Category Archives: Clinical Interviewing

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

Clinical Interviewing, Writing

Istanbul Tomorrow

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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:

excellent-clinical-interviews-istanbul-no-vidsDownload

Peace, love, and virtual hugs,

John S-F

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice, Writing

Neurogenesis and Ideas for Training Your Brain to Listen with Empathy

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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!

Clinical Interviewing, Personal Reflections, Research, Writing

The Delight of Scientific Discovery

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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

Clinical Interviewing

Checklists from the Forthcoming 7th Edition of Clinical Interviewing

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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:

suicide-documentation-checklistDownload

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

checklist-for-challenging-client-behaviorsDownload

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

checklist-to-prep-for-young-clientsDownload

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

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice, Suicide Assessment and Intervention

A Free Video on Collaborative Safety Planning for Suicide Prevention

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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

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice, Suicide Assessment and Intervention

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

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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.

Clinical Interviewing, Happiness, Personal Reflections, Suicide Assessment and Intervention

Eye Contact, Influencers, and Self-Care CBT

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While searching for updated guidance on cross-cultural eye contact in counseling and psychotherapy (for the 7th edition revision of Clinical Interviewing), I came across a young therapist with over 1 million YouTube subscribers. She was perky, articulate, and very impressive in her delivery of almost-true information about the meaning of eye contact in counseling (from about 5 years ago). There were so many public comments on her video . . . I couldn’t possibly read or track them all. Sadly, although she waxed eloquent about trauma and eye contact, she never once mentioned culture, or how the meaning of eye contact varies based on cultural, familial, and individual factors. Part of my takeaway was her retelling a version of a John Wayne-esq sort of message wherein we should all strive to look the other person in the eye. Ugh. I’m sad we have so many perky, articulate influencers who share information that’s NOT inclusive or deep or particularly accurate. Oh well.

Curious, and TBH, perhaps a bit jealous of this therapist’s YouTube fame, I clicked on her most recent video. I discovered her in tears, describing how she needs a break, and detailing a range of symptoms that fit pretty well with major depressive disorder. Oh my. This time I felt sad for her and her life because it must have turned into a runaway train of influencer-related opportunities and demands. My jealousy of her particular type of fame evaporated.

Many therapists—including me—aren’t as good at practicing as we are preaching. Every day I try to get better and fail a little and succeed a little. Life is a marathon. Small changes can make their way into our lives and become bigger changes.

Because of our Clinical Interviewing revision, I’m saying “No” to presentation opportunities more often than usual. That’s a good thing. Setting limits and taking care of business at home is essential. However, in about one month, I’ve set aside a week for a gamut of presentations and appearances. These presentations and appearances all include some content related to positive psychology, positive coping, and how we can all live better lives in the face of challenging work. Here they are:

  1. On Friday, November 4 at 8:30am, I’ll be doing an opening keynote address for the Montana CBT conference. The keynote is titled, “Exploring the Potential of Evidence-Based Happiness.” The whole conference looks great (12.75 CEs available). I’ve also got a break-out session from 1:15pm to 3:15pm, titled, “Using a Strengths-Based Approach to Suicide Assessment and Treatment in Your Counseling Practice.” You can register for the two-day Montana CBT conference here: https://www.eventbrite.com/e/montana-cbt-conference-registration-367811452957Helena
  2. On Monday, November 7 at 11am in Missoula I’ll be presenting for the University of Montana Molli Program. Although in-person seats are sold-out, people can still register to attend online. https://www.missoulaevents.net/11/07/2022/the-art-science-and-practice-of-meaningful-happiness/ The presentation title is: The Art, Science, and Practice of Meaningful Happiness. Molli is the Osher Lifelong Learning Institute at UM – which focuses on educational offerings for folks 50+ years-old.
  3. On Wednesday, November 9 from 12:30-4:30pm I’ll be doing a Strengths-Based suicide assessment and treatment workshop for Bitterroot Connect in Hamilton, MT. https://sites.google.com/starckcounseling.com/adrianna-starck-counseling/bitterroot-valley-connect

In closing, I’m posting something everyone needs, an 11-second video featuring one of our new piglets, Alfalfa, doing her “lay down” trick.

Be well . . .

John S-F