Category Archives: Personal Reflections

The Efficacy of Antidepressant Medications with Youth: Part II

After posting (last Thursday) our 1996 article on the efficacy of antidepressant medications for treating depression in youth, several people have asked if I have updated information. Well, yes, but because I’m old, even my updated research review is old. However, IMHO, it’s still VERY informative.

In 2008, the editor of the Journal of Contemporary Psychotherapy, invited Rita and I to publish an updated review on medication efficacy. Rita opted out, and so I recruited Duncan Campbell, a professor of psychology at the University of Montana, to join me.

Duncan and I discovered some parallels and some differences from our 1996 article. The parallels included the tendency for researchers to do whatever they could to demonstrate medication efficacy. That’s not surprising, because much of the antidepressant medication research is funded by pharmaceutical companies. Another parallel was the tendency for researchers to overstate or misstate or twist some of their conclusions in favor of antidepressants. Here’s the abstract:

Abstract

This article reviews existing research pertaining to antidepressant medications, psychotherapy, and their combined efficacy in the treatment of clinical depression in youth. Based on this review, we recommend that youth depression and its treatment can be readily understood from a social-psycho-bio model. We maintain that this model presents an alternative conceptualization to the dominant biopsychosocial model, which implies the primacy of biological contributors. Further, our review indicates that psychotherapy should be the frontline treatment for youth with depression and that little scientific evidence suggests that combined psychotherapy and medication treatment is more effective than psychotherapy alone. Due primarily to safety issues, selective serotonin reuptake inhibitors should be initiated only in conjunction with psychotherapy and/or supportive monitoring.

The main difference from our 1996 review was that in the late 1990s and early 2000s, there were several SSRI studies where SSRIs were reported as more efficacious than placebo. Overall, we found 6 of 10 reporting efficacy. An excerpt follows:

Our PsychInfo and PubMed database searches and cross- referencing strategies identified 10 published RCTs of SSRI efficacy. In total, these studies compared 1,223 SSRI treated patients to a similar number of placebo controls. Using the researchers’ own efficacy criteria, six studies returned significant results favoring SSRIs over placebo. These included 3 of 4 fluoxetine studies (Emslie et al. 1997, 2002; Simeon et al. 1990; The TADS Team 2004), 1 of 3 paroxetine studies (Berard et al. 2006; Emslie et al. 2006; Keller 2001), 1 of 1 sertraline study (Wagner et al. 2003), and 1 of 1 citalopram study (Wagner et al. 2004).

Despite these pharmaceutical-funded positive outcomes, medication-related side-effects were startling, and the methodological chicanery discouraging. Here’s an excerpt where we take a deep dive into the medication-related side effects and adverse events (N.B., the researchers should be lauded for their honest reporting of these numbers, but not for their “safe and effective” conclusions).

SSRI-related medication safety issues for young patients, in particular, deserve special scrutiny and articulation. For example, Emslie et al. (1997) published the first RCT to claim that fluoxetine is safe and efficacious for treating youth depression. Further inspection, however, uncovers not only methodological problems (such as the fact that psychiatrist ratings provided the sole outcome variable and the possibility that intent-to-treat analyses conferred an advantage for fluoxetine due to a 46% discontinuation rate in the placebo condition), but also, three (6.25%) fluoxetine patients developed manic symptoms, a finding that, when extrapolated, suggests the possibility of 6,250 mania conversions for every 100,000 treated youth.

Similarly, in the much-heralded Treatment of Adolescents with Depression Study (TADS), self-harming and suicidal adverse events occurred among 12% of fluoxetine treated youth and only 5% of Cognitive Behavioral Therapy (CBT) patients. Additionally, psychiatric adverse events were reported for 21% of fluoxetine patients and 1% of CBT patients (March et al. 2006; The TADS Team 2004, 2007). Keller et al. (2001), authors of the only positive paroxetine study, reported similar data regarding SSRI safety. In Keller et al.’s sample, 12% of paroxetine-treated adolescents experienced at least one adverse event, and 6% manifested increased suicidal ideation or behavior. Interestingly, in the TCA and placebo comparison groups, no participants evinced increased suicidality. Nonetheless, Keller et al. claimed paroxetine was safe and effective.

When it came to combination treatment, we found only two studies, one of which made a final recommendation that was nearly the opposite of their findings:

Other than TADS, only one other RCT has evaluated combination SSRI and psychotherapy treatment for youth with depression. Specifically, Melvin et al. (2006) directly compared sertraline, CBT, and their combination. They observed partial remission among 71% of CBT patients, 33% of sertraline patients, and 47% of patients receiving combined treatment. Consistent with previously reviewed research, Sertraline patients evidenced significantly more adverse events and side effects. Surprisingly and in contradiction with their own data, Melvin et al. recommended CBT and sertraline with equal strength.

As I summarize the content from our article, I’m aware that you might conclude that I’m completely against antidepressant medication use. That’s not the case. For me, the take-home points include, (a) SSRI antidepressants appear to be effective for some young people with depression, and (b) at the same time, as a general treatment, the risk of side effects, adverse effects, and minimal treatment effects make SSRIs a bad bet for uniformly positive outcomes, but that doesn’t mean there won’t be any positive outcomes. In the end, for my money—and for the safety of children and adolescents—I’d go with counseling/psychotherapy or exercise as primary treatments for depressive symptoms in youth, both of which have comparable outcomes to SSRIs, with much less risk.

And here’s a link to the whole article:

 

Antidepressant Medications for Treating Depression in Youth: A 25-Year Flashback

About 25-years ago Rita and I published an article titled, “Efficacy of antidepressant medication with depressed youth: what psychologists should know.” Although the article targeted psychologists and was published in the journal, Professional Psychology, the content was relevant to all mental health professionals as well as anyone who works closely with children.

Yesterday, when teaching my research class to a fantastic group of Master’s students in the Department of Counseling at UM, I had a moment of reminiscence. Not surprisingly, along with the reminiscence, came a resurgence of emotion and passion. I was sharing about how it’s possible to find an area of interest that hooks so much passion, that you might end up tracking down, literally everything ever published on that topic (as long as the topic is small enough!).

The motivation behind my interest in the efficacy of antidepressants with youth came about because of a confluence of factors. First, I was working with youth every day, many of whom were prescribed antidepressant medications. Second, I was in a sort of professional limbo—working in full-time private practice—but wishing to be in academia. Third, out of virtual nowhere, in 1994, Bob Deaton, a professor of social work at the University of Montana, asked Rita and I to do an all-day presentation for the Montana Chapter of the National Association of Social Workers. Bob’s offer was not to be refused, and I’ve been in Bob Deaton’s debt ever since. If you’re out there reading this, thanks again Bob, for your confidence and the opportunity.

To prep, Rita and I split up the content. One of my tasks was to dive into all things related to antidepressant medications. Before embarking on the journey into the literature, I expected there would be modest evidence supporting the efficacy of antidepressants in treating depression in youth.

My expectations were completely wrong. Much to my shock, I discovered that not only was there not much “out there,” but the prevailing research was riddled with methodological problems and, bottom line, there had NEVER been a published study indicating that antidepressants were more effective in treating depression in youth than placebo. I was gob smacked.

Just to give you a taste, here’s the abstract:

Pharmacologic treatments for mental or emotional disorders are becoming increasingly popular, especially in managed care environments. Consequently, psychologists must remain cognizant of medication efficacy concerning specific mental disorders. This article reviews all double-blind, placebo- controlled efficacy trials of tricyclic antidepressants (TCAs) with depressed youth that were published in 1985-1994. Also, all group-treatment studies of depressed youth using fluoxetine, a serotonin-specific reuptake inhibitor (SSRI), are summarized. Results indicate that neither TCAs nor SSRIs have demonstrated greater efficacy than placebo in alleviating depressive symptoms in children and adolescents, despite the use of research strategies designed to give antidepressants an advantage over placebo. The implications of these findings for research and practice are discussed.

Early in my research class this semester, an astute young woman asked about the “rule” she had heard about that you shouldn’t cite research that’s more than 10-years-old. It was a great question. I hope I responded rationally, but my apoplectic-ness may have showed in my complexion and words. In my view, we cannot and should not ignore past research. As Samuel Clemens once wrote, “History doesn’t repeat itself, it only rhymes.” If we don’t know the old stuff, we may miss out on the contemporary rhyming pattern. In our article, 25-years-old now, we also discussed some medication research reporting shenanigans (although we used more professional language. Here’s an excerpt of our discussion about drop-out rates.

Dropout rates. Side effects and adverse events can significantly affect medication study outcomes by causing participants to discontinue medication treatment. For example, in the IMI [imipramine] study with children ( Puig-Antich et  al.,  I987), 4 out of 20 (20%) of the medication group did not complete the study, whereas in the two DMI [desipramine] studies ( Boulos et al., l99 l; Kutcher et al., 1994 ), 6 out of 18 (33%) and 9 out of 30 (30%) medication participants dropped out because of side effects. For each of these studies, participants who dropped out of the treatment groups before completing the treatment protocol were eliminated from data analyses. The elimination of dropout participants from data analyses produced inappropriately inflated treatment-response rates. For example, although Puig-Antich et al. (1987) reported a treatment-response rate of 56% (9 of 16 participants), if all participants are included within the data analyses, the adjusted or intent-to-treat response rate is 45% (9/20). For the three studies that reported the number of medication protocol participants who dropped out of the study, the average reduction in response rate was 16.5%. Overall, intent­to-treat response rates ranged from less than 8% to 45% (see Table 2 for intent-to-treat response rates for all reviewed TCA studies).

What’s the value, you might wonder, of looking back 25-years at the methodology and outcomes related to tricyclic antidepressant medication use? You may disagree, but I think the rhyming pattern within antidepressant medication research for youth (and adults) remains. If you’re interested in expanding your historical knowledge about this rhyming, I’ve linked the article here.

Research can be boring; it can be opaque; it can be riddled with stats and numbers. Nevertheless, for me, research remains exciting, both as a source of amazing knowledge, but also as something to read with a critical eye.

Gestalt Theory and Spirituality

In our Counseling and Psychotherapy Theories in Context and Practice book, we include short sections on spirituality for each of the major theories. Previously, I’ve posted all the others (just search spirituality on this blog to find them), but discovered this evening that I forgot to post the Gestalt one. Maybe I forgot because it’s especially short and enigmatic . . . meaning, I didn’t find much out there on the crossroads between Gestalt theory and spirituality. If you know of something, please enlighten me!

Here’s the very short excerpt:

Spirituality

Although not always visible or palpable, Gestalt theory and therapy have deep spiritual roots. Laura Perls studied with Martin Buber and had interests in Taoism. Fritz Perls studied Zen Buddhism. Paul Goodman had interests in Taoism, and Gestalt writer, Dave Mann (2010) contended that Goodman’s book, Nature heals, is consistent with his Taoist beliefs about living with nature in accordance with nature. It may be that Gestalt experiments are consistent in style with the Zen Buddhist koan, a puzzle orriddle designed to open Zen novices to deeper levels of consciousness. At the very least, Zen Buddhism and Gestalt therapy share an attitude of acceptance of the now and an exploration of experience.

There are, of course, differences between Gestaltists regarding the role and nature of spirituality in Gestalt theory and practice. For some, the I-Thou connection is where the transcending and spiritual contact happens. Boundaries dissolve and deeper connections and insights blossom. This may have been what led Jesse Thomas (1978) to publish an early Gestalt-spiritual work titled, “The youniverse: Gestalt therapy, non-western religions, and the present age.” Spirituality, from the Gestalt perspective, is both personal and universal (or youniversalJ).

At the other end of the continuum are individuals who don’t see spirituality as warranting a place in Gestalt theory and practice (Mann, 2010). Mann (2010) recommended that Gestalt therapists, like clients, need to decide where they stand on religion and spirituality, recognizing, at the same time, that where they stand may well change. This brings us to perhaps the most famous words Fritz Perls ever wrote, the Gestalt prayer:

I do my thing and you do your thing.

I am not in this world to live up to your expectations,

And you are not in this world to live up to mine.

You are you, and I am I,

and if by chance we find each other, it’s beautiful.

If not, it can’t be helped.

(Perls, Gestalt therapy verbatim, 1969, p. 24)

Coping with Suicide Deaths

A recent smoky sunrise on the Stillwater River

As most of you know, I recently published an article in Psychotherapy Networker on my long-term experience of coping with the death of a client by suicide. In response to the article, I’ve gotten many supportive responses, some of which included additional published resources on coping with client death by suicide.

This blog post has two parts. First, I’m promoting the Networker article again to get it more widely shared as one resource for counselors and psychotherapists who have lost a client. Below, is an excerpt from the article. . . followed by a link. Please share with friends and colleagues as you see fit.

Second, at the end of this post I’m including additional resource articles that several people have shared with me over the past two weeks.

Here’s the excerpt . . .

The Prevention Myth

I’d worked with Ethan for about 20 sessions. Stocky, socially awkward, and intellectually gifted, he often avoided telling me much of anything, but his unhappiness was palpable. He didn’t fit in with classmates or connect with teachers. Ethan felt like a misfit at home and out of place at school. Nearly always, he experienced the grinding pain of being different, regardless of the context.

But aren’t we all different? Don’t we all suffer grinding pain, at least sometimes? What pushed Ethan to suicide when so many others, with equally difficult life situations and psychodynamics, stay alive?

One truth that reassures me now, and I wish I’d grasped back in the 1990s, is that empirical research generally affirms that suicide is unpredictable. This reality runs counter to much of what we hear from well-meaning suicide-prevention professionals. You may have heard the conventional wisdom: “Suicide is 100 percent preventable!” and, “If you educate yourself about risk factors and warning signs, and ask people directly about suicidal thoughts or plans, you can save lives.”

Although there’s some empirical evidence for these statements (i.e., sometimes suicide is preventable, and sometimes you can save lives), the general idea that knowledge of suicide risk, protective factors, and warning signs will equip clinicians to predict individual suicides is an illusion. In a 2017 large-scale meta-analysis covering 50 years of research on risk and protective factors, Joseph Franklin of Vanderbilt University and nine other prominent suicide researchers conducted an exhaustive analysis of 3,428 empirical studies. They found very little support for risk or protective factors as suicide predictors. In one of many of their sobering conclusions, they wrote, “It may be tempting to interpret some of the small differences across outcomes as having meaningful implications, . . . however, we note here that all risk factors were weak in magnitude and that any differences across outcomes . . . are not likely to be meaningful.”

Franklin and his collaborators were articulating the unpleasant conclusion that we have no good science-based tools for accurately predicting suicide. I hope this changes, but at the moment, I find comfort in the scientific validation of my personal experience. For years, I’ve held onto another suicide quotation for solace. In 1995, renowned suicidologist Robert Litman wrote, “When I am asked why one depressed and suicidal patient dies by suicide while nine other equally depressed and equally suicidal patients do not, I answer, ‘I don’t know.’”

Here’s the link to the full article: https://www.psychotherapynetworker.org/magazine/article/2565/the-myth-of-infallibility

Here are the additional resources people have shared with me:

Ellis, T. E., & Patel, A. B. (2012). Client suicide: what now?. Cognitive and Behavioral Practice19(2), 277-287.

Jorgensen, M. F., Bender, S., & McCutchen, A. (2021) “I’m haunted by it:” Experiences of licensed counselors who had a client die by suicide. Journal of Counselor Leadership and Advocacy. DOI: 10.1080/2326716X.2021.1916790

Knox, S., Burkard, A. W., Jackson, J. A., Schaack, A. M., & Hess, S. A. (2006). Therapists-in-training who experience a client suicide: Implications for supervision. Professional Psychology: Research and Practice, 37(5), 547-557.

Ting, L., Jacobson, J. M., & Sanders, S. (2008). Available supports and coping behaviors of mental health social workers following fatal and nonfatal client suicidal behavior. Social work, 53(3), 211-221.

As always, thanks for reading, and have a great day!

To Give Away: One Happy Rooster

Yesterday, Rita posted a free rooster to give away on a local Facebook page. She was surprised that no one claimed him. I waxed empathic, “I don’t understand,” I said, “people always want free things. Getting a free rooster would make the right person very happy.”

We’ve been studying happiness, but not the smiley sort of happiness. We’re into Aristotelian eudaimonic happiness (of course we are). You know, the sort of happiness you experience from living your life in ways that honor others and consistent with your deep values. That just might involve high-quality daily interactions with a free rooster. Think about it.

I was so puzzled by not having our rooster snapped up for immediate adoption that I took to the streets. Really, it was just one street. We’re living in Absarokee for the summer; there are streets, but not very many, and I only spent time on one street.

I cleverly wove the rooster opportunity into my banking business. With only two employees left in the bank on a late Friday afternoon, I asked with great cheer, “Would either of you like a free rooster?” They both quickly said “No thanks,” but I got my transaction processed in record time.

Rita was still in the grocery store (we were dividing and conquering our errands). I marched in, offered to carry her beer, and announced, “Hey. Anybody want a free rooster?” The cashiers avoided eye contact. The bagger started talking about his pigs; they made him happy. He didn’t need a rooster. I guess that proves it’s possible to have too much happiness.

Despite repeated rejections, I’m still convinced that our rooster could bring free happiness to someone. In fact, I think our failed transactions are evidence that happiness is in the eye of the beholder. When I was a teenager, our neighbors got a rooster. We woke up every morning to fantasies of murdering the neighbor’s rooster. I started plotting a late-night abduction. After all, roosters are the mother of opportunity. [I know that’s a wrong and terrible butchering of the saying “necessity is the mother of invention,” and I know that butchering must be the wrong word here, but I’m typing fast and consequently it’s impossible for me to suppress or repress my aggression and mother issues when free associating at this pace. Freud would be happy. But then Freud had his own peculiar tastes regarding what made him happy, which is, of course my point.

The famous Peanuts cartoonist, Charles Shulz, wrote a book titled, “Happiness is a warm puppy.” Although warm puppies likely bring happiness for many people, they’re certainly not the recipe for happiness for everyone. If I recall correctly, for Linus, happiness was a warm blanket.

And I can’t stop myself from thinking that, perhaps, for some lucky person out there . . .

. . . happiness is a warm, free, pet rooster.   

If you’re that person, contact me, because right now, for me, happiness is giving away a free pet rooster.

This Month’s Psychotherapy Networker Magazine and the Myth of Infallibility

Hi All,

In this post I’m sharing a link to an article I just had published in Psychotherapy Networker. Although I had hoped it would be the Networker’s “lead article,” instead, they put Shankar Vedantam first? And then a bunch of other people, like David Burns and Martha Manning? Seriously? All jokes aside, the truth is, I’m humbled to be included.

The article—titled “The Myth of Infallibility”—is about my immediate and ongoing emotional reactions to the loss of a client to suicide. I hope the article provides useful information and emotional support for counselors and psychotherapists who have experienced—or will experience—a similar loss.

You can use the following link to bypass the paywall and read the article for free.

https://www.psychotherapynetworker.org/magazine/article/2565/the-myth-of-infallibility/f576ab48-e662-46f0-b122-06ab19d35e28/OIM

Thanks for reading this. Please share the link if you feel so moved. One of my counseling colleagues shared it with all her students, which seemed great to me, mostly because IMHO, we don’t talk much or get formal training on how to cope when or if we have a client who dies by suicide.

Today, I’m especially grateful for all the people in my life who have supported me in one way or another, over so many years.

Thank you and have a great week.

John S-F

Who’s Afraid of a Little CRT?

Critical Race Theory (CRT) has been in the news lately, especially in Montana. As it turns out, several Montana public officials (you know who you are) appear frightened by CRT. Their response to the idea (not the reality) of CRT being taught anywhere or anytime is to try to ban it, as in make it illegal. It’s like a modern Montana-style prohibition (“Don’t you go out and get caught with a bottle of CRT or we’ll be taking you on down to see the sheriff!”).

All jokes aside (well, not all), I have a couple brief comments and a question.

I’m struck that, in the 21st century, anyone is using the old tried and failed strategies of banning ideas and burning books. Alcohol prohibition seemed rather unsuccessful. . . and we don’t need to know what happened with Romeo and Juliet to understand that, that which is forbidden, takes on a certain sex appeal.

My other main thought is that, just in case anyone was sleeping through science class, Critical Race Theory is a . . . (wait for it) . . . a theory! As with all theories, it’s not a perfect explanation of anything. It’s a working model, a set of ideas, with maybe a few scientific hypotheses. The right response to CRT isn’t to outlaw it—because if CRT is outlawed, then only outlaws will understand CRT. Instead, CRT is great food for thought, discussion, and public and private discourse. Rather than make it illegal, we should be discussing, evaluating, and critiquing its usefulness and validity, rather than acting like studying the presence of systemic racism in American history is blasphemy. If you contemplate the issue, the answer is “Yes, of course” there has been, from the beginning, systemic racism in the U.S. (think Columbus, slavery, Indian Boarding Schools, etc.). However, the fact that systemic racism is an historic and contemporary reality doesn’t make every jot and tittle of CRT true; but certainly it suggests we take it seriously. If not, we risk tempting our children with forbidden fruit or teaching them to be afraid of new ways of thinking. Either way, banning or illegalizing or running like scared rabbits away from CRT does a disservice to our state, our country, and our children.  

My question is whether I should write an Op-Ed piece on this topic. If you think so, let me know. If you think not, tell me I should let it go.

The Art of The Email

Most of my life involves emailing.

Most of the time I take irrational pride in my emails. I work very hard to eliminate typos and grammatical problems. I also work very hard to give my emails just the right touch of snark and hilarity.

My goal is to send literary emails. I keep waiting for someone to publish them. Something like the Freud-Jung letters. But alas, no one has offered, and so, once again, I have to be the responsible party and do the right thing and publish them here.

My emails are in italics; the introduction to each email is not in italics.

  1. To an academic friend from Xavier University who wrote to me to share one of his student’s complaints about the fact that we said something positive about Paul-Michel Foucault in our Counseling and Psychotherapy Theories textbook:

Anyhow, I guess I’ll be cancelling Foucault in the future. I checked online, and the dude was a bad sexual predator creep. If it seems appropriate, offer my apologies to your student. It’s tough to stay up on all the idiotic creeps out there. When I read about them, I can’t figure out where they found the time to act out on all their stupid sexual perversions. Well, obviously, that’s not the only question I have . . .

2. To a former student who had the audacity to suggest she could beat me at games like Charades/Pictionary/Balderdash/Cards Against Humanity:

As someone who is a trained observer of human insecurities, I think you should know that when someone (like, let’s say, you) writes something like “You telling me you’ve never lost those games means nothing. . .” it’s a clear indication that whatever that person (like, let’s say, you) is writing about “means something.” You may be familiar with the protesting too much line from William S. . . . and he may have, indeed, been speaking of thou-est defense mechanisms.

If I cry during our upcoming competition, it will be from glee and not mushrooms or your game-playing domination fantasies.

Is the idea of using your corpse as a scarecrow an unusual idea? I’ve been away from human contact for so long that I’m not sure of what’s normal and what’s not and therefore take no personal responsibility for the normality of whatever I’m writing.

3. To the same former student (see above) who for some reason wrote to me about being open to being taxidermied after death and placed as a “greeter” on our porch:

You’re always so full of good ideas that I’m not sure what I can add. Back in the 20th century, we had a life-sized Jean Luc Picard cardboard cut-out that we kept on our porch to greet visitors. Should I outlive you, I’d be honored to keep your taxidermy self in our garden. Right now, Rita is writing about mushroom-based caskets as an alternative that results in quick biodegradation. We could put your likeness in a mushroom patch and then you might melt into the ground.

I probably should stop with all my good ideas now.

4. To an attorney who’s helping me with the details of a legal contract:

I’m glad to hear we’re outside the boundaries of HIPAA. One of my life goals is to pretty much always stay outside the boundaries of HIPAA. That’s why, when I ask people for their vaccination status, I also tell them I won’t be billing their insurance😊.

5. To a former student and professional counselor:

No one other than you would ever think to begin an email message with a statement about unmanned robot lawnmowers. I’d ask you about what you’re reading in your spare time, but I’m worried for what I might hear.

6. To my fellow faculty, when I forward them information I received from our national accrediting body:

Hi All,

I haven’t looked at this myself, but it seemed like I should pass it on.

7. To my Fall, 2021 Research class:

Hello Prospective Researchers,

It’s June, and anyone with any sense is thinking about the COUN 545 Research class right about now. Haha. Not really. I’m just procrastinating on other things.

I’m writing because I had emailed a few of you before saying that I would likely NOT be teaching the Research class . . . however . . . the excellent, very good news is that I WILL BE teaching the Research class. The plan is for us to be live, in-person, and following whatever health guidelines the University has in place for fall semester. I know, the good news just won’t stop.

I just wanted to clarify what’s happening and dispel any rumors and let you know in advance that we’ll be having the best research class experience ever.

More stuff will come your way (like a syllabus) in late July or early August. Until then, you should start systematically collecting data wherever you go and whatever you’re doing (sorry, more research jokes there, no need to do that).

Seriously, until then, you should have a fantastic summertime.

That’s all for now. And you all should have a fantastic June weekend!

John S-F

My Six Promises to Members of the Association for Humanistic Counseling

Rita and I have been watching way too many bad detective shows. You know the format, someone gets abducted, then the hero or detective or agent tells the frightened parent or spouse or sibling, “We’ll get her back, I promise.”

The words “I promise” are accompanied by intense eye contact and complete—albeit unfounded—confidence.

IMHO, these scenes represent a very poor use of the words, “I promise.” How can you promise something over which you don’t have complete control? For example, I can promise never to leave the toilet seat up again, but I can’t promise to rescue someone who just got abducted by aliens. What the writers/actors really mean to say is something like, “By golly, I’ll do my best to rescue your son from the jaws of that shark, but I don’t really have control over all the variables here, and so, although I wish I could guarantee a positive outcome, I can’t.”

Now you see why no one is asking me to become a screenwriter.

My point is that I’m about to make several promises to the members of the Association for Humanistic Counseling, and I want everyone reading this to know that I take promise making very seriously. I’m a careful and contemplative promise-maker. . . and I promise to do my best to fulfill the following promises during my online keynote speech this coming Friday, June 4, from 1-2pm (EDT).

Wait, one other sidetrack, before I share my list of promises.

My speech is titled, “Growth through Struggle: Embracing Sparkling Moments and Strengths, while Avoiding Avoidance and Denial.”

Now you can see why no one is asking me to come up with titles for their keynote speeches.

In the description of my speech, I included the following statement (which is sort of like a promise): “Join John Sommers-Flanagan in this keynote presentation, for a review of five positive strategies counselors can use for lightening their burdens, while simultaneously embracing deep existential challenges.” The problem here is that the five positive strategies I’ll be sharing come from the so-called “happiness” literature, and when talking about happiness with people who are fully in touch with their existential angst and nihilism, it’s advisable to offer a few caveats.

And so here come the caveats (aka promises):

  • I promise not to use reductionistic pop-psych pretend brain science terminology like the “amygdala hijack,” partly because if we really imagine an amygdala hijack, then we have to conjure up miniature D.B. Cooper character to conduct the hijacking, and those of us who embrace the humanist label tend to be rather disinclined to attribute our behavior to imaginary entities that live in our brains.
  • When talking about evidence-based happiness interventions, for obvious reasons, I promise to never use the phrase, “Happiness Hack.”
  • Throughout the keynote, I’ll never use the term “Mental illness” unless I’m explaining to everyone why I never use the term “Mental illness.”
  • Because I like to use a little Carl Rogers terminology here and there, I may spontaneously weave the term “organismic” into my speech. I’m sharing this in advance because, at that moment when I’m speaking to hundreds of people via Zoom and feeling nervous, there’s always the possibility that Sigmund Freud will pop into my brain, double-crossing Rogers, and taking over my unconscious. This could cause me to misspeak, and say “orgasmic” instead of “organismic.” Keep in mind that if you think you hear the word “orgasmic” during my keynote, I promise, what I really meant was “organismic” in the Rogerian sense of the word.
  • I promise to stretch myself, my self-awareness, and my understanding of the whole of existential humanism by refusing to boil down any part of human existence into the presence or absence of specific hormones or neurotransmitters like oxytocin, serotonin, and dopamine.
  • I won’t engage in reductionistic and sexist discourse by using rhyming words, like “fight or flight,” to describe complex, multidimensional human behavioral choices.

Overall, I promise to do my best to talk about how to use happiness interventions to help cope with the immense struggles many of us have been experiencing, without pretending that any of us can easily discover a secret, magic, or miraculous solution to human suffering.

If you’re interested in tuning into this keynote speech, during which I do not say the word “orgasmic,” yes, there’s still time. You can register and experience to whole slate of amazing, live, online presentations brought to you by the fabulous Association for Humanistic Counseling and their cool and fantastic President, Victoria Kress, by clicking here:  https://www.humanisticcounseling.org/ahc-conference Then, just scroll down until you see, “Register for the Conference.”

I hope to see you there.

Today’s Mindfulness Epiphany in 98 Words

I just realized that mindfulness meditation is all about nonjudgmental acceptance of the experience of failing at mindfulness meditation. Mindfulness meditation always involves failure, therefore it requires nonjudgmental acceptance.

We fail at mindfulness because we are always more or less distracted; we cannot achieve perfect mindfulness.

Practice does not make perfect; practice makes practice.

If the goal of mindfulness is to practice, then we cannot fail, unless we fail to practice.

But if we practice nonjudgmental acceptance, failing to practice is neither failure nor victory.

All this brings us back around the circle to never failing, but just being.