Category Archives: Suicide Assessment and Intervention

Vid-Podding with Francesca on “Normalize the Conversation”

Apparently, video podcasts are the thing. Or maybe they’ve been a thing for a while. . . or at least since early 2020 and the onset of the Zoom age. I think we should call them vid-pods.

Two weeks ago, I promoted a vid-pod with Paula Fontenelle, Stacey Freedenthal, and me. It was Paula’s vid-pod, titled “Understand Suicide.” Paula is very experienced, very knowledgeable and produces great vid-pods. You can check out all her work, including her podcast (aka vid-pod) at: https://www.understandsuicide.com/

Late last year, Victor Yalom of Psychotherapy.net asked if he could connect me for a possible appearance on a vid-pod called “Normalize the Conversation.” Normalize the Conversation is the brain-child of Francesca Reicherter. Francesca is also the Founder and President of “Inspiring My Generation.” I think Victor wanted me to promote our 7.5-hour marathon Suicide Assessment and Treatment video training series with Psychotherapy.net. . . so here’s the link to that: https://www.psychotherapy.net/videos/expert/john-sommers-flanagan

In contrast to Paula, Stacey, Victor, and me, Francesca is very young. . . and she’s a powerhouse. I’m not sure where she finds the time to do all that she’s doing. She’s 23, but started her mental health advocacy work at age 12. She has published a workbook, founded her own organization, and has over 60 vid-pod episodes online. She’s also a graduate student. You can read more about Francesca here: https://inspiringmygeneration.org/2021/05/28/francesca-reicherter-starting-the-conversation-on-mental-health-conditions/

You can also check out all her vid-pods at: https://podcasts.apple.com/us/podcast/normalize-the-conversation/id1587903841 – The vid-pod with me is from February 2, 2022 and here: https://podcasts.apple.com/us/podcast/what-you-should-know-about-the-clinical-interview/id1587903841?i=1000549745008

Francesca and I did a recording together and she did a bunch of editing and promoting and this past week she sent me some video clips of our time together. What you’ll immediately notice in the video clips is that Francesca is an artist at getting people to talk. Throughout the clips, I’m talking and she’s not. Somehow, she got me to talk for about 47 minutes (although she did some nice summaries and commentary here and there). If my experience is at all representative, I suspect Francesca will be a talented therapist and fabulous listener.

You can check out the vid-pod clips below, but more importantly, check out all the amazing work of Paula, Stacey, Victor, and Francesca . . . all of whom are making the world a place where supportive and quality mental health services are more accessible.

Feeling Happy About (and a little jealous of) Craig Bryan’s New Book, “Rethinking Suicide”

While engaged in a little late-night Twitter scrolling, I came across a fascinating post and thread questioning the utility of suicide screening for low risk populations (e.g., schools). Having been mildly opposed (along with the UK and Canada), to general population suicide screenings, I felt validated, especially upon discovering that Craig Bryan was author of the Twitter thread. Dr. Bryan is one of the best and most authoritative resources on suicide in the world. As of two nights ago, I was only familiar with his professional book with David Rudd (Brief cognitive-behavior therapy for suicide prevention) and his excellent work with military veterans, suicide, and lethal means management. I also knew he had recently published a new book titled, “Rethinking Suicide.”

Then, today, I checked out Rethinking Suicide online. I was gob smacked. It’s fantastic.

This post is mostly to pitch Craig Bryan’s book.

Among other gems, Dr. Bryan frames suicide prevention as a “wicked problem” and tells us about the origin of the term, wicked problem. What’s not to love about that.

Here’s a quote from his introduction: “Consistent with the perspective of suicide as a wicked problem, I will argue in this book that we need to replace our solution-based approach to suicide prevention with a process-based approach focused on creating and building lives worth living” (p. 7). Wow. That’s like music to my ears.

Dr. Bryan also weaves in “confirmation bias” (more music) as part of his critique of using so-called “mental illness” as an explanatory mechanism in suicide (I know if you know me and this blog, you know I don’t even use the term mental illness unless I’m explaining why I don’t use the term mental illness, and so I’m destined to love Dr. Bryan’s deconstruction of that concept).

Anyway, you can find Rethinking Suicide through your favorite online bookseller. I recommend it highly. I’ve ordered my copy.  It’s about time we all started rethinking suicide.  

Promo and Discount for the Upcoming Psychotherapy Networker Symposium

Hi All,

I’d like to invite you to join me at this year’s Psychotherapy Networker Symposium, where I’ll be speaking alongside over 60 of the world’s leading therapists and experts.  

The Symposium is a special place where you not only learn with many of the best in the world and dive into what’s new in the field, but also where you can join a warm community of like-minded professionals to rest, rejuvenate, and be inspired for the year to come.  

And as a subscriber to my blog, you can save an extra $50 on registration when you use code SYM50 to attend in-person or online. Learn more here https://web.cvent.com/event/03998a0b-77a0-4ed6-a384-677316bf7d0d/websitePage:b2f73631-8191-4d29-9042-4dae64d267b1?RefId=jflanagan

This year’s keynote presenters include: 

  • Esther Perel, renowned couple therapist and author of Mating in Captivity and The State of Affairs 
  • Steven Hayes, developer of Acceptance & Commitment Therapy 
  • Resmaa Menakem, author of NYT Bestseller My Grandmother’s Hands 
  • Emily Nagoski, NYT Bestselling author of Come as You Are and Burnout 
  • Ramani Durvasula, author of Should I Stay or Should I Go: Surviving a Relationship with a Narcissist. 
  • Rev. angel Kyodo Williams, critically acclaimed author of Being Black: Zen and the Art of Living with Fearlessness and Grace hailed as “a classic” by Buddhist pioneer and psychologist Jack Kornfield. 

For those interested, there’s also a special evening appearance from comedian Gary Gulman, host of the acclaimed HBO comedy special and documentary, The Great Depresh

Check out the entire lineup and register for the in-person or online experience here: https://web.cvent.com/event/03998a0b-77a0-4ed6-a384-677316bf7d0d/websitePage:b2f73631-8191-4d29-9042-4dae64d267b1?RefId=jflanagan

The Symposium is a pretty cool event and I’m honored to be presenting (twice). Although I can’t figure out why they didn’t include me among the keynoters (hahaha, just joking), the keynote lineup is very impressive.

I hope to see you there either in-person or online! 

All my best,

John SF

How on Earth Could Suicide Rates Go Down Along with the Onset of the Pandemic in 2020?

Last week I got to be part of an amazing conversation with Paula Fontenelle and Stacey Freedenthal. Paula and Stacey are experts in suicide prevention, postvention, and treatment. You can easily find them and some of their great work online using your favorite search engine. They both have books out. Paula’s is: Understanding Suicide and Stacey’s is: Helping the Suicidal Person.

Paula invited Stacey and I onto her podcast (which is also a video production). We all sat in separate rooms in three different states (Oregon, Colorado, and Montana) and talked about, “How on earth” it could be that pandemic-related mental health stress and distress is up (the research says so), and yet suicide rates in 2020 dipped, for the first time in two decades? What a great question!

Between the three of us, we had many answers. That’s good, because death by suicide is always influenced by many factors (in the scientific world, we like to say that suicide is multi-determined). Our answers are speculative, but I think it’s good to be speculative, as long as you admit to the fact that you’re being speculative.

The most fascinating of many fascinating explanations for the recent reduction in suicide rates was our “in real time” discovery that the pandemic relief checks went out in April of 2020. That was important because, year-after-year, the CDC reports that April is nearly ALWAYS the month with the highest suicide rates and in 2020, it was the LOWEST. Why is April always linked to high suicide rates? No one knows for sure, but Paula, Stacey, and I talk about potential explanations for that too. As T. S. Eliot wrote:

“April is the cruelest month, breeding lilacs out of the dead land, mixing memory and desire, stirring dull roots with spring rain.”

If you’re interested in suicide-related phenomena—not everyone is—you should listen or watch Paula’s “Understand Suicide” podcast. You can watch any of the episodes for great info, but for our episode, here are the links.

To watch: https://youtu.be/fPrDdQg7G_E

To listen: https://bit.ly/3KrJILO

Have a great weekend.

For a Win-Win-Win on Giving Tuesday – Support College Student Mental Health

After facing an overwhelming number of choices on Black Friday and Cyber Monday, now we’re faced with another litany of excellent choices for Giving Tuesday. There are so many wonderful charities to support. You can’t go wrong with supporting food banks, shelters, and other organizations that push back against poverty. You also can’t go wrong supporting children, minorities, education, and the environment . . . these are all huge needs.

Along with the preceding charity types, this year Rita and I are wholeheartedly supporting college student mental health. We’ve seen the struggles firsthand and we believe college students can benefit from greater access to mental health services. Specifically, we’re supporting a University of Montana Foundation project called “The University of Montana Mental Health and Happiness Fund.” We see the University of Montana Mental Health and Happiness Fund as a win-win-win. Here’s why.

The first win is that the funds will go to provide more hours of mental health counseling for college students. Unfortunately, more than ever before, college students are stressed and experiencing mental health struggles. These struggles can include suicidal thoughts and behaviors. As far as age groups vulnerable to death by suicide, the college student age group is among the highest (along with older males). Supporting college student mental health can literally save lives and help college students graduate and become significant contributors to their communities. Currently, Counseling Services at the University of Montana needs more counselors to meet increased needs.

The second win is about “workforce development.” In Montana, and around the nation, we need a continuous flow of competent and capable mental health professionals. That’s why the first priority of the University of Montana Mental Health and Happiness Fund is to support a ½ time Counseling Intern for UM’s Counseling Services department. Funding an intern means that the intern gains valuable experience and supervision and can then go out and contribute to mental health in the community. If we receive more funds than expected, we will either fund a second ½ time counseling intern or we will fund happiness promotion projects at UM and within the Western Montana area.

The third win is basic economics. College students contribute to local economies. When they graduate, college students also create capital. College students become entrepreneurs, scientists, grant writers, community leaders, parents, and grandparents. In all these roles, college graduates will do better and be better if they have better mental health.  

Our 2021 fundraising goal is $45,000. We’ve already raised over $22,000. Please help us reach our goal so we can contribute to positive mental health and happiness at the University of Montana.

If you’re interested in joining Rita and me in supporting the University of Montana Mental Health and Happiness fund here are the instructions.

  1. Click on this Link for Support
  2. As you complete the donation form, about halfway down the page, you will see “Designation Choice.” Choose “Other.”
  3. In the Additional Comments/Info Section – type/write University of Montana Mental Health and Happiness Fund

Thanks for considering college student mental health for this Giving Tuesday!

Who Wants a Two-Day Professional Workshop on Strengths-Based Suicide Assessment and Treatment?

I’ve got a friend who writes to me in acronyms. TBH is “To be honest.” LMK is “Let me know.” IMHO is “In my humble opinion.” FYI is “For your information.” YSKAT is “You should know about this.”

When I read my friend’s emails, there are always more letters than words, if YKWIM (you know what I mean).

This leads me to my PP (promotional point).

TBH signing up for a two-day SBSASTW (strengths-based suicide assessment and treatment workshop) isn’t everyone’s COT (cup of tea). TAI (think about it). That’s like 13 hours of suicide-related content. If you TAI, it CBYD (could bring you down).

That’s why, we will weave some PDC (pretty damn cool) EBHIs (evidence-based happiness interventions) into our 13 hours. This will be the MFE (most fun ever) two days of suicide training on November 19 and 20. YCBOI (you can bet on it).

But IMHO, woohoo. Really YSKAT. IMHO signing up for a two-day strengths-based suicide assessment and treatment workshop is TRTTD (the right thing to do).

YAMBWing (You also may be wondering), when John writes “we” is he going with the singular “we” or is he indicating there will be other presenters. TBH, John doesn’t know, but he’s hoping to recruit some of the amazing participants from this summer MHP (Montana Happiness Project) retreat to join in on the FUN (fricken unbelievably nice).

OK. I’ve had it with all these letters. And so, if you want to sign up, check out “Session three” on this link: https://www.familiesfirstmt.org/umworkshops.html

If that doesn’t help, send me an email (john.sf@mso.umt.edu) and I’ll see if I can help you figure out how to sign up. Just LMK. The session is also Zoomable.

A Free Psychotherapy.net Video Offering

I’m just writing you all on this beautiful fall afternoon in Montana to let you know about a FREE 20ish minute video titled, “Working Online with Suicidal Clients in the Age of COVID.” The video features Victor Yalom of Psychotherapy.net and me discussing issues related to suicide and distance counseling.

In honor of national Suicide Prevention Awareness Month, Psychotherapy.net is offering this video free (n.b., to access the video, you’ll need to enter your email address). Note: I used “n.b.” in my previous parenthetical comment to stick with the “Yalom” theme, because I learned to use n.b. (along with a plethora of new vocabulary words, like solipsistic, amnestic, servility, internecine, and sacrosanct), from reading Irvin Yalom’s group psychotherapy textbook.

Here’s the link: https://academy.psychotherapy.net/suicide-prevention-2021-jsf-signup

Victor and I also collaborated on a longer (7.5 hour) suicide assessment and treatment psychotherapy.net video that may be available through your university library subscription.

I hope you’re all as healthy and well as possible.

Happy Autumn,

JSF

The ACA Town Hall is Tomorrow

Rita and I get to be the guests for tomorrow’s online ACA Town Hall. The topic for the day is suicide, but more generally, the Town Hall, moderated by ACA President Dr. Kent Becker, is designed to be a community event for ACA members. The suicide discussion will be brief and there will be several other break-out groups in the Zoom format.

To participate, you’ll need to be a member of the American Counseling Association (ACA). As ACA members, you can attend for free, but you need to register in advance. Here’s the link: https://imis.counseling.org/store/events/registration.aspx?event=DOH2021SEP

My apologies for the late notice on this.

I hope everyone is well and thriving as much as possible.

John

Early Birds and Two Upcoming Strengths-Based Suicide Trainings

On September 24, I’m doing a full-day online-only Strengths-Based Suicide Assessment and Treatment Planning workshop. The workshop is on behalf of the Association for Humanistic Counselors . . . a cool professional organization if there ever was one.

I’m posting today because today is the last day for the “Early bird rates” for this AHC workshop. Just in case you want to be an early bird, this link will give you that chance . . . at least for a few more hours: https://events.r20.constantcontact.com/register/eventReg?oeidk=a07eibjc7x5afb40bd4&oseq=&c=&ch=&fbclid=IwAR2mwGRA6UgOtrTXBdWlS8ZlQAArlPlQR3LGOZigxdIeyodKcIBtY1yovXs

Just in case you want two-days of Strengths-Based Suicide Training or you want to come to the U of Montana or you need some college credit, we’ve got a full two-day version of the workshop happening in Missoula on November 19 and 20. In addition, if you’re wanting a continuing education smörgåsbord, this link also includes two day trainings with the fabulous Dr. Kirsten Murray (Strong Couples) and the amazing Dr. Bryan Cochran (LGBTQI+ Clients). Here’s that link: https://www.familiesfirstmt.org/umworkshops.html

There’s more happening too . . . but for now, this is probably enough for one post.

Have a fantastic week, and don’t be afraid to be the early bird.

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!