF Dance Party

This is a link to a hot off the presses article in Counseling Today. The focus is all about how professional counselors (and all psychotherapists) can be BOTH evidence-based AND relationally oriented. My co-author, Kindle Lewis, is one of our fantastic doctoral students in the Department of Counselor Education at the University of Montana. And . . . by the way. . . the University of Montana is NOW the NEW best college destination on the planet. Ask me why:).

Here’s the link: http://ct.counseling.org/2017/11/building-better-counselors/

Why Parents Spank Their Children and Why They Should Stop

John hair and rylee at one

Let’s start with some numbers. About 30% of children have been hit/spanked by their caretakers or parents before turning 1 year old. About 85% of parents use hitting/spanking at some point to “discipline” their children. Spanking and hitting children is common among American parents.

Many parents who spank their children do so for religious, cultural, or other reasons. Many parents who spank or use corporal punishment are, in many ways, wonderful parents. The purpose of this blog—and the accompanying podcast—is not to villainize parents who spank. Instead, the purpose is to explore the positive and the negatives of spanking and guide readers (or listeners) toward the possibility that there are better alternatives to teaching children. If you want to listen now, here’s the podcast link: http://practicallyperfectparenting.libsyn.com/ or https://itunes.apple.com/fr/podcast/practically-perfect-parenting/id1170841304?l=en

The next part of this blog is excerpted from the classic and popular book, “How to Listen so Parents will Talk and Talk so Parents will Listen.” Just kidding. The book is neither classic nor popular. It also didn’t win any awards. But since I wrote the book, and I like it, I was briefly tempted to exaggerate its beauty and wonder. Now I’m back to reality. It’s a book. Some people find it helpful. But it didn’t make the New York Times bestseller list (yet).

Physical or Corporal Punishment (from Sommers-Flanagan and Sommers-Flanagan, 2011)

Physical or corporal punishment can involve hitting, pushing, slapping, washing children’s mouths out with soap, holding children down, and other physical encounters designed to obtain behavioral compliance. Corporal punishment always involves using direct power to reduce undesirable behavior.

Spanking is a particularly controversial topic with parents and when entering into a discussion about spanking practitioners are warned to use substantial sensitivity and tact (which we will discuss later). For now, we want to emphasize that our professional position on spanking and physical or corporal punishment is straightforward and based on psychological research and common sense. Kazdin (2008) provides an excellent description of what the research says about using punishment (including spanking):

. . . study after study has proven that punishment all by itself, as it is usually practiced in the home, is relatively ineffective in changing behavior. . . .

Each time, punishing your child stops the behavior for a moment. Maybe your child cries, too, and shows remorse. In our studies, parents often mistakenly interpret such crying and wails of I’m sorry! as signs that punishment has worked. It hasn’t. Your child’s resistance to punishment escalates as fast as the severity of the punishment does, or even faster. So you penalize more and more to get the same result: a brief stop, then the unwanted behavior returns, often worse than before. . . .

Bear in mind that about 35% of parents who start out with relatively mild punishments end up crossing the line drawn by the state to define child abuse: hitting with an object, harsh and cruel hitting, and so on. The surprisingly high percentage of line-crossers, and their general failure to improve their children’s behavior, points to a larger truth: punishment changes parents’ behavior for the worse more effectively than it changes children’s behavior for the better. And, as anyone knows who has physically punished a child more harshly than they meant to—and that would include most of us—it feels just terrible. (pp. 15, 16, 17)

For those of you who work with children and are familiar with the behavioral literature on punishment, Kazdin’s position on punishment is probably not new information. Virtually all child development and child behavior experts agree that punishment is ill-advised (Aucoin, Frick, & Bodin, 2006; Eisenberg, Spinrad, & Eggum, 2010; Gershoff, 2002). And if you’ve tracked the rationale for avoiding punishment closely, you may have noticed that we—and Kazdin—haven’t even mentioned two of the main reasons why punishment is inadvisable: (1) Punishment generally models aggression and (2) punishment involves paying substantial attention to negative behavior—which is why it often backfires and becomes positively reinforcing.

In the end, however, Kazdin’s position and all the research data in the world probably won’t convince many parents to stop using punishment. This is no big surprise: Using too much punishment can be habitual, irrational, and cultural—which is why we almost always avoid trying to engage parents in a rational argument regarding the merits and disadvantages of spanking.

We have additional resources on how to talk with parents in ways to help them see alternatives to spanking. These include:

The Practically Perfect Parenting Podcast, Episode 19 (10/23/17) on iTunes: https://itunes.apple.com/fr/podcast/practically-perfect-parenting/id1170841304?l=en

Or via Libsyn: http://practicallyperfectparenting.libsyn.com/

Appendix B, Tip Sheet 1: The Rules of Spanking, from “How to Listen so Parents will Talk and Talk so Parents will Listen” http://www.wiley.com/WileyCDA/WileyTitle/productCd-1118012968.html

You can also check out Dr. Kazdin’s website and book at: http://alankazdin.com/

And here’s the description of the podcast:

Why Parents Spank Their Children and Why They Should Stop

What do you feel when your lovely child misbehaves and then the misbehavior continues or repeats? What happens when you feel terribly angry and just want to make your child’s behavior stop? What happens if you spank your child . . . and then . . . much to your relief, your child’s annoying behavior stops! In this episode, not only do Dr. Sara and Dr. John discuss the negative outcomes linked to spanking, John also annoys Sara so much that she takes the impressive step of turning off his microphone. Will John ever get to speak again? How long does his microphone time-out last? This episode includes a clip of what Cris Carter, former Minnesota Viking and Hall of Fame wide receiver, thinks about physical discipline. You also get to hear what Dr. Elizabeth Gershoff discovered in her meta-analysis of corporal punishment research.

When talking about B.F. Skinner and the science of negative reinforcement, for the first time in history, John says something that’s technically incorrect. If you’re the first person to correctly identify what John says that’s wrong, you will receive a copy of his book, “How to Listen so Parents will Talk and Talk so Parents will Listen.” You can enter by posting your idea on the Practically Perfect Parenting Podcast Facebook page or on John’s blog, at johnsommersflanagan.com.

 

 

Brain Equity: Grandpa Pancake’s Tips for Healthy Children’s Brains

Rainbow 2017

These are the opening comments from a speech I made, along with speeches from Mike Halligan and Deb Halliday, for the Montana Young Child Conference in Helena . . . The powerpoints with the “Brain Equity Tips” are toward the bottom of this blog.

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Yesterday, today, and tomorrow have and will include many huge and tragic things happening in the world. There’s been hurricanes, shootings, and many other tragic events that are obviously important and that capture our attention.

But it’s also important for us not to become too preoccupied or obsessed with world events, partly because we have obligations and responsibilities right in front of us that also are immensely important. One of these things is parenting. Another is the formal and informal education of young children. We need to make sure that we’re not too distracted to do these things well.

Also, more than ever, local and national and global tragedies tend to divide us into sides. I’m tired of that divisiveness. That’s one great thing about tonight. We’re all on the same page. We can be together in our commitment to children’s education and well-being. For tonight, let’s bracket some of the huge world events and national events that divide us and may occupy a lot of our psyches, and bring our focus back to the very personal, immediate, and interpersonal process of raising and educating healthy, happy, ethical, and successful children

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I had my own, tiny little miniature, difficult experience yesterday. It was very hard. And I’d like to start this talk by sharing it with you.

I turned 60 years-old.

Don’t get me wrong. It was also a wonderful experience. But like lots of things in life: There was joy and there was horror.

Yesterday morning, I had to say, outloud, “I am 60-years-old.” It was painful. I was with my group of 8 doc students. They brought me pastries. Then, one of them asked, “Is it okay if we ask you your age? How polite. I hemmed and hawed. “Very old,” I said. “It’s big number.” It’s a difficult birthday. I’m 60.”

There were gasps. Seriously. Audible gasps in the room. One student acted VERY surprised. She said. “Oh! I was off 10 years! You don’t look . . . I didn’t think . . . I thought you were 70.”

A few minutes later, another one of them asked if they can call me grandpa pancake.

But we all have our limits. I said, NO. It’s Professor Pancake to you.

Being 60 and being Grandpa pancake, I decided it would be okay for me to begin this talk with an old painful memory

At some point in 1983 I got a new girlfriend. I know you might be thinking, what’s up? Now that John is 60 is he just going to ramble from one personal story to another? Maybe so. Someone gave me this microphone and so now I’m just talking.

Anyway, I got a new girlfriend. The point is that she had a 6-year-old daughter. At the time, I was on the verge of thinking I was pretty darn smart and clever. I was getting my doctorate in psychology. I could do Chi Square statistics in-my-head. Life was good.

My girlfriend invited me over for dinner. She lived at Aber Hall at UM because she was the Head Resident. And her daughter will be there. Kind of a big deal.

Dinner was served. Chelsea, my wife’s daughter, wrote our names in crayon, so we’d know where to sit. John, Rita, Chelsea. So sweet. Then, partway through dinner, I noticed Chelsea had a piece of lettuce sticking to her front teeth. Now, in my family of origin, we had this super-funny joke. Whenever someone got food on their lip or teeth, we’d say, “Hey, you’ve got food in your teeth and it’s making me sick.”

That’s pretty hilarious, don’t you think. So, in the moment of being a spontaneous cool boyfriend, I decided to share my family of origin humor with Chelsea. I looked at her and said, “You’ve got food in your teeth and it’s making me sick.”

You can probably guess how well that worked.

Chelsea started crying. She crawled up on her mom’s lap. Seeing the error of my ways, I got down on my knees and apologized.

This is a prime example of what makes parenting so darn difficult. There are an infinite number of multiple and rapidly shifting scenarios. That makes it impossible to be completely prepared for what happens next. It’s like Alfie Kohn wrote:

Even before I had children, I knew that being a parent was going to be challenging as well as rewarding. But I didn’t really know.

I didn’t know how exhausted it was possible to become, or how clueless it was possible to feel, or how, each time I reached the end of my rope, I would somehow have to find more rope.

The multiple and rapidly shifting scenarios that parents face include everything and anything. When I was the Executive Director for Families First in Missoula, I remember a mom who told me her daughter was pooping in the potted plants in the house. There was the mom whose daughter was afraid of the things that came out of toilets. There was a set of parents whose 10-year-old daughter was running the household. The parents whose children wouldn’t wear socks with seams . . . or eat any food that wasn’t white or yellow . . . or who first began using the F word at age five . . . in church.  Grocery store meltdowns, bad report cards, biting at daycare, not reading well, being too bossy with friends, forgetting homework, resisting homework, becoming school phobic, not cleaning their room, cleaning their room too much . . . you know what I mean, the challenging situations parent face are endless.

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For those of you interested and those of you who were at the Montana Young Child event and requested access to my powerpoints, click on this link: Montana Young Child Helena Keynote 2017

Thanks for reading and thanks for your commitment to the education and well-being of all children.

What’s Good About West Virginia?

The easy and short answer to the “What’s Good About West Virginia?” question is: Chris Schimmel, Ed Jacobs, and Sherry Cormier. The harder and longer answer is harder and longer and consequently won’t be answered here.

This post includes two educational content-pieces related to my presentation today at the Morgantown Art Museum, but that we don’t have time to cover.

What’s Good About You?

            [This excerpt is adapted from our Tough Kids, Cool Counseling book]

About 25 years ago, in collaboration with a colleague of ours, Dudley Dana, Ph.D., we began using a relationship-building assessment procedure that can provide a rich interpersonal interaction between young clients and counselors.  The procedure is called “What’s good about you?” It’s designed primarily as an informal assessment of self-esteem. Depending on the age of the child with whom you’re working, you can introduce it as a game with specific rules:

I want to play a game with you. Here’s how it works. I’m going to ask you the same question 10 times. The only rule is that you can’t use the same answer twice. So, I’ll ask you the same question 10 times, but you have to give me 10 different answers.

When playing this game all you need to do is get out a tablet or clipboard with paper and then ask your client, “What’s good about you?” Your client may moan and complain about this game.  You can empathize, but encourage full participation.  This assessment activity should be done at a point in counseling when you know your clients well enough to provide a few genuine positive statements in case they can’t come up with anything good to say about themselves.

After your client responds to the question say, “Thank you” and smile and write down whatever was said, while repeating the statement out loud. If your client says, “I don’t know” write that response down too, but add with a smile, “I’ll write that down, but you can only use that answer once.”

The “What’s good about you?” game will provide you (and perhaps your clients) with interesting insights into client self-perceptions and self-esteem. For example, some youth have difficulty clearly staking claim to a positive talent, skill, or personal attribute. They sometimes identify possessions like, “I have a nice computer” or “I have some good friends” instead of taking personal ownership of an attribute such as, “I’m a great skate-boarder,” or “My friendly personality helps me make friends.” Similarly, they may describe a role they have (e.g., “I’m a good son”), rather than identifying personal attributes that make them good at the particular role (e.g., “I’m thoughtful and very responsible and so I am a good son”). Obviously, the ability to clearly state one’s positive personal attributes may be evidence of higher or more intact self-esteem.

You can also gather interpersonal assessment data also through the “What’s good about you?” procedure. For example, we’ve had some assertive or aggressive children request or even insist that they be allowed to switch roles and ask us the “What’s good about you?” questions. We always happily comply with these requests because they:

  • provide us with a modeling opportunity,
  • provide clients with an empowerment experience, and
  • are a sign of engagement.

Additionally, the way young clients respond to this interpersonal request can be revealing.  For instance, youth who meet the diagnostic criteria for conduct disorder (or who are angry with adults) sometimes ridicule or mock the procedure, while most other children and adolescents cooperate and seem to enjoy the process. See Box 2.1 for an interesting example of using this procedure with a multicultural client.

The What’s Good About You Activity in a Multicultural Context

While implementing the What’s Good About You activity with an Japanese American teen, I (John) recently had the opportunity to directly experience multiple and contextual levels of identity in a Japanese American teenage client. Specifically, when asked to respond with 10 different answers to the question, “What’s good about you?” the 15-year-old boy responded with a direct and assertive refusal. He said, “I’m not comfortable with that. We don’t talk like that in our family?” Upon hearing his refusal, I immediately accepted his position and fortunately, he was willing to share his perspective with me. He made it clear that making positive statements about oneself was inappropriate, not only in his family, but also within his Japanese culture. Interestingly, he noted that his Japanese mother and White father were both especially encouraging of him to raise his self-esteem and wanted him to be able to say positive things about himself. However, he tended to find their efforts demeaning in the sense that he felt they were worried about him and his self-esteem—which just made him even less willing to say positive things about himself (after all, if they really thought he was so wonderful, why then, did they need to keep telling him that as if he needed it). At the same time, he also expressed an interest in being able to display more confidence in social situations—similar to his White American friends. This situation illustrates how tensions can arise between cultural identity, familial context, social context, and personal or individual distress and how it is the counselor’s responsibility to negotiate these various tensions, without judgment, in partnership with the client or student.

Here’s a link to the video of me doing “What’s good about you?” with  a 16-year-old girl. The audio isn’t great, but the process is very interesting: https://www.youtube.com/edit?o=U&video_id=4GtfO-rBIIg

The Three-Step Emotional Change Trick

For a description and video demo of the Three-Step Emotional Change Trick, go here: https://johnsommersflanagan.com/2017/03/12/revisiting-the-3-step-emotional-change-trick-including-a-video-example/

The Extra California Association for School Psychologists Handout

This morning I’m in Orange County, CA on my way to Chicago from Missoula and, naturally, feeling a little emotionally dysregulated. I never used to like the term emotional dysregulation much, but now I think it’s pretty good. Among other things, relational disruptions, travel, and trauma can all produce a mix of emotions that might be aptly described as emotional dysregulation. Recently, I’ve had an experience where I find my response is relatively equal and shifting parts of excitement and anxiety. It’s not a terrible experience; I know there’s positive excitement in there somewhere. But sometimes it gets overshadowed by the anxiety.

Back to Orange County. The link below takes all the CASP participants (and other interested parties) to the “long form” of the presentation for today, which is quite surprisingly titled, “Tough Kids, Cool Counseling.”

 

CASP Extra Handout