Category Archives: Writing

Guidelines for Giving and Receiving Feedback

Feedback 2

Giving and receiving feedback is a huge topic. In this blog post the focus is on giving and receiving feedback in classroom settings or in counseling/psychotherapy supervision. The following guidelines are far from perfect, but they offer ideas that instructors and students can use to structure the feedback giving and receiving process. Check them out, and feel free to improve on what’s here.

Before you do anything, remember that feedback can feel threatening. Hearing about how we sound and what we look like is pretty much a trigger for self-consciousness and vulnerability. Sometimes, when we look in the mirror, we don’t like what we see, and so obviously, when someone else holds up a mirror, the feedback we experience may be . . . uncomfortable. . . to say the least. To help everyone feel a bit safer, the following can be helpful:

  • Acknowledge that feedback is scary.
  • Emphasize that feedback is essential to counseling skill development.
  • Share the feedback process you’ll be using
  • Make recommendations and give examples of what kind of feedback is most useful.

Acknowledge that Feedback is Scary: You can talk about mirrors (see above), or about how unpleasant it is for most people to hear their own voices or see their own images, or tell a story of difficult and helpful feedback. I encourage you to find your own way to acknowledge that feedback triggers vulnerability.

Feedback is Essential: Encourage students to lean into their vulnerability and be open to feedback—but don’t pressure them. Explain: “The reason you’re in a counseling class is to improve your skills. Though hard to hear, constructive feedback is useful for skill development. Don’t think of it as criticism, but as an opportunity to learn from mistakes and improve your counseling skills.” What’s important is to norm the value of giving and getting feedback.

Share the Process You’ll be Using: Before starting a role play or in-class practice scenario, describe the guidelines you’ll be using for giving and receiving feedback (and then generate additional rules from students in the class). Here are some guidelines I’ve used:

  • Everyone who volunteers (or does a demonstration or is being observed) gets appreciation. Saying, “Thanks for volunteering” is essential. I like it when my classes established a norm where whoever does the role-playing or volunteers gets a round of applause.
  • After being appreciated, the role-player starts the process with a self-evaluation. You might say something like, “After every role play or presentation, the first thing we’ll do is have the person or people who were role-playing share their own thoughts about what they did well and what they think they didn’t do so well.”
  • After the volunteer self-evaluates, they’re asked whether they’d like feedback from others. If they say no, then no feedback should be given. Occasionally students will feel so vulnerable about a performance that they don’t want feedback. We need to accept their preference for no feedback and also encourage them to solicit and accept feedback at some later point in time.

Giving Useful Feedback: Feedback should be specific, concrete, and focused on things that can be modified. For example, you can offer a positive or non-facilitative behavioral observation (e.g., “I noticed you leaned back and crossed your arms when the client started talking about their sexuality.”). After making an observation, the feedback giver can offer a hypothesis (e.g., “Your client might interpret you leaning back and crossing your arms as judgmental”). The feedback giver can also offer an alternative (“Instead, you might want to lean forward and focus on some of your excellent nonverbal listening skills.”). BTW: General and positive comments (e.g., “Good job!”) are pleasant and encouraging, but should be used in combination with more specific feedback; it’s important to know what was good about your job.

Constructive or corrective feedback shouldn’t focus so much on what was done poorly, but emphasize what could be done to perform the skill correctly. Constructive or corrective feedback might sound like this: “I noticed you asked several closed questions that seemed to slow down the counseling process. Closed questions aren’t bad questions, but sometimes it’s easier to keep clients talking about important content if you replace your closed questions with open questions or with a paraphrase. Let’s try that.”

Other examples: Instead of saying, “Your body was stiff as a board,” try saying, “I think you’d be more effective if you relaxed your arms and shoulders more.” Or you could take some of the evaluation out of the comment by just noticing or observing, rather than judging, “I noticed you said the word, ‘Gotcha’ several times.” You can also ask what else they might say instead, “To vary how you’re responding to your client, what might you say instead of ‘Gotcha’?”

General negative comments such as “That was poorly done.” should be avoided. To be constructive, provide feedback that’s specific, concrete, and holds out the potential for positive change. Also, feedback should never be uniformly negative. Everyone engages in counseling behaviors that are more or less facilitative. If you happen to be the type who easily sees what’s wrong, but you have trouble offering praise, impose the following rule on yourself: If you can’t offer positive feedback, don’t offer any at all. Another alternative is to use the sandwich feedback technique when appropriate (i.e., say something positive, say something constructive, then say another positive thing).

IMHO, significant constructive feedback is the responsibility of the instructor and should be given during a private, individual supervision session. The general rule of: “Give positive feedback in public and constructive feedback in private” can be useful.

Finally, students should be reminded of the disappointing fact that no one performs perfectly, including the teacher or professor. Also, when you do demonstrations, be sure to model the process by doing a self-evaluation (including things you might have done better), and then asking students for observations and feedback.

 

 

Suicide Education Resources . . . and Why is it so Easy to Experience Imposter Syndrome?

100 Days: What Happens Next?

Elephants

For many, watching a sweaty Donald Trump give himself high praise for being able to pass a cognitive test that awards points for accurately identifying a picture of an elephant is oddly reassuring. Liberals, #NeverTrumpers, and other hopeful humans have had difficulty covering their glee. Mocking Trump’s person-woman-man-camera-TV buffoonery and how it illustrates his diminished or diminishing mental capacity is gratifying.

Speaking of buffoonery—because it’s more pleasant than what I’ll speak of next—a former student of mine sent me his proposal for a new cognitive test. He calls it the Idaho Cognitive Assessment (IdCA). Here’s what he wrote:

Listen, I’ve been making up five item memory tests for myself lately, and I ace them every time. For example, I’ll list off the names of my three kids, Monica, and our dog, and when I try to remember them a minute later, it’s easy for me. It’s not easy for everyone, but it’s easy for me. I even give myself extra points if I get them in order.

The IdCA is a fabulous and perfect parallel to the Donald Trump Cognitive Assessment (DtCA).  Using his clever spontaneity, Trump made up the DtCA on the spot while being filmed by a person, a woman, a man, a camera, and a TV. Just for the record, although the Montreal Cognitive Assessment (MoCA) isn’t especially difficult, it’s harder than the IdCA and the DtCA. But because Trump lies about everything we still don’t really know if could identify an elephant, remember five items, or pass the MoCA.

What I wish (and, I suspect, many others) is that Donald Trump was only a sweaty buffoon making a comedic cameo on Fox News. But, sadly, he’s more than a sweaty buffoon; he’s a dangerous sweaty buffoon, serial liar, and incompetent leader who’s putting the future of the United States and planet Earth at risk. What I fear is that while gloating over his buffoonery, we’ll forget that Trump is also an evil genius.

Trump is a once-in-a-century antisocial demagogue. If you don’t know what that means, check out my Slate article or this blog post: https://johnsommersflanagan.com/2018/11/05/my-closing-argument-take-a-breath-check-your-moral-compass-and-vote-for-checks-and-balances-in-government/.

Trump has a particularly unsavory personality type. Documentation of this personality type goes back to Aristotle’s student, Theophrastus (371 – 287 B.C.), who wrote:

The Unscrupulous Man will go and borrow more money from a creditor he has never paid . . . . When marketing he reminds the butcher of some service he has rendered him and, standing near the scales, throws in some meat, if he can, and a soup-bone. If he succeeds, so much the better; if not, he will snatch a piece of tripe and go off laughing (from Widiger, Corbitt, & Millon, p. 63).

About 2000 years later, the famous American physician, Benjamin Rush, picked up on Theophrastus’s theme, becoming intrigued with what was briefly called moral insanity. In cases of moral insanity, individuals are capable of clear and lucid thought, but repeatedly engage in irresponsible, immoral, and destructive behaviors without experiencing guilt or shameless. These shameless criminals act boldly, but without moral compass, believing that only they could possibly divine the true and correct way forward. In an apt description of Trump’s everyday behavior, Rush wrote: “Persons thus diseased cannot speak the truth upon any subject” (1812, p. 124).

Although predicting the future is always inexact, Trump’s personality type provides a reasonable foundation. That being the case, my personality-based predictions for Trump’s future behaviors are below—along with ways in which we, as U.S. citizens interested in the continuation of a democratic republic—can respond.

  1. Trump will tell more and bigger lies. As threats to his presidency and risks of defeat loom, Trump’s lies will grow in size and frequency. The good news is that Trump’s lies will grow more obvious, and hopefully the American public and media can leverage them to further grow opposition.
  2. Trump will continue to show poor judgment, principally because he’s the only one who living in his personal decision-making echo chamber. Trump’s logic and gut are impaired. His decisions will continue to often be wrong and dangerous. The good news about Trump’s poor judgment is that if the media can pounce on his upcoming egregiously bad decisions, the public may continue to grow in their distrust of him.
  3. Trump will deflect responsibility. Trump’s moral philosophy includes complete opposition to taking responsibility for mistakes. This pattern will continue. As in the past, he’ll blame others (e.g., Obama, Biden, Clinton) for things they’ve never done. In many cases, his deflecting responsibility will include abject projection (Crooked Hillary was clearly a projection by Crooked Donald). Trump’s tendency to project his own criminal behavior onto others can provide leads to what he’s doing. Also, and this is critical, EVERYTHING Trump does needs to be framed as the responsibility of every individual member of the GOP, until and unless they split from him.
  4. To compensate for his slagging physical and intellectual abilities, Trump will become increasingly desperate to look strong. The bad news is that Trump posturing may translate into more tear gas, more fomenting of foreign conflict, and more steps toward martial law. The good news is that he cannot stop himself from looking and acting pathetic . . . and as organizations like the Lincoln Project target Trump’s weakness and pathetic efforts to appear competent, they’re proving their exceptional media savvy.
  5. Trump will stoke division and inflame hatred. This is a common Trumpian strategy. The good news is that many Americans are aware of this strategy and can compensate with unification. The other good news is that if polls continue downward, Trump won’t be able to resist stoking division within his own ranks.
  6. Trump will continue to seek profit and praise to assuage his battered ego. Again, the more desperate his follows this path, the more likely he is to make mistakes, and the more opportunities there are to catch him, red-handed, in criminal activity.
  7. Trump will continue in his role as influence-peddler in chief. Trump will use money, power, legal intimidation, and any leverage he can find to recruit and embolden followers. The details of how he accomplishes this and the psychological vulnerability of ForeverTrumpers is grist for another mill, but count on it to continue, and count on it to continue to seem completely irrational.

I know there’s nothing much new here. But the point is that now and into the future we need to maintain a planned and proactive attack on Trump’s competence, with unwavering focus on catching him and holding him accountable for the many lies, mistakes, and criminal activities he will be engaging in for the next 100 days. We know Trump is an immensely narcissistic compulsive liar who lacks basic self-awareness and seems unable to muster up empathy or compassion for anyone other than his loyal, criminal, and sycophantic followers—even when those followers happen to have deep links to pedophilia or the Russian mob. However, we also know that these traits were in place four years ago, and he was elected anyway. That’s why, right now, as we enter the home-stretch, we all need to be focused like a laser on deconstructing his genius while simultaneously, exposing his weaknesses, his criminal activities, and every manifestation of his pathetic buffoonery . . . as he makes his way down the slippery metaphoric ramp toward November 3, 2020.

Trump on Ramp

To Mask or Not to Mask: Making America Rational Again

Make America Rational Again

About 4 years ago, I made a MARA hat. MARA stands for “Make America Rational Again.” My hat was in honor of the late Albert Ellis, a famous psychologist who relentlessly advocated for rational thinking. Given that some folks are doubting Covid-19, while others are passionately accusing health officials of infringing on their God-given liberties, I’m thinking my MARA hat from the last presidential election is still in style.

Way back when I was a full-time therapist working mostly with teenagers, I developed a method for talking with my teen-clients about their freedoms. When they complained about their parents infringing on their rights—those damn parents were pronouncing unreasonable curfews, alcohol prohibitions, and other silly mandates—I’d say something like this:

“Really, you only have three choices. You can do whatever your parents think you should do. That’s option #1. Or, you can do the opposite of what your parents think you should do. That’s option #2. Those are easy options. You don’t even have to think.”

Hoping to pique the teen’s interest, I’d pause and to let my profound comments linger. Sometimes I got stony silence, or an eye-roll. But usually curiosity won out, and my client would ask:

“What’s the third choice?”

“The third choice is for you to make an independent decision. But that’s way harder. You probably don’t want to go there.”

Actually, most of my teenage clients DID want to go there. They wanted to learn, grow, develop, and become capable of effective decision-making. Sadly, that doesn’t seem to be the case today. All too often, Americans are basing their decision-making on poor information. For example, when people are gathering the 411 on whether they should mask-up in public settings, to where do they turn? The rational choice would be medical professionals and virologists. But instead, people are turning to Facebook, Twitter, and even worse, Fox News, where misinformation from Tucker Carlson, Laura Ingraham, and Sean Hannity is offered up with nary a shred of journalistic ethics or integrity (for a fun and fabulous SNL Parody with Kate McKinnon as Laura Ingraham, check out this link: https://www.youtube.com/watch?v=XezLiezWN0E).

A related question that’s especially pressing right now is this: “How should we respond to coronavirus deniers and rabid anti-maskers?” Speaking for myself, I’ve been struggling to find the right words. Saying what I’m thinking—which usually starts with “WTF!? Have you been listening to Tucker Carlson instead of Dr. Fauci?”—seems too offensive and unhelpful. Instead, I’m making a commitment to letting go of the outrage, putting my 2016 campaign hat back on, and making myself rational again. Instead of being angry, my plan is to retreat to rationality. I’ll say things like this: “Hey, I’m curious, have you read the latest article in the New England Journal of Medicine titled, “Observational study of hydroxychloroquine in hospitalized patients with Covid-19?” or, “What are your thoughts about the chilblain-like lesions doctors are finding on patients with Covid-19?” or “According to the CDC and Dr. Fauci and the American Medical Association, the cloth face coverings—although imperfect—statistically reduce the likelihood of spreading the coronavirus.”

I invite you to join me in gathering good data for our personal and social decision-making. Together, we can Make America Rational Again.

Individualizing Suicide Risk Factors in the Context of a Clinical Interview

Spring 2020

In response to my recent post on “The Myth of Suicide Risk and Protective Factors” Mark, a clinical supervisor from Edmonton, wrote me and asked about how to make individualizing suicide risk factors with clients more concrete/practical and less abstract. I thought, “What a great question” and will try to answer it here.

Let’s start with two foundational prerequisites. First, clinical providers need to be able to ask about suicide in ways that don’t pathologize the patient/client. Specifically, if clients fear that disclosing suicide ideation will result in them being judged as “crazy” or in involuntary hospitalization, then they’re more likely to keep their suicidal thoughts to themselves. This fear dynamic is one reason why we emphasize using a normalizing frame when asking about suicide.

Second, both before and after suicide ideation disclosures, providers need to explicitly emphasize collaboration. Essentially, the message is: “All we’re doing is working together to better understand and address the distress or pain that underlies your suicidal thoughts.” In other words, the focus isn’t on getting rid of suicidal thoughts; the focus is on reduction of psychological pain or distress.

With these two foundational principles in place, then the provider can collaboratively explore the primary and secondary sources of the client’s psychological pain. In our seven-dimensional model, we recommend exploring emotional, cognitive, interpersonal, physical, cultural-spiritual, behavioral, and contextual sources of pain. Collaborative exploration is fundamental to individualizing risk factors. The general statistics showing that previous attempts, social isolation, physical illness, being male, and other factors predict suicide are mostly useless at that point. Instead, your job as a mental health provider is to pursue the distress. By pursuing the distress, you discover individualized risk factors. The following excerpt from our upcoming book illustrates how asking about “What’s bad” and “What feels worst?” results in individualized risk factors.

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     The opening exchange with Sophia is important because it shows how clinicians—even when operating from a strength-based foundation—address emotional distress. In the beginning the counselor drills down into the negative (e.g., “What’s making you feel bad?”), even though the plan is to develop client strengths and resilience. By drilling down into the client’s distress and emotional pain, and then later identifying what helps the client cope, the counselor is individualizing risk and protective factor assessment, rather than using a ubiquitous checklist.

Counselor: Sophia, thanks for meeting. I know you’re not super-excited to be here. I also know your parents said you’ve been talking about suicide off and on for a while, so they wanted me to talk with you. But I don’t know exactly what’s happening in your life. I don’t know how you’re feeling. And I would like to be of help. And so if you’re willing to talk to me, the first thing I’d love to hear would be what’s going on in your life, and what’s making you feel bad or sad or miserable or whatever it is you’re feeling?

The counselor began with an acknowledgement and quick summary of what he knew. This is a basic strategy for working with teens (Sommers-Flanagan & Sommers-Flanagan, 2007), but also can be true when working with adults. If counselors withhold what they know about clients, rapport and relationship development suffers.

The opening phrase “I don’t know. . .” acknowledges the limits of the counselor’s knowledge and offers an invitation for collaboration. Effective clinicians initially and intermittently offer invitations for collaboration to build the working alliance (Parrow, Sommers-Flanagan, Sky Cova, & Lungu, 2019). The underlying message is, “I want to help, but I can’t be helpful all on my own. I need your input so we can work together to address the distress you’re feeling.”

The opening question for Sophia is negative (i.e., What’s making you feel bad or sad or miserable or whatever it is you’re feeling?). This opening shows empathy for the emotional distress that triggers her suicidality and clarifies the link between her emotional distress and the triggering situations. By tuning into negative emotions, the counselor hones in on the presumptive primary treatment goal for all clients who are suicidal—to reduce the perceived intolerable or excruciating emotional distress (Shneidman, 1993).

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Collaborative exploration is the method through which risk and protective factors are individualized. If Sophia had a previous attempt, the reason to explore the previous attempt would be to discover what created the emotional distress that provoked the attempt, and how counseling or psychotherapy might address that particular factor. For example, if bullying and lack of social connection triggered Sophia’s attempt, then we would view bullying and social disconnection as Sophia’s particular individualized risk factors. We would then build treatments—in collaboration with Sophia and her family—that directly address the unique factors contributing to her pain, and provide her with palpable therapeutic support.

I hope this post has clarified how to individualize suicide risk factors and use them in treatment. Thanks for the question Mark!

A Glorious Moment

Pumpkins at birth

One nice thing about having my own blog is I get to post whatever I want. Sometimes that means I suffer from my own bad judgment. But not today.

Today, I’m posting a link to a fresh, new article in Democracy: A Journal of Ideas. The article is titled, “Our False Promise of Justice.” Not only is this article timely and compelling; not only is it well-reasoned and compassionate; not only is it balanced and beautiful prose; it’s also written by Rylee Sommers-Flanagan, my youngest daughter, who happens to be an attorney, a graduate of Stanford Law School, and a pretty fantastic person. Okay, so now I’m just bragging.

Despite my bragging, the preceding information is all true. At least IMHO.

If you read it and like it, please do me the favor of sharing this article with your friends and on social media.

Here’s the link: https://democracyjournal.org/magazine/our-false-promise-of-justice/

 

The Myth of Suicide Risk and Protective Factors

 

HummingbirdMyths are fascinating, resilient ideas that openly defy reality.

Some people say, “All myths are based in truth.” Well, maybe so, but tracking down the myth’s truthful origins reminds me of my friends back in high school who used to take their dates snipe hunting. Maybe the idea that all myths are based in truth is a myth too?

Suicide is a troubling problem (this is an obvious understatement). To deal with this troubling problem, one of the tools that most well-intended prevention programs advocate is to watch for suicide risk factors and warning signs, and when you see them, intervene. This would be great guidance if only useful or accurate suicide risk factors and warning signs existed. Sadly, like the snipe, you can look all night for useful or accurate risk factors and still come up empty.

I’m writing about mythical risk factors and warning signs today because I just covered this content in our suicide assessment and treatment manuscript. In the following excerpt, we’re writing about suicide competencies for mental health professionals:

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Cramer and colleagues (2013) noted, “One of the clinician’s primary objectives in conducting a suicide risk assessment is to elicit risk and protective factors from the client” (p. 6). As we’ll discuss in greater detail later, this competency standard is problematic for at least three reasons. First, in an extensive meta-analysis covering 50-years of research, the authors concluded: “All [suicide thoughts and behavior] risk (and protective factors) are weak and inaccurate. This general pattern has not changed over the past 50 years” (Franklin, et al., 2017, p. 217).

Second, the number of potential risk and protective factors that counselors should be aware of is overwhelming. Granello (2010a) reported 75+ factors, we have a list of 25 (Sommers-Flanagan & Sommers-Flanagan, 2017), and even Cramer and colleagues lamented, “It would be impossible for clinicians to be familiar with every risk factor” (p. 6). Jobes (2016) referred to suicidology as “a field that has been remarkably obsessed with delineating countless suicide ‘risk factors’ (that do little for clinically understanding acute risk)” (p. 17).

Third, prominent suicide researchers have concluded that using risk and protective factors to categorize client risk is ill-advised (McHugh, Corderoy, Ryan, Hickie, & Large, 2019; Nielssen, Wallace, & Large, 2017). For example, even the most common suicide symptom and predictor (i.e., suicide ideation), is a poor predictor of suicide in clinical settings; this is because suicide ideation occurs at a very high frequency, but death by suicide occurs at a very low frequency. In one study, 80% of patients who died by suicide denied having suicidal thoughts, when asked directly by a general medical practitioner (McHugh et al., 2019). Even the oft-cited risk factor of previous suicide attempt has little bearing whether or not individuals die by suicide.

When AAS (2010) and Cramer and his colleagues (2013) described the risk and protective factor competency, eliciting risk and protective factors from clients was standard professional practice. However, in recent years, researchers have begun recommending that practitioners avoid using risk and protective factors to categorize client risk as low, medium, or high—principally because these categorizations are usually incorrect (Large, & Ryan, 2014). In a review of 17 studies examining 64 unique suicide prediction models, the authors reported that “These models would result in high false-positive rates and considerable false-negative rates if implemented in isolation” (Belsher et al., 2019, p. 642).

To summarize, this suicide competency boils down to four parts:

  1. Competent practitioners should still be aware of evidence-based suicide risk and protective factors.
  2. Competent practitioners are aware that evidence-based suicide risk and protective factors may not confer useful information during a clinical interview.
  3. Instead of over-relying on suicide risk and protective factor checklists, competent practitioners identify and explore client distress and then track client distress back to individualized factors that increase risk and enhance protection.
  4. Competent practitioners use skills to collaboratively develop safety plans that address each client’s unique risk and protective factors.

Although risk and protective factors don’t provide an equation that tell clinicians what to do, knowing and addressing each unique individual’s particular risks and strengths remains an important competency standard.

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As always, even though getting feedback on this blog is yet another mythical phenomenon,  please send me your thoughts and feedback!

 

 

 

A Sneak Peek at Our Upcoming Suicide Assessment and Treatment Book with the American Counseling Association

Spring Sunrise and Hay

Rita and I are spending chunks of our social distancing time writing. In particular, we’ve signed a contract to write a professional book with American Counseling Association Publications on suicide assessment and treatment planning. We’ll be weaving a wellness and strength-oriented focus into strategies for assessing and treating suicidality.

Today, I’m working on Chapter 6, titled: The Cognitive Dimension. We open the chapter with a nice Aaron Beck quotation, and then discuss key cognitive issues to address with clients who are suicidal. These issues include: (a) hopelessness, (b) problem-solving impairments, (c) maladaptive thinking, and (d) negative core beliefs.

Then we shift to specific interventions that can be used to address the preceding cognitive issues. In the following excerpt, we focus on collaborative problem solving and illustrate the collaborative problem-solving process using a case example. As always, feel free to offer feedback on this draft content.

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Collaborative Problem-Solving

Though not a suicide-specific intervention, problem-solving therapy is an evidence-based approach to counseling and psychotherapy (Nezu, Nezu, & D’Zurilla, 2013). Components of problem-solving are useful for assessing and intervening with clients who are suicidal. As Reinecke (2006) noted, “From a problem-solving perspective, suicide reflects a breakdown in adaptive, rational problem solving. The suicidal individual is not able to generate, evaluate, and implement effective solutions and anticipates that his or her attempts will prove fruitless” (p. 240).

Extended Case Example: Sophia – Problem-Solving

In Chapter 5 we emphasized that clinicians should initially focus on and show empathy for clients’ excruciating distress and suicidal thoughts. However, there often comes a moment when a pivot toward the positive can occur. Questions that help with this pivot include:

  • What helps, even a tiny bit?
  • When you’ve felt bad in the past, what helped the most?
  • How have you been able to cope with your suicidal thoughts?

In response to these questions, clients who are suicidal often display symptoms of hopelessness, mental constriction, problems with information processing, or selective memory retrieval. Statements like, “I’ve tried everything,” “Nothing helps,” and “I can’t remember ever feeling good,” represent cognitive impairments. Even though your clients may think they’ve tried everything, the truth is that no one could possibly try everything. Similarly, although it’s possible that “nothing” your client does helps very much, it’s doubtful that all their efforts to feel better have been equally ineffective. These statements indicate black-white or polarized thinking, as well as hopelessness and memory impairments (Beck et al., 1979; Reinecke, 2006; Sommers-Flanagan & Sommers-Flanagan, 2018).

Pivoting to the Positive

Picking up from where we left off in Chapter 5, after exploring the distress linked to Sophia’s suicide ideation in the emotional dimension, the counselor (John) pivots to asking about the positive (“What helps?”) and then proceeds into a problem-solving assessment and intervention strategy. One clearly identified trigger for Sophia’s suicidal thinking is her parent’s fighting. She cannot directly do anything about their fights, but she can potentially do other things to shield herself from the downward cognitive and emotional spiral that parental fighting activates in her.

John: Let’s say your parents are fighting and you’re feeling suicidal. You’re in your room by yourself. What could you do that’s helpful in that moment? [The intent is to shift Sophia into active problem-solving.]

Sophia: I have a cat. His name is Douglas. Sometimes he makes me feel better. He’s diabetic, so I don’t think he’ll live much longer, but he’s comforting right now.

John: Nice. My memory’s not perfect, so is it okay with you if I write a list of all the things that help a little bit? Douglas helps you be in a better mood. What else is helpful?

Sophia: I like music. Blasting music makes me feel better. And I play the guitar, so sometimes that helps. And volleyball is a comfort, but I can’t play volleyball in my room.

John: Yeah. Great. Let me jot those down: music, guitar, volleyball, and being with your cat. And volleyball, but not in your room! I guess you can think about volleyball, right? And how about friends? Do you have friends who are positive supports in your life?

Although the fact that Douglas the cat has diabetes includes a depressive tone, the good news is that Sophia immediately engages in problem-solving. She’s able to identify Douglas and other things that help her feel better.

Throughout problem-solving, regularly repeating positive coping strategies back to the client is important. In this case, John summarizes Sophia’s positive ideas, and then asks about friends and social support—a very important dimension in overall suicide safety planning.

Sophia: Yeah, but we’re all busy. My friend Liz and I hang out quite a bit. I can walk into her house, and it will feel like my house. But we’re both in volleyball, so we’re both really busy. But our season will end soon. Hopefully that will help.

John: Ok, the list of things that seem to help, especially when you’re in a hard place with your parents fighting: Douglas the cat, music, guitar, and volleyball, and friends. Anything else to add?

Sophia:  I don’t think so.

Often, the next step in collaborative problem-solving is to ask clients for permission to add to the list, thus turning the process into a shared brain-storming session. At no time during the brainstorming should you criticize any client-generated alternatives, even if they’re dangerous or destructive. In contrast, clients will sometimes criticize your ideas. When clients criticize, just agree with a statement like, “Yeah, you’re probably right, but we’re just brainstorming. We can rank and rate these as good or bad ideas later.”

Overall, the goal is to use brainstorming to assess for and intervene with mental constriction. During brainstorming, Sophia and John generated 13 things Sophia could do to make herself feel better. Sophia’s ability to brainstorm in session is a positive indicator of her responsiveness to treatment.

 

2020 Dreams from My Mother

Mom in Chair

By most estimates, moms have had it rough this year. Day care centers are closed and moms are working from home; at the same time they’re homeschooling, keeping their children from watching porn on the internet, and sanitizing everything. And then there’s that former reality television star who perpetually gets himself in the news, rambling in front of cameras about treating the novel coronavirus with disinfectants in the body. In an optimal world, mothers would get celebrated way more than once a year. In a decent world, they’d be able to protect their children from exposure to Donald Trump.

Looking back 50 years or so, my own mother—she’s in a care facility now—was a mysteriously effective role model. She was more submissive than dominant, never hit me or raised her voice, didn’t directly boss anyone around, but indirectly gave my sisters and me VERY CLEAR guidance on what behaviors were expected in our home, and out in the world.

Rarely did my mother explicitly tell us how to behave. But once, when an African American family moved into our all-white neighborhood, she proactively, quietly, and firmly sat my sisters and me down and told us we would always treat them with respect. We did. When my mom got serious, we never questioned her authority.

One time, she was driving and a car squealed past us in a no-passing zone. She sighed, glanced over at me, and said, “I’ll be very disappointed if you ever drive like that.” For the next 5 decades, including my teen years, my friends and family have ridiculed me for my slow, conservative driving. I watch my speedometer, stop at yellow lights, and slow down at uncontrolled intersections. My mother said it once, I remembered what she said, and I still don’t want to disappoint her.

Without a stern word, my mother taught us to love our neighbors (even when they were annoying), showed us how to treat everyone with kindness and respect (even when they didn’t deserve it), and modeled how we could be generous with our time and energy by focusing on the needs and interests of others.

Once, when the family was out watching Paul Newman and Robert Redford in Butch Cassidy and the Sundance Kid, a sex scene started. Immediately, my mom elbowed my dad, and I was ushered from the theater. My mom didn’t want me to see or hear things that might lead me down the wrong path. She would cover my eyes and ears (literally) to stop me from being exposed to negative influences.

All this leads me to wonder how my mother would handle the disastrous role-model-in-chief. Mr. Trump is a mother’s nightmare, spewing out perverted values on a daily basis.

My mother’s first strategy would be to not let me hear whatever terrible ideas Trump gets out of his brain and into his mouth. She would have blocked me from watching news pieces about Mr. Trump’s playboy models, paid off porn stars, shitholes, Pocahontas, pussy-grabbing, gold star families, and references to women as pigs.

As much as my mother would have hated Mr. Trump’s sexist and racist words, she would be even more apoplectic about his poor character. If we saw or heard Mr. Trump counterattacking his critics, she would have sat us down, and talked about how an eye for an eye will leave us all blind.

If my mother caught us reading Trump’s tweets, she would have gathered us around the kitchen table for a spelling lesson. She would explain, “there’s no such word as unpresidented,” the phrase “twitter massages” makes no sense, “smocking guns” is just wrong, “the Prince of Whales” is from Wales, and journalists cannot win the “Noble prize.” She would never allow us to utter the word covfefe in our house.

My mother would be deeply offended by Mr. Trump’s incessant lying. If she were parenting us right now, every day she’d find a way to show us how we should admit our mistakes, take personal responsibility, and resist the temptation to blame others. She would talk about truth-telling. She would explain that Mr. Trump being President is a tragic mistake and that we should all work very hard to make sure this tragic mistake ends, so this malevolent man cannot continue to abuse women, minorities, and the American people.

But, for parents like my mother, Mr. Trump offers small advantages. As a teaching device, horrendous role models work quite well. In the end, and with one sentence, my mother would steal away all of Trump’s past and future influence. She would say, “I’ll be very disappointed if you ever act like that man.”

And we wouldn’t.

 

Happy Habits for Hard Times: Gratitude and Inspiration

Snow Angel

Episode 6 of the Happy Habits for Hard Times series was posted yesterday on the College of Education of the University of Montana’s website.

But it’s probably still relevant today.

The written portion of episode 6 is below.

You can get to the video via this link: https://coehs.umt.edu/happy_habits_series_2020/hhs_module_six.php

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You are what you focus on. When you remember what you’re grateful for and notice what inspires you, your day will be much better.

Humans tend to repeat behaviors that work out well for them and tend to stop doing things that don’t turn out well. Usually, when you get rewarded for something, you keep doing it. Of course, it’s more complicated than that, but today’s topic is all about introducing two new behaviors that we hope you’ll find rewarding.

As you know from previous episodes, there are behaviors (strategies) you can engage in that are likely to boost your mood. In this episode of Happy Habits, we elaborate on two strategies, but we’re confident you can think of more on your own. We are also aware that for some strange reason, even though these behaviors are rewarding, it’s still hard to get started doing them. That’s a topic for another day. For now, trust us and try these. There’s a reasonable chance that when you do them, you’ll feel better, and you’ll want to keep doing them.

Happiness Habit: Expressing Gratitude

Although it’s true that nearly everyone experiences gratitude, most of us don’t intentionally create time and space to express it. Expressing gratitude is a smart thing to do. It reminds you that you have positive things you are grateful for, it feels good to say “Thanks” and often, you make someone else feel good. Expressing gratitude makes for a nice, positive loop.

Along with the COVID-19 pandemic, it can be tempting to think we have little to be grateful for. While this may be true, it won’t help to dwell on the negative and feel sorry for yourself. Someone once said, “Oh, you think you have nothing to be thankful for? Take your pulse.” Now is a good time to use your brain to force yourself to think and behave with positivity.

Try the following steps:

  1. Identify someone toward whom you feel or have felt appreciation and gratitude. You may have plenty of options. It’s helpful to choose someone toward whom you believe you haven’t yet expressed enough gratitude.
  2. Write a gratitude note to that person. Include in the note why you feel gratitude toward to the person. Include specifics as needed, as well as words that best express your sincere heartfelt feelings toward the person.
  3. Find a way to express your feelings directly to your gratitude target. You can read the note in person, over the phone, or send it in whatever way you find best.

Your plan is to express gratitude. That means you need to drop any expectations for how the recipient of your gratitude should or will respond. Don’t focus on their response, instead, focus on doing the best job you can expressing the gratitude that you sincerely feel.

If the person loves hearing about your gratitude, cool. If the person is uncomfortable, or not positive, or silent, that’s okay. Your goal should be within your control—meaning: all you can control is your end of the communication and not how the communication is received.

If you get inspired, feel free to repeat this gratitude experiment a second or third time. You may find that gratitude begets gratitude.

Happy Habit: Notice Something Inspiring

Inspiring things are always happening. People are caring for the infirmed and elderly, risking their own health. People are volunteering, donating, and doing what they can. The word inspire comes from the Middle English enspire, from the Old French inspirer, and from the Latin inspirare ‘breathe or blow into’ from in- ‘into’ + spirare ‘breathe.’ The word was originally related to a divine or supernatural being, in a sense, ‘impart a truth or idea to someone’.

You can go pretty much anywhere on the internet right now and find inspiring stories. But instead, if possible, we want you to go live, in real time. We want you to watch for and then closely observe something inspiring that’s happening in your daily life.

The inspiring action that you notice may be small or it may be big. It might give you a tiny lift, or be jaw-droppingly inspiring. The key is that it involves intentionally watching for that which will inspire. Keep all your sensory modalities open for inspiration. Then, if you’re up for it, jot down what inspired you, or share it with someone else. What was it like to intentionally pay attention to things that might inspire you? The key is attitude. For whatever time you devote to this exercise, you’re focused on noticing positive actions and events. You’ve given yourself a little respite from the bad news lurking in every corner right now.

Inspiration can lift you up. Try it out. See what it can do for you.