All posts by johnsommersflanagan

Happiness and Well-Being (in Livingston, Montana)

Cow

Yesterday, at the fabulous West Creek Ranch retreat center just North of Yellowstone Park, I introduced community leaders from Livingston, Montana to a man named James Pennebaker. It was a brief meeting. In fact, I’m not sure anyone remembers the formal introduction.

I should probably mention that James Pennebaker wasn’t in the room. The meeting consisted of me putting a short and inadequate description of one of his research studies up on a screen. The study went something like this:

Back in 1986, Pennebaker randomly assigned college students to one of two groups. The first group was instructed to write about personally traumatic life events. The second group was instructed to write about trivial topics. Both groups wrote on four consecutive days. Then, Pennebaker obtained health center records, self-reported mood ratings, physical symptoms, and physiological measures.

Pennebaker reported that, in the short-term, participants who wrote about trauma had higher blood pressure and more negative moods that the college students who wrote about trivia. But the longer term results were, IMHO, amazing. Generally, the students who wrote about trauma had fewer health center visits, better immune functioning, and overall improved physical health.

Pennebaker’s theory was that choking back important emotions takes a physical toll on the body and creates poorer health.

Since 1986, Pennebaker and others have conducted much more research on this phenomenon. The results have been similar. As a consequence, over time, Pennebaker has “penned” several books on this topic, including:

  • Opening Up: The healing power of expressing emotions
  • Writing to Heal: A guided journal for recovering from trauma & emotional upheaval
  • Expressive Writing: Words that heal
  • The Secret Life of Pronouns: What our words say about us
  • Opening Up by Writing It Down

As most of you know, after a couple decades presenting on suicide assessment and treatment, Rita and I have pivoted toward happiness and well-being. The coolest thing about talking about happiness and well-being is that doing so is WAY MORE FUN, and it results in meeting and laughing with very cool people, like the Livingston professionals.

Speaking of Livingston professionals, just in case you forgot that you met James Pennebaker, here’s a link to my powerpoints from yesterday: Livingston 2019 Final

I hope you had as much fun listening as I did talking.

The Dialectics of Diagnosis at MFPE in Belgrade

Waving

Today I’m in Bozeman on my way to present to the Montana School Counselors in Belgrade, MT. As my friends at the Big Sky Youth Empowerment Program like to say, “I’m stoked!” I’m stoked because there’s hardly anything much better than spending a day with Montana School Counselors. Woohoo!

My topic tomorrow is “Strategies for Supporting Students with Common Mental Health Conditions.” That means I’ll be reviewing some DSM/ICD diagnostic criteria and that brings me to reflect on the following. . . .

Not long ago (July, 2019), Allsopp, Read, Corcoran, & Kinderman published an article in Psychiatry Research, not so boldly titled, “Heterogeneity in psychiatric diagnostic classification.” Hmm, sounds fascinating (not!).

A few days later, a summary of the article appeared in the less academically and more media oriented, ScienceDaily. The ScienceDaily’s contrasting and much bolder title was, “Psychiatric diagnosis ‘scientifically meaningless.” Wow!

The ScienceDaily summary took the issue even further. They wrote: “A new study, published in Psychiatry Research, has concluded that psychiatric diagnoses are scientifically worthless as tools to identify discrete mental health disorders.”

Did you catch that? Scientifically worthless!

In an interview with ScienceDaily, Allsopp, Read, and Kinderman stoked the passion, and avoided any word-mincing.

Dr. Kate Allsopp said, “Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences.”

Professor Peter Kinderman, University of Liverpool, said: “This study provides yet more evidence that the biomedical diagnostic approach in psychiatry is not fit for purpose. Diagnoses frequently and uncritically reported as ‘real illnesses’ are in fact made on the basis of internally inconsistent, confused and contradictory patterns of largely arbitrary criteria. The diagnostic system wrongly assumes that all distress results from disorder, and relies heavily on subjective judgments about what is normal.”

Professor John Read, University of East London, said: “Perhaps it is time we stopped pretending that medical-sounding labels contribute anything to our understanding of the complex causes of human distress or of what kind of help we need when distressed.”

In contrast to the authors’ conclusions, nearly every conventional psychiatrist believes the opposite–and emphasizes that psychiatric diagnosis is of great scientific and medical importance. For example, the Midtown Psychiatry and TMS Center website says, “A correct diagnosis helps the psychiatrist formulate the most effective treatment that will result in remission.”

No doubt there.

In addition, although I literally love that Allsopp, Read, and Kinderman are so outspoken about the potential deleterious effects of diagnosis, I think maybe they take it too far. For example, “Shall we pretend that we should provide the same intervention for panic attacks as we provide for conduct disorder, autism spectrum disorder, and gender dysphoria?”

That’s me talking now . . . and as I discussed this with Rita, she amplified that, of course, if you have a student who’s intentionally engaging in violent acts that harm others, we’re not treating them the same as a student who’s suffering panic attacks. Obviously.

Psychiatric diagnosis is a great example of a dialectic. Yes, in some ways it’s meaningless and overblown. And yes, in some ways it provides crucial information that informs our treatment approaches.

This leads me to my final point, and to my handouts.

What’s our School Counseling take-away message?

Let’s keep the baby and throw out with the bathwater.

Let’s de-emphasize labels – because labelling, whether accurate or inaccurate and whether self-inflicted or other inflicted, are possibly pathology-inducing.

Instead, let’s focus on specific behavior patterns, as well as abilities, impairments, stressors, and trauma experiences that interfere with academic achievement, personal and social functioning, and career potential.

In case you’re interested in more on this. My handouts for the workshop are below.

The Powerpoints: MFPE 2019 Belgrade Final

Managing fear and anxiety:Childhood Fears Rev

Student de-escalation tips: De-escalation Handout REV

Why Kids Lie and What to Do About It

 

 

Happy Afternoon at ACES in Seattle: Now, Let’s Talk About Suicide Assessment and Treatment Planning

IMG-4449

In a few minutes, along with Kelley McHugh, I’ll be doing my second ACES presentation today. This one is titled, “A New Model for Teaching and Learning about Suicide Assessment and Intervention.” Hana Meshesha was scheduled to join in the fun, but she wasn’t able to come today.

Along with our other doc students, Kelley and Hana are fabulous, focused, smart, and they contribute to my learning.

In the following powerpoints, you’ll see how Kelley, Hana, and I are thinking about how counseling students and professionals should be trained in suicide assessment and intervention. As always, we’re interested in your feedback. Here’s a link to the ppts: ACES Suicide Seattle 2019 Final

And here are a couple suicide assessment/treatment journal articles that might be helpful: Conversations About Suicide by JSF 2018 and SF and Shaw Suicide 2017

Happy Saturday Morning at ACES in Seattle

Space_Needle_2011-07-04

The Association of Counselor Educators and Supervisors (ACES) conference is underway in Seattle. Seattle is a fabulous location. It’s great to be back in my home state.

It’s also great to be with so many fabulous people. Counselor educators are some of the nicest people on the planet. The conversations are intellectually stimulating, kind, compassionate, and positive relationship skills are on display everywhere.

Speaking of positive relationship skills, this morning, Kim Parrow (a fantastic doc student in our Counseling program at U of Montana) and I are presenting on Evidence-Based Relationship Factors (EBRFs). If you’re not sure what EBRFs are, or want to learn more, then check out the resources below.

The Powerpoints are here: ACES Seattle Kim and John Final REV

A previously published journal article from the Journal of Mental Health Counseling is here: JoMHC EB Article by John SF 2015

In My Great and Unmatched Wisdom

One Wipe Charlies

In my great and unmatched wisdom I hereby proclaim that today Opposite Day.

Never mind that Opposite Day is a fictional children’s holiday and that it’s officially celebrated on January 25. Just because today’s not January 25 and I’m not a child, doesn’t mean I don’t get to say opposite things. I get to say opposite things because I’ve said I get to say opposite things.

When my nephews were little, we never waited for Opposite Day. Instead, we’d suddenly start playing the Opposite Game. It’s just like Opposite Day, but spontaneous. We’d say hello when we meant goodbye. I’d say things like, “Tommy, you’re the smartest person I know!” Or, “Paul, you’re one good looking guy.” I was totally hilarious, maybe the funniest uncle ever to exist on planet Earth.

Sometimes our spontaneous opposite games got a little out of control, but that was the point. One time, when grandma showed up and Tommy and Paul rolled their eyes and said, “It’s terrible to not see you” she looked hurt. We had to call time-out and explain the game to her. Even after the explanation, she didn’t seem to get it.

Funny thing, even when you’re playing at saying things that are the opposite of the truth, sometimes people don’t catch on. People get confused. For example, if the media happened to be listening to us, they might get confused and literally report things we said, even though we meant the opposite. That’s especially funny. When that happens, whether it’s by accident or on purpose, the correct response is to say, “I was only joking.”

After a while, if you intermittently play the Opposite game and mix it with being normal, people won’t know when to take you seriously and when to not take you seriously. For example, the other day I made a phone call, it was a perfect phone call. I said, “Hey dude, I’ll bring you over some of that medicinal plant you’re needing for nausea. It really sucks to feel sick, and I want to help. I’d like you to do me a favor though. If you could spontaneously give my boss a call and tell him how much you appreciate my great and unmatched wisdom, that would be nice.”

To be certain that I’d communicated perfectly, I ended the conversation by saying, “I’m only joking you know. I’m quite the humorist. Never mind what I said before. You look really nice today.”

The best thing about being in charge of the opposite game is that it keeps everybody else off balance. In comparison, I’m always on my game, because I’m the only one who knows when the opposite game rules are in effect.

I remember how that worked with my nephews. At the end of the day, sometimes I’d hug them and yell, “I hate you.” They knew what I really meant.

Oh, and BTW. Thanks for reading this. I value you as a person and I hope you love yourself. You know one thing that might help. If you’d just keep this blog post to yourself. Don’t share it. Seriously. I’m joking.

 

Hacking Affect and Mood in 325 Words

Rita Wood Surfing

Affect is how you look to me.

Affect involves me (an outsider) judging your internal emotional state (as it looks from the outside). Whew.

Mood is how you feel to you.

Mood is inherently subjective and limited by your vocabulary, previous experiences, and inclination or disinclination toward feeling your feelings.

Independently, neither affect nor mood makes for a perfect assessment. But let’s be honest, there’s no such thing as a free lunch, and there’s no such thing as a perfect assessment. Even in elegant combination, affect and mood only provide us with limited information about a client’s emotional life.

Our information is limited and always falls short of truth because, not only is there always that pesky standard error of measurement, also, emotion is, by definition, phenomenologically subjective and elusive. Emotion, especially in the form of affect or mood, is a particularly fragile and quirky entrepreneur of physiology and cascading neurochemical caveats. Nothing and everything is or isn’t as it seems.

As an interviewer, even a simple emotional observation may be perceived as critical or inaccurate or offensive in ways we can only imagine. Saying, “You seem angry” might be experienced as critical or inaccurate and inspire the affect you’re watching and the mood your client is experiencing to hide, like Jonah, inside the belly of a whale.

Oddly, on another day with the same client, your emotional reflection—whether accurate or inaccurate—might facilitate emotional clarity; affect and mood may re-unite, and your client will experience insight and deepening emotional awareness.

As a clinician, despite your efforts to be a detached, objective observer, you might experience a parallel emotional process. Not only could your understanding of your client deepen, but ironically, because emotional lives resist isolation, you might experience your own emotional epiphany.

Rest assured, as with all emotional epiphanies—including our constitutionally guaranteed inevitable and unenviable pursuit of happiness—you’ll soon find yourself staring at your emotional epiphany through your rear view mirror.

*************************************

Just for fun, below I’ve included a link to a brief clip of me doing a mental status examination with a young man named Carl. A longer version of my interview with Carl is available with the 6th edition of Clinical Interviewing. https://www.youtube.com/watch?v=1lu50uciF5Y