Aotearoa New Zealand Conference Keynote

NZ Tree and John

Kia ora.

Today is the future in New Zealand where I have the distinguished and humbling honor to present the closing keynote speech at the New Zealand Psychological Society’s Jubilee Conference.

Attached here are two things:

  1. The Brainstormed powerpoint slides from my workshop last Wednesday. These include a list of resources that New Zealand professionals and students have found useful in their suicide assessment, intervention, and prevention work. NZ 2018 Workshop Brainstorming
  2. The powerpoint slides for today’s keynote:NZ 2018 Suicide Keynote Final
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New Zealand Jubilee Resources!

Kia ora.

I’m in New Zealand to present at their 50th Anniversary Jubilee Psychology Society Conference. . . which is way cool. Below are two resource links.

First, the Powerpoint Slides: NZ 2018 Suicide Workshop

Second, a link to my 2018 Journal of Health Service Psychology article on suicide assessment and intervention: https://www.nationalregister.org/pub/the-national-register-report-pub/journal-of-health-service-psychology-winter-2018/conversations-about-suicide-strategies-for-detecting-and-assessing-suicide-risk/

Have a fabulous week!

John

The Long Version of the Trump Personality Slate Magazine Article

 

Publishing a piece in Slate Magazine was fun and interesting. The editor did a nice job reining me in and trimming the piece to an appropriate length. However, for anyone interested in the long-winded JSF version of the article, here it is. As you’ll notice, I included the examples of Trump’s behavior that fit the Millon personality descriptors.

My dad helped inspire the Slate article with his clear and concise comments about DJT’s “con man” skills. Here we are NOT talking about DJT.

John and Max Seattle

Preparing for and Containing a Trumpian Endgame

Pundits and professionals regularly express concerns about Donald Trump’s mental health. Most speculations focus on Narcissistic Personality Disorder (NPD). It’s easy to see why. If you look at the DSM-5 criteria for NPD, Trump’s public behaviors are obviously consistent with all nine diagnostic criteria. Even further, because only five of nine criteria are needed for an NPD diagnosis, Trump getting nine of nine is huge; perhaps no one has ever seen a narcissism quite so beautiful. Nevertheless, we still can’t diagnose Trump with NPD. That’s because it’s unethical to diagnose anyone without first conducting a professional evaluation. Also, Trump doesn’t meet the distress or impairment criteria required for a mental disorder diagnosis.

As disturbing as observations of Trump’s narcissism may be, what’s frightening about his personality isn’t narcissism. Narcissistic traits among politicians and presidential candidates—who often have big personalities—are common. Far more worrisome and dangerous is that his statements and behaviors fit so well with a different personality style. This style is what the renowned psychologist, Theodore Millon, called “The Aggrandizing-Devious-Antisocial Personality” (aka antisocial personality).

Millon summarized these personalities as “driven by a need to . . . achieve superiority.” They act “to counter expectation of derogation and disloyalty at the hands of others,” and do this by “actively engaging in clever, duplicitous, or illegal behaviors in which they seek to exploit others for self-gain.” Sound familiar?

What follows are summary descriptions of Millon’s antisocial personality style. Keep in mind that Millon’s statements are not diagnostic criteria for a mental disorder. The purpose here is not psychiatric diagnosis. Instead, my goal is to describe Trump’s personality, speculate on his future behaviors, and discuss strategies for how antisocial behaviors can be contained. To invoke a cliché, knowledge confers power; the more we understand Trump’s personality, the better prepared we can be for the directions his behaviors may take us.

Impulsive Imprudence. Millon described antisocial personalities as “. . . shortsighted, incautious, and imprudent. There is minimal planning, limited consideration of alternative actions, and consequences are rarely examined.”

Reading this, you may immediately think of Trump’s impetuous meetings with Kim Jong Un and Vladimir Putin, his sudden decision to impose international tariffs, or a different example. Whatever the case, it’s easy to spot incautious patterns in Trump’s behavioral repertoire. Now, and going forward, Trump needs continuous supervision and monitoring. This is especially the case when he meets with authoritarian leaders. Millon further described this impulsive style, “There is a tendency to jump from one exciting and momentarily gratifying escapade to another, with little or no care for potentially detrimental consequences.” Trump will probably need a clean-up team to finish his work or conduct damage control following his various escapades.

Blaming Others for Shirked Obligations. Antisocial personalities “frequently fail to meet or intentionally negate obligations of a marital, parental, employment, or financial nature.” When negative outcomes arise, Trump will be inclined to blame external forces or subordinates. This is the equivalent of a personal philosophy in direct opposition to President Harry Truman’s, “The buck stops here.” Holding Trump responsible for his behaviors has been, is, and will be extremely challenging.

Pathological Lying. Millon wrote, “Untroubled by guilt and loyalty, they develop a talent for pathological lying. Unconstrained by honesty and truth, they weave impressive talks of competency and reliability. Many . . . become skillful swindlers and imposters.”

Trump’s disregard for truth and fact is already legendary, with over 4,200 Trump lies since his inauguration. Millon also noted that antisocial personalities “play their games of deception with considerable skill” and “experience a degree of pleasure” from their deceptions, gaining “special joy in . . . taking from others.” These descriptions underline the need for the press and Congress to continually monitor and report the accuracy of Trump’s statements.

Declarations of Innocence. During times of trouble, antisocial personality types employ an innocence strategy. “When . . . caught in obvious and repeated lies and dishonesties, many will affect an air of total innocence, claiming without a trace of shame that they have been unfairly accused.”

Trump has repeatedly proclaimed his innocence, calling the Mueller investigation a “witch hunt” and frequently tweeting, “No collusion!” As he feels increasingly threatened, Trump’s claims of innocence will likely escalate, along with spirited efforts to arouse support by pinning the blame on individuals who are well-hated by his populist base—like President Obama or Hillary Clinton.

Empathy Deficits. Antisocial personalities are devoid of empathy and compassion. Millon called this “A wide-ranging deficit in social charitability, in human compassion, and in personal remorse and sensitivity.” He added that “many have a seeming disdain for human compassion.” Going forward, Trump’s efforts to display empathy or sustain charitable behaviors will sound and feel much less genuine than his glowing statements about himself or his aggressive attacks on his detractors.

Counterattacks. Millon noted that antisocial personalities are hyper-alert to criticism. He “sees himself as the victim, an indignant bystander subjected to unjust persecution and hostility” feeling “free to counterattack and gain restitution and vindication.” For Trump, the urge to counterattack appears irresistible. He often uses a favorite attack or counterattack strategy among antisocials—projecting their own malicious ideas and behaviors onto others through name-calling and accusations of illegal (or crooked) behavior. Trump’s pattern of lashing out at others will only continue to escalate.

Moral Emptiness. Antisocial personalities have no ethical or moral compass. As Millon described, they “are contemptuous of conventional ethics and values” and “right and wrong are irrelevant abstractions.” Antisocials may feign religiosity—when it suits their purpose. But the moral litmus test will always involve whether they stand to gain from a particular behavior, policy, or government action. For instance, adopting an anti-abortion stance could serve as a calculated strategy, despite having a history of being “very pro-choice.” In all likelihood, no method for Trump to achieve his ends—including separating children from parents—will be morally beneath him.

Clinicians have observed that some individuals with antisocial personalities burn out. Over time, negative family and legal consequences take a toll, prompting antisocials to conform to social and legal expectations. However, as in Trump’s case, when antisocial personalities wield power, burning out is unlikely. Power provides leverage to evade personal responsibility for financial maleficence and sexual indiscretions. Antisocial personalities who have the upper hand will increase their reckless, impulsive, and self-aggrandizing behaviors in an effort to extend their ever-expanding need for power and control. Trump will continue to be drawn toward authoritarian leaders, because they symbolize his interpersonal goal of gaining power and authority over everyone.

Because antisocial personalities don’t change on their own and don’t respond well to interventions, containment is the default management strategy. Without firm, unwavering limits, deception, law-breaking, greed, manipulation, and malevolent behaviors will increase. An antisocial person in a position to self-pardon or self-regulate is a recipe for disaster. Containment must be forceful and uncompromising, because if an antisocial personality locates a crack or loophole, he will exploit it. Staff interventions, comprehensive law enforcement, and judicial systems that mandate accountability must be in place.

Three main containment strategies remain in play: Republican control; the Mueller investigation, and a November blue wave.

Unfortunately, although many Republicans are concerned about Trump’s behaviors, they’re no match for Trump’s populist charisma. Defying Trump is too costly; he can make Republicans pay with electoral consequences and his populist base will pelt defectors with threatening hate mail. Like him or not, Republicans have little motivation for clashing with a powerful leader who promises them judicial appointments and legislative opportunities, the likes of which they’ve not seen in their lifetimes.

Recruiting independent actors to resist Trump is also difficult. Trump skillfully uses intimidation, direct and indirect threats, and offers of power to recruit new supporters who will walk to the microphone, as Brett Kavanaugh did, and speak to the world of Trump’s unprecedented greatness. Exhibiting a glaring lack of judicial independence, Kavanaugh opened his nomination speech with a no holds barred endorsement of Trump’s character, stating, “No president has ever consulted more widely, or talked with more people from more backgrounds, to seek input about a Supreme Court nomination.” Never mind that reflective consultation is anathema to antisocial personalities or that Kavanaugh would have had to review 230 years of Supreme Court nominations to support his statement. Soliciting others to lie for them is a common antisocial strategy. Kavanaugh‘s genuflection to Trump is a foreboding example of how far and deep Trump’s power and influence run.

The Mueller investigation and November blue wave are in danger of being outpaced by Trump’s unmatched speed and skill for playing “games of deception.” Trump’s talent for quickly tweeting divisive messages and propaganda is well-established. Without organized political opposition and a massive public movement for truth, justice, and integrity, Trump will continue winning and most Americans will continue losing.

Even if one or more of these containment strategies succeeds, it’s difficult to envision the American public emerging unscathed. Trump and his followers have shredded civil discourse and elevated division, distrust, and hatred. If he is dethroned, Trump has all but ensured that public conflict over his fall from grace will be painful and violent. Preparation for a Trumpian “call to arms” is necessary.

Coming together to contain a common threat is the best path forward. Trump’s personality and probable future behaviors are inconsistent with American virtues and values and the rule of law. Our youth don’t need a presidential role model who pays off porn stars, locks up children, and locks out the press if they ask him hard questions. For all Americans who crave integrity, honesty, and civil discourse, it’s time to gather together under a large (metaphorical) tent, where all are welcome and respected. We can sort out our differences on climate change, guns, and abortion later. If we don’t come together now—as Mr. Trump himself might say—we’ll soon be facing a huge national and global crisis like no one has ever seen before.

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John Sommers-Flanagan (johnsommersflanagan.com) is a clinical psychologist, professor of counselor education at the University of Montana, and author of eight books, including Clinical Interviewing (6th edition, John Wiley & Sons). The views expressed here are not representative of the University of Montana or the Montana University System.

 

My Slate Article on Donald Trump’s Dangerous Personality Dimensions

Hi All.

The Slate Magazine article where I use Theodore Millon’s personality descriptions to articulate possible challenges linked to Trump and the U.S. Presidency is out. Here’s the link: https://slate.com/technology/2018/08/no-matter-how-bad-it-gets-trump-will-never-give-up.html

As always, feel free to comment. You can do that here or on the Slate article itself.

John SF

The Rest of the Story on Trump’s Personality

AOIP6519

The Slate article on Donald Trump and his personality is coming out tomorrow morning. Of course, as with all things writing, it was wonderful and challenging. Writing for a popular online magazine like Slate is a new venue for me, so I learned plenty, and was honored to work with Slate’s Health and Science editor, Susan Matthews. She helped me be more focused and more articulate.

I’ll post a link to the article here tomorrow.

The main focus of the article was to look at Donald Trump’s personality through the lens of Theodore Millon’s antisocial personality formulations. Millon’s perspective is fascinating and I think some of his descriptive phrases fit Trump “beautifully,” but one of the  points of the article is for you to be the judge.

In the meantime, I want to share a paragraph that got cut. As we made revisions, it fell slightly outside the focus, but it was one of my favorite paragraphs. . . so here it is:

Recruiting independent actors to resist Trump is difficult. Trump skillfully uses intimidation, direct and indirect threats, and offers of power to recruit new supporters who will walk to the microphone, as Brett Kavanaugh did, and speak to the world of Trump’s unprecedented greatness. Exhibiting a glaring lack of judicial independence, Kavanaugh opened his nomination speech with a no holds barred endorsement of Trump’s character, stating, “No president has ever consulted more widely, or talked with more people from more backgrounds, to seek input about a Supreme Court nomination.” Never mind that reflective consultation is anathema to antisocial personalities or that Kavanaugh would have had to review 230 years of Supreme Court nominations to support his statement. Soliciting others to lie for them is a common antisocial strategy. Kavanaugh‘s genuflection to Trump is a foreboding example of how far and deep Trump’s power and influence run.

After the article is out, I’ll be posting more content that wasn’t quite ready for prime time.

 

Initiating Conversations about Suicide . . .

Street Sunrise

The following content is adapted from:Conversations about suicide: Strategies for detecting and assessing suicide risk.” It’s from an article I published in the Journal of Health Service Psychology earlier this year.

I’m posting it because I always think it helps to talk and write about suicide assessment and intervention issues, but also because this content addresses some unique nuances in approaching suicidal clients.

Here we go . . . please share your comments and questions . . . or just share this so others can have access.

Showing Empathy, Building Rapport, and Staying Balanced

Working with suicidal clients may involve unique empathic responses. For example, clients with depressive symptoms may have long response latencies and may focus exclusively on negative emotions. Showing patience while waiting for clients to respond is part of the empathic rapport-building process. You might say, “Take your time” or “I can see you’re thinking about how you want to answer my question” or “Right now everything is feeling sluggish.”

Speech content for suicidal clients can be or can become singularly and profoundly negative. This profound negativity can naturally affect you, causing you to react in ways that are positive and encouraging, but not empathic. Examples include:

  •     This too shall pass.
  •     Suicide is a permanent solution to a temporary problem.
  •     Let’s focus on what’s been going well in your life.

The problem with these responses is that if they are used to counter client negativity, clients may conclude that you “don’t get them,” and then will cling even more strongly to their negative perceptions, while feeling greater isolation. Consequently, instead of shifting to positive content, you should use empathic reflections, at least briefly, to clearly connect with your clients’ unbearable distress and depressive symptoms (“I hear you saying that, right now, you feel completely miserable and hopeless”).

Empathic Reflections

Using a “completely miserable and hopeless” reflection can be useful in two ways. First, it demonstrates your willingness to be with your client right in the midst of despair. Second, as motivational interviewing practitioners have discussed, your “completely miserable and hopeless reflection” might function as an amplified reflection (Miller & Rollnick, 2013). If so, your client might respond with positive change talk (e.g., “I’m not completely miserable and hopeless”).

Along with expressing empathy directly in ways that connect with clients in their despair, it is also important to use emotional and behavioral reflections in ways that leave open the possibility of positive change. This could involve saying “Right now you’re feeling . . . “ instead of just saying “You’re feeling . . .” The difference is that saying “Right now” leaves open the possibility that the sad and bad feelings may change in the next moment, next hour, or next day.

Using the Client’s Language

When possible, using the client’s language is recommended. If, for example, a client says something like, “I feel like shit” or “I am completely stuck in this pit of despair,” you might want to use the words “shit” or “shitty” or “despair.” Additionally, offering an “invitation for collaboration” is important. This could involve statements like, “I’d like to know more about what it’s like in your pit of despair” or “Do you mind telling me more about what’s feeling shitty right now?” Expressing your interest in working with and hearing from clients and intermittently asking permission to explore different problems or emotions can contribute significantly to collaborative mental health professional-client work.

Using Validation

Validation or reassurance also can facilitate rapport. Validation includes statements like, “Given the very difficult things going on in your life right now, it’s natural that you would feel down and depressed.” As long as your response is authentic, using immediacy or brief self-disclosure is another validation strategy that deepens the working alliance: “As you talk about the great sadness you have around the loss of your daughter, I find myself feeling sadness along with you” (Sommers-Flanagan & Sommers-Flanagan, 2017).

Dealing with Irritability

Suicidal clients are sometimes extremely irritable. In such cases it may be difficult to develop rapport. Client irritability also can provoke negative emotional reactions in you. Consequently, when clients express irritability, using a three-part response is recommended: (a) reflective listening, (b) gentle interpretation, and (c) a statement of commitment to keep working with and through the irritability.

  •     As you talk, I hear annoyance and irritability in your voice (reflective listening).
  •     When I hear that, to me it seems like it’s partly just an expression of how tired you are of feeling bad and sad. Irritability is really just a part of being very depressed (gentle interpretation).
  •     I want you to know, that my plan is to keep on working with you and to try not to let any of the annoyance or irritability you’re feeling get in the way of our work together (statement of commitment).

Dealing with Ruptures

Clients’ expressions of irritability can also signal a mental health professional-client relationship rupture. You may have said something that your client didn’t like and, in response, your client may show irritability and anger, or withdraw. If you think your client’s irritability is about a relational rupture (instead of irritability associated with depression), several options can be useful (Safran, Muran, & Eubanks-Carter, 2011; Sommers-Flanagan & Sommers-Flanagan, 2017).

  •     Acknowledge you empathic or interpretive “miss” or error: “I missed the importance you’re feeling about your physical symptoms”
  •     Apologize directly to the client: “I’m sorry for not getting how strongly you feel about your relationship break up.”
  •     Concede to the client’s perspective: “I think I need to see this from your shoes.”
  •     Change the task or goals: “What I’m sensing is that you’d rather not talk about your past. How about we shift to talking about right now or about the future?”

Using Balanced Questioning

Before or after asking directly about suicide, you may find yourself using traditional diagnostic questions about depression and/or other suicide risk factors. In general, diagnostic and risk factor questions are good questions because they help deepen your understanding of the client’s unique psychological-emotional-behavioral state. However, using a balance of positive and negative questioning is recommended. Specifically, if you ask about sadness, it is also important to ask about happiness (e.g., “What are the things in your life right now that lift your mood just a bit?”). Although it is possible that clients who are depressed and suicidal will answer all your questions (even the positive ones) in the negative (e.g., “Nothing lifts my mood, ever.”), when that happens you gain valuable information about the depth of your clients’ depression and whether they have a reactive mood. As needed, you can use Linehan’s Reasons for Living Scale (Linehan, Goodstein, Nielsen, & Chiles, 1983) and solution-focused resources to identify questions with positive phrasing that balance traditional diagnostic assessment protocols (de Shazer, Dolan, Korman, McCollum, Trepper, & Berg, 2007).

Asking Directly about Suicide Ideation

The standard for all helping professionals is to ask clients directly about suicide ideation. Despite this universal guidance, asking directly can trigger clinician anxiety; it can also be difficult to find the right words to elicit an honest and open client response. Many questionnaires and suicide prevention protocols encourage asking directly with a question like, “Have you been having any thoughts about suicide?”

Using the “Have you been having . . .” question is a reasonable default, but it lacks clinical sophistication. Various writers in the suicide assessment and intervention area recommend using alternative wording and framing when asking clients directly about suicide (Jobes, 2016; Shea and Barney, 2015; Sommers-Flanagan & Shaw, 2017). Three distinct approaches are described here.

Using a Normative Frame

Wollersheim (1974) advocated for using a normalizing frame when interviewing suicidal clients. She wrote,

Well, I asked this question since almost all people at one time or another during their lives have thought about suicide. There is nothing abnormal about the thought. In fact it is very normal when one feels so down in the dumps. The thought itself is not harmful. (Wollersheim, 1974, p. 223)

Although Wollersheim is offering reassurance to her client after asking about suicide, her recommendation captures the essence of using a normative frame. The question flows from the client’s descriptions of depressive symptoms or personal distress and then frames suicide ideation as normative, given the client’s distressing condition. Depending on the specific client population and symptoms, normative framing could include:

  •     You’re saying you’ve been very down and depressed. It’s normal for people who are feeling depressed to sometimes think about suicide. Has that been the case for you? Have you had thoughts about dying or ending your life?
  •     It’s not unusual for teenagers to sometimes have thoughts about suicide. I’m wondering if you’ve had thoughts about suicide.

Some clinicians resist using the normative frame. They complain that a normative frame increases their worry about putting the idea in the client’s mind. Although there is research indicating that most clients appreciate being asked directly about suicide, it can still be difficult to embrace the normative frame. If so, there are several alternatives, including the “I ask all my clients about suicide” frame. Here’s an example:

I’m a mental health professional and so part of my job is to ask all of my clients about suicide.  And so I’m wondering, have you had any suicidal thoughts now, recently, or farther back in the past?

A normative frame lowers the bar and makes it easier for clients to admit to suicide ideation. Although suicide ideation is not a good predictor of suicide attempts, it is obvious that clients do not make attempts or die by suicide without first having thoughts about suicide. Additionally, it is important to note that whether you use a normative frame that focuses on reducing clients’ feelings of being deviant, or the frame where you emphasize that it is normal for you to ask all your clients about suicide, it is important that you practice, in advance and aloud, so that using normalizing statements becomes comfortable for you.

AS ALWAYS . . . FEEL FREE TO CONTINUE THE DISCUSSION BY SHARING YOUR THOUGHTS AND REACTIONS TO THIS POST.

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