Category Archives: Writing

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

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.

Strategies for Dealing with Insomnia and Nightmares, Part II

This is part II of a two-part blog. For part I, see Sunday’s post: https://johnsommersflanagan.com/2021/05/23/strategies-for-dealing-with-insomnia-and-nightmares-part-i/

Asking About Trauma

You may have a form to screen clients for a trauma history. However, more often than not, you’ll need to ask directly about trauma, just like you need to ask directly about suicidality. In many cases, as discussed in Chapter 3, it may be beneficial to wait and ask about trauma until the second or third session, or until there’s a logical opportunity. Although insomnia and nightmares don’t always signal trauma, when they co-exist, they provide an avenue to ask about trauma.

Counselor: Miguel, I’d like to ask a personal question. Would that be okay?

Miguel: Okay.

Counselor: Almost always, when people have nightmares about guns and death, it means they’ve been through some bad, traumatic experiences. When you’ve been through something bad or terrible, nightmares get stuck in your head and get on a sort of repeating cycle. Is that true for you?

Miguel: Yeah. I went through some bad shit back in Denver.

Counselor: I’m guessing that bad shit is stuck in your brain and one ways it comes out is through nightmares.

Miguel: Yeah. Probably.

Even when clients know their trauma experiences are causing their nightmares, they can still be reluctant to talk about the details. Physical and emotional discomfort associated with trauma is something clients often want to avoid. To reassure clients, you can tell them about specific evidence-based approaches—approaches that don’t require detailed recounting of trauma or nightmare experiences. Two examples include eye movement desensitization reprocessing (EMDR; Shapiro, 2001) and imagery rehearsal therapy (Krakow & Zadra, 2010). 

Miguel: If I talk about the nightmares, they get more real. I have enough trouble keeping them out of my head now.

Counselor: That’s a good point. But right now your dreams are so bad that you’re barely sleeping. It’s worth trying to work through them. How about this? I’ve got a simple protocol for working with nightmares. You don’t even have to talk about the details of your nightmares. I think we should try it and watch to see if your dreams get better, worse, or stay the same? What do you think?

Miguel: I guess maybe my nightmares can’t get much worse.

Evidence-Based Trauma Treatments

In Miguel’s case, the first step was to get him to talk about his insomnia, nightmares, and trauma. Without details about his experiences, there was no chance to dig in and start treatment. The scenario with Miguel illustrates one method for getting clients to open up about trauma. Other clinical situations may be different. We’ve had Native American clients who were having dreams (or not having dreams, but wishing for them), and we needed to begin counseling by seeking better understanding of the role and meaning of dreams in their particular tribal culture.

 Counselors who work with clients who are suicidal should obtain training for treating insomnia, nightmares, and trauma. Depending on your clients’ age, symptoms, culture, the treatment setting, and your preference, several different evidence-based treatments may be effective for treating trauma. The following bulleted list includes treatments recommended by the American Psychological Association (2017) or the VA/DoD Clinical Practice Guideline Working Group (2017), or both (Watkins et al., 2018).

  • Cognitive Processing Therapy (Resick et al., 2017).
  • Eye-Movement Desensitization Reprocessing (Shapiro, 2001)
  • Narrative Exposure Therapy (Schauer et al., 2011)
  • Prolonged Exposure (Foa et al., 2007).
  • Trauma-Focused Cognitive Behavioral Treatment (Cohen et al., 2012).

Although the preceding list includes the scientifically supported approaches to treating trauma, you may prefer other approaches, many of which are suitable for treating trauma (e.g., body-centered therapies, narrative exposure therapy for children [KID-NET], etc.).

Specific treatments for insomnia and nightmares are also essential for reducing arousal/agitation. Evidence-based treatments for insomnia and nightmares include:

  • Cognitive-Behavioral Therapy for Insomnia (CBT-I; Cunningham & Shapiro, 2018).
  • Imagery Rehearsal Therapy (IRT; Krakow & Zadra, 2010).

Targeting trauma symptoms in general, and physical symptoms in particular (e.g., arousal, insomnia, nightmares) can be crucial to your treatment plan. Addressing physical symptoms in your treatment instills hope and provides near-term symptom relief.

[Check out the whole book for more info: https://imis.counseling.org/store/detail.aspx?id=78174%5D

Strategies for Dealing with Insomnia and Nightmares, Part I

What follows is an excerpt from, Suicide Assessment and Treatment Planning: A Strengths-Based Approach (American Counseling Association, 2021). We address insomnia and nightmares in Chapter 7 (the Physical Dimension). This is just a glimpse into the cool content of this book.

Insomnia and nightmares directly contribute to client distress in general and suicidal distress in particular. In this section, we use a case example to illustrate how counselors can begin with a less personal issue (insomnia), use empathy, psychoeducation, and curiosity to track insomnia symptoms, eventually arrive at nightmares, and then inquire about trauma. Focusing first on insomnia, then on nightmares, and later on trauma can help counselors form an alliance with clients who are initially reluctant to talk about death images and trauma experiences.

Focusing on Insomnia

Miguel was a 19-year-old cisgender heterosexual Latino male working on vocational skills at a Job Corps program. He arrived for his first session in dusty work clothes, staring at the counselor through squinted eyes; it was difficult to tell if Miguel was squinting to protect his eyes from masonry dust or to communicate distrust. However, because the client was referred by a physician for insomnia, he also might have just been sleepy.

Counselor: Hey Miguel. Thanks for coming in. The doctor sent me a note. She said you’re having trouble sleeping.

Miguel: Yeah. I don’t sleep.

Counselor: That sucks. Working all day when you’re not sleeping well must be rough.

Miguel: Yeah. But I’m fine. That’s how it is.

To start, Miguel minimizes distress. Whether you’re working with Alzheimer’s patients covering their memory deficits or five-year-olds who get caught lying, minimizing is a common strategy. When clients say, “I’m fine” or “It is what it is” they may be minimizing.

But Miguel was not fine. For many reasons (e.g., pride, shame, or age and ethnicity differences), he was reluctant to open up. However, given Miguel’s history of being in a gang and his estranged relationship with his parents, the expectation that he should quickly trust and confide in a white male adult stranger is not appropriate.

Rather than pursuing anything personal, the counselor communicated empathy and interest in Miguel’s insomnia experiences.

Counselor: Not being able to sleep can make for very long nights. What do you think makes it so hard for you sleep?

Miguel: I don’t know. I just don’t sleep.

When asked directly, Miguel declines to describe his sleep problems. Rather than continue with questioning, the counselor fills the room with words (i.e., psychoeducation). Psychoeducation is a good option because sitting in silence is socially painful and because multicultural experts recommend that counselors speak openly when working with clients from historically oppressed cultural groups (Sue & Sue, 2016). The reasoning goes: If counselors are open and transparent, culturally diverse clients can evaluate their counselor before sharing more about themselves. As Miguel’s counselor talks, Miguel can decide, based on what he hears, whether his counselor is safe, trustworthy, and credible. 

Counselor: Miguel, there are three main types of insomnia. There’s initial insomnia—that’s when it takes a long time, maybe an hour or more, to get to sleep. They call that difficulty falling asleep. There’s terminal insomnia—that’s when you fall asleep pretty well and sleep until maybe 3am and then wake up and can’t get back to sleep. They call that early morning awakening. Then there’s intermittent insomnia—that’s like being a light sleeper who wakes up over and over all night. They call that choppy sleep. Which of those fits for you?”

Miguel: I got all three. I can’t get to sleep. I can’t stay asleep. I can’t get back to sleep.

Counselor: That’s sounds terrible. It’s like a triple dose of bad sleep.

As Miguel begins opening up, he says “I haven’t slept in a week.” Although it’s obvious that zero minutes of sleep over a week isn’t accurate, for Miguel, it feels like he hasn’t slept in a week, and that’s what’s important.

Exploring Nightmares

After Miguel yawns, the counselor asks permission to share his thoughts.

Counselor: Miguel, if you don’t mind, I’d like to tell you what I’m thinking. Is that okay?

Miguel: Sure. Fine.

Counselor: When someone says they’re having as much trouble sleeping as you’re having, there are usually two main reasons. The first is nightmares. Have you been having nightmares?

Miguel: Shit yeah. Like every night. When I fall asleep, nightmares start.

Counselor: Okay. Thanks. I’m pretty sure I can help you with nightmares. We can probably make them happen less often and be less bad in just a few meetings.

The counselor’s confidence is based on previous successful experiences, including using a nightmare treatment protocol that has empirical support (Imagery Rehearsal Therapy; Krakow & Zadra, 2010). Although evidence-based treatments aren’t effective for all clients, they can establish credibility and instill hope. Nevertheless, Miguel doesn’t immediately experience hope.

Miguel: Yeah. But these aren’t normal nightmares.

Counselor: What’s been happening?

Miguel: I keep having this dream where I’m sticking a gun in my mouth. People are all around me with their voices and shit telling me, “pull the trigger.” Then I wake up, but I can’t get it out of my head all day? What the hell is that all about?”

Counselor: That’s a great question.

When the counselor says, “That’s a great question,” his goal is to start a discussion about all the reasons why someone (Miguel in this case), might have a “gun in the mouth” dream. If Miguel and his counselor can brainstorm different explanations and possible meanings for the dream images, it’s less likely for Miguel to interpret his dream as a sign that he should die by suicide. What’s important, we tell our clients, is to look at many different possible meanings the unconscious or God or the Great Spirit or the universe or indigestion might be sending to the dreamer. To help clients expand their thinking and loosen up on their conclusions about their dream’s meaning, we’ve used statements like the following:

You may be right. Your dream might be about you dying or killing yourself. But our goal is to listen to the message your brain sent you and be open to what it might mean. It’s perfectly normal to think your dream was about you dying by suicide—but that’s not necessarily true. That’s not the way the brain and dreams usually work.               Some counselors use self-disclosure about dreams or nightmares they’ve had themselves. Others offer hypothetical or historical dream examples. Either way, normalizing nightmares helps clients become more comfortable talking about their bad dreams and nightmares.

To be continued . . . NEXT TIME . . . we ask about trauma.

If you’re interested in this content, you can buy the whole darn book from ACA here: https://imis.counseling.org/store/detail.aspx?id=78174

If you want the eBook, you can buy it through John Wiley & Sons: https://www.wiley.com/en-ai/Suicide+Assessment+and+Treatment+Planning%3A+A+Strengths+Based+Approach-p-9781119783619

The eBook is also available through Amazon: https://www.amazon.com/Suicide-Assessment-Treatment-Planning-Strengths-Based-ebook/dp/B08T7VNCMK/ref=sr_1_9?dchild=1&qid=1621798923&refinements=p_27%3AJohn+Sommers-Flanagan%3BRita+Sommers-Flanagan&s=books&sr=1-9

The Root of (Most) Misery

For years I’ve been teaching counseling students that the cause of most emotional and psychological misery can be boiled down to one word. To inflame their competitive spirits, I tell them this powerful word starts with the letter E, and offer prizes to students if they can guess the correct word.

Sadly, no one ever guesses that I’m talking about “Expectation.”

Expectation is, IMHO, the biggest source of bad, sad, and maladaptive emotions. I suffer from my own expectations all the time. Just this morning, while trying to listen to a podcast on a walk, I became irrationally enraged with all things Apple. Why? Because my iPhone podcasting app didn’t work in an elegant, user-friendly manner. Even worse is that I’m fully aware of how silly it is for me to justify holding such high—or even modest—expectations when it comes to technology. I have repeated lived experiences that should have led me to know how often I (and others) are thwarted by technology. I also happily rely on and use technology for many hours every day, and although it feels otherwise, most of the time technology provides . . . my computer powers up, my emails get sent, my phone dials the right number, and magical things like Zoom conferences happen without adverse incident.

Here’s the irony: My expectations thwart my happiness far more often than technology thwarts my personal plans and goals. Nevertheless, I’m eager to throw a childish fit when an app malfunctions, but I continue to barely question my unrealistic expectations despite their predictable adverse emotional outcomes. Funny that (as the Brits might say). I resist blaming and changing that which I have some control over (my expectations), while I let loose with relentless complaints about that which I have little control over (technology).

The fortune in my fortune cookie from dinner with my father gave me a nudge toward recognizing and managing my expectations. Panda Express—not usually where I look for guidance—provided me with the wisdom I seek.

If I were inclined to use the word “wiring” when referring to neural networks (I’m not), I might question whether there’s a glitch in my wiring. However, because I’m pretty certain I’ve got no wires in my brain, I’m going after the glitch in my attitude. Sure, as I pursue my attitudinal glitch, my brain may undergo physical, chemical, and electrical changes, but I suspect the fix will be ever so much more complicated than clipping a wire here, and reconnecting another one there.

Thanks for reading . . .

Cultural Specificity and Universality: An Indigenous Example

These days mostly we tend to orient toward the culturally specific, and that’s a good thing. Much of intersectionality, cultural competency, and cultural humility is all about drilling down into unique and valuable cultural and individual perspectives.

But these are also the days of Both-And.

In contrast to cultural specificity, some theorists—I’m thinking of William Glasser right now—were more known for their emphasis on cultural universality. Glasser contended that his five basic human needs were culturally universal; those needs included: Survival, belonging, power (recognition), freedom, and fun.

Although Glasser’s ideas may (or may not) have universal punch, he’s a white guy, and pushing universality from positions of white privilege are, at this particular point in history, worth questioning. That’s why I was happy to find an indigenous voice emphasizing universal ideas.

I came across a quotation from a Lakota elder, James Clairmont; he was discussing the concept of resilience, from his particular linguistic perspective:

The closest translation of “resilience” is a sacred word that means “resistance” . . . resisting bad thoughts, bad behaviors. We accept what life gives us, good and bad, as gifts from the Creator. We try to get through hard times, stressful times, with a good heart. The gift [of adversity] is the lesson we learn from overcoming it.

Clairmont’s description of “the sacred word that means resilience” are strikingly similar to several contemporary ideas in counseling and psychotherapy practice.

  • “Resisting bad thoughts, bad behaviors” is closely linked to CBT
  • “We accept what life gives us, good and bad, as gifts from the Creator” fits well with mindfulness
  • “We try to get through hard times, stressful times, with a good heart” is consistent with optimism concepts in positive psychology
  • “The gift [of adversity] is the lesson we learn from overcoming it” and this is a great paraphrase of Bandura’s feedback and feed-forward ideas

In these days of cultural specificity, it makes sense to work from both perspectives. We need to recognize and value our unique differences, while simultaneously noticing our similarities and areas of convergence. Clairmont’s perspectives on resilience make me want to learn more about Lakota ideas, both how they’re similar and different from my own cultural and educational experiences.

Working in the Cognitive Dimension

Today I’ve been putting together my powerpoints for the upcoming Nate Chute Foundation workshop. The NCF workshop is on two consecutive Tuesday evenings, starting this coming Tuesday.

While reviewing content for the ppts, I tried to pull all the intervention strategies from my brain, and failed. My excuse is that there are too many possible interventions for my small brain to memorize. As a consequence, I was forced to check out the “Practitioner Guidance and Key Points to Remember” sections at the end of all the intervention chapters. To give you a taste, here’s a photo of the “summary” page at the end of the cognitive chapter.

The Cognitive Dimension – Chapter Summary

Each of these bulleted items represents a potential method or strategy for intervening in the cognitive dimension with clients or students who are experiencing suicidality. I’m looking forward to talking about these strategies at the Nate Chute workshop, but rather than trying to commit them to memory (like Ebbinghaus would have), I’ll be using my powerpoint slides as a memory aid.

I hope you’re all having a great Sunday night.

John SF

How To Do Suicide Safety Planning: A Case Example

Earlier today I had a 90-minute Zoom meeting with the staff from Bridgercare of Bozeman, Montana. Bridgercare is a medical clinic focusing on sexual and reproductive health. Our meeting’s purpose was to provide staff with training on how to integrate a strengths-based approach to suicide assessment and treatment into their usual patient care.

It’s probably no big surprise to hear this, but even through Zoom, the Bridgercare staff was fabulous. They’re clearly dedicated to the safety and wellbeing of their patients. I enjoyed meeting them and wish I could have been there live and in-person (but, having gotten my second vaccine shot today, more live and in-person events are in my future!).

One member of the medical staff asked if I had material on how to enhance the safety planning process with patients. After fumbling the question for a while, I remembered that I included a safety planning case example in Chapter 8 of our suicide book. I’ve included the excerpt below. Although the case is written in my voice, as you read through, think about how you might put it into your voice.

This case description illustrates a positive working relationship and outcome. Just to make sure you know that I’m not too Pollyannaish about suicide-related work, the whole book also includes cases and situations with less positive scenarios and outcomes.

**********************

Below, the counselor is discussing a safety plan with a 21-year-old cisgender female college senior named Kayla. Kayla was attending a large state university and living off campus in a small apartment. In this case, Kayla was social distancing in compliance with state stay-at-home orders; the session was conducted remotely, via an online video-based HIPAA-compliant platform (e.g., Doxy.me, SimplePractice, etc.).

The Opening and Unique Suicide Warning Signs

Counselor: Kayla, I’m putting your name on the top of this form [holds form up to camera]. It’s called a safety planning form. Some very smart people made up this form to help people stay safe. There are six questions. We’re supposed to fill it out together. If you hate it when we’re done, we can toss it in the trash. Okay?

Kayla: Okay. That’s possible.

Counselor: That would be fine. Here’s the first question. I’m just going to read them to you. Then you answer, I’ll write down your answers, and then we talk about your answer. What are the signs, in yourself or in your environment that will be a warning that tells you that you need to do something to keep yourself safe?

Kayla:    I just like feel a wave of sadness and defeat. Like my life means nothing. Like I’m a damaged, bad person who should die.

Counselor: Okay. A wave of sadness and defeat. How will you know that wave has come? What do you feel in your body or think in your brain?

Kayla:    I feel a physical ache. I think about being abused. I think horrible thoughts.

Counselor: I’m writing down, “Wave of sadness and defeat, and physical ache, and thoughts of being damaged, bad, and abused.” Those are all signs that you should follow this safety plan.

Kayla:    Also, being home alone at night.

In this initial exchange the counselor empowers Kayla to reject the plan if she wants to. Offering to let Kayla reject the plan probably makes it more likely for her to take ownership of the plan. If Kayla ends up rejecting the plan, that information becomes part of the overall assessment and guides treatment decision-making.

Kayla immediately engages in the process. Specifically, her trauma-based thoughts of being damaged and bad could be fruitful therapeutic grist for cognitive processing therapy or EMDR, both of which address trauma and focus on beliefs about the self. However, when using the SPI, it’s best to stay focused on the SPI, and save the deeper therapeutic content for later. The counselor could (and should) have said, “For now, we’re working on this plan. But later on, if you want, we can start working on your feelings of being damaged and bad.”

Personal Coping Strategies

Counselor: What can you do in the moment to cope with suicidal thoughts and feelings?

Kayla:    Look. I could cut myself to feel better, but nobody wants me to do that.

Counselor: I’m sure it’s true that people don’t want you cutting. I also think it’s true that people would rather have you cut yourself than kill yourself. If cutting keeps you alive, we should put it in the plan, at least for now.

Kayla: I think it should be there then.

Counselor: Okay. So, cutting goes on here as a method for calming or soothing yourself. Have I got that right?

Kayla:    Yeah. It calms me down when I’m upset.

Counselor: What else could calm you down or distract you from suicidal thoughts?

Kayla:    I could listen to music or call a friend.

Counselor: Great. I’m writing those ideas into the plan right now.

Brainstorming coping responses is similar to other processes discussed in chapter 5 (problem-solving and alternatives to suicide). One key principle is to accept all responses before evaluating them later. In the preceding interaction, the counselor accepts that cutting might be a viable (even if not preferred) short-term coping strategy, and then continues to nudge Kayla to generate additional coping ideas. Although cutting isn’t addressed in this case example, after developing the safety plan, therapeutic conversations about cutting and alternatives to cutting, should become a part of ongoing counseling (see Kress et al., 2008; Stargell et al., 2017). 

Social Contacts and Settings

Counselor: I’m wondering about those times when you’re alone. Who could you be with to stay safe? Even if it’s only for you to distract yourself?

Kayla:    I have a friend named Monroe. He’s crazy. He’s always happy. Sometimes he annoys me, but he’s a good distraction.

Counselor: Monroe sounds like a great distraction. He’s in the plan. Are you able to see him in person, or would you do Facetime or a Zoom call.

Kayla: He lives in the apartment building and we could meet up outside.

Counselor: That sounds great. Who else?

Kayla: I can always call my parents, but when I do, I feel like failure. I’m an adult.

Counselor: If you’re feeling suicidal, would your parents want you to call?

Kayla: Yeah.

Counselor: Okay then. Let’s put your parents down. We can talk more later about how calling them might make you feel. 

The counselor does a good job of getting Kayla to be specific about how she could connect with Monroe. Overall, Kayla doesn’t have an extensive social support network. Expanding that network will likely become an important goal for counseling.

People Whom I Can Ask Help

Counselor: This question is similar to the last one, but a little different. Instead of people who are distracting, now I’m wondering who you can turn to if you’re in crisis?

Kayla:    Monroe wouldn’t be the right person for that.

Counselor: Not Monroe. But who would be right for that?

Kayla:    My parents, I guess. And my aunt, Sarah. She’s always been there for me. I could call her if I need to. And my grandma.

Counselor: Good. That’s four. Your mom, your dad, your aunt Sarah, and your grandma. Are they around here, or would you call or text them?

Kayla:    My parents and aunt live close by, but we’d probably just Facetime because they’re older I don’t want them to get COVID. My grandma lives in Minnesota.

While generating lists, it’s useful to draw clients into being even more specific than illustrated in this exchange. For example, as Kayla identifies people to call, getting specific about texting or calling, where the person might be, and what to do if there’s no answer, is good practice. Role playing a call or text can be useful, because rehearsing behaviors make them more likely to occur.

Mental Health Professionals or Agencies to Contact

Counselor: How about professionals or agencies that you can call if you’re in a crisis?

Kayla:    I don’t have anyone.

Counselor: Wait. You need to put me here. I should be on the list. I can be available for short calls Sunday through Thursday evenings up until 9pm.

Kayla:    Okay.

Counselor: And there’s 9-1-1, right? You can always call 9-1-1. In an emergency, that’s what you do. There’s also a new suicide hotline number, 9-8-8. I’m going to write that number down too. You don’t have to call any number, but it’s good to have them just in case you do want to call for professional help during a crisis. The other thing to remember about calling hotlines is that you may get someone you don’t like or don’t connect with. If that happens, keep trying, but also, jot down a few notes so you can tell me about it. 

 In the preceding exchange, the counselor offers to be a limited option. Whether you provide a personal contact number is up to you. Whatever you do, spell it out in your informed consent and have boundaries around the times when communications with you are acceptable. Because calling hotlines may or may not feel helpful, empowering Kayla to critique her hotline experience and then report it to the counselor might increase her willingness to call.

How Can I Make My Environment Safe?

Counselor: This last question has to do with how you can make your environment safe. We’ve talked about various things, like how you can cope and who you can call. Now we need to talk about whether there’s anything dangerous in your home, anything that could be used to kill yourself if you were suddenly suicidal.

Kayla: Yeah. Well I bought a hand-gun last year. That’s how I would do it.

Counselor: Right. Thanks for telling me about the gun. Can I just tell you what I’m thinking right now?

Kayla:    Sure.

Counselor: With guns and suicide, there are two good options. One is for you to give it to someone for now, until you’re feeling better. The other is for you to safely store the gun or get a trigger lock. I’m just being totally honest with you about this. The reason we should get your gun locked up or given to your parents or someone else, is because most of the time, people are intensely suicidal for only 5 or 10 or maybe 30 minutes. During that intense time, people can do things they later regret. Most people who make a suicide attempt don’t make another attempt. It’s usually a one-time thing. My main goal is for you to be safe.

Kayla:    But I’m not planning to use the gun or anything.

Counselor: Right. That’s great. But let’s say your Aunt Sarah was suicidal and she had a gun, would you be willing to keep it for her if it made her safer?

Kayla: Of course I would.

Counselor: So, whether it’s you or your Aunt Sarah, we want to make sure suicide doesn’t happen because of one terrible moment. 

The preceding is an example of psychoeducation around suicidality and safety planning. If you have a good rapport and connection with your client, the psychoeducation is likely to be well-received. If your rapport and connection is less good, then you’ll either need to work on the relationship, or take a more directive and authoritative role to promote your client’s safety. 

Counselor: All right. I’ve written down your ideas for the safety plan. Now, I’m going to scan it and send it to you through our secure portal. As we’ve already discussed, we’re going to make a bigger plan for your counseling. But in the meantime, we need to keep you safe so we can do the counseling. Right now, you’ve got this safety plan you can use, and we can revise it if we need to.  Okay?

Kayla:    Okay.

Counselor: Kayla, thank you very much for working with me on this safety plan. I think we made a good plan together.

Kayla:    Me too. I guess I won’t throw it in the trash.

Counselor: You’re pretty funny.

Please excuse any typos or bad grammar. The preceding is a pre-published (and pre-copyedited) version from my computer. To check out and possibly purchase the whole darn book, you can go here: https://imis.counseling.org/store/detail.aspx?id=78174

What’s Happening in Happiness Class?

We start every happiness class with music.

As many of you know, the class generated a pretty cool song playlist. Typically, I select a song from the playlist, download it into my powerpoint, and start the music at 12:55pm. I say typically in that optimistic—see the glass half-full—sort of way, because, in reality, sometimes I struggle to get the music video to play, other times I start it a bit late (and begin to hear my Zooming students query, “What’s happening? Where’s the music?”), and still other times I go rogue and pick an off-list song that I happen to think fits the topic perfectly.

Last week, before we explored spirituality and forgiveness, I couldn’t resist playing “Heart of the Matter” by Don Henley . . . and now I can’t stop the tune and lyrics in my head . . . “Forgiveness, forgiveness, even if, even if, you don’t love me anymore.” For your immediate listening pleasure, here’s the Henley music link:  https://www.youtube.com/watch?v=Rxni_Icyjj8&list=RDRxni_Icyjj8&start_radio=1&t=213

Usually I consider it best practice to keep my camera and microphone off during the opening music. You can imagine why. Holding on to the small shreds of respect that I’ve not yet squandered seems like good judgment, because if I let go, things might look like this: https://www.youtube.com/watch?v=W0Nju66rif4&feature=youtu.be

After the opening music I burst into the Zoom scene with energetic and pithy commentary designed to get everyone focused in on our topic of the day. Then, after a few orienting announcements, I send students into Zoom break-out rooms where they ask and answer the questions: “What do you remember from our last class” and “What about our last class seemed important to you and your life?”

My sense—based on our immediate debriefing after the break-out rooms—is that some students are finding joy in their five-minute one-on-one Q & A time. However, recently I heard from a few students that they particularly dislike the Zoom break-out experience. This leads me to a conundrum (why are there so many conundrums?). Should I continue with the opening class break-out rooms, or should I find another pedagogical strategy? Please enlighten me on whether you think I should continue with the break-out rooms or find a suitable alternative.

Following the break-out rooms and debriefing, I (sometimes accompanied by Rita), launch into lecture content. We talked about spirituality for three class meetings, and have also hit gratitude, kindness, cognitive methods for dealing with pesky negative thoughts, and much more. In order to not completely bore anyone, I shift in and out of the powerpoint slides, inserting side commentaries, forcing students to imagine their part of research studies, and facilitating experiential activities. My favorite two activities (so far) were having students engage in an on-camera Gestalt two-chair with themselves (the visuals were hilarious) . . . and having everyone shout out the word “fail” over and over again for 60 seconds. The “fail” activity is based on research on deconstructing particular words so they lose their power over us, and begin just sounding like funny sounds. The best part of that activity was having students report back that when they yelled “fail” repeatedly into their computers, their roommates thought they were having serious existential meltdowns.

Class usually closes with a large group discussion, during which I’m humbled by the depth and breadth of student commentary. On occasion, I’ve pushed quieter students to comment, and in every case, they’ve delivered. I’d share some examples, but the student comments are theirs to share. Let me just say, on their behalf, it’s good to listen to students.

Class ends with a flurry of good-byes, as well as expressions of gratitude and affection.

Although I’m not completely certain students are feeling the joy, I can say with confidence that I am. I’m loving the experience and deeply appreciating how often my students are making the Zoom version of happiness class . . . magical.