Category Archives: Writing

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.

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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.   

How To Moodle

Grading a Quiz

Although automated quiz grading is awesome, two of your 25 quiz items need manual grading.

Click on item 24 of Student 1, to initiate manual grading.

Scroll everywhere without finding any place to manually enter grade.

Scroll again.

Find link to “manual override”

Click on manual override.

Enter grade.

Look for “save” button.

Notice that the Moodle screen doesn’t quite fit your laptop screen.

Begin muttering.

Plug laptop into larger external screen.

Move visual to larger screen.

Click on “save changes.”

Feel satisfaction from effective Moodle problem-solving.

Notice that nothing happens.

Swear.

Try clicking on next item that needs manual override.

Notice that nothing happens.

Swear again.

Click on item heading (in hopes of accessing ALL ungraded items)

Notice that instead of taking you into the item, Moodle takes you back to the whole list of student quiz scores.

Scroll sideways to re-locate items to grade.

Notice that item 24 for Student 1 IS NOW GRADED!

Smile to yourself at your Moodle success.

Follow identical process to grade item 24 for Student 2.

Notice the process no longer works.

Move to F-word in profanity cache.

Search “How to override an individual quiz item” in Google.

Almost find the right answer.

Try using the almost right answer.

Fail.

Continue with F-bombs, now in close combination with Moodle.

Write email to University IT help, trying not to type F-Moodle as Subject Line.

Wait.

Get tired of waiting.

Try grading again.

Notice that Moodle no longer recognizes you as having grading privileges.

Give yourself grading privileges.

Begin grading again.

Begin wishing you had used crayons to administer and grade quiz.

Step away from Moodle.

Begin an email invoicing Moodle or IT or the Universe for your lost time.

Delete email.

Consider describing your problems with Moodle in your next email to students, because you need to apologize to them for the delay in quiz-grading.

Delete paragraph of email to students where you described all your Moodle problems.

Send email.

Realize that Moodle timed out while you were composing your email, and consequently your email did not send.

Realize (again, because this has happened before) that Moodle has no automatic back-up for emails and consequently you have to re-write what was likely the most eloquent email you’ve ever written.

Recall that you had previously sworn to yourself to never again write a long email in Moodle.

Exercise risk management by stepping away from the computer.

Consider resigning from the University because of continued problems with Moodle, Qualtrics, Box, and repeated difficulties recalling your passwords.

Recognize, through a finely honed capacity for self-awareness and self-reflection, that you need to take a nap before engaging in any rash decision-making.

Take a nap.

Awake refreshed and optimistic.

Consider logging into Moodle.

Procrastinate, hoping Moodle will upgrade itself by the time you’ve finished writing a snarky blog about Moodle.

Post blog.

Happy Birthday Alfred Adler

Recently someone mistook me for an Adlerian. This got me thinking, “Maybe I am an Adlerian?” Then again, if you look at the history of counseling and psychotherapy, most of us are Adlerians. At one presentation I attended back when we attended those things, the presenters started with, “In the beginning, there was Adler.”

As a Happy Birthday tribute to Alfred Adler, below is an excerpt from our Adlerian theories chapter. There’s much more, of course, like, for example, what Adlerian theory would have to say about the Super Bowl.

Happy Birthday Dr. Adler.

Historical Context

Freud and Adler met in 1902. According to Mosak and Maniacci (1999), Adler published a strong defense of Freud’s Interpretation of Dreams, and consequently Freud invited Adler over “on a Wednesday evening” for a discussion of psychological issues. “The Wednesday Night Meetings, as they became known, led to the development of the Psychoanalytic Society” (p. 3).

Adler was his own man with his own ideas before he met Freud. Prior to their meeting he’d published his first book, Healthbook for the Tailor’s Trade (Adler, 1898). In contrast to Freud, much of Adler’s medical practice was with the working poor. Early in his career, he worked extensively with tailors and circus performers.

In February 1911, Adler did the unthinkable (Bankart, 1997). As president of Vienna’s Psychoanalytic Society, he read a highly controversial paper, “The Masculine Protest,” at the group’s monthly meeting. It was at odds with Freudian theory. Instead of focusing on biological and psychological factors and their influence on excessively masculine behaviors in males and females, Adler emphasized culture and socialization (Carlson & Englar-Carlson, 2017). He claimed that women occupied a less privileged social and political position because of social coercion, not physical inferiority. Further, he noted that some women who reacted to this cultural situation by choosing to dress and act like men were suffering, not from penis envy, but from a social-psychological condition he referred to as the masculine protest. The masculine protest involved overvaluing masculinity to the point where it drove men and boys to give up and become passive or to engage in excessive aggressive behavior. In extreme cases, males who suffered from the masculine protest began dressing and acting like girls or women.

The Vienna Psychoanalytic Society members’ response to Adler was dramatic. Bankart (1997) described the scene:

After Adler’s address, the members of the society were in an uproar. There were pointed heckling and shouted abuse. Some were even threatening to come to blows. And then, almost majestically, Freud rose from his seat. He surveyed the room with his penetrating eyes. He told them there was no reason to brawl in the streets like uncivilized hooligans. The choice was simple. Either he or Dr. Adler would remain to guide the future of psychoanalysis. The choice was the members’ to make. He trusted them to do the right thing. (p. 130)

Freud likely anticipated the outcome. The group voted for Freud to lead them. Adler left the building quietly, joined by the Society’s vice president, William Stekel, and five other members. They moved their meeting to a local café and established the Society for Free Psychoanalytic Research. The Society soon changed its name to the Society for Individual Psychology. This group believed that social, familial, and cultural forces are dominant in shaping human behavior. Bankart (1997) summarized their perspective: “Their response to human problems was characteristically ethical and practical—an orientation that stood in dramatic contrast to the biological and theoretical focus of psychoanalysis” (p. 130).

Adler’s break from Freud gives an initial glimpse into his theoretical approach. Adler identified with common people. He was a feminist. These leanings reflect the influences of his upbringing and marriage. They reveal his compassion for the sick, oppressed, and downtrodden. Before examining Adlerian theoretical principles, let’s note what he had to say about gender politics well over 90 years ago:

All our institutions, our traditional attitudes, our laws, our morals, our customs, give evidence of the fact that they are determined and maintained by privileged males for the glory of male domination. (Adler, 1927, p. 123)

Raissa Epstein may have had a few discussions with her husband, exerting substantial influence on his thinking (Santiago-Valles, 2009).

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You can take a peek at our Theories text on Amazon: https://www.amazon.com/Counseling-Psychotherapy-Theories-Context-Practice/dp/1119473314/ref=sr_1_1?crid=LIAVFMJLE5TD&dchild=1&keywords=sommers-flanagan&qid=1612716309&s=books&sprefix=sommers-%2Caps%2C205&sr=1-1

Seven Dimensions and Suicide Assessment and Treatment

To help practitioners focus on wellness within the whole person, Rita and I have been writing about seven life dimensions as they pertain to suicide assessment and treatment. Although treatments for individuals who are suicidal should focus on suicide, it’s also true that there’s much more to whole person in the room than suicidality. The seven dimensions we’re using include the following:

  1. The emotional dimension
  2. The cognitive dimension
  3. The interpersonal dimension
  4. The physical dimension
  5. The cultural/spiritual dimension
  6. The behavioral dimension
  7. The contextual dimension

The visual excerpt from chapter 4 included with this post (above) focuses on the emotional dimension. In chapter 4 we discuss how to use empathy to emotionally connect with clients, but also on a variety of strategies for helping clients (and students) develop strengths, resiliency, and wellness within the emotional dimension.

The book is primarily available the the American Counseling Association. Here’s the ACA link: https://imis.counseling.org/store/detail.aspx?id=78174

Learning to Work Effectively with Parents

In anticipation of my upcoming workshop, I’m posting this short excerpt from our book: How to Listen so Parents will Talk and Talk so Parents will Listen.

Theory into Practice: The Three Attitudes in Action

In the following example, Cassandra is discussing her son’s “strong-willed” behaviors with a parenting professional.

Case: “Wanna Piece of Me?”

Cassandra: My son is so stubborn. Everything is fine one minute, but if I ask him to do something, he goes ballistic. And then I can’t get him to do anything.

Consultant: Some kids seem built to focus on getting what they want. It sounds like your boy is very strong-willed. [A simple initial reflection using common language is used to quickly formulate the problem in a way that empathically resonates with the parent’s experience.]

Cassandra: He’s way beyond strong-willed. The other day I asked him to go upstairs and clean his room and he said “No!” [The mom wants the consultant to know that her son is not your ordinary strong-willed boy.]

Consultant: He just refused? What happened then? [The consultant shows appropriate interest and curiosity, which honors the parent’s perspective and helps build the collaborative relationship.]

Cassandra: I asked him again and then, while standing at the bottom of the stairs, he put his hands on his hips and yelled, “I said no! You wanna piece of me??!”

Consultant: Wow. You’re right. He is in the advanced class on how to be strong-willed. What did you do next? [The consultant accepts and validates the parent’s perception of having an exceptionally strong-willed child and continues with collaborative curiosity.]

Cassandra: I carried him upstairs and spanked his butt because, at that point, I did want a piece of him! [Mom discloses becoming angry and acting on her anger.]

Consultant: It’s funny how often when our kids challenge our authority so directly, like your son did, it really does make us want a piece of them. [The consultant is universalizing, validating, and accepting the mom’s anger as normal, but does not use the word anger.]

Cassandra: It sure gets me! [Mom acknowledges that her son can really get to her, but there’s still no mention of anger.]

Consultant: I know my next question is a cliché counseling question, but I can’t help but wonder how you feel about what happened in that situation. [This is a gentle and self-effacing effort to have the parent focus on herself and perhaps reflect on her behavior.]

Cassandra: I believe he got what he deserved. [Mom does not explore her feelings or question her behavior, but instead, shows a defensive side; this suggests the consultant may have been premature in trying to get the mom to critique her own behavior.]

Consultant: It sounds like you were pretty mad. You were thinking something like, “He’s being defiant and so I’m giving him what he deserves.” [The consultant provides a corrective empathic response and uses radical acceptance; there is no effort to judge or question whether the son “deserved” physical punishment, which might be a good question, but would be premature and would likely close down exploration; the consultant also uses the personal pronoun I when reflecting the mom’s perspective, which is an example of the Rogerian technique of “walking within.”]

Cassandra: Yes, I did. But I’m also here because I need to find other ways of dealing with him. I can’t keep hauling him up the stairs and spanking him forever. It’s unacceptable for him to be disrespectful to me, but I need other options. [Mom responds to radical acceptance and empathy by opening up and expressing her interest in exploring alternatives; Miller and Rollnick (2002) might classify the therapist’s strategy as a “coming alongside” response.]

Consultant: That’s a great reason for you to be here. Of course, he shouldn’t be disrespectful to you. You don’t deserve that. But I hear you saying that you want options beyond spanking and that’s exactly one of the things we can talk about today. [The consultant accepts and validates the mom’s perspective—both her reason for seeking a consultation and the fact that she doesn’t deserve disrespect; resonating with parents about their hurt over being disrespected can be very powerful.]

Cassandra: Thank you. It feels good to talk about this, but I do need other ideas for how to handle my wonderful little monster. [Mom expresses appreciation for the validation and continues to show interest in change.]

As noted previously, parents who come for professional help are often very ambivalent about their parenting behaviors. Although they feel insecure and want to do a better job, if parenting consultants  are initially judgmental, parents can quickly become defensive and may sometimes make rather absurd declarations like, “This is a free country! I can parent any way I want!”

In Cassandra’s case, she needed to establish her right to be respected by her child (or at least not disrespected). Consequently, until the consultant demonstrated respect or unconditional positive regard or radical acceptance for Cassandra in the session, collaboration could not begin.

Another underlying principle in this example is that premature educational interventions can carry an inherently judgmental message. They convey, “I see you’re doing something wrong and, as an authority, I know what you should do instead.” Providing an educational intervention too early with parents violates the attitudes of empathy, radical acceptance, and collaboration. Even though parents usually say that educational information is exactly what they want, unless they first receive empathy and acceptance and perceive an attitude of collaboration, they will often resist the educational message.

To summarize, in Cassandra’s case, theory translates into practice in the following ways:

  • Nonjudgmental listening and empathy increase parent openness and parent–clinician collaboration.
  • Radical acceptance of undesirable parenting behaviors or attitudes strengthens the working relationship.
  • Premature efforts to provide educational information violate the core attitudes of empathy, radical acceptance, and collaboration and therefore are likely to increase defensiveness.
  • Without an adequate collaborative relationship built on empathy and acceptance, direct educational interventions with parents will be less effective.

Want to learn more? You can still sign up for the online (Zoom) 2-day professional workshop through the Families First Learning Lab: https://www.familiesfirstmt.org/umworkshops.html

The Book . . . Again

Just for fun, here’s a photo of a page from our Suicide Assessment and Treatment Planning book. This page is the lead in to a section that focuses in on how to work with clients who are suicidal, but whom also may be naturally also experiencing irritability, hostility, and hopelessness. For info, go to the publisher, ACA: https://imis.counseling.org/store/detail.aspx?id=78174

Three ways for dealing with Annoying Blog Posts

Just a heads up. I’ll be writing several posts about our new book this week. Be forewarned, these posts may be annoying. Annoying can happen when people feel enthusiastic. My apologies in advance.

In response to these upcoming posts from me (or annoying posts from others), you can apply one of three strategies.

  • You can respond with positive affirmation, sharing, and by empathically matching my enthusiasm. Keep in mind that positive affirmation may make me happy. The downside is you risk reinforcing my “new book posting” behavior.
  • You can respond with no response. That was a favored B.F. Skinner and Ivan Pavlov strategy. Think of it as putting me on a pain-free extinction schedule.
  • You can respond with negativity or punishment. Skinner, Adler, and child advocates oppose punishment, because punishment can backfire, causing undesired behavior to increase, or triggering erratic behaviors.

True confession: When reading offensive or annoying posts, sometimes, even though I know better, I give into temptation, and respond with negativity. That’s nearly always a bad idea, mostly because option #3 of the preceding list is a poor extinction strategy. In one recent study, when social media posts received highere numbers of negative responses, the original social media posters responded back with even more posts. In other words, attention—even negative attention—acts as positive reinforcement and often increases the behavior toward which it was aimed. The take-home message is that, generally speaking, if you want to extinguish annoying blog posting behavior, following Skinner’s and Pavlov’s advice makes for good behavioral strategy.

Although I’m wary of the possibility of you all putting me on an extinction schedule, below is an excerpt from the Preface of our fancy new book. Right now the book is only available on the publisher’s website (https://imis.counseling.org/store/detail.aspx?id=78174), but I suspect it will soon make its way over to Amazon and the rest of the booksellers.

Preface

Writing a book about suicide may not have been our best idea ever. Rita made the point more than once that reading and writing about suicide at the depth necessary to write a helpful book can affect one’s mood in a downward direction. She was right, of course. Her rightness inspired us to pay attention to the other side of the coin, so we decided to integrate positive psychology and the happiness literature into this book. As is often the case when grappling with matters of humanity, focusing on suicide led us to a deeper understanding of suicide’s complementary dialectic, a meaningful and fully-lived life, and that has been a very good thing.

Before diving into these pages, please consider the following.

Do the Self-Care Thing

            In the first chapter, we strongly emphasize how important it is to practice self-care when working with clients who are suicidal. Immersing ourselves in the suicide literature required a balancing focus on positive psychology and wellness. While you’re reading this book and exploring suicide, you cannot help but be emotionally impacted, and we cannot overstate the importance of you taking care of yourself throughout this process and into the future. You are the instrument through which you provide care for others . . . and so we highly encourage you to repeatedly do the self-care thing.

What is the Strengths-Based Approach?

            Many people have asked, “What on earth do you mean by a strengths-based approach to suicide assessment and treatment planning?” In response, we usually meander in and out of various bullet points, relational dynamics, assessment procedures, and try to emphasize that the approach is more than just strengths-based, it’s also wellness-oriented and holistic. By strengths-based, we mean that we recognize and nurture the existing and potential strengths of our clients. By wellness-oriented we mean that we believe in incorporating wellness activities into counseling and life. By holistic we mean that we focus on emotional, cognitive, interpersonal, physical, cultural-spiritual, behavioral, and contextual dimensions of living.

You will find the following strengths-based, wellness-oriented, and holistic principles woven into every chapter of this book.

  1. Historically, suicide ideation has been socially constructed as sinful, illegal, or a terribly frightening and bad illness. In contrast, we believe suicide ideation is a normal variation on human experience that typically stems from difficult environmental circumstances and excruciating emotional pain. Rather than fear client disclosures of suicidality, we welcome these disclosures because they offer an opportunity to connect deeply with distressed clients and provide therapeutic support.
  2. Although we believe risk factors, warning signs, protective factors, and suicide assessment instruments are important, we value relationship connections with clients over predictive formulae and technical procedures.
  3. We believe trust, empathy, collaboration, and rapport will improve the reliability, validity, and utility of data gathered during assessments. Consequently, we embrace the principles of therapeutic assessment.
  4. We believe that counseling practitioners need to ask directly about and explore suicide ideation using a normalizing frame or other sophisticated and empathic interviewing strategies.
  5. We believe traditional approaches to suicide assessment and treatment are excessively oriented toward psychopathology. To compensate for this pathology-orientation, we explicitly value and ask about clients’ positive experiences, personal strengths, and coping strategies.
  6. We believe the narrow pursuit of psychopathology causes clinicians to neglect a more complete assessment and case formulation of the whole person. To compensate, we use a holistic, seven-dimensional model to create a broader understanding of what’s hurting and what’s helping in each individual client’s life. 
  7. We value the positive emphasis of safety planning and coping skills development over the negative components of no-suicide contracts and efforts to eliminate suicidal thoughts.

Goodbye 2020 . . . You’re Nothing but History Now

Happy New Year!

As a method for putting 2020 behind me and focusing on a hopeful 2021, I engaged in some forward thinking (rather unusual for me) and wrote an op-ed piece for the Missoulian newspaper to be published TODAY! Below, I’ve pasted the beginning of the article, along with a link to the whole darn thing in the Missoulian. If you feel so moved, please share and like this. . . and I hope you experience the return of happiness in 2021.

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The Return of Happiness: Your 2021 Guide

Usually a great source of snarky humor, the Urban Dictionary lists its top definition for 2020 as, “The worst year ever.” Sadly, even the Urban Dictionary couldn’t find creative inspiration from the horrors of 2020. Goodbye, 2020; you will not be missed.

. . . for the rest of the article, click below:

Your Weekend Homework: The Return to Happiness

As we approach the end of 2020, many of us are looking forward–like never before in the history of time–to turning that calendar to a new page and a new year. Readers of the Washington Post were recently surveyed and wrote, 2020 has been exhausting, relentless, and heartbreaking. Let’s put 2020 behind us and never look back (other than to remind ourselves of mistakes we shouldn’t make again).

In honor of turning the calendar to 2021, I’m working on an Op-Ed piece titled “The Return to Happiness.” The point of the piece is to acknowledge how good it is to move on, but also discuss the nature of New Year’s resolutions and how to make resolutions that have a reasonable chance of being accomplished. In the end, I’ll be making a pitch for everyone to sign up for my University of Montana course “The Art & Science of Happiness.” Well, not everyone, but anyone who wants to have a cool online “university” experience that provides an opportunity to test out the best, evidence-based, approaches to happiness on planet earth.

The course starts in January, and, for the first time ever, will be offered to “community” participants as a non-credit experience. This means EVERYONE can sign up. The catch is that it costs $150. But if you do the math, that’s only $10/week or about $3.50 an hour to discuss, learn, experiment with, and establish new happiness habits for 2021.

Here’s a description of the course:

Over the past 20 years, research on happiness has flourished. Due to the natural interest that most Americans have for happiness, research findings (and unfounded rumors) have been distributed worldwide. Every day, happiness is promoted via online blogs, newspaper and magazine articles, Twitter posts, Instagram videos, TikTok, and through many other media and social media venues. Ironically, instead of increases in national happiness, most epidemiological research indicates that all across the U.S., children, adolescents, adults, and seniors are experiencing less happiness, more depression, and higher suicide rates. To help sort out scientific reality from unsubstantiated rumors, in this course, we will describe, discuss, and experience the art and science of happiness. We will define happiness, read a popular happiness book, examine scientific research studies, try out research experiments in class, engage in extended happiness lab assignments, and use published instruments to measure our own happiness and well-being. Overall, we will focus on how happiness and well-being are manifest in the physical, cognitive, emotional, interpersonal, spiritual/cultural, behavioral, and contextual dimensions of our lives.

Other things to know: If you take the course as a community, non-credit, participant, you won’t take the quizzes, or get graded, and assignments will be optional. However, you will be asked to participate in small group lab sessions designed to give you (and others) a chance to talk and listen to each other as you experience and experiment with specific happiness assignments.

If you’re interested, you can register at this link: https://www.campusce.net/umextended/course/course.aspx?C=627&pc=13&mc=&sc

If you know friends who could use a happiness boost for 2021, share this post with them. And if you’ve got questions, you know where to find me.

Have a fantastic weekend.