Opening Thoughts on Feminism

This is the opening section from our feminist chapter in Counseling and Psychotherapy Theories in Context and Practice — written with help from Maryl Baldridge, M.A.

For years, psychiatric journals have touted the salutary effects of antidepressants by printing “before” and “after” pictures showing a woman leaning on a mop looking despondently at her kitchen floor, and then happily mopping it after taking her medication.

—E. Kaschak, Engendered Lives (1992, p. 22)

At the American School Counselor Association National Conference in 2011, Georgie Bright Kunkel, a 90-year-old woman, delivered a keynote address. She bounded onto the stage—not looking a day over 80. She introduced herself as the oldest stand-up comic in Washington state (Was there an older stand-up comic somewhere else on the planet?). She proceeded to crack jokes about everything from sex to . . . well . . . sex, and then sex again. In the middle of her routine, she slipped in a serious story that went something like this:

I was working as a school counselor at an elementary school. To kick off our career day, I contacted a woman friend of mine who was an airplane pilot. She agreed to land her one-person plane in the middle of our schoolyard. We were all very excited. We gathered the students outside and watched as she guided the plane down and smoothly landed on the playground. The students crowded around as she emerged from the tiny plane, helmet in hand. When it became apparent she was a woman, one of our male students turned to me and asked, “Where’s the pilot?” It was clearly a one-person plane, but in this boy’s mind, men were pilots and women were stewardesses. This was a sad truth for many of our students. But what interested me more was the impact of this event on our students’ career ambitions. We had decided to take a student survey before and after career day. Before my friend landed on our playground, exactly 0% of our female students listed “airplane pilot” as one of their potential career choices. After career day, about 40% of the girls listed airline pilot as a career to consider in the future.

This is an example of a feminist working therapeutically to bring about development, change, options, and liberation. Feminist therapy can be transformative. It was designed, in part, to break down unhelpful stereotypes and free all humans to fulfill their potentials.


Something Different

This is a poem that came to me at about 30K feet. It’s about aging and memory.

If you don’t like poetry or metaphor — it might be good to stop reading here:).

If you like poetry, you might want to read it twice.


Another Visitation

One armed men

And withered women

Hold candles where their teeth should be

Wax dripping



Carpet that needs replacing

It’s hard to find your way

This way

Because wrinkles

Will not slacken

And carpets

Will not give up the floor


Refusing to move

As successors greedily lie in wait

Rolled into a consciousness contracting

In a universe expanding

Small orbits

Are especially strong

And wrinkles, old carpets,

Even dimming candlelight

Are intriguingly pleasant

As drops of hot wax

Blister your fingers

Partly because scars

Last longer

Than memories

Reflections on Listening to Irvin Yalom at the ACA Conference

After a few hectic and overstimulating days at the ACA World Conference in San Francisco, I’ve now secured the back table at a Starbucks in Vancouver, WA for brief written reflection. This reflection weaves quotations (and paraphrases) from the great Irvin Yalom into my own personal conference experiences.

My formal conference highlight was watching and listening as NPR’s Craig Windham interviewed Yalom onstage for the keynote. After listening to Yalom’s keynote six years ago, I think the interview format was an ingenious method for capturing a more personal glimpse into Yalom and his writing than a stand and deliver keynote speech.

I especially enjoyed listening to Yalom reflect on his early years. Two statements stand out:

On his career decision-making as a child of Russian immigrants: “We had two choices: We could become a doctor or a failure.”

On his unparalleled greatness within the field of group psychotherapy: “My wife thinks it’s rather ironic that I became an expert in group psychotherapy, because I’m really quite uncomfortable in groups.”

Early in his “speech” Yalom emphasized the importance of counselors to the field of psychotherapy. In several ways he made curiously stimulating statements emphasizing (I’m paraphrasing now) that counselors are the future of psychotherapy. As a hybrid counselor and psychologist, I wonder if he would have made the same statements had he been keynoting at the annual American Psychological Association meeting.

My reactions to Yalom’s claim about counselors being the future of psychotherapy are free-ranging like the chickens in our backyard, but here are two:

Yes, I think counselors will be the future of psychotherapy, but only if we’re able to stop getting in our own way . . . And psychologists will undoubtedly be the future of measuring psychotherapy efficacy . . . if they (or we) can manage to focus on issues more meaningful than pharmacology and neuroscience.

For those curious about where Yalom finds his writing inspiration, in response to Windham’s questioning, he disclosed that as a Californian he has mastered the evening hot tub experience. Subsequently, he’s able to write most productively in the morning about “what I’ve learned in the hot tub.” I suspect there’s a bit more to it than that . . . but for those of us aspiring toward more writing greatness it makes for a solid rationale for nightly inspirational hot-tubbing.

On the popularity of his Group Psychotherapy text, Yalom stated: “I suspect it’s because of the stories in the book that I smuggled in . . .”

On his personal experience of fame (keep in mind that about 4K of us had to line up like rock concert fans to see him), he shared his own sort of dissociated imposter feelings:

“There’s a part of this that is very unreal. I don’t have any foundation. My parents were uneducated. They had very little schooling. I don’t have any foundation behind me. It’s a little shaky for me. I compare it to a lily growing in a swamp. There’s no foundation underneath. No matter how successful I am, I question . . . is this really me. Am I really successful?”

As an existential psychotherapist, it’s not surprising that Yalom believes deeply in helping clients pursue meaning. This is where it gets personal for all of us. He said, “Cancer cures psychoneurosis” and that “Life cannot be postponed.” Over the years he has helped many clients focus on their regrets—which often translate into moments when they weren’t able to face life and life fully in the moment. But we shouldn’t mistake Yalom’s live-in-the-moment philosophy for old-fashioned California hot-tub hedonism.  Yalom’s version of living in the moment is at once emotional AND intellectual; it is inspirational AND intentional.

Yalom also said that “Storytelling . . . may be the very best way I can teach.” Lucky for me I’ve gathered a few teaching stories over the years. Sometimes a combination of reality and my own constructive fiction, at this ACA I had a chance to share many stories. First, in a six hour pre-conference Learning Institute on Wednesday attended by 32 fabulous counselors, and later in an ACA-sponsored Friday session on Connecting and Working Effectively with Challenging Youth attended by about 200. In terms of reaping my own share of attention and praise, this was perhaps my best ACA conference ever.

But then Sunday morning comes. And when I awaken, what grand thoughts trickle into my consciousness? Do I think of the 25 people who lined up to have me sign copies of “Tough Kids, Cool Counseling?” Do I lie on the floor of my high-school educated parents home—where I’ve stopped for a short visit—feeling smug satisfaction about the glory I felt when Craig Windham of NPR fame also stood in line to have me sign a book FOR HIM. Do I reflect on the sweet and ego-boosting comments he shared with me about my work?

Nope. Nothing so grand knocks on the door of my early morning awareness. Instead, I’m transported back to a moment when, immediately after speaking to 200 conference attendees and spontaneously signing a couple books and receiving repeated praise from participants, a bold young woman approached me. She had attended BOTH my six hour workshop AND my 90 minute talk . . . and so forgive me my anticipation of praise as I looked into her eyes. But instead, she tells me that she’s not sure she learned anything from the six hour workshop. My well-practiced response is to welcome the criticism, while fending off disappointment and defensiveness. I feel precariously situated on my own lily pad. She goes on to explain that she’d “accidentally” gotten stuck in the 90 minute presentation and that based on what I’d talked about in there she thought I’d want the constructive feedback. “Of course I do,” I say . . . “Of course I do . . . and thank you very much for that.”

This is the stinging mantra to which I awaken this lovely and cloudy Sunday morning. A mantra of self-doubt . . . of possible regret . . . of wondering what I did wrong . . . of how I might improve myself.

Which brings me back to one of my favorite Yalom quotations (from his Group Psychotherapy text) about universality:

“During my own 600-hour analysis I had a striking personal encounter with the therapeutic factor of universality . . . I was very much troubled by the fact that, despite my strong positive sentiments, I was beset with death wishes for [my mother], as I stood to inherit part of her estate. My analyst responded simply, “That seems to be the way we’re built.” That artless statement offered not only offered considerable relief but enabled me to explore my ambivalence in great depth.” (p. 7)

Thank you Dr. Yalom for helping me and many others more deeply understand ambivalence, regret, self-doubt, personal meaning, death, and many of the other interesting ways the human psyche is built. And thank you, bold young woman, for providing me with hot-tub-free grist for my morning therapeutic writing mill.

On My Way to ACA . . . and Thoughts on Drunken Sexual Consent

Hey. I’m on my way to the American Counseling Association conference in San Francisco. Tomorrow (Wednesday) I’ll be doing a full-day workshop on working effectively with challenging teenagers. If you’re reading this and will be at the conference, I’ll be hanging out at the John Wiley & Sons booth in the Exhibition Hall off and on (especially Thursday evening about 5pm) and will be doing an author signing for ACA on Friday from 4-5pm at the ACA booth. Please stop by and introduce yourself or catch me at the conference somewhere and say hello.

On my way to SF I had a chance to read an exceptionally courageous article in the University of Montana Kaimin (the student newspaper). It was written by a young woman who is coming out about two rape experiences on campus. Both involved her being far too drunk and she was brave enough to acknowledge that. However, as she notes, being drunk and dressing provocatively is not a message to all stimulated males that she WANTS sex.

This is a tough situation. It’s about consent and risky behavior and the many different channels of human communication. What I like about her article is that by disclosing her experiences she is contributing to consciousness-raising and it is ONLY through consciousness-raising that we can hope to shift the social norms away from the acceptability of presumed (drunken) consent on college campuses and elsewhere.

There’s an important message here for college males who might interpret a college woman’s behavior as “asking for it.” We need to resist our natural male urges and think about this. Okay, she is exposing herself to a risky situation and maybe she should know better . . . but think of her as your sister or your daughter or your future wife and make the right decision to control your sexual impulses in favor of a better situation where you can be ABSOLUTELY certain that you’re getting clear and unequivocal sober consent.

Drunken sexual encounters are all-too-common on college campuses. We are all responsible. Neither drunk males or females can really give consent. There is diminished capacity. For everyone I hope the Kaimin article can raise awareness. We all can do better than obtaining sexual gratification under the cloud of a drunken haze.

Webinar Reflections and a Suicide Myth Quiz

Last week I had the privilege of doing a Wiley Faculty Network Webinar on Teaching Suicide Assessment to graduate students in counseling and psychology. It was a first webinar experience for me and I have a few reflections and a suicide myth quiz from the webinar.

Observation #1: When doing Webinars, keep your eyes on your content (and not the “news feed” with names of friends and colleagues making interesting comments). If you watch the comments you will sound dull and slow – sort of like people sound when they’re talking to you on the phone while watching an engaging television show or surfing the internet.

Observation #2: There are lots of faculty and graduate students out there who want to do their best to help others through suicidal crises. This is very cool. I am always a little verklempt (sp) about how many kind and helpful people there are out there in the world.

Now . . . here’s the suicide quiz. Let’s see how you do. Answer the following True or False. The answers are at the bottom.

  1. Suicide rates are typically highest in rainy and cloudy climates, like Seattle, the Northeast, and the United Kingdom.
  2. Suicide rates are typically highest in the Winter months, especially around the holidays. 
  3. Antidepressant medications (i.e., SSRIs like prozac and celexa) can REDUCE a client’s suicidal impulses.
  4. Antidepressant medications (i.e., SSRIs like prozac and celexa) can INCREASE a client’s suicidal impulses.
  5. Suicide rates in the U.S. are usually higher than homicide rates.
  6. The most common means of suicide among females is firearms.









  1. False.  In the U.S., every year the highest rates are nearly always in Montana, Alaska, Wyoming, and Nevada – and the lowest rates are in the cloudy Northeast
  2. False:  U.S. Suicide rates are nearly always highest in the Spring (April and May, in particular; Mondays have highest rates and Saturdays lowest and, surprisingly, December has the lowest rates).
  3. True:  Yes, there is evidence that antidepressant medications can REDUCE a client’s suicidal impulses.
  4. True:  Yes, there is evidence that antidepressant medications can INCREASE and even CREATE suicidal impulses. [Increased akathisia and violent thoughts]
  5. True:  U.S. Suicide rates (about 30K per year) are typically higher than U.S. homicide rates (about 20K per year).
  6. True:  Firearms constitute the most common method for completed suicides for both females and males.




March Madness Invitation

Hey. It’s trash talking time. You can join my ESPN based free bracket competition by going to, clicking on The Tournament Challenge and then Join Groups and then finding our group: Montana Trash Talkers. The password is Montana. I plan to win again this year and have forgotten that I didn’t win last year. You’re all toast . . . one and done . . . your performance already sickens me:)

If you’ve received this email feel free to join in or ignore me.

This game is free. If you are the winner of this group, I will send a $50 donation to the charity of your choice. I will also be donating $10 for each of my incorrect selections (from one bracket) to the Missoula Food Bank.

Have an excellent day! I look forward to your participation and trash talking.

John SF

Differential Activation Theory and Suicide Assessment

In anticipation of my upcoming suicide assessment interviewing webinar, I’m posting this and other suicide assessment interviewing material.

Differential Activation Theory

Differential activation theory suggests that when previously depressed and suicidal individuals experience a negative mood, they are likely to have their negative information processing biases reactivated. The original theory:

. . . stated that during a person’s learning history—and particularly during episodes of depression—low mood becomes associated with patterns of negative information processing (biases in memory, interpretations, and attitudes). Any return of the mood reactivates the pattern, and if the content of what is reactivated is global, negative, and self-referent (e.g., “I am a failure; worthless and unlovable.”), then relapse and recurrence of depression is highly likely. (Lau, Segal, & Williams, 2004, p. 422)

This theory and supporting empirical research indicates that during the course of a clinical interview, certain questioning procedures may move a previously depressed client toward a more negative mood state with an accompanying increase in negative information processing and suicide ideation. In fact, there are many studies indicating that both depressed and non-depressed clients and non-clients can be quickly and powerfully affected by mood inductions (Lau et al., 2004; Mosak, 2000; Teasdale & Dent, 1987).

For example, in a recent study, participants were divided into three groups: (a) those previously depressed with suicide ideation; (b) those previously depressed without suicide ideation; and (c) those with no history of previous depression (Lau et al., 2004). Following a mood challenge in which participants spent eight minutes listening to a depressive Russian opera at ½ speed while reading 40 negative statements such as, “There are things about me that I do not like,” participants generally experienced a worsening of mood and performed more poorly on a cognitive problem-solving test than prior to the mood challenge. Additionally, the participant group with a history of depression and suicide ideation exhibited significantly greater impairment in problem solving than the comparison groups. The authors concluded: “. . . when mood has returned to normal, cognitive variables may return to normal, but those who have been depressed and suicidal in the past are vulnerable to react differentially to changes in mood—with greater deterioration in problem-solving ability” (p. 428). This deterioration in problem solving is consistent with Edwin Shneidman’s concept of mental constriction, which we address later in this chapter.

Overall, the research clearly indicates that all individuals, depressed or not and suicidal or not, can have their mood quickly and adversely affected through rather simple experimental means. Additionally, it appears that previously depressed individuals may experience differential activation and therefore also have increases in negative cognitive biases about the self, others, and the future. Further, it appears that previously suicidal individuals may be particularly vulnerable to having their problem-solving abilities adversely affected when they experience a negative mood state.

Depressogenic Social, Cultural, and Interview Factors

In addition to the preceding research findings, there are a number of contemporary social and cultural factors that may predispose or orient individuals toward depressive and suicidal states. More than ever the United States media is involved in defining depressive states and promoting medical explanations for depression and suicidality. There are many books, magazine articles, and Internet sites encouraging individuals to examine themselves to determine if they might be suffering from depression, bipolar disorder, an anxiety disorder, AD/HD or other mental disorders. In particular, pharmaceutical advertisings encourage individuals to consult with their doctor to determine whether they might benefit from a medication designed to treat their emotional and behavioral symptoms. Unfortunately, as most of us know from personal experience and common sense, it is very easy to move into a negative mood in response to suggestions of personal defectiveness (which, over time, certainly may be as potent as eight minutes of a slow Russian opera). Consequently, it would not be surprising to find that continually rising depression rates and accompanying pharmaceutical treatments are, in part, related to increased awareness of depressive conditions.

Even more relevant to the suicide assessment interviewing process, it may be that interviewers who focus predominantly or exclusively on the presence or absence of negative mood states inadvertently increase such states. This possibility is consistent with constructive theory in that whatever we consciously focus on, be it relaxation or anxiety or depression or happiness, tends to grow. It is also consistent with anecdotal data from our students who report feeling surprisingly down and depressed after conducting and role-playing suicide assessment interviews.

Our concern is that traditional medically oriented depression and suicide assessment interviewing may sometimes inadvertently contribute to, rather than alleviate, underlying depressive cognitive and emotional processes. Consequently, in the following sections on suicide assessment interviewing, we guide you toward balancing negatively oriented depression and suicidality questions with an equal or greater number of questions and prompts designed to increase the focus on more positive client experiences and emotional states. This serves two functions. First, including positive questions and prompts may help clients focus on positive experiences and therefore improve their current mood state and problem-solving skills. Second, if clients are unable to focus on positive personal experiences or display positive affect, it may indicate a more chronic or severe depressive and suicidal condition. Overall, our primary message is that we should always pay close attention to the manner in which we use words, questions, and language when conducting depression and suicide assessment interviews.

Adopting a New Client and Suicide-Friendly Interviewer Attitude

Consistent with the CAMS approach as well as other more recent treatment perspectives (Action and Commitment Therapy (ACT); and Dialectal Behavior Therapy (DBT); we want to encourage you to adopt a fresh new attitude toward clients who may present with depressive and suicidal symptoms. Specifically, consider these attitudinal statements:

Depression and suicidality are natural conditions that arise, in part, from normal human suffering. Consequently, just because a client arrives in your office with depressive symptoms and suicidal features, this does not necessarily indicate deviance—or even a mental disorder.

Given that depressive and suicidal symptoms are natural and normal, it is acceptable for you, as an interviewer, to validate and normalize these feelings if they arise. This is especially important because many suicidal individuals feel socially disconnected, emotionally invalidated, and as if they are a burden to others (Joiner, 2005). There is no danger in accepting and validating client emotions—even self-destructive emotions.

In the spirit of the CAMS approach, we encourage you to listen to your clients’ suicidal thoughts and impulses nonjudgmentally; these thoughts and impulses represent your clients’ unique efforts to cope with their interpersonal and life problems.

Rather than continually drilling down into your clients’ depressive and suicidal symptoms, be sure to balance your clinical interview with questions that focus on the positive and your clients’ unique reasons for living. Forgetting to ask your client about positive experiences is like forgetting to go outside and breathe fresh air.

Fortunately, most people who experience depression recover, with or without treatment. Additionally, most people at least briefly consider suicide as an alternative to life, and of those who seriously contemplate—or even attempt—suicide, most end up choosing life instead of suicide.

A note of caution is in order. People often hesitate to ask directly about suicidal ideation out of a fear that they will somehow cause a sad person to suddenly think of suicide as an option. Asking about suicidal thoughts or impulses is not the same as dwelling on negative and depressing thoughts and feelings. Balancing the focus between negative and more positive, solution-focused material can be both wise and helpful. Failing to ask about suicide is neither.

Author, Speaker, University of Montana Professor