All posts by johnsommersflanagan

Counseling and Psychotherapy Theory and Practice, Happiness, Personal Reflections, Writing

Anger Management — Revisited

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What’s new about anger? Everything and nothing. You will feel angry over and over in your life. Each time it will be your familiar anger, which may come to feel old, tired, and boring. But each time it also will be new and compelling—as if you’ve been charged with energy to change the world.

Here’s one big truth about anger; it will come around again.

Here’s another: when doing anger management, it’s helpful to develop awareness of your usual triggers because if you see it coming, you may have a better chance to handle your anger in ways that are less embarrassing or destructive.

Here’s a third. This one I like to tell my clients and students: One good thing about having anger problems is that—and you can count on this—you will get many opportunities to work on your anger in the future, because it won’t be long until your anger visits you again (and again).

To summarize: Anger is repetitive; it’s good to develop self-awareness of your personal triggers; you will be presented with many opportunities to deal with your anger differently.

What follows is a slight revision of a post from seven years ago.

The speedometer reads 82 miles per hour. The numbers 8 and 2, represent to me, a reasonable speed on I-90 in the middle of Montana. Our speed limit signs read eight-zero. So technically, I’m breaking the law by two miles per hour. But the nearest car is a quarter mile away. The road is straight. Having ingested an optimal dose of caffeine, my attention is focused. All is well.

In my rear-view mirror, I notice a car slowly creeping up on me from behind. He gets a little to close to my rear bumper, and then slowly drifts into the left lane past me, lingering beside me and edging ahead. Then, with only three car lengths between us, he puts on his blinker and drifts in front of me. Now, with no other cars in sight, there’s just me and Mr. 83 mph on I-90, three car lengths apart.

An emotion rises into awareness. It’s anger, from a distance. I see it coming slowly, as if it’s in the rear-view mirror of my brain. At this distance, it’s only annoyance. I feel it and see it coming and immediately know it can go in one of three directions: My annoyance could sit there and remain unpleasant, until I tire of it. If I provide it with oxygen, could rise up and blossom into full-blown anger. Or, I can send it away, leaving room for other—more pleasant—thoughts and actions.

That’s not to say annoyance and anger is wholly unpleasant. Part of me likes it; part of me feels so damn aggrieved and indignant and justified.

All this self-awareness is fabulous. This is the Sweet Spot of Self-Control.

Without moving or speaking, “Hello anger,” I say, to myself, in my brain.

In this sweet spot, I experience expanding awareness, a pinch of energy, along with unfolding possibilities. I love this place. I love the strength and power. I also recognize anger’s best buddy, the behavioral impulse. This particular impulse (they vary of course), is itching for me to reset my cruise control to 84 mph.  It’s coming to me in the shape of a desire—a desire to send the driver in front of me a clear message. Isn’t that what anger, in its behavioral manifestation, aggression, is all about—sending a message?

“You should cut him off,” the impulse says, “and let him know he should give you some space.”

The sweet spot is sweet because it includes the empowered choice to say “No thanks” to the impulse and “See you later” to anger.

Now I’m listening to a different voice in my head. It’s smaller, softer, steadier. “It doesn’t matter” the voice whispers. “Let him move on ahead. Revenge is only briefly sweet. Those who seek revenge should dig two graves.”

I smile remembering an anger management workshop. With confidence, I had said to the young men in attendance, “No other emotion shifts as quickly as anger. You can go from feeling completely justified and vindicated, but as soon as you act, you can feel overwhelmed with shame, regret, or embarrassment.”

One participant said, “Lust. Lust is like anger. One second you want something more than anything, but the next second you might wish you hadn’t.”

“Maybe so,” I said.

There are many rational reasons why acting on aggressive behavioral impulses is ill-advised. Maybe the biggest is that the man in the car wouldn’t understand my effort to communicate with him. This gap of understanding is common across many efforts to communicate. But it’s especially linked to retaliatory impulses. When angry, I can’t provide nuance in my communication; I can’t make it constructive.

The quiet voice in my brain murmurs: “You’re no victim to your impulses. You drive the car; the car doesn’t drive you.” That doesn’t make much sense. Sometimes the voice in my head speaks in analogy and metaphor. It’s a common problem. I want straight talk, but instead I get some silly metaphor from my elitist and intellectual conscience.

But here’s what I get. I get that my conscience is telling me that this sweet spot is sweet because I get to see and feel my self-control. Not only do I see my behavioral options, I get to see into the future and evaluate their likely outcomes. I get to reject poor choices and avoid negative outcomes. I’m not a victim of annoyance, anger, or aggressive impulses. I make the plan. I drive the car.

The other driver is now far ahead. I recognize that I could resurrect my anger. I choose to let it go instead.

I haven’t always let go of my anger. In my teen years I developed a temper. I had many sport-related fits of embarrassing anger. I went to psychotherapy. My therapist listened, and helped me grow my better judgment. He said, “I don’t believe in the bowel movement theory of anger control.” That was a little indirect, and interesting. We don’t have to expel it. We can sit with it. We can reflect on it. We can watch it go away. We can put it in the rear-view mirror, or let it pass us by. Using our functional frontal lobes, we can experience the joy of the Sweet Spot of Self-Control.

My anger is like an old, greedy, needy, and fickle friend. It has an all-or-nothing mentality. My anger wants attention and power, because it values power over long-term happiness.

Anger is also a source of energy; it can fuel us to be assertive, to fight injustice, to be clear on our values. Anger has its place, and is sometimes a useful partner: a partner whom we should keep in the passenger seat, never letting it get behind the wheel and drive—even on a wide-open Montana highway.

Clinical Interviewing, Suicide Assessment and Intervention, Writing

A Strengths-Based Approach to Suicide Prevention with Marginalized Communities

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This morning I’m doing a one-hour webinar for Division 17 of the American Counseling Association. The focus is on how we can do suicide assessment, treatment, and prevention with people from historically and currently marginalized or oppressed communities. To deal with this immense issue, it would help if we had some superpowers.

Here are the ppts for this morning:

suicide-talk-for-d17Download

We know, from decades of sociological and psychological research that many different factors contribute to global and regional changes in suicide rates. We also know that, in general, suicide is at least in part driven by individual experiences and perceptions of high personal distress (Shneidman’s “psychache”). Researchers have also identified how poverty, racism, and factors like neighborhood safety/climate can contribute to suicidality. In our suicide book, we call these factors–factors that are typically outside of the self, but that can be internalized–as “contextual.” What follows is an excerpt on contextual factors from Suicide Assessment and Treatment Planning: A Strengths-Based Approach.

Externalizing the External          

At age 82, in an interview with the Los Angeles Times (Stein, 1986), B. F. Skinner said: “I have to tell people that they are not responsible for their behavior. They’re not creating it; they’re not initiating anything. It’s all found somewhere else.”

We find Skinner’s words reassuring. All humans are influenced—to some extent—by factors outside themselves. This is not to say people are helpless victims of their environments; there are methods for coping with external stressors. But the first step, even though the stressor is obviously external, is to re-externalize it, because all too often, it’s all too easy, to internalize the external.

Coping Strategies for Toxic or Malignant Stressors

When clients are exposed to larger sociological and uncontrollable stressors, they can experience frustration, helplessness, and hopelessness. As a counselor, mostly you’re unable to change the unchangeable for your clients. Within the counseling relationship, you can express both empathy for your client’s situation, and indignation that society can be so painful and difficult to change. Depending on the counseling goals, you can provide empathy, commiseration, assistance in discerning achievable goals, learning opportunities, and advocacy or support for activism.

Empathic Commiseration

News events pertaining to racism, climate change, global pandemics, and other topics activate and agitate some clients (and counselors). When this happens, empathic commiseration is a good first step. Empathy from you can universalize client emotional reactions and help clients feel more normal. Simple statements like, “I agree. It’s so hard to watch the news” can facilitate recognition that excessive media exposure heightens feelings of helplessness and depression.

Other scenarios where clients are exposed to environmental toxicity, but unable to extricate themselves from the situation, can be especially demoralizing. In such cases, brainstorming about how to mobilize community resources, how to gain access to safe spaces, and how to engage in self-advocacy can be important and empowering. As with goal-setting in other dimensions, helping clients evaluate their own behaviors and the factors over which they have control, may mitigate frustration. Having you to resonate with their frustration and show compassion is crucial.

Discernment and Goal-Setting

People associated with Alcoholics Anonymous are familiar with Richard Neibauer’s (1932) serenity prayer: God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference. Similar guidance comes from Shantideva, an 8th century Indian Buddhist Scholar, who put it this way: If there’s a remedy when trouble strikes, what reason is there for dejection? And if there is no help for it, what use is there in being glum? (Shantideva, The way of the Bodhisattva, p. 130). Clients who are religious or spiritually oriented may find particular comfort and insight in the words of Neibauer or Shantideva.

Yet another version of the Serenity Prayer comes from 20th century Philosopher W. W. Bartley. Bartley took a break from writing about philosophical rationalism, to put the message of the Serenity Prayer into a Mother Goose nursery rhyme format:

For every ailment under the sun

There is a remedy, or there is none;

If there be one, try to find it;

If there be none, never mind it.

When it comes to helping clients deal with complex contextual difficulties, these prayers or philosophies can be a good place to start, both for professionals, and for clients. Recognizing and accepting that some problems in life are unchangeable can bring solace. Trying to change that which is unchangeable generally fuels unhappiness.

The developers of mindfulness-based cognitive therapy (MBCT; Segal, Williams, & Teasdale, 2013) put their own brain-based 21st century spin on the Serenity Prayer. To summarize, they say the brain has two basic modes of functioning. The first mode is problem-solving. The brain is quite good at problem-solving. But some problems are unsolvable. When faced with insoluble problems, rather than letting go of the problem-solving process, the brain naturally persists, relentlessly continuing to problem-solve, ruminate, and chew on old ideas and failures. Anxiety and fear escalates. If the brain gets hooked on unsolvable problems, it can take clients down into bottomless rabbit-holes and exacerbate emotional discomfort.

What about that second basic brain modality? Mindfulness practitioners say that engaging the second mode can unhitch our brains from the out-of-control problem-solving train. The second brain modality operates on a less natural principle: The principle of acceptance. MBCT practitioners emphasize shifting into noticing, or nonjudgmental acceptance. Although the brain is capable of intermittent nonjudgmental acceptance, shifting into that modality is tough. Most clients can’t make that switch in the moment. That’s okay. Accepting failure to switch into nonjudgmental mindfulness is part of mindful acceptance. Coaching clients to make efforts at mindfulness and then to accept their failings and inadequacies might facilitate client self-acceptance and grow mindful parts of the brain, like the insula (Haase et al., 2016). Nonjudgmental acceptance requires regular practice. No one ever gets it right all the time.

Opportunity Ameliorates

James Garbarino (2001) wrote: “Stress accumulates; opportunity ameliorates” (p. 361). Within the trauma literature, it’s clear that toxic stress increases illness (Shern et al., 2016); it’s also clear that providing traumatized youth and adults with physical, social, and academic opportunities mitigates trauma and increases health. In part, your role with clients who have experienced trauma and who are chronically reactivated by socio-political events, is to assist them in finding and participating in local resources and opportunities.

Clients who are suicidal and in the midst of toxic and uncontrollable contextual factors, may feel they don’t have the time or energy for new opportunities. Like Katie from chapter 5, they may need support, assistance, and resources to step outside of their survival mode. Practical problems like childcare, transportation, and inaccessible community organizations can loom large. In such situations, you may need to engage in advocacy or activism to help your clients get connected to the resources and opportunities they need.

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice

Evidence-Based Relationship Factors in Supervision and Practice

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Today I’ll be online providing a 2-hour workshop titled “Evidence-Based Relationship Factors in Supervision and Practice” on behalf of the Cognitive Behavioral Institute and Geneva College. This workshop content is related to the excellent work of John Norcross, Michael Lambert, and other prominent professionals who have advocated (and researched!) the scientific truth that RELATIONSHIPS are powerful influencers of positive treatment outcomes in counseling and psychotherapy. This topic is also the focus of a forthcoming book authored by a former doc student of mine, Kimberly Parrow (more on her excellent work in a future blog).

For now, I’m posting the ppts for today’s online workshop here:

ebrfs-for-cbi-and-geneva-college-2023Download

And here’s the workshop description: Counselors and psychotherapists have a long and storied history of arguing with one another over what makes therapy effective. Some say: We should teach and supervise our students to use empirically-supported treatments (i.e., procedures, as in medicine). Others say: We should teach and supervise our students to establish therapeutic relationships. Although it’s clear that specific treatments and therapeutic relationships both contribute to outcomes, when supervisors and practitioners think of empirically-supported approaches, they tend to think of manualized treatments or procedures. However, in recent years, specific relationship factors have been identified and linked to positive counseling and psychotherapy outcomes (Norcross & Lambert, 2018). These factors include: cultural humility, congruence, unconditional positive regard, empathic understanding, emotional bonds, mutual goal-setting, and more. In this workshop, participants will learn to identify, describe, and apply evidence-based relationship factors in supervision and practice. Video-clips, live demonstrations, and reflective opportunities will be used to facilitate learning.

I hope you have an excellent day and weekend wherein you are enacting as many evidence-based relationship factors as you can fit into your life!

Best,

John S-F

Happiness

Bad Sleep . . . Bad Judgment

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No one has excellent judgment when sleep deprived and so no one should expect to have excellent judgment when sleep deprived. I’m making this bold claim based on my recent personal experience of writing and posting last week’s blog titled, “Sleep Well.” Sometimes I write late at night. That’s great for the muse and creativity; it’s less great for me remembering what the heck I was planning to write. I start writing. . . I finish writing. . . and sometimes I stay with my focus, while other times, well, I forget the whole point.Last week, my main reason for writing a blog on sleep was to link readers to a specific sleep podcast. However, because I was doing my late-night writing thing, by the time I finished it, I completely forgot to mention the podcast or include the link. Has this sort of thing ever happened to you? My guess is that, if it does, it happens more often when you’re sleep deprived, than when you’re sleep restored. Now, after a nice weekend of restorative sleep, here’s info and the link to the podcast.The podcast is called “All things Vagus.” I confessed to the host (Kathy Mangan, who is great) that I was scientifically opposed to “polyvagal theory” but she still let me on the show. That’s an example of how great she is. Here’s the description for the April 3, 2023 episode, titled: Sleep Well, Be Well: Why talk about sleep? It is important to our health, so we need to get clear on the types of insomnia and how we can cope with distress and anxiety that might be disrupting our rest.The link: https://allthingsvagus.fireside.fm/10P.S.: This is a 42-minute podcast episode, which makes it a nice length to go along with the workout you should be doing every day to optimize your sleep. And if you optimize your sleep, you’re more likely to remember what you’re writing about.

Happiness

Sleep Well

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When it comes to literally everything, knowledge is power. The more we know and the more we understand, the better we’re able to cope with—as Alfred Adler used to say—the tasks of life. One very important task of life is to sleep well.

In September, 1975, I went to college for one reason: to play college football and baseball. Going to class and learning anything was required for me to be able to do what I wanted to do. So, I went to class and I played sports.

Being away from the structure of home and family, I didn’t sleep well. Then, several months into my college career, I started having what I considered “Very weird experiences.” I didn’t tell anyone about those experiences, because they were weird and I was a young male and unaccustomed to being open with others about any of my private experiences. The very weird experiences just kept on happening.

The experiences happened as I tried to nap (on the floor, or a couch, a bed, or wherever I was). While dropping off to sleep, or waking up, I would start to hear what sounded like loud static. The static was bad and weird on its own, but then I discovered I couldn’t move, which was especially disturbing because I began seeing the shape of an ominous figure standing at the end of my bed, or couch, or in the doorway. I had to just lay there in panic because, of course, I was paralyzed.

Eventually, I would completely wake up, be able to move, and discover no one was in my room. And eventually, maybe because I adjusted to college or started sleeping better, the very weird experiences stopped. But, while they were happening, I searched my mind for explanations.

Because there was no Internet and no Google back then, I relied on what was in my brain. But basically, I had nearly nothing in my brain. Remember, I was interested in sports, not knowledge. . . and I was a bit averse to doing anything rational, like going to the library or consulting a professional. Consequently, being a meaning-making creature, I created two hypotheses, basically out of thin air.

Hypothesis #1: I was about to be possessed by a demon.

Hypothesis #2: I might be developing psychic powers.

There was no hypothesis #3. My mind bounced from hypothesis 1 to hypothesis 2, and back again.

Funny thing. In the early 2000s, I happened to be reading the Diagnostic and Statistical Manual of Mental Disorders and found a section that described a phenomenon called, “Sleep paralysis.” I was, as they say, gobsmacked. The description was EXACTLY my experience, including the frightening and shadowy figure at the end of the bed.

My point is that it’s good to know stuff in general, and good to know specific stuff about our own experiences around mental health and. . . including that thing we call insomnia. I’ve posted before about insomnia (https://johnsommersflanagan.com/2012/05/23/insomnia/). I will also post more soon, but for now, I’m just sharing the “sleep hygiene” slide from my happiness and sleep lectures.

Sleep hygiene is a thing. I’ve got lots of funny and snarky things to say about sleep hygiene. Maybe the most important is that sleep is an elusive little bugger. What I mean by that is that sleep comes somewhat easier when we stop trying too hard, and often runs away when we’re feeling especially desperate to get some good sleep. The other piece of important information is that having sleep disruptions and not sleeping the magical 8 hours is pretty darn normal. Many or most people have regular sleep disruptions. And, fun fact, expecting that you should get 8 hours of sleep every night can get in your head and interfere with you getting 8 hours of sleep a night.

For now, here’s the famous sleep hygiene powerpoint slide (below). More to come (later) on tricks and techniques for sleeping well. Thanks for reading.

Counseling and Psychotherapy Theory and Practice, Suicide Assessment and Intervention

Three Leftover American Counseling Association Conference Videos

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During a couple of my presentations at the ACA conference in Toronto (pictured above) I wasn’t able to fit in some short demonstration videos. To address my time management problems, I’m posting links to them here, along with a short description. Note: All of the videos for suicide demonstrations are non-scripted simulations.

Video 1: An example of an opening of a session with Kennedy, a 15-year-old cisgender white female with a history of suicidal ideation. Key things to watch for include how I immediately mention suicide, focus on sources of distress in Kennedy’s life, and acknowledge things I know and things I don’t know. If we think about emotional distress (aka Shneidman’s psychache) as contributing to suicidality, contemplate what you think is the driver of Kennedy’s feelings of suicidality. The link: https://www.youtube.com/watch?v=gR7YU0VrHqw&t=5s

Video 2: An example of me closing the session with Kennedy using Stanley & Brown’s (2013) Safety Planning Intervention. As always, I’m not perfect in the video, but it shows a process during which I’m trying to cover the safety planning categories in an interpersonally engaging and pleasant manner. The link: https://www.youtube.com/watch?v=jd7PM9HFDO4&t=10s

Video 3: I’m working with Chase, a 35-year-old Gay cisgender male. In this video, I try to get Chase to see a potential pattern of him being suicidal in response to bullying in the past and being interpersonally invalidated in the present. Chase dismisses my “light interpretation” with something like, “That’s the hand I was dealt.” Again, although I’m imperfect in this video, I do take the hint and shift from an abstract interpretation to a concrete assessment process I call the “Social Universe.” During that process, it becomes clear that Chase is spending too much time with “toxic” people in his life and not much time with people who accept him. Additionally, he presents as quite depressed and unable to come up with anyone “validating” and so I shift to a process called, “Building hope from the bottom up” by asking him, “Who’s the least validating or most toxic?” Chase responds pretty well to a process that starts at the bottom or most negative place.”  The link: https://www.youtube.com/watch?v=UNBR3bKyE4I&t=7s

Thanks to everyone who attended the ACA conference, for being the kind of professionals who are pursuing awareness, knowledge, and skills in order to be more effective in helping others life meaningful lives. I was humbled by your engagement with the learning process.

Boys and Men, Counseling and Psychotherapy Theory and Practice, Happiness, Suicide Assessment and Intervention

Men, Suicide, and Happiness: Helping Men Live Meaningful Lives

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Tomorrow morning, March 31, 2023, at 8am, I’m co-presenting with Matt Englar-Carlson and Dan Salois on suicide and happiness with men at the American Counseling Association World Conference in Toronto.

Here’s the session blurb:

Men and boys account for nearly 80% of all suicide deaths in the U.S. Factors contributing to high suicide rates include: constricted emotional expression, reluctance to seek help, firearms, alcohol abuse, and narrowly defined masculinity. In this educational session, we will use a case demonstration to illustrate suicide assessment counseling methods to help boys and men liberate themselves from narrow masculine values, while embracing alternative and meaningful paths to happiness.

If you’re in Toronto, I hope to see you there. . . and for anyone interested, here’s the Powerpoint presentation:

men-suicide-and-happiness-2023-final-no-vidDownload
Boys and Men, Happiness, Multicultural, Personal Reflections, Suicide Assessment and Intervention

What’s Happening at the Upcoming American Counseling Association World Conference: Take III

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I’m really not sure what’s happening with WordPress, but because of tech and formatting issues, this is my third effort to post this blog. Now, I’m trying an approach that requires me to separately copy and paste each paragraph into this post. I used to be able to paste the whole document and it worked just fine. Now, if I do that, it makes all 10 paragraphs into one long paragraph and I look technologically even dumber than I am. Next month, WordPress will likely make me copy and paste the blog word by word.

You may be wondering, “How are you doing John?”

I think I’ll pass on answering that for now because WordPress is now graying out each sentence I type as soon as I press “enter.” And it’s repeating some short paragraphs and even though I delete them and they appear to be gone, when I try to publish this, the deleted paragraphs re-appear. I don’t know what any of this means other than WordPress must be angry with me because I asked them for help.

What I’ve been wanting to post is that I’m honored to be speaking several times at the American Counseling Association World Conference in Toronto next week. Here’s what’s happening. . .

Bright and early Friday morning, March 31 from 8am to 9:30am, I’ll be joined by Matt Englar-Carlson of Cal State Fullerton and Dan Salois of the University of Montana, for an educational session titled, “Men, Suicide, and Happiness: Helping Men Live Meaningful Lives.” We’ll be starting our talk by wondering why there isn’t more focus on the fact that men die by suicide at 3+ the rates of women and by wondering who gets to define what constitutes intimacy and intimate conversations among men. If you come to our talk and are not fully satisfied, you just might win an evening out getting a beer with us as we lament the unpopularity of masculine psychology. Or you might not. Life is like that.

At 1pm to 1:30pm on Friday I have the great fortune of joining Amanda Evans and Kenson Hiatt of James Madison University for a poster session titled, “Wellness and Social Justice: A Positive, Liberation-Oriented Approach.” Among the many things that are cool about this presentation is the fact that Dr. Evans has creatively combined social justice, positive psychology, and liberation psychology in ways that—as far as I know—have never been done before. Given the usual awkward nature of poster sessions, I hope you’ll drop by for some conversations about how we can integrate these important perspectives and facilitate social justice. But if you’re the type who prefers walking and studiously avoiding eye-contact with poster presenters, that works too.

From 3:30pm to 5pm on Friday, I have the privilege of offering an “Author Session” titled, “Top Tips for Weaving a Strengths-Based Approach to Suicide into Your Practice.” This session—based on our ACA book by nearly the same name, I will offer strengths-based tips about viewing suicidality as an unparalleled counseling opportunity, making your assessments therapeutic, building hope from the bottom-up, and much more. Right afterward, there will be a book-signing session . . . and I hope you’ll come to that, if only to talk to me and save me from the embarrassing situation of sitting alone next to a pile of books.

On Saturday, April 1 (and this is no joke), I’ll be presenting an education session on “Counseling for Happiness: Facilitating Client and Student Wellness.” Here’s the blurb:

Most people who seek counseling not only want to deal with their problems and distress, they also want to live happier and more meaningful lives. In this education session, the presenter will describe and demonstrate six evidence-based happiness strategies that professional counselors can use with clients and with themselves. The discussion will also address how specific happiness interventions may be more or less culturally appropriate. Using an open and collaborative experimental mindset is encouraged.

In addition to these formal appearances, I will also be hanging out at the John Wiley and Sons booth in the exhibition hall (especially on Thursday, March 30, from 2-5pm for the Expo Grand Opening). If you happen to be in Toronto for the ACA Conference, I hope to see you there.