Category Archives: Uncategorized
A Strengths-Based Approach to Suicide Assessment & Treatment with a Particular Focus on Marginalized Client Populations
Early this morning, I had a chance to Zoom in and present a workshop for Saint Michael’s College in Vermont. This was probably a good thing, because they had more than their share of snow to deal with. I got to be in Vermont virtually from beautiful Missoula Montana, where we’ve had spring most of winter. I wish we could borrow a few feet of that Vermont snow to get us up to something close to normal.
But my point is to share my ppts from this morning, and not talk about the weather. I had a great two hours with the Saint Michael’s professionals . . . as they posed excellent and nuanced questions and made insightful comments. Here’s a link to the ppts:
Thoughts on Ethnic Matching From Clinical Interviewing (7th edition)
Every chapter in Clinical Interviewing has several pop-out boxes titled, “Practice and Reflection.” In this–the latest–edition, we added many that include the practice and perspective of diverse counselors and psychotherapists. Here’s an example from Chapter One.
PRACTICE AND REFLECTION 1.3: AM I A GOOD FIT? NAVIGATING ETHNIC MATCHING IN PRIVATE PRACTICE
The effects of ethnic matching on counseling outcomes is mixed. In some cases and settings, and with some individuals, ethnic matching improves treatment frequency, duration, and outcomes; in other cases and settings, ethnic matching appears to have no effects in either direction (Olaniyan et al., 2022; Stice et al., 2021). Overall, counseling with someone who is an ethnic/cultural match is meaningful for some clients, while other clients obtain equal meaning and positive outcomes working with culturally different therapists.
For clients who want to work with therapists who have similar backgrounds and experiences, the availability of ethnically-diverse therapists is required. In the essay below, Galana Chookolingo, Ph.D., HSP-P, a licensed psychologist, writes of personal and professional experiences as a South Asian person in independent practice.
On a personal note, being from a South Asian background in private practice has placed me in a position to connect with other Asians/South Asians in need of culturally-competent counseling. In my two years in solo private practice, I have had many individuals reach out to me specifically because of my ethnicity and/or the fact that I am also an immigrant to the U.S. (which I openly share on my website). These individuals hold an assumption that I would be able to relate to a more collectivistic worldview. Because I offer free consultations prior to meeting with clients for an intake, I have had several clients ask directly about my ability to understand certain family dynamics inherent to Asian cultures. I have responded openly to these questions, sharing the similarities and differences I am aware of, as well as my limitations, since I moved to the U.S. before age 10. For the most part, I have been able to connect with many clients of Asian backgrounds; this tends to be the majority of my caseload at any given time.
As you enter into the multicultural domain of counseling and psychotherapy, reflect on your ethnic, cultural, gender, sexual, religious, and ability identities. As a client, would you prefer working with someone with a background or identity similar to yours? What might be the benefits? Alternatively, as a client, might there be situations when you would prefer working with someone who has a background/identity different than yours? If so, why and why not?
Reflecting on Dr. Chookolingo’s success in attracting and working with other Asian/South Asian people . . . what specific actions did she take to build her caseload? How did she achieve her success?
[End of Practice and Reflection 1.3]
For more info on ethnic matching, see these articles:
Olaniyan, F., & Hayes, G. (2022). Just ethnic matching? Racial and ethnic minority students and culturally appropriate mental health provision at British universities. International Journal of Qualitative Studies on Health and Well-being, 17(1), 16. doi:https://doi.org/10.1080/17482631.2022.2117444
https://www.tandfonline.com/doi/full/10.1080/17482631.2022.2117444
Stice, E., Onipede, Z. A., Shaw, H., Rohde, P., & Gau, J. M. (2021). Effectiveness of the body project eating disorder prevention program for different racial and ethnic groups and an evaluation of the potential benefits of ethnic matching. Journal of Consulting and Clinical Psychology, 89(12), 1007-1019. doi:https://doi.org/10.1037/ccp0000697
Acts of Kindness . . . in Hawai’i
This is our room with a view.
I’m a little embarrassed to report that Rita and I are on the Big Island of Hawai’i. We’re house-sitting for a friend. I know it’s hard work (insert eye-roll here). I have to wipe up the gecko poop and pee every morning. We’re here and experiencing this great fortune because a friend presented us with a very big act of kindness.
This week’s Montana Happiness Challenge is all about acts of kindness. Turns out, kindness is emotionally and psychologically healthy; this is true whether we engage in the act, receive the act, or observe the act. In a fascinating study titled, “Brief exposure to social media during the COVID-19 pandemic: Doom-scrolling has negative emotional consequences, but kindness-scrolling does not,” the researchers noted that doom scrolling during COVID reduced positive affect and optimism. In contrast, looking for positive stories of kindness on the internet either had no effect, or reduced negative affect.
As someone who has done more doom-scrolling than kindness scrolling, that’s good information to know. Here’s a link to the study: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257728
Below, please find the kindness homework for this week. I know it’s Wednesday and the week is growing shorting, but I’ve found that being in Hawai’i is terribly distracting. Who knew?
Here’s a gecko trying to either work on or poop on my computer.
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About a decade or two ago, the concept, “Random acts of kindness” gained traction. Now, about a decade or two later, I’m a little sad that random acts of kindness has become the most common way we talk about kindness. I say this despite the fact that I’m a big fan of randomness and kindness.
For your assignment this week, I’d like all of us to break away from the mentality of randomness and embrace the mentality of intentionality.
Intentional acts give us—as actors in the grand theater of life—greater agency. Instead of being stuck with a script someone else wrote, when we embrace intentionality, we become the author of every scene. Rather than randomly responding to opportunities with kindness, we exert our will. What this means is that when an opportunity for kindness pops up, we already have a plan . . . and that plan involves creatively finding a way to respond with kindness. How cool is that?
Let’s think about this together.
Toward whom would you like to demonstrate kindness? A stranger? If so, it might feel random in that you might act kind in a moment of spontaneity. But your spontaneity—although wonderful—is a moment when your intentionality (to be a person who acts with kindness) meets opportunity. In this way, even acts toward strangers that seem or feel spontaneous, will be acts that reflect your deeper values and character.
Maybe you’d like to intentionally be kind to a friend, a parent, or a sibling. Again, this requires thought and planning and the ability to step outside yourself. Assuming that others want what you want can backfire. You’ll need to step into another person’s world: What would your friend, parent, or sibling appreciate?
To stay with the theater metaphor, you’re the script-writer and you’ve written yourself into this performance. For this week, the script or plan includes a character who values kindness and who watches for opportunities to share that value with others. You’re that character.
Your job is to translate your character trait of kindness into actions that represent kindness. I don’t what that will look like for you. Maybe you don’t either. That’s the magic—where your character meets opportunity and opportunity meets planned spontaneity.
Your other job is to share about your kindness experiences on social media. You can share your efforts to act with kindness or share your experience of someone acting with kindness toward you.
Have a fabulous and kindness-filled week!
John
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.
- Click on this Link for Support
- As you complete the donation form, about halfway down the page, you will see “Designation Choice.” Choose “Other.”
- 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!
Strengths-Based Suicide Workshop with the Association for Humanistic Counseling
Here’s the ppts for today’s conference:
Last Call to Enroll in the U of Montana Happiness Class
My apologies for the redundant post . . . but as a counselor friend of mine likes to say, “Redundancy works.” Below is info on the upcoming (tomorrow!) UM Happiness class.
Fact: You can enroll in my Art & Science of Happiness (COUN 195) course through the University of Montana as a non-credit community participant? The course is fully online via Zoom.
When: Live on Zoom every Tuesday and Thursday from 1:00pm to 2:20pm (MST), beginning January 12 and ending April 27. You can attend live, or watch later.
What: You’ll hear and see lectures, demonstrations, video clips, small group lab activities, and role-plays.
Format: Because the course is online, live attendance isn’t required. Although I encourage live attendance, you can watch the course on your own schedule.
Cost: For community participants, the cost is $150 for the whole semester. That’s about $3.50 per instructional hour.
Why: You’ll get an amazing educational experience that just might increase your happiness in 2021. To enroll, go to: https://www.campusce.net/umextended/course/course.aspx?C=627&pc=13&mc=&sc
Please note: if you’re a University of Montana student (or want to become one) you can enroll in the course for three (3) semester credits. Go to Cyberbear, find the course (COUN 195), and enroll: https://www.umt.edu/cyberbear/.
Why Everyone loved the Quiet and Powerful Paula Sommers . . . and why we so Desperately miss her
On Monday, August 31, 2020, Paula Ann Sommers passed on to the place where only the kindest and most loving people on the planet go after death. We don’t know the exact location, but she’ll be there, sharing her angelic love and kindness. Paula was 91 years old, living in a small family group home in Woodinville, WA. She was suffering from dementia and had recently tested positive for COVID-19.
Paula was born to Angelo and Lucille Costanzo in Portland, Oregon. She had two older brothers, Robert (Bob) and Lawrence (Larry) Costanzo. Paula loved her parents and her older brothers, often telling stories of their years together growing up on the Oregon coast. Paula’s stories of Seaside and Arch Cape made these locations mystical and magical to the 13 cousins (children of Bob, Larry, and Paula).
After graduating from Seaside High School in 1948, Paula worked at Patty’s Fountain. In the summer of 1948, Max Sommers walked into the restaurant with a mutual friend. The friend, knowing Paula already had a boyfriend (or two), bet Max that Paula wouldn’t accept a ride home with him. Max took the bet. Not long after Paula saw Max—and his new yellow convertible—Max won the bet. In Max’s words, the bigger prize was to be with the love of his life. Last November, 2019, was Paula and Max’s 70th wedding anniversary.
In 1949, with the help of a VA loan, Paula and Max purchased City Shade Company in Vancouver, Washington. She worked at City Shade with Max for over 44 years. Paula regularly confessed to stealing cash from the company’s cash-box. Having absolutely no ability for stealth or deceit, she confessed to her so-called crimes, just as openly as she shared her heart and love with everyone who entered the doors at City Shade. Among her many remarkable gifts, Paula exuded warmth, genuine caring for others, and unmitigated kindness; she created moments in time and space that made people feel loved, accepted, and prized. In the days following her death, we (her children) have heard dozens of stories of how she unselfishly provided comfort to others. Around Christmas, virtually anyone who entered her home received a gift. For several years she gave out gym bags; other years there were shirts, sweaters, and blouses; still other years, games, toys, and fudge. Her kindness and generosity had no bounds.
As the daughter of an Italian American immigrant, Paula experienced discrimination. Then, as a Catholic, she met, fell in love with, and married a Jewish man. These experiences fueled her determination to reject all forms of prejudice and discrimination with an intensity that might have been labeled as hate (but Paula was philosophically opposed to using the word hate for anything). Instead of railing in negativity against racism, sexism, and homophobia, Paula simply lived her values, welcoming everyone into her bubble of love and kindness. The Christian family next door, the Jewish relatives, the Black family up the street, the lesbian daughter of friends, people on the street living in poverty, Muslims she had never met, children at restaurants . . . to be in proximity of Paula put everyone in danger of a hug, a gift, a smile, an empathic ear, and her unwavering love and acceptance.
Children from the neighborhood came to the Sommers home just as much to be with Paula as to see her children. There was only one Black family in the neighborhood. Paula loved that family with all her heart, soul, and spirit. When they were hungry, she fed them. If the boy who was struggling to understand his sexuality needed to talk, he wandered down the street and sought out Paula. Like moths to a flame, children were instantly attracted to “Mrs. Sommers,” because they saw her for what she was, an oasis of love and acceptance in a world of judgment. Despite this, Paula was nearly oblivious of her popularity. As is true with other Catholic saints, Saint Paula walked humbly in the world, never overestimating herself, while quietly living out her deep values of love, acceptance, kindness, and generosity.
Along with her talents for customer service, listening, and parenting, Paula was also an excellent cook. Every meal was an event that didn’t start until everyone was seated. Special guests got the coveted lace tablecloth, but everyone got food and comfort that would linger in their memories. Paula especially loved desserts. Everyone who knew anything knew that if fresh cookies weren’t on the counter, they could find a cache of snickerdoodles, chocolate chip cookies, banana bread, pumpkin bread, or lemon poppyseed bread in the third drawer on the south end of kitchen. If you came for dinner, it was advisable to “save room in your stomach” for Paula’s pies of the lemon meringue, pumpkin, pecan, apple, and other varieties. Her cheesecakes were to die for. Paula had a mathematical formula for calculating precisely how many pies (or cheesecakes or cakes) were required for a particular meal. She took the number of guests, and divided by two. If eight people were expected, she made four pies. Despite being teased by her children for constantly overestimating dessert needs, in the end, rarely did any of Paula’s desserts exist after noon the following day. Either Paula sent generous servings away with happy recipients, or her naysayers ate all the leftover desserts for breakfast.
In the Sommers family, there were very few rules, because when everyone feels loved and prized for their unique personalities, very few family rules are needed. She never yelled at her children. She never hit her children (although she did chase one child around with an eggbeater until they both dissolved in laughter). One of Paula’s most famous rules was, “We never use the word hate in our family.” She offered an alternative, “You can say you dislike something very intensely.” The word hate was simply the opposite of everything Paula believed in and stood for. In rare cases, when one sibling insulted another, Paula would counter, “If John’s dumb, you’re dumb too, because you’re both in the same family.” To this day, the Sommers children have no memory of sibling rivalry. The Sommers family was a team; Paula gently guided us away from conflict and toward love. When angry, she vacuumed and cleaned the house until everything was spotless and her anger had diminished. Freudian sublimation was never so complete. No one went to bed angry. Everyone was valued. No one doubted Paula’s love.
For many years, Paula mailed out so many greeting, sympathy, and birthday cards that we believe she single-handedly drove up the stock price of Hallmark Cards. Consistent with her character and values, she signed every card the same way: “Love always, Paula.”
For Valentine’s Day, 2010, Regence BlueShield of Oregon made a video recording of Paula and Max talking about their relationship and marriage. During the recording, Max said “Paula is the most unselfish person you ever saw, and you can’t help but take on some of those traits for fear of looking bad if you don’t.” This was the essence of Paula Ann (Costanzo) Sommers. Whenever she was, through kindness, love, and generosity, she inspired everyone to be better, lest they not keep up.
Paula is survived by her husband, Max (Vancouver, WA), her children Gayle (Vancouver, WA and Surprise, AZ), Peggy (Kirkland, WA), and John (Absarokee/Missoula, MT), and her grandchildren Chelsea Bodnar (Missoula, MT), Jason Lotz (Chino Hills, California), Patrick Klein (Vancouver, WA), Aaron Lotz (Seattle, WA), Rylee Sommers-Flanagan (Helena, MT), and Stephen Klein (Los Angeles, CA). Paula is also survived by eight great grandchildren, nieces, nephews, and friends of the family, many of whom who refer to her as their “Favorite Aunt,” or “Quite possibly the kindest person I have ever met.”
Memorial plans for Paula are to be arranged. The family is considering online and face-to-face alternatives. Paula was a staunch supporter of people with limited incomes and resources. Memorial donations can be made in honor of Paula Sommers to whatever charity you believe would fulfill her desire to help those in need. More importantly, she would want all who read this to live in ways to spread happiness, unity, and love. In the spirit of Paula’s life and values, we hope—in her honor—you will take a day, a week, a month, a year, or the rest of your life to intentionally share kindness, acceptance, and generosity with others. And, as Paula would say, “Love always.”
Treating and Preventing Suicide: Follow-Up and Resources
On Wednesday, we had about 3,000 people register for the ACA-sponsored webinar, “Treating & Preventing Suicide.” That was a fantastic turn out and I owe a BIG THANKS to Zachary Taylor of PESI for skillfully moderating the event and to Victoria Kress (Distinguished Professor from Youngstown State University) for sharing her insights about suicide assessment, prevention, and non-suicidal self-injury. Questions and comments from participants were excellent; it would have been great to have more than only one hour.
During the webinar we promised I would post additional suicide and NSSI resources on my blog. Other events have conspired (as they will) to delay this posting to this particular moment in time. Because we’re posting this content after the event, I’m aware that we may not efficiently get this out to everyone who was online and interested. Consequently, if you get this post and you know someone who’s not following this blog, but who might want this information, please feel free to forward or share.
The following content is from Victoria:
An article on self-harm published in Psychotherapy Networker:
https://www.psychotherapynetworker.org/blog/details/1313/treating-self-harm
Vicki also co-authored the following two publications:
Kress, V. E., & Hoffman, R. M. (2008) Non-suicidal self-injury and motivational interviewing: Enhancing readiness for change. Journal of Mental Health Counseling, 30, 311-329.
Stargell, N. A., et al., (2017-2018). Student non-suicidal self-injury: A protocol for school counselors. Professional School Counseling, 21, 37-46. Click here for the pdf.
Vicki also shared this document on suicide assessment:
My top resources include:
Sommers-Flanagan, J. (2018). Conversations about suicide: Strategies for detecting and assessing suicide risk. Journal of Health Service Psychology, 44, 33-45.
Sommers-Flanagan, J. (2018). Suicide assessment and intervention with suicidal clients [Video]. 7.5 hour training video for mental health professionals (produced by V. Yalom). Mill Valley, CA: Psychotherapy.net — https://www.psychotherapy.net/video/suicidal-clients-series
Sommers-Flanagan, J. (2019). Suicide assessment for clinicians: A strength-based model. ContinuingEdCourses.net
Sommers-Flanagan, J. (2019). Suicide interventions and treatment planning for clinicians: A strength-based model. ContinuingEdCourses.net
Because Rita and I just turned in our ACA book manuscript (coming in Feb), I’ve got a huge list of suicide-related citations. Below, I’m listing a few highlights related to our discussion on Wednesday. Books and articles about the top evidence-based approaches have an asterisk (*).
Ahuja, A., Webster, C., Gibson, N., Brewer, A., Toledo, S., & Russell, S. (2015). Bullying and suicide: The mental health crisis of LGBTQ youth and how you can help. Journal of Gay & Lesbian Mental Health, 19(2), 125-144. https://doi.org/10.1080/19359705.2015.1007417
Binkley, E. E., & Liebert, T. W. (2015). Prepracticum counseling students’ perceived preparedness for suicide response. Counselor Education & Supervision, 54(2), 98-108.
Bryan, C. J., Bryan, A. O., & Baker, J. C. (2020). Associations among state‐level physical distancing measures and suicidal thoughts and behaviors among U.S. adults during the early COVID‐19 pandemic. Suicide and Life Threatening Behavior, e12653, 1-7. https://doi.org/10.1111/sltb.12653
*Bryan, C. J., & Rudd, M. D. (2018). Brief cognitive-behavioral therapy for suicidal prevention. Guilford Press.
Cureton, J. L., & Clemens, E. V. (2015). Affective constellations for countertransference awareness following a client’s suicide attempt. Journal of Counseling & Development, 93(3), 352-360. https://doi.org/10.1002/jcad.12033
Erbacher, T. A., Singer, J. B., & Poland, S. (2015). Suicide in the schools: A practitioner’s guide to multi-level prevention, assessment, intervention, and postvention. Routledge.
Finn, S. E., Handler, L., & Fischer, C. T. (2012). Collaborative/therapeutic assessment: A casebook and guide. Wiley.
Freedenthal, S. (2018). Helping the suicidal person: Tips and techniques for professionals. Routledge.
Granello, D. H. (2010a). A suicide crisis intervention model with 25 practical strategies for implementation. Journal of Mental Health Counseling, 32(3), 218-235. https://doi.org/10.17744/mehc.32.3.n6371355496t4704
Granello, D. H. (2010b). The process of suicide risk assessment: Twelve core principles. Journal of Counseling & Development, 88(3), 363-371. https://doi.org/10.1002/j.1556-6678.2010.tb00034.x
Healy, D. (2009). Are selective serotonin reuptake inhibitors a risk factor for adolescent suicide? The Canadian Journal of Psychiatry/La Revue Canadienne De Psychiatrie, 54(2), 69-71. https://doi.org/10.1177/070674370905400201
Hedegaard, H., Curtin, S.C., & Warner, M. (2020). Increase in suicide mortality in the United States, 1999–2018. NCHS Data Brief, 362. National Center for Health Statistics.
*Jobes, D. A. (2016). Managing suicidal risk: A collaborative approach (2nd ed.). Guilford Press.
*Joiner, T. (2005). Why people die by suicide. Harvard University Press.
Large, M. M., & Kapur, N. (2018). Psychiatric hospitalisation and the risk of suicide. The British Journal of Psychiatry, 212(5), 269-273. https://doi.org/10.1192/bjp.2018.22
Large, M. M., & Ryan, C. J. (2014). Suicide risk categorisation of psychiatric inpatients: What it might mean and why it is of no use. Australasian Psychiatry, 22(4), 390-392. https://doi.org/10.1177/1039856214537128
*Linehan, M. (1993). Cognitive behavioral therapy of borderline personality disorder. Guilford Press.
*Linehan, M. (2015). DBT® skills training manual (2nd ed.). Guilford Press.
Maris, R. W. (2019). Suicidology: A comprehensive biopsychosocial perspective. Guilford Press.
*Stanley, B. & Brown, G. K (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256–264. https://doi.org/10.1016/j.cbpra.2011.01.001
Wenzel, A., Brown, G. K., & Beck, A. T. (2009) Cognitive therapy for suicidal patients: Scientific and clinical applications. American Psychological Association.
That Time When Sara P. Punk’d John SF during Filming of the Counseling and Psychotherapy Video Series
Over the past decade or so, Rita and I have been involved in some better and worse video production experiences. When I say better and worse, mostly I mean more embarrassing and less embarrassing.
Once, back in 2012, Sara Polanchek volunteered to help me do a psychoanalytic video demonstration. In honor of Freud, I suppose, the videographer begins by over-handling my tie. Then, we officially start the session with me asking Sara to free associate, and Sara takes over. Late in the clip, the other voice you hear in the background is Rita, whom I suspect collaborated with Sara on trying to embarrass me (even more than I would have been naturally embarrassed simply be trying to demonstrate a psychoanalytic session).
I tried posting this clip several years ago, but somehow the version didn’t actually include Sara’s opening disclosure. . . which was the whole point. So here’s the full 1 minute and 55 seconds: https://www.youtube.com/watch?v=SeihJqtenyc
John Sommers-Flanagan 