Counseling and Psychotherapy Theory and Practice

CBT and Spirituality

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Evening Snow Absarokee

We have a friend who is the pastor of a church in Absarokee, Montana. My impression is that she frequently talks about theories of counseling and psychotherapy . . . even though I’m sure she hasn’t planned to integrate psychological theory into her sermons. The fact that I hear psychological theories as she talks theology is just another way in which the lens of the listener frames what is heard, seen, and experienced.

Today she was preaching about feelings of inferiority. She made the case, as Adler would, that inferiority feelings are natural and normal. Then she shifted to God’s acceptance or grace. Surprisingly (to me) her focus on acceptance reminded me of Albert Ellis’s REBT and his concept of universal self-acceptance. Although my friend was speaking about God’s acceptance of all humans, regardless of our warts and behaviors, I found myself thinking of times when I’ve heard parents express deep acceptance of their children and of when clients have strived to experience greater self-acceptance.

All this brought me to a place where I started thinking about how Ellis and his REBT model might actually have a spiritual dimension. “That was pleasantly unexpected” I thought to myself . . . which prompted me to write this Sunday evening spirituality post.

The following is an excerpt (preview) from the cognitive behavior chapter of the forthcoming 3rd edition of Counseling and Psychotherapy Theories in Context and Practice. Please let me know what you think.

CBT and Spirituality

Like all therapists, cognitive behavior therapists work with religious or spiritual clients. Given that cognitively oriented therapists routinely identify and challenge (either through disputation or collaborative empiricism) client beliefs, there’s a risk that clients’ deeply held religious or spiritual beliefs might also be challenged. Additionally, practiced as a radical modernist scientific paradigm, CBT has been critiqued for overlooking transcendence, grace, and evil (Stewart-Sicking, 2015).

Looking at the situation logically (which cognitive theorists would appreciate), CBT practitioners have three options:

  1. Ignore client religion and spirituality.
  2. Freely challenge religious beliefs, whenever they cause emotional distress.
  3. Integrate religious/spiritual knowledge into practice in a way that supports nuanced discussions of religion and spirituality. Unhelpful or irrational thoughts might be questioned, as needed, but not central religious values (Johnson, 2013).

Historically, cognitive therapists have followed these first two options, mostly ignoring religion, or questioning its rational foundations (Andersson & Asmundson, 2006; Nielsen & Ellis, 1994). However, in the past decade or two, interest in integrating religion/spirituality into counseling and psychotherapy has increased (Stewart-Sicking, 2015).

It can help to think about client religion/spirituality as a multicultural/diversity issue. If so, the general guide is for therapists to (a) seek awareness of their own spiritual and religious attitudes and how they might affect counseling process and specific clients, (b) obtain relevant knowledge about religion/spirituality, (c) learn religion/spirituality specific skills, and (d) advocate for individuals who are oppressed on the basis of religion/spirituality as needed and as appropriate. Each of these cultural competence components can be stimulating for individual practitioners.

For practitioners interested in religion/spirituality integration with cognitive approaches, the following two areas can provide focus for further training and development.

Gain and Apply Scriptural Knowledge with Clients

Gaining knowledge regarding how to use specific religious scriptures to dispute irrational or maladaptive cognitions may seem daunting. However, from an REBT perspective, Nielsen (2001) wrote:

Since clients usually upset themselves through their awfulizing, demanding, frustration intolerance, and human rating, REBTers need only search Scriptures that decatastrophize life, suggest forbearance in the face of uncontrollable people and situations, tolerance of life’s frustrations, and that affirm basic human equality. The prominent religious writings of most major world religions emphasize such rational values. (p. 38)

Using scriptural knowledge would be most appropriate when working with clients who have similar religious beliefs. Nielsen (2001) is advocating general knowledge, but general knowledge could prove problematic. For example, if a Jewish therapist quoted the Koran to a Muslim client, the discussion might quickly shift away from being therapeutic. On the other hand, having general knowledge, if used sensitively, could represent appreciation of religious diversity and enhance the working alliance.

Use Spiritual Principles of Acceptance for Managing Disturbing Cognitions.

Contemporary CBT approaches (covered in Chapter 14) offer an alternative way of viewing and handling so-called irrational or maladaptive cognitions. These approaches include acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and mindfulness-based cognitive therapy (MBCT). ACT, DBT, and MBCT integrate religious/spiritual philosophy (e.g., Buddhism, contemplative Christian, etc.) and generally view cognitions as disturbing, but not necessarily pathological. Acceptance of all cognitions is advocated; encouraging clients to dispute or restructure their thoughts, memories, and experiences can increase suffering (Hayes, 2016).

 

Counseling and Psychotherapy Theory and Practice

Behavior Therapy and Spirituality

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1974 Football Cropped II

The whole idea of integrating behavior therapy with religion and spirituality might seem odd or off or impossible. But here in Theories Land, we don’t believe in the impossible. In fact, many religious folks do just fine with behavior therapy and many behavior therapists do just fine with religious folks. If you think about it, for behaviorists, the focus is purely on problematic behaviors. In some ways, this naturally leads to an acceptance of all people . . . .

Put another way, for behaviorists, there’s no room or need for discrimination based on race, sexuality, or religion. Behaviorists work with all people to help them with their problem behaviors.

Rather than digressing into the political, let’s refocus on behavior therapy and spirituality. Here’s the short section from the 3rd edition of Counseling and Psychotherapy Theories in Context and Practice. If you feel moved (by the spirit, or anything else), please let me know what you think.

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

Strict behaviorists don’t believe in the utility of cognition. The clients’ problems are behaviors. Behavioral treatments involve new learning to facilitate behavior change. If you stick with the perspective that cognition is irrelevant—which is the perspective we’re sticking with in this chapter—then client religious or spiritual beliefs are also not relevant.

Considering religious and spiritual beliefs as irrelevant doesn’t imply disrespect for religious and spiritual beliefs. Behaviorists are respectful of beliefs, but the focus of therapy would be on behaviors—these behaviors could include religious or spiritual behaviors. If you’re following the logic here, then you can see that behavior therapy is 100% compatible with religion and spirituality.

The focus of behavior therapy with religious and spiritual clients would be on behaviors that are related to religion and spirituality. From a behavioral model, the question is, “Are your religious/spiritual behaviors causing you distress or contributing to your well-being?” The good news about this is that behavior therapy is an evidence-based approach for modifying behavior, including the development of positive and healthy habits (and behaviors commonly thought of as representing self-control and self-discipline). The focus on enhancing self-control and self-discipline is a good fit for clients with religious or spiritual orientations (Shapiro, 1978).

Researchers have explored the relationship between behavioral activation and client values. In one study, it was found that when individuals with high intrinsic religious values engaged in a greater frequency of religious behaviors, they reported reduced depressive symptoms (Agishtein et al., 2013). Conversely, for individuals with low intrinsic religious values, increasing religious behaviors were associated with more depressive symptoms. In conclusion, despite disregard for religious/spiritual beliefs, a strict behavioral approach can be used to increase or decrease specific religious and spiritual behaviors. . . and increasing or decreasing specific religious and spiritual behaviors may be therapeutic—depending on the individual client and his/her/their situation.

 

Counseling and Psychotherapy Theory and Practice

Person-Centered Spirituality

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Rogerian Spirituality

Most of the distinct figures who developed major theories of psychotherapy also had distinct views about religion and spirituality. As you may recall, Freud was antagonistic toward religion. One of the interesting parts of exploring how each theoretical orientation deals with spirituality has involved learning a bit more about the religious and spiritual perspectives of people like Freud, Adler, and others.

In chapter 5 of Counseling and Psychotherapy Theories in Context and Practice, the focus is on Carl Rogers. Other than knowing that he was raised in a conservative Christian family, I didn’t know much about Rogers and his personal spirituality. Here’s a sampling of what I discovered.

Person-Centered Spirituality

On his journey to developing person-centered theory and therapy, Carl Rogers renounced traditional Christianity. Given that all religions, including Christianity, can be viewed as directly imposing judgmental conditions of worth, Rogers’s renouncing Christianity as antithetical to his beliefs is not surprising. In particular, Rogers may have been especially reactive to religious dogma because of his childhood experiences in an extremely conservative Christian family. Thorne (1990) proposed that Rogers broke from Christianity, at least in part, over the doctrine of original sin.

Although he died an agnostic, toward the end of his life, Rogers began speaking about transcendental or mystical experiences (Thorne, 1992). These spiritual statements were mostly made in the context of interpersonal mutuality and human connection, derived from person-centered or I-Thou experiences. Within the person-centered world, his statements about spirituality have been viewed as controversial (Fruehwirth, 2013). In an interview with Elizabeth Sheerer, one of Rogers’s early colleagues at the University of Chicago Counseling Center, Sheerer was asked about why Rogers never formally addressed spirituality. Her response included:

That’s Carl. This was an area of difficulty for Carl. We learned early in the game not to talk about religion with Carl … it was uncomfortable for him …. But, of course, his work is so profoundly influenced by his background in Christianity. I don’t think he could have developed without that background. (Barrineau, 1990, pp. 423–424)

There have been contemporary efforts to build a bridge between spirituality and PCT. One example is Fruehwirth’s (2013) work connecting PCT and Christian contemplation. He proposed that if wordless contemplation can be regarded as “the heart of the Christian spiritual tradition” (p. 370), then parallels can be drawn to wordless contemplation and the PCT experience. Similarly, a case can be made connecting the acceptance doctrine of Christian, Buddhist, and other religious viewpoints with the PCT process.

Overall, it seems reasonable that, for some therapists and clients, the deep interpersonal acceptance inherent in the PCT experience might have religious, spiritual, or mystical components. Spiritual-based acceptance is probably the main place where an integration of PCT and religion/spirituality can occur. In contrast, wherever and whenever judgment flows from religious doctrine, religion and PCT are incompatible.

 

Counseling and Psychotherapy Theory and Practice, Writing

Existential Spirituality

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Bikes Snow 2

An impromtu word search of the existential theory chapter for the 3rd edition of Counseling and Psychotherapy Theories in Context and Practice revealed 17 appearances of the word “spirituality.” That’s nice. Seventeen is a prime number. Seventeen is also one of my favorite spiritual numbers. Back in 2nd grade in Sunday school in a synagogue in Portland, my teacher asked us to guess a number from 1 to 20. The winner had the honor of taking a special Bible story book home for the week. My guess was a perfect 17. I got the book for the week. Obviously, the number 17 is a spiritual force in my life.

More important is the sublime integration of spirituality into existential theory. Or not. It seems to go one way or another. Either existential theorists are deeply spiritual/religious or they’re atheist/agnostic. There is no middle ground. Or maybe there is? [More on this conundrum below]

What follows are several short excerpts from the Existential Theory chapter. These excerpts culminate with the short section on Existential Spirituality.

Soren Kierkegaard

The Danish philosopher Soren Kierkegaard (1813–1855) lived nearly his entire life in Copenhagen. Kierkegaard was devoutly religious. He was shaken when he discovered, at age 22, that his father had not only cursed God, but also seduced his mother prior to marriage. Subsequently, Kierkegaard’s writings focused primarily on religious faith and the meaning of Christianity. Eventually he concluded that religious faith was irrational and attainable only via a subjective experiential “leap of faith.” For Kierkegaard, virtuous traits such as responsibility, honesty, and commitment are subjective choices—often in response to a subjective religious conversion. Kierkegaard did not describe himself as an existentialist, but his work is a precursor to the existential philosophical movement, which formally began some 70 years following his death.

Friedrich Nietzsche

In contrast to Kierkegaard who began from a position of religious faith, the German philosopher Friedrich Nietzsche (1844–1900) had negative feelings about Christianity. It was he who, in his book Thus Spake Zarathustra, wrote, “God is dead.” Although he may have been referring to societal emptiness, he also claimed that religion used fear and resentment to pressure individuals into moral behavior. Instead of following a religion, he believed, individuals should channel their passions into creative, joyful activities. Irvin Yalom offers a fascinating view of Nietzsche’s psychological suffering in a historical fiction piece titled When Nietzsche Wept. In this novel, Yalom (1992) weaves existential principles into a fictional therapeutic encounter between Breuer, Freud, and Nietzsche.

Kierkegaard and Nietzsche represent an interesting paradox or dialectic in existential thinking. A dialectic is a process where learning is stimulated from the integration of opposites. On the one hand, some existentialists embrace deep religious faith, whereas others are staunchly atheistic. Still others claim an agnostic middle ground. These differences in fundamental beliefs represent a wide sweep of human intellectual diversity and provide for fascinating philosophical exploration. You will glimpse existential dialectics intermittently in this chapter.

Four Existential Ways of Being

There are four primary existential ways of being-in-the-world. They include:

  1. Umwelt: Being-with-nature or the physical world.
  2. Mitwelt: Being-with-others or the social world.
  3. Eigenwelt: Being-with-oneself or the world of the self.
  4. Uberwelt: Being-with-the-spiritual or over world.

Boss (1963), Binswanger (1963), and May et al. (1958) described the first three of these existential ways of being. van Deurzen (1988) added the fourth.

These dimensions of existence are ubiquitous and simultaneous. Some people focus more on one dimension than others or shift from one to another depending on particular intentions or situations. For example, while on a hike up the Stillwater gorge in Montana, it’s easy to experience being-with-nature as water powerfully cascades around you. However, depending on other factors, this experience can take people inward toward eigenwelt, toward an uberwelt spiritual experience, or stimulate a deep mitwelt (albeit a nonverbal one). In most cases, the direction your being-ness moves within a given situation is likely a combination of several factors, such as: awareness, anxiety, previous experiences, intention, and/or your spiritual predisposition.

The Daimonic

According to Rollo May, “The daimonic is any natural function which has the power to take over the whole person” (1969, p. 123). Historically, Daimon possession was used to explain psychotic episodes and is popularly referred to as demonic possession. However, May repeatedly emphasized that daimonic and demonic are not the same concept: “I never use the word demonic, except to say that this is not what I mean” (May, 1982, p. 11).

The daimonic is an elemental force, energy, or urge residing within all persons that functions as the source of constructive and destructive impulses. May wrote, “The daimonic is the urge in every being to affirm itself, assert itself, perpetuate and increase itself .… [The reverse side] of the same affirmation is what empowers our creativity” (May, 1969, p. 123).

Similar to C. G. Jung, May considered harnessing and integrating the daimonic as a central psychotherapy task. He viewed psychotherapy as an activity that plumbs the depths of an individual’s most basic impulses … the purpose of which is to acknowledge, embrace, and integrate every bit of being and energy into the whole person. May commented specifically about the danger of leaving the daimonic unintegrated:

If the daimonic urge is integrated into the personality (which is, to my mind, the purpose of psychotherapy) it results in creativity, that is, it is constructive. If the daimonic is not integrated, it can take over the total personality, as it does in violent rage or collective paranoia in time of war or compulsive sex or oppressive behavior. Destructive activity is then the result. (May, 1982, p. 11)

The goal is to integrate natural daimonic urges and energies in ways that maximize constructive and creative behavior.

Existential Spirituality

A spiritual-oriented client was engaging in guided imagery with an existential therapist. The client “discovered” a locked door in the basement of his “self.”

“What’s behind the door?” the therapist asked.

“It’s darkness,” he said. With shivers of fear, he added, “There’s dread. It’s the dread of being unacceptable. . . of being unacceptable to God. Even worse, it’s my dread of being unforgiveable.”

“Shall we go in?” asked the therapist.

Silence followed.

The therapist noticed his client’s reluctance and said, “Let’s wait a moment and breathe. I’m wondering if you can even get in the door. I’m wondering if you want to get in. There’s no rush. We know where the door is. We can wait. Or we can create a key and try to get in. Or we can leave the door shut. But first let’s wait here and breathe before deciding anything.”

For two minutes, client and therapist sat breathing together. The paralyzing fear diminished and the client said, “I have a key. Let’s look inside.”

“Yes. Let’s look inside.”

The key opened the lock. The door creaked open. In the dreaded darkness, there was light. A dialogue with the dread and unforgiveable ensued and the client found a broad sense of love and acceptance. There were tears of relief. His spiritual load was lightened. His basement demons were exorcised.

In this chapter we’ve discussed the deep and profound quality of existential psychotherapy. Schneider (2010) called it the “Rediscovery of Awe.” Frankl and Wong referred to it as the pursuit of meaning. In existential therapy, meaning and awe are individualized, as is spirituality. There’s great potential in combining the existential and the spiritual in psychotherapy, but clients should be forewarned and informed: combining the spiritual and existential isn’t about formulaic or surface explanations; it requires a commitment to go deep and explore doubts, uncertainties, and core vulnerabilities.

Here’s a link to the new Theories 3rd edition cover: https://www.amazon.com/Counseling-Psychotherapy-Theories-Context-Practice/dp/1119279127/ref=dp_ob_title_bk

 

 

Counseling and Psychotherapy Theory and Practice

Adlerian Spirituality

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John and Jon on M

In these uncertain times, I know you’ve been wondering about the future. You’re probably asking, “Who will prevail in the 2018 midterm elections?” “Will the evil New England Patriots win the Super Bowl again?” and “When will the coveted 3rd edition of Counseling and Psychotherapy Theories in Context and Practice finally be available?”

Predicting the future is complicated. My psychic powers tell me that the answers to those first two questions remain uncertain and are dependent upon various intervening events such as Hillary’s emails, the battle between fake and real news, economic inflation (as well as inflation of various footballs), and the health and well-being of several very old quarterbacks. However, based on the fact that Saturn has entered my 4th House and is dropping a psychological anchor, I can say with confidence that the 3rd edition of our theories textbook is coming soon . . . probably in April, 2018.

In the run-up (as the Brits like to say) to the publication of T3 (Theories, 3rd edition), I’ll be intermittently posting a few exciting T3 previews.

One new feature is a short section on how each primary counseling and psychotherapy theory intersects with spirituality. We’re including this feature because of the core role that spirituality plays for many clients (and many counselors and psychotherapists). In addition, spirituality is often a key component of multicultural sensitivity.

Way back in June of last year, I posted the spirituality section for psychoanalytic theory (chapter 3). You can read that here: https://wordpress.com/post/johnsommersflanagan.com/2571

Today’s post includes a look at spirituality from the Adlerian perspective (chapter 3). Keep in mind that these spirituality sections are very short samplings, designed only to help readers understand how spirituality can be viewed from specific theoretical perspectives. If you’re interested in additional (and deeper) information, we recommend you track down the citations from each chapter.

Here’s the spirituality taste or peek or snippet from the Adlerian chapter.

Adlerian Theory and Spirituality

Over the years, Adlerian theory has been open to client spirituality and has attracted practitioners and writers with strong religious convictions (Cashwell & Watts, 2010; Johnson, 2013; Sweeney, 2009). This is probably because of Adler’s emphasis on social equality and justice, but also because, as Carlson and colleagues (2006) wrote:

The cardinal tenet of Adlerian theory is social interest, something Adler equated with the mandate to “Love one’s neighbor as oneself” and the Golden Rule. (pp. 33–34)

Although the Golden Rule is a Christian concept, Adlerian writers and practitioners are consistently open to other religious and spiritual perspectives. In particular, Johansen (2010) provided guidelines for integrating individual psychology (IP) concepts into Christianity, Judaism, Buddhism, Hinduism, and Islam. Overall, as described in the theoretical principles section of this chapter, Adlerians view spirituality as a life task that can contribute encouragement and meaning into clients’ lives (Bluvshtein, Belangee, & Haugen, 2015).

Consistent with what is known about Adler, the specifics of client spirituality and religious belief is of minimal importance. Recall that the Adlerian position is that all behavior is purposeful. Consequently, what’s important is for what purpose religion is used, and not the particulars of a client’s theology. A couple Adlerian questions about spirituality might include: “Does the client use religion (or spirituality) to promote separation and violence? Or is religion (spirituality) used to bring people together as a working and compassionate community?

Given Adler’s valuing of social interest and interdependence, the latter of these alternatives is clearly the Adlerian way.

Personal Reflections, Politics

The Birth of My New Secret Magic Unprofessional Blog

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John Rap

People sometimes say, “Rules are made to be broken.”

I always say, “That’s just ridiculous. Rules were made to be followed.”

But every yang has a yin and it’s come time for me to let a little of my rule-breaking yin out.

As you know, I have this (Dr. John Sommers-Flanagan) professional blog. It’s serious, with a side of irreverence. But despite my irrepressible irreverence, being narrowly professional left me feeling like an academic in a tweed jacket. As an example, I felt compelled to avoid politics and profanity. I began realizing that this professional blog was too much yang.

So I invented a yin-flavored unprofessional blog. In my unprofessional blog I speak more freely about politics and personal experiences. It’s also a secret blog, and I use a mysterious yin alias, so that helps.

In this professional blog (the one you’re reading now), I avoid particular words, especially words like “secret” or “magic.” I avoid these words because magic is fake, and my professional self thinks that whenever writers use “secret,” it means they’re marketing something. It’s like unveiling the “secret rules to happiness.” The rules aren’t really secret and they won’t bring you happiness, but the words work to sell books and get likes on Facebook and Twitter. I also avoid words that don’t fit with my scientific, academic persona. That means I don’t use words like countless or tireless, because they’re just stupid words; nothing is countless and no one is tireless.

The inaugural post of my new Secret Magic Unprofessional Blog is about gun safety. It’s unprofessional, so don’t click on this link unless you want to read my thoughts on the social and political issue of gun violence and gun safety. Here’s the link:https://mysecretmagic.com/

Okay, I know, gun safety isn’t even controversial and my Pathetic Open Letter to the NRA is political like oatmeal is political. That’s because gun safety is all about professional issues related to suicide, mental health, and child safety. Okay, so I use the F-word and called a certain politician a dip-shit, but that’s just me tossing in some unprofessional language to make a point about what’s right and good and I know you know that making a point about what’s right and good isn’t really much political.

If you enjoy my Secret Magic Unprofessional Blog, please LIKE it and FOLLOW it and share it NOW and OFTEN: https://mysecretmagic.com/. As is the case with most bloggers, my purpose isn’t to become rich and famous. Instead, I’m all about exercising my freedom of expression, while irrationally hoping that someone on the planet might hear my voice and experience learning or pleasure or meaning or inspiration or solidarity. Now that would be magic.

https://mysecretmagic.com/

Personal Reflections, Politics

The Psychology of Evidence-Based Haiku and Freedom (#WordsMatter)

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nick-nacks

“Words were originally magic.” At least that’s what Freud said.

Freud, Captain America, and most sentient humans and cartoon characters who haven’t sold their souls, would likely agree that restricting words and language constricts human creativity and potential.

The White House is trying to ban the Centers for Disease Control (CDC) from using specific words. Not long ago, a five-year-old I know used the F-word. I put him in time-out. In this case, the CDC will get put in time-out for using the words “evidence-based” or “vulnerable.” Who does that?

It’s hard to find words to describe people who would restrict words, especially the words needed to report scientific findings. Ironically, for this government: Hate speech is fine. Pornography is no problem. Sexist language designed to demean is something you should grab onto and never say you’re sorry about. This is not a government that promotes family values.

Thou shalt not say: “transgender” or “entitlement.”

Who can use words to prohibit words? That’s a narcissistic megalomaniac fantasy.

Government repression of free speech has inspired me to reflect on the power of words. This reflection somehow led me East, into a temporary preoccupation with Haiku. The impulse to create Haiku with forbidden CDC words was irresistible.

Thou shalt not speak truth

Totalitarians shout

No science for you!

Once upon a time, we the people, formed a more perfect union. The purpose of said union was predominately to protect life, liberty, and the pursuit of happiness. For many, happiness happens when freedom includes science and a recognition that the CDC, being a government agency, is funded by me and you and, by design, is all about protecting life, liberty, and the pursuit of happiness. This made me think of Dr. Suess.

The White House is not the boss of me.

The White House is not the boss of the CDC.

The White House should not tell

Its citizens to go to hell.

We will free our words and use our actions.

To remove the man and all his factions.

I could understand the White House restricting use of the “F-word” or the “C-word.” But now the CDC isn’t supposed to use the word “diversity?” That’s a perversely impressive expression of totalitarian suppression. However, as with most totalitarian expressions, it misunderestimates (in honor of George W. Bush) a basic Haiku-truth.

Vulnerable white

Presidents must obey all

Science-based facts

There’s a robust psychological principle called reactance. In case you wondered, reactance is evidence-based. Reactance is resistance that naturally occurs when behavioral freedoms are threatened. What usually happens is: (a) Freedoms are threatened, (b) motivational arousal occurs, (c) efforts are made to restore threatened freedoms. This means we push back to affirm or re-affirm, our freedom. In honor of reactance, here’s a two-part 5-7-5 Haiku:

I: An entitled

Totalitarian once

Said: Shut the fuck up

II: Instead, we use words

To resist the regime that

Seeks devolution

Haiku can have spiritual dimensions. It requires slowing down, counting syllables, and ending a story near the beginning. There are several famous Zen Haiku poems. None of which are included here among my amateurish Haiku attempts.

This brings me to this blog’s end, which is also only the beginning of something else. To close, I offer a progressive Christian Haiku prayer for freedom:

Dear Lord Jesus, may

I kneel and say transgender?

Yes, my love, you may.

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice, Suicide Assessment and Intervention

Eight Core Conditions that Often Contribute to Suicide

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Rainbow 2017Many professionals and media sources have proclaimed that suicide is a 100% preventable problem. Although I completely disagree with that message—and find it terribly offensive—I also believe that we should do what we can to prevent suicide.

Recently I was asked to write a journal article summarizing the conditions or dimensions that commonly contribute to suicide. To give you a flavor of these dimensions, below I’ve included brief descriptions of each one. However, I also want to emphasize that suicidologists and suicide researchers agree that death by suicide is nearly always unpredictable. Suicide is unpredictable despite the fact that, afterwards, many people and professionals will feel as though they should have “seen the signs” and done something more to prevent the death.

Knowing the following eight dimensions is useful when they’re used to enhance your compassion and capacity to collaborate with individual clients and persons. They’re not designed to be used as suicide risk factors or predictors.

Here are the eight dimensions.

Unbearable Psychological/Emotional Distress (Shneidman’s Psychache)

Shneidman (1985) originally identified “psychache” as the central psychological force leading to suicide. He defined psychache as negative emotions and psychological pain, referring to it as “the dark heart of suicide; no psychache, no suicide” (p. 200). In more modern patient-oriented language, psychache is aptly described as unbearable emotional distress. Unbearable distress can involve many factors, or center around one main trauma, loss, or other psychologically activating experiences; it may be accompanied by distinct cognitive, emotional, or physical symptoms.

Problem-Solving Impairment (Shneidman’s Mental Constriction)

Depression or low mood is commonly associated with problem-solving impairments. Originally, Shneidman called these impairments mental constriction, and defined them as “a pathological narrowing of the mind’s focus . . . which takes the form of seeing only two choices: either something painfully unsatisfactory or cessation” (1984, pp. 320–321). Researchers have reported support for Shneidman’s original ideas about mental constriction (Ghahramanlou-Holloway et al., 2012; Lau, Haigh, Christensen, Segal, & Taube-Schiff, 2012).

Agitation or Arousal (Shneidman’s Perturbation)

Agitation or arousal is consistently associated with death by suicide (Ribeiro, Silva, & Joiner, 2014). Shneidman (1985) originally used the term perturbation to refer to internal agitation that moves patients toward suicidal acts. When combined with high psychological distress and impaired problem-solving, agitation or arousal seems to push patients toward acting on suicide as a solution to their distress. Trauma, insomnia, drug use (including starting on a trial of serotonin-reuptake inhibitors), and many other factors can elevate agitation (Healy, 2009).

Thwarted Belongingness and Perceived Burdensomeness

Joiner (2005) developed an interpersonal theory of suicide. Part of his theory includes thwarted belongingness and perceived burdensomeness as contextual interpersonal factors linked to suicide. Thwarted belongingness involves unmet wishes for social connection. Perceived burdensomeness occurs when patients see themselves as flawed in ways that make them a burden to others.

Hopelessness

Hopelessness is a broad cognitive variable related to problem-solving impairment and linked to elevated suicide risk (Hagan, Podlogar, Chu, & Joiner, 2015; Strosahl, Chiles, & Linehan, 1992). Hopelessness is the belief that whatever distressing life conditions might be present will never improve. In many cases, patients hold a hopeless view—even when a rational justification for hope exists.

Suicide Desensitization

Joiner (2005) and Klonsky and May (2015) have described how fear of death or aversion to physical pain is a natural suicide deterrent present in most individuals. However, at least two situations or patterns can desensitize patients to suicide and reduce natural suicide deterrence. First, some patients may be predisposed to high pain tolerance. This predisposition is likely biogenetic, as in blood-injury phobias (Klonsky & May, 2015). Second, patients may acquire, through desensitization, a numbness that reduces natural fears of pain and suicide. Chronic pain, self-mutilation, and other experiences can be desensitizing.

Suicide Plan or Intent

In and of itself, suicide ideation is a poor predictor of suicide. Nevertheless, ideation is an important marker to explore with patients; exploring ideation can lead to asking directly about whether patients have a suicide plan. Suicide plans may or may not be associated with suicide intent. Some patients will keep a potential suicide plan on reserve, just in case their psychological pain grows unbearable. These patients do not intend to die by suicide, but they want the option and sometimes they have thought through the method(s) they might employ.

Lethal Means

Access to a lethal means is a situational dimension that substantially contributes to suicide risk. Firearms are far and away the most lethal suicide method. Specifically, Swanson, Bonnie, and Appelbaum (2015) reported that firearms result in an 84% case fatality rate. Although firearms can quickly become a politicized issue in the U.S., researchers have repeatedly found that access to firearms greatly magnifies suicide risk (Anestis & Houtsma, 2017).

 

Parenting, Personal Reflections, Writing

Parenting in the Age of Trump . . . and other Parenting Challenges

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John and Paul with Fish

This past week, Donald Trump posted another name-calling Tweet about Kim Jong Un being short and fat. Before that, he was famously recorded by Access Hollywood saying it was okay to grab women by the pussy. Somewhere in between, he tweeted about shooting Muslims with bullets dipped in pig’s blood and referred to “firing those SOBs.”

This blog isn’t designed to be political. I don’t mean to be picking on Donald Trump. However, the extraordinary number of provocative statements he generates every day makes him a ready example of a poor media role model. His statements are often of the ilk that republicans, democrats, and independents would all rather not have their 12-year-old children hear, much less repeat. The point is that sometimes politicians, news reporters, comedians, musicians, athletes, and other celebrities make statements that are incompatible with mainstream American family values. This isn’t new. For those of us who were parents back then, about 20 years ago President Bill Clinton made a statement about oral sex that—at the very least—constituted horrid advice for teenagers. The other point is that somehow parents have to figure out how to best deal with provocative statements that leak out of the media and into our children’s brains.

In this week’s episode of the practically perfect parenting podcast, Dr. Sara Polanchek and I take on the contemporary Trump phenomenon, as well as the equally challenging phenomenon of comedians who try to make a joke out of holding a picture of a severed Trump head. How should parents deal with this stream of objectionable content?

Not surprisingly, Sarah and I have a thing or two to say about Parenting in the Age of Trump. We encourage you to contemplate, in advance, how you want to address revolting media-based material to which your children will be inevitably exposed. Our hope is for you to identify your personal and family values and then learn how to stimulate your children’s moral development. Bottom line: we can’t completely control the objectionable media discourse, and so we might as well use it for educational purposes.

You can listen to the Practically Perfect Parenting Podcast on iTunes: https://itunes.apple.com/us/podcast/practically-perfect-parenting-podcast/id1170841304?mt=2

Or you can listen to it on Libsyn: http://practicallyperfectparenting.libsyn.com/

You can follow and like us on Facebook: https://www.facebook.com/PracticallyPerfectParenting/

And just as soon as I gain better control of my Twitter finger, then you’ll be able to find us on Twitter too.

 

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Building Better Counselors

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JSF Dance Party

This is a link to a hot off the presses article in Counseling Today. The focus is all about how professional counselors (and all psychotherapists) can be BOTH evidence-based AND relationally oriented. My co-author, Kindle Lewis, is one of our fantastic doctoral students in the Department of Counselor Education at the University of Montana. And . . . by the way. . . the University of Montana is NOW the NEW best college destination on the planet. Ask me why:).

Here’s the link: http://ct.counseling.org/2017/11/building-better-counselors/

The place to click if you want to learn about psychotherapy, counseling, or whatever John SF is thinking about.