Category Archives: Suicide Assessment and Intervention

On the Road to Billings . . . and Well-Being . . . and Happiness

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Tonight I have the honor of offering a public lecture in Billings. Situated as a part of a series of community suicide-related talks, my title is “Psychological Well-Being and the Pursuit of Happiness.” I suspect somewhere between 3 and 30 people will be in attendance. Although I’m hoping for 30, I’m realistically assuming that Rita and the program’s host will show. Counting me, that makes three!

To help get attendance over 3, someone suggested I edit this post to include the time and location. I’m on at 7pm till 8:30pm on the second floor of the MSU-B library, room 231. Hope to see you there.

Below, I’m pasting the handout for tonight. Being in the green lane, I’m trying to save paper and make these products available online. Here you go!

Psychological Well-Being and the Pursuit of Happiness

John Sommers-Flanagan, Ph.D.

Following is a summary of key points for John Sommers-Flanagan’s presentation for the Big Sky Youth Empowerment Program and Montana Social Scientists, LLC, Billings, MT – November 7, 2019

Introduction: Happiness can run very fast. So, let’s chase well-being instead

  1. The Many Roads to Well-Being. You can find well-being on emotional, mental, social, physical, spiritual/cultural, behavioral, and environmental roadways.
  2. It’s Natural, but not Helpful, to do the Opposite of What Creates Well-Being. If we want to catch well-being, we need to actively plan and pursue it.
  3. The Pennebaker Studies. Writing or talking about deeper emotions and thoughts will make you healthier (better immune functioning) and happier. Choking off our emotions is inadvisable.
  4. The Cherries Story. It’s not what happens to us . . . but what we think about what happens to us . . . that increases or decreases our misery. Focusing on your good qualities can be difficult, but doing so helps build a strong foundation.
  5. Savoring. Use the power of your mind to extend and expand positive experiences.
  6. Why Children (and Adults) Misbehave. When people feel a deep sense of belonging and socially useful, the need to misbehave and feelings of suicide diminish.
  7. Exercise is the Solution (No matter the question). Exercise reduces depression in youth and offsets the genetic predisposition toward depression in adults. You can stretch or lift or do cardio, but get moving!
  8. Holding Hands and Hugging is a Chemical Gift (or not). Consent, timing, and desirable companionship are foundational to whether touch contributes to health.
  9. If You Can’t Catch Happiness or Well-Being, Start Chasing Meaning. Regular involvement in spiritual, cultural, religious, or social justice groups will feel so good that you might experience happiness and well-being along the way.
  10. Remember gratitude. All too often we forget to notice and express gratitude. Put it on your planner; both you and the person who receives your gratitude will thank you for it.

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John Sommers-Flanagan is a Professor of Counseling at the University of Montana. For more information, go to his blog at johnsommersflanagan.com. John is solely responsible for the content of this handout. Good luck in your pursuit of wellness.

A Sneak Peek at the Suicide Assessment and Treatment Planning Workshop Coming to Billings on November 8

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Anybody wondering what’s new in suicide assessment and treatment?

If so, come listen to any or all of a very nice suicide prevention/intervention line-up on November 7 and 8 on the campus of Montana State University in Billings. Here’s a news link with detailed info: https://billingsgazette.com/news/local/let-s-talk-montana-suicide-prevention-workshops-coming-to-msub/article_9a6f04ff-376f-56b8-a6a8-9a0160ba1cbb.html

For my part, I’m presenting the latest iteration of the suicide assessment and treatment model Rita and I have been working on for the past couple years. To help make suicide assessment and treatment planning easier, we’ve started using six common sense life domains to organize, understand, and apply specific assessment and intervention tools.

Another unique component of our model is an emphasis on client strengths and wellness. Obviously, in the context of suicide, it’s impossible (and wrong) to ignore clients’ emotional pain and suffering. However, we also think it’s possible (and right) to intermittently recognize, nurture, and focus on clients’ strengths, well-being, and goals.

What follows is a sneak peek at what I’ll be covering on Friday, November 8.

Suicide Interventions and Treatment Planning: Foundational Principles

Two essential principles that cut across all modern evidence-based protocols and evidence-based interventions form the foundation of all contemporary suicide assessment and treatment models:

  • Collaboration – Working in partnership with clients
  • Compassion – Emotional attunement without judgment

Collaborative practitioners work with clients, not on clients. Clients experiencing suicidal thoughts and impulses typically know their struggles from the inside out. Their self-knowledge makes them an invaluable resource. Carl Rogers (1961) put it this way,

It is the client who knows what hurts, what directions to go, what problems are crucial, what experiences have been deeply buried. It began to occur to me that unless I had a need to demonstrate my own cleverness and learning, I would do better to rely upon the client for the direction of movement in the process. (p. 11)

Compassionate practitioners resonate with client emotions and engage in respectful and gentle emotional exploration. Although compassion involves an empathic emotional response, it also includes tuning into and respecting client cognitions, beliefs, and experiences. For example, some clients who are suicidal feel spiritually or culturally bereft or disconnected. Regardless of their own beliefs and cultural values, compassionate counselors show empathy for their clients’ particular spiritual or cultural distress.

Clients who are or who become suicidal are often observant, sensitive, and intelligent. If they feel you’re judging them, they’re likely to experience a relationship rupture (Safran, Muran, & Eubanks-Carter, 2011). When ruptures occur, clients typically become less open, less engaged, and less honest about their suicidal thoughts and impulses. They also may become angry, aggressive, and critical of your efforts to be of help. In both cases, relational ruptures signal a need to work on mending the therapeutic relationship.

[For a helpful meta-analysis with recommendations on repairing ruptures, check out this article from the Safran lab: http://www.safranlab.net/uploads/7/6/4/6/7646935/repairing_alliance_ruptures._psychotherapy_2011.pdf%5D

The Six Life Domains

Working with clients who are suicidal can be overwhelming. To help organize and streamline the assessment and treatment planning process, it’s helpful to consider six distinct, but overlapping life domains. These domains provide a holistic description of human functioning. When clients experience suicidal thoughts and impulses, you can be sure the suicidal state will manifest through one or more of these six domains (i.e., emotions, cognitions, interpersonal, physical, spiritual/cultural, and behavioral; see below for a brief description of the six domains). All case examples and content in the workshop use these six domains to focus and organize client problems, goals/strengths, and interventions.

Suicidality as Manifest through Six Life Domains             

The Emotional Domain. A driving force in the suicidal state is excruciating emotional distress. Shneidman called this “psychache” and toward the end of his career concluded: “Suicide is caused by psychache” (1993, p. 53). Extreme distress is experienced subjectively. This is one reason there are so many different suicide risk factors. When a specific experience triggers excruciating distress for a given individual (e.g., unemployment, insomnia, etc.), it may increase suicide risk. Reducing emotional distress and facilitating positive emotional experiences is usually goal #1 in your treatment plan. Treatment plans often target general distress as well as specific and problematic emotions like (a) sadness, (b) shame, (c) fear/anxiety, and (d) guilt/regret.
The Cognitive Domain. Suicidal distress interferes with cognitive functioning. The resulting constricted thinking impairs problem-solving and creativity. The emotional distress and depressed mood associated with suicidality decreases the ability to think of or value alternatives to suicide. Several other cognitive variables are also linked to suicidality, including hopelessness and self-hatred. Most treatment plans will include collaborative problem-solving, and gentle challenging of maladaptive thoughts. Specific interventions may be employed to support client problem-solving, increase client hopefulness, and decrease client self-hatred.
The Interpersonal Domain. Hundreds of studies link social problems to suicidality, suicide attempts, and suicide deaths. Joiner (2005) identified two interpersonal problems that are deeply linked to suicide: thwarted belongingness and perceived burdensomeness. Many risk factors (e.g., recent romantic break-up, family rejection of sexuality, health conditions that cause people to feel like a burden) can exacerbate thwarted belongingness and cause people to perceive themselves as a social burden. Improving interpersonal relationships is often a key part of treatment planning.
The Physical/Biogenetic Domain. Physiological factors can contribute to suicide risk. In particular, researchers have recently focused on agitation or physiological arousal; these physical states tend to push individuals toward suicidal action. Additionally, chronic illness or pain, insomnia, and other disturbing health situations (including addictions) contribute to suicide, especially when accompanied by hopelessness. When present, physical conditions and biogenetic predispositions should be integrated into suicide prevention, treatment planning, and risk management.
The Spiritual/Cultural Domain. Meaningful life experiences can be a protective influence against suicide. No doubt, a wide range of cultural or religious pressures, spiritual/religious exile, or other factors can decrease an individual’s sense of meaning and can contribute to suicidal thoughts and behaviors. Including spiritual or meaning-focused components in a treatment plan can improve outcomes, especially among clients who hold deep spiritual and cultural values.
The Behavioral Domain. All of the preceding life domains can contribute to suicide, but suicide doesn’t occur unless individuals act on suicidal thoughts and impulses. The behavioral domain focuses on suicide intentions and active suicide planning. When clients actively plan or rehearse suicide, they may be doing so to overcome natural fears and aversions to physical pain and death; natural fears and aversions stop many people from suicide. Joiner (2005) and Klonsky and May (2015) have written about how desensitization to physical pain and to ideas of death move people toward suicidal action. Several factors increase risk in this domain and may be relevant to treatment planning, (a) availability of lethal means (especially firearms), (b) using substances for emotional/physical numbing, and (c) repeated suicide rehearsal (e.g., increased cutting behaviors).

*Note: These domains will always overlap, but they can prove helpful as you collaboratively identify problem areas and goals with your client.

If you’re interested in learning more about this suicide assessment and treatment planning model, I hope to see you in Billings on November 8!

 

 

 

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

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

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

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

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

On the Road from Suicide to Happiness: Please Send Directions!

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Buddhists often say that life is suffering. Some days, for many of us, that feels about right.

But on other days, the inverse also rings true. Life is joy. Joy is the dialectical sunshine that intermittently breaks through clouds of suffering to interrupt our melancholy.

Don’t worry. Even though there’s currently a September Winter Storm Warning happening in Montana, I’m not going all weather on you. Besides, there’s not much I love more than clouds, rain, and winter storms. Also, to be fair, Buddha and the Buddhists recognized long ago that there’s a road we can take to get away from storms of suffering.

Maybe it’s my penchant for bad weather that’s drawn me, for the past two years, deeply into the professional monsoon of clinical depression, suicide assessment, and suicide interventions. What’s odd about that is that I don’t believe that depression or suicidality should be as pathologized as they have been. I’m a proponent of the right to die. I also find light and hope in the existential perspective that encourages us to embrace and integrate our darker, depressive sides, so we can emerge more whole and, as the existentialist Kirk Schneider likes to say, experience a Rediscovery of Awe.

For the past two years, focusing on suicide has felt very important. Our society isn’t very good at discussing suicide in an open and balanced way. All too often, suicide gets inaccurately conflated with illness or shame or moral weakness. These inaccuracies have inspired me to talk openly about suicide whenever given the opportunity.

But, to be honest, talking and writing about suicide—even from a professional perspective—isn’t all that fun. Those who know me know how much I like to tell funny stories. For years, I’ve had an untreated addiction to showing Far Side and Calvin and Hobbes cartoons during presentations. You wouldn’t believe how hard it is to find suicide cartoons that are workshop-worthy. When I show my cartoon with the white rat in the cage hanging itself and the lab scientist saying, “Looks like discouraging data on the antidepressant” if there’s any laughter it’s a painful and strained laughter, at best.

I do have one amazing depression cartoon; it’s a Gary Larson Far Side scene of a sad looking man on a bed in a messy room with the caption, “The bluebird of happiness long absent from his life, Ned is visited by the Chicken of Depression.”

But let me get out of my addiction and to the point. In my work on suicide prevention and intervention, I’ve slowly realized that we need to paddle upstream. I won’t stop talking about depression and suicide, but I want to more explicitly acknowledge that disabling depression and tragic suicides are often the inverse of well-being or happiness turned upside down. To address this effort at integration, I’m preparing materials to teach and present on the science of happiness. This is where I need your help. Yes, please send more suicide and depression cartoons, but even more importantly, send me happiness cartoons! I’m expanding my focus, and getting ready to spend more time talking about how we can all live happier and more meaningful lives. One way I’m doing this is by teaching a new “Happiness” course this spring at the University of Montana.

As background, I should let you know that I’m familiar with the Yale Happiness Class, the Penn Positive Psychology Center, and other popular resources. Although I’ll use this mainstream material, I want to do something different.

Here’s how you can help.

I’m looking for lecture material and happiness lab activities. Examples include,

Lecture content

  • Video clips
  • Songs with meaning
  • Demonstration activities
  • Quirky/meaningful stories

Lab activities

  • 30-60 minute specific experiential activities that can deepen student learning
  • Evidence-based experiential activities that demonstrate how to counter depression or embrace meaning

Because I’ll be delivering the course to undergraduates, as you contemplate sending me a map with directions to happiness, please put on your 19-year-old hat and help me find destinations with academic substance, but that will still appeal to the college-age generation.

As always, thanks for reading. I wish you a weekend (and life) filled (at least intermittently) with the sort of happiness and joy that’s palpable enough to sustain you until the next bluebird of happiness lands on your shoulder. And if you live in Montana, be sure to stay warm in the winter storm.

John S-F

When Happiness Ran Away: Thoughts on Suicide and the Pursuit of Happiness

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Several days prior to driving across the state to a party with her family, a friend met up with Rita and me. We talked about happiness. She said she liked the word contentment, along with the image of hanging out in a recliner after a day of meaningful work.

Following the party, she wrote me an email, sharing, rather cryptically, that her party planning turned out just okay, because,

“Sigh. Some days happiness runs so fast!”

I loved her image of chasing happiness even more than the image of her reclining in contentment.

As it turns out, being naturally fleet, happiness prefers not being caught. Because happiness is in amazing shape, if you chase it, it will outrun you. Happiness never gets tired, but usually, before too long, it gets tired of you.

In the U.S., we’ve got an unhealthy preoccupation with happiness, as if it were an end-state we can eventually catch and convince to live with us. But happiness doesn’t believe in marriage—or even in shacking up. Happiness has commitment issues. Just as soon as you start thinking happiness might be around to stay, happiness suddenly disappears in the night.

Maybe our preoccupation with happiness is related to that revered line in the U.S. Declaration of Independence about the right to life, liberty, and the pursuit of happiness. Grandiose words indeed, because, at this point in the history of time, I’m not so sure any of us have an inalienable right to any of those three wondrous ideals.

But don’t let my pessimism get you down. Even though I’m not all that keen on pursuing happiness, I believe (a) once we’ve defined happiness appropriately, and (b) once we realize that instead of happiness, we should be pursuing meaningfulness, then, (c) ironically or paradoxically or dialectically, happiness will sneak back into our lives, sometimes landing on our shoulders like a delicate butterfly and other times trumpeting like a magnificent elephant.

Another reason not to feel down is because next Tuesday, October 1, I’ll be in Red Lodge, Montana as the speaker of the month for the Red Lodge Forum for Provocative Issues.

How cool is that?

My Red Lodge Forum presentation is: Suicide, Suicide Prevention, and the Pursuit of Happiness.

Just in case you’re passing through Red Lodge or happen to know someone in the general vicinity, below I’ve pasted the promotional email for the event. Please come if you can. There will be a fancy dinner, which inevitably involves a full stomach, which, even though I’m talking about suicide, might provide you with a twitch or two of happiness.

Here’s the promo:

From: Red Lodge Forum <redlodgemtforum@gmail.com>
Sent: Sunday, September 22, 2019 2:13 PM
To: ‘Red Lodge Forum’ <redlodgemtforum@gmail.com>
Subject: Tuesday October 1st Forum for Provocative Issues. Dinner reservations open

Forum for Provocative Issues

Suicide, Suicide Prevention, and the Pursuit of Happiness

Tuesday, October 1

PROGRAM

Beginning in 2005, death by suicide in the U.S. began rising, and despite vigorous national and local suicide prevention efforts, suicide rates have continued rising for 13 consecutive years. Depending on which metrics you prefer, suicide rates are up from somewhere between 33% and 61% from their levels at the turn of the century.

In Montana, we have the dubious distinction of the highest per-capita suicide rates in the U.S., at about 29.0 per 100,000 Montanans. Why? What is so peculiar about Montana?

But suicide is about much more than numbers. Join us on Tuesday, October 1 when Distinguished Professor at the University of Montana, John Sommers-Flanagan talks about what contributes to suicide, why Montana’s rate is so high, what’s wrong with suicide prevention efforts, and how we should talk with friends about suicide. Although suicide is a difficult, emotionally charged, subject, John will explore emotions that can create and sustain happiness.

FORUM CATERER CHANGE

In the next section, you will notice our caterer has changed. Martha Young, who has faithfully served our delicious meals for eight years, first at Café Regis, and more recently at the Senior Center, is unable to caterer our October meal. Prerogative Kitchen, an outstanding local restaurant,  has agreed to stand in.

DINNER RESERVATIONS NOW OPEN

Dinner at the Red Lodge Senior Center (13th St and Word Ave) will start at 5:30 pm and our program shortly after 6. If you plan to have dinner, email RedlodgeMtForum@gmail.com (no text or calls) with:

  • your reservation request,
  • your general meal choice (meat/fish, veggie, non-gluten), and
  • your cell number

If you don’t receive an email confirmation of your request promptly, please resubmit it. When I know specific dinner choices later this week, I will ask you to confirm your choice.

If you plan to attend the forum but not eat, come around six but donate $5 to help defray room rental and other expenses.

The price for this  dinner is $18. Please bring a check written prior to your arrival to Prerogative Kitchen for $18 per person. It will reduce traffic at the door, seat everyone faster, and make our cashier’s job easier.  If you want to leave an additional gratuity, simply leave cash on the table. Do not include gratuities in your check.

If you have friends who are interested in attending the forum, feel free to forward this message.

HAS YOUR EMAIL CHANGED?

If you change your email address and want to continue receiving forum notices, remember to send the change to RedlodgeMtForum@gmail.com.

INFORMATION ABOUT UPCOMING AND PAST FORUMS

For quick access to all news about upcoming and past programs, become a member of our Facebook group page, which supports FPI programs.  To access the page, simply search “Forum for Provocative Issues.”  This is an open group, but we carefully screen applicants to avoid potential problems by asking three simple questions.

USE OF FORUM EMAILS

I never share the emails of forum members. However, I have on occasion sent information about community issues and events that I think members will find valuable.

FORUM SUGGESTIONS

If you have an idea for a forum, email it to RedlodgeMtForum@gmail.com.

FUTURE FORUMS

The dates for our 2019/2020 season follow. Mark them on your calendar now to avoid conflicts.

  • November 5, The Future of Nuclear Energy, Redfoot
  • December 10, Japanese American Internment Camp Conditions in WWII, Russell
  • January 14, Fighting Fires, Saving Homes, Trapp
  • February 4, Apollo 8 and the Race for Space, Dragon
  • March 3, Subject TBD, Darby
  • April 7, Dark Money in Politics, Adams
  • May 5, Genetics and the Future of the Human Race, Gunn

 

 

Trauma, Suicide, and Motivational Interviewing: A Handout for BYEP Mentors

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Trauma may be the most common underlying factor contributing to mental disorders. Unfortunately, trauma is often overlooked, partly because it can manifest itself in so many different ways. That said, here are some common definitions. Trauma always involves a stressful trigger that activates a trauma response. Because, like everything, trauma responses are brain-based and involve the body, symptoms affect the whole person.

Old, informal, and useful definitions include:

  • A stressor outside the realm of normal human experience (but sadly, trauma is all-too-common)
  • A betrayal . . . (e.g., something that should not happen)
  • Occurrence of an event that’s emotionally overwhelming

Below I’ve listed the essence of the DSM-5 definition for Post-Traumatic Stress Disorder (note that the whole idea of PTSD centers on the chronic or long-lasting effects of trauma).

Exposure to a traumatic stressor that involves direct personal experience, witnessing, or learning about events involving threatened death, serious injury, or a threat to your physical integrity. The trauma response includes:

  • Intrusion symptoms (recurring unwanted memories, nightmares, flashbacks, and triggered distress)
  • Avoidance of trauma-related thoughts or external cues
  • Negative cognitive alternations (e.g., memory gaps, no joy, etc.)
  • Arousal and reactivity (e.g., irritability, risky behaviors, hypervigilance, insomnia, startle response)

Trauma and trauma responses can be big, medium, and small. Big traumas meet the DSM-5 diagnostic criteria for PTSD or acute stress disorder. Small traumas are usually disturbing and disruptive, but the body and brain adjust to them within 2-3 days. Medium size traumas have lasting effects, but don’t meet formal diagnostic criterial, and are usually referred to as subclinical.

I like to think of Trauma with an uppercase T (like in the DSM) and all other traumas that are difficult, challenging, and require adjustment as traumas with a lowercase t.

What to Say

Sometimes trauma responses or symptoms are visible and obvious. If so, it’s good to say and do some of the following:

  • Listen and show compassion
  • Reassure participants that physical/psychological responses are normal, take up energy & need soothing
  • Note that very effective treatments are available (e.g., This American Life)
  • Brainstorm on what helps
  • Remember: A pill is not a skill
  • Link and universalize (“It’s normal to have pleasant and unpleasant reactions to things we talk about”)
  • Brainstorm on more and less healthy reactions (Using substances is a quick distraction, but not a fix)
  • Share hopeful stories (what skills can be developed?)
  • Self-disclosure can help. But be careful with self-disclosure and remember that it’s not about you

Trauma is a normal and natural human response. You may experience trauma just by listening to people talk about trauma, or you may have your own direct experiences. When in the business of helping others, be sure to take good care of yourself.

Three Suicide Myths

Myth #1: Suicidal thoughts are about death and dying.

Most people assume that suicidal thoughts are about death and dying. On the surface, it seems like a no-brainer: Someone has thoughts about death, therefore, the thoughts must be about death. But the truth isn’t always how it appears from the surface. The human brain is complex. Thoughts about death may not be about death itself.

Myth #2: Suicide and suicidal thinking are signs of mental illness.

Not true. Philosophers and research scientists agree: nearly everyone on the planet thinks about suicide at one time or another—even if briefly. The philosopher Friedrich Nietzsche referred to suicidal thoughts as a coping strategy, writing, “The thought of suicide is a great consolation: by means of it one gets through many a dark night.”

Myth #3: Scientific knowledge about suicide risk factors and warning signs allows for the prediction and prevention of suicide.

Believing in this myth can make surviving family members, friends, and helping professionals experience too much guilt and responsibility. In fact, even the most famous suicidologists say that it’s impossible to consistently and accurately predict suicide.

Tips for Talking about Suicide

We need to be able to talk directly about suicide with courage and calmness. But first, we should listen. Here’s what you should listen for in general

  • Emotional pain
  • A sense of feeling trapped or ashamed
  • Not believing that anything can possibly help to reduce the pain and misery

While listening, show acceptance, empathy, and compassion. Remember: suicidal thoughts are not signs of illness or moral failing; if you judge the person, it will make it harder for the person to be open. Also remember: when people talk with you about their suicidal thoughts, that’s a good thing, because you can’t help unless they’re comfortable enough with you to speak openly about their suicidal thoughts and feelings.

Traditional warning signs in particular

Although it’s good to know these warning signs, there’s not much research supporting the idea that anything predicts suicide.

  • Active suicidal thinking that includes planning and talk about wanting to die
  • Preparation and rehearsal behaviors (stockpiling pills, giving away belongings, etc.)
  • Hopelessness related to feeling that the excruciating distress will never end
  • Recklessness, impulsivity, dramatic mood changes
  • Anger, anxiety, and agitation
  • Feeling trapped
  • No reasons for living, no purpose in life, broken relationships
  • Increased alcohol or substance abuse
  • Immense shame or self-hatred

How should I ask about suicide?

The answer to this is always, “Ask directly.” But we can do even better than that. We need to de-shame suicidal thoughts and talk. Before asking, communicate that you know suicidal thoughts are a normal and natural response to emotional pain and disturbing situations. For example, you could ask it this way, “I know that it’s not unusual for people to think about suicide. Have you had any thoughts about suicide?”

What should I say if someone admits to thinking about suicide? You can say things like,

  • Thanks for telling me.
  • It sounds like things have been terribly hard.
  • Thanks for being so honest, that takes courage.
  • I know I can’t instantly make everything better, but I want you to live and I want to help.
  • How can I best support you right now?
  • What can we do together that would help?
  • When you want to give up, tell yourself to hold off for one more day, hour, minute—whatever you can.
  • Or . . . use your good listening skills and reflect back the feelings and thoughts that the person shared.

Resources for Help

  • National Suicide Prevention Lifeline: Call 800-273-TALK (800-273-8255)
  • Crisis Text Line: Text HOME to 741741
  • Bozeman Help Center – 24-Hour Crisis Line: (406) 586-3333

What is Motivational Interviewing?

Motivational interviewing (MI) is an evidence-based approach to treating substance problems, health concerns, and other mental health issues. MI is “person-centered” and based on the foundational principle that clients should be the ones who make the case for change in their lives. MI:

  • Focuses on the common problem of ambivalence about change.
  • Relies on four central listening skills (OARS): open questions, affirming, reflecting, and summarizing.
  • Helps clients transition from less healthy to more healthy behaviors

Four overlapping components combine to create the spirit of MI:

  • Collaboration (partnership; dancing, not wrestling)
  • Acceptance (UPR, accurate empathy, autonomy, affirmation)
  • Compassion (honoring the client’s best interest)
  • Evocation (tapping the client’s well of wisdom)

MI is a specific treatment approach that requires professional training. However, operating on a few basic MI principles can improve nearly anyone’s approach to helping others. For more information, see the book: Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. New York, NY: Guilford Press.

This handout is from a mentor workshop for the Big Sky Youth Empowerment Program. These ideas are based on research and collected from professionals who have experience working with people who are feeling suicidal. These guidelines should not be considered medical advice and are no substitute for getting an appointment with a licensed health or mental health professional. See: johnsommersflanagan.com for more information.

The End of Suicide Prevention Week

Chair

The September 12 edition of the New York Times included an opinion piece titled “What Lies in Suicide’s Wake” by Peggy Wehmeyer. Ms. Wehmeyer previously worked as a correspondent on ABC’s “World News Tonight.” In the opinion piece, Ms. Wehmeyer shared experiences following her husband’s death by suicide in 2008.

Wehmeyer’s account of widowhood by suicide grabs you by the throat and brings you to your knees. If you’re a suicide survivor, read it with caution, because it will bring you anger, sadness, pain, and guilt.

Wehmeyer’s story also made me want to take action. I wanted to do to her what Robin Williams did to Matt Damon in his role of the therapist in Good Will Hunting. Williams looked at a file on Damon’s history of abuse, and then stood in front of him, saying,

“All this shit. This is not your fault. Look at me son. It’s not your fault.” Then Williams repeated “It’s not your fault” until Damon collapsed crying in his arms.

Some burdens are too big. I want to take Ms. Wehmeyer in my arms and tell her she’s taking on too much. Her former husband chose suicide. That’s a tragedy. But it’s not her fault.

After a suicide, shame and guilt spread like warm butter on hot toast, seeping into crevices, muscles, joints, and neurons. Guilt stabs you in the heart and then pummels your brain with the most obvious, most painful, most important, and most impossible question, “Why?”

Why . . . is a stupid, impenetrable, devious, and unhelpful question. But suicide survivors can’t stop themselves from painfully ruminating on, Why did this happen? If I were the god of suicide recovery, I’d cancel that question from the genetic blueprint. After a suicide, the question Why is pointless and unanswerable.

I’m a psychologist and a counselor. I’ve got plenty of friends in the mental health professions. Many of my friends, being of the post-modern or existential ilk, like to exclaim, usually with intellectual delight and breathless discovery, that “Humans are meaning makers!!” Well, duh.

Of course humans are meaning makers. Basically, that’s all we do. We make up shit all the time in an effort to explain our existence and our experiences. Let’s say your romantic partner breaks up with you, if you’re like most humans, you’ll wonder “Why?” And then you’ll painfully exfoliate your soul until you corner yourself with some irrational bullshit like, “I must be unlovable” or “I’m defective” or “I’m undesirable.” Or, if you’re inclined the other direction, you’ll quickly conclude, “He was an asshole” or “She’s defective” or “I hope my ex gets hit by a train.” And there are the new-age explainers who repeatedly wax philosophical, saying, “It wasn’t meant to be” or “The universe is telling me that it’s not my time for a romantic relationship.”

Asking why shit happens (and then answering yourself) is simply not helpful; it’s not helpful because you will, being human, come up with dozens of stupid, irrational, and unhelpful explanations for terrible things that happen. In the aftermath of suicide, if you’re like Ms. Wehmeyer, and many of us are, most of your stupid, irrational, and unhelpful explanations will involve blaming yourself. You’ll think things like, “I should have loved him better” or, you’ll embrace the ultimate piece of bullshit, that, somehow, as Ms. Wehmeyer wrote, “I missed those [suicide] signs until it was too late.”

No she didn’t. Wehmeyer didn’t miss the signs. And neither did you. Predicting suicide is impossible for even the best suicide researchers on the planet. Like Robin Williams said: It’s not your fault. You’re not the god of suicide prevention. Things happen. Shit happens. People kill themselves. Suicide started eons before you were born and it will continue for eons after.

Accepting tragedy sucks. It sucks more than nearly anything else we can think of. But tragedy strikes. And most of the time, tragedies are outside our control. Does that mean you should stop trying to prevent suicide and save lives? Of course not. Do what you can when you can. Does it mean you should stop blaming yourself for actions and choices that other people make and that are beyond your control? Hell yes!

In case you missed it, National Suicide Prevention Week is just ending. All week we’ve been encouraged to watch for warning signs, to follow up on our concerns by directly asking friends, family, and colleagues how they’re doing, and if they’ve been thinking about suicide. All this is great stuff. But, along with the many educational messages we’ve heard, somebody has to point out the cold, hard truth.

Sometimes you track the warning signs, you ask all the right questions, and you love people with all your heart, and they’ll still die by suicide. If that happens, it doesn’t mean you missed the signs or that you weren’t lovable enough. If suicide happens, you need to take care of yourself; you need to talk about your sadness, pain, and regrets. But you need to add one more thing. You need to listen to Robin Williams (who also died by suicide) and forgive yourself, because . . . All this shit. This is not your fault. . . . It’s not your fault.

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Resources for help

  • National Suicide Prevention Lifeline: Call 800-273-TALK (800-273-8255)
  • Crisis Text Line: Text HOME to 741741
  • Bozeman Help Center – 24-Hour Crisis Line: (406) 586-3333

 

Want to Learn More about Suicide Interventions and Treatment Planning? Here’s a link to a brand new CE course

John and Max SeattleOver the past several months I’ve been busy writing a 2-part continuing education course on a strength-based approach to suicide assessment, interventions, and treatment planning. As you may recall, Part One of this course was published last May (see: http://www.continuingedcourses.net/active/courses/course114.php ).

Today, I’m announcing that Part Two, titled, Suicide Interventions and Treatment Planning for Clinicians: A Strength-Based Model, is now available. To check it out, go to: http://www.continuingedcourses.net/active/courses/course115.php

Just in case you’d rather watch a CE video on this topic, last year I also did a cool three-part (7.5 hours total) continuing education video on suicide assessment and treatment.with Victor Yalom and Psychotherapy.net. Here’s a link to that resource: Psychotherapy.net: https://www.psychotherapy.net/video/suicidal-clients-series

Happy Labor Day!

John SF