Tag Archives: Bozeman

Cool Counseling, Parenting

Understanding and Taming the Anxiety Beast in Your Child

Leave a comment

Nora Twirl

I’m feeling a little nervous about going back to Bozeman this coming Thursday, November 14. This time, instead of continuing on with my latest streak of suicide and happiness presentations, the focus is on something I love even more: Parenting. I’m nervous because I obviously need help and support for coming up with titles to my talks. Somehow I’ve claimed that I’ll be taming beasts this Thursday. Looking back, I’m wondering why I made up such a grandiose sounding title. Ugh. Help wanted.

Despite my own anxiety, I’ll be presenting on behalf of Thrive, a very cool parenting education and children’s support organization in Bozeman. The event is called the Thriving Institute.

Location: Bozeman Public Library

Time: 6pm to 8pm

You can register online at: allthrive.org

Check out the fancy flyer here! Thriving Institute – Understanding and Taming the Anxiety Beast in Your Child

In anticipation of Thursday’s talk, I’m re-posting a blog from last year. It’s about children and anxiety, and it’s got an accompanying podcast. Here’s the re-post!

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

Facing fear and anxiety is no easy task. It’s not easy for children; and it’s not easy for their parents. Here’s a short piece of historical fiction that captures some of the dynamics that can emerge when you’re helping children face their fears.

“I’m scared.”

My nephew turned his pleading fact toward me. He was standing on the diving board. I was a few feet below. We had waited in line together. Turning back now meant social humiliation. Although I knew enough to know that the scene wasn’t about me, I still felt social pressure mounting. If he stepped down from the diving board, I’d feel the shame right along with him. My own potential embarrassment, along with the belief that he would be better served facing his fears, led me to encourage him to follow through and jump.

“You can do it,” I said.

He started to shake. “But I can’t.”

Parenting or grand-parenting or hanging out with nieces and nephews sometimes requires immense decision-making skill. I’d been through “I’m scared” situations before, with my own children, with grandchildren, with other nephews and nieces. When do you push through the fear? When do you backtrack and risk “other people” labeling you, your son, your daughter, or a child you love as “chicken?”

This particular decision wasn’t easy. I wanted my nephew to jump. I was sure he would be okay. But I also knew a little something about emotional invalidation. Sure, we want to encourage and sometimes push our children to get outside their comfort zones and take risks. On the other hand, we also want to respect their emotions. Invalidating children’s emotions tends to produce adults who don’t trust themselves. But making the decision of when to validate and when to push isn’t easy.

I reached out. My nephew took my hand. I said, “Hey. You made it up here this time. I’ll bet you’ll make the jump next time.” We turned to walk back. A kid standing in line said, “That’s okay. I was too scared to jump my first time.”

Later, when the line had shrunk, my nephew wanted to try again. “Sure,” I said. “I’ll walk over with you.”

He made the jump the second time. We celebrated his success with high-fives and an ice-cream sandwich.

Like all words, the words, “I’m scared” have meaning and provoke reactions.

Sometimes when parents hear the words, “I’m scared” they want to push back and say something like, “That’s silly” or “Too bad” or “Buck-up honeycup” or something else that’s reactive and emotionally invalidating.

The point of the story about my nephew isn’t to brag about a particular outcome. Instead, I want to recognize that most of us share in this dilemma: How can we best help children through their fears.

Just yesterday I knelt next to my granddaughter. She was too scared to join into a group activity. She held onto my knee. We were in a public setting, so I instantly felt embarrassment creeping my way. I dealt with it by engaging in chit-chat about all the activity around us, including commentary about clothes, shoes, the color of the gym. Later, when she finally joined in on the activity, I felt relief and I felt proud. I also remembered the old lesson that I’d learned so many times before. In the moment of a child’s fear, my potential emotional pain, although present, pales in comparison to whatever the child is experiencing.

If you’d like to hear more about how to help children cope with their fears, you can listen to Dr. Sara Polanchek and me chatting about this topic on our latest Practically Perfect Parenting Podcast. Here are the links.

On iTunes: https://itunes.apple.com/us/podcast/practically-perfect-parenting-podcast/id1170841304?mt=2

On Libsyn: http://practicallyperfectparenting.libsyn.com/

And follow us on Facebook: https://www.facebook.com/PracticallyPerfectParenting/

 

 

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice, Writing

The Dialectics of Diagnosis at MFPE in Belgrade

Leave a comment

Waving

Today I’m in Bozeman on my way to present to the Montana School Counselors in Belgrade, MT. As my friends at the Big Sky Youth Empowerment Program like to say, “I’m stoked!” I’m stoked because there’s hardly anything much better than spending a day with Montana School Counselors. Woohoo!

My topic tomorrow is “Strategies for Supporting Students with Common Mental Health Conditions.” That means I’ll be reviewing some DSM/ICD diagnostic criteria and that brings me to reflect on the following. . . .

Not long ago (July, 2019), Allsopp, Read, Corcoran, & Kinderman published an article in Psychiatry Research, not so boldly titled, “Heterogeneity in psychiatric diagnostic classification.” Hmm, sounds fascinating (not!).

A few days later, a summary of the article appeared in the less academically and more media oriented, ScienceDaily. The ScienceDaily’s contrasting and much bolder title was, “Psychiatric diagnosis ‘scientifically meaningless.” Wow!

The ScienceDaily summary took the issue even further. They wrote: “A new study, published in Psychiatry Research, has concluded that psychiatric diagnoses are scientifically worthless as tools to identify discrete mental health disorders.”

Did you catch that? Scientifically worthless!

In an interview with ScienceDaily, Allsopp, Read, and Kinderman stoked the passion, and avoided any word-mincing.

Dr. Kate Allsopp said, “Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences.”

Professor Peter Kinderman, University of Liverpool, said: “This study provides yet more evidence that the biomedical diagnostic approach in psychiatry is not fit for purpose. Diagnoses frequently and uncritically reported as ‘real illnesses’ are in fact made on the basis of internally inconsistent, confused and contradictory patterns of largely arbitrary criteria. The diagnostic system wrongly assumes that all distress results from disorder, and relies heavily on subjective judgments about what is normal.”

Professor John Read, University of East London, said: “Perhaps it is time we stopped pretending that medical-sounding labels contribute anything to our understanding of the complex causes of human distress or of what kind of help we need when distressed.”

In contrast to the authors’ conclusions, nearly every conventional psychiatrist believes the opposite–and emphasizes that psychiatric diagnosis is of great scientific and medical importance. For example, the Midtown Psychiatry and TMS Center website says, “A correct diagnosis helps the psychiatrist formulate the most effective treatment that will result in remission.”

No doubt there.

In addition, although I literally love that Allsopp, Read, and Kinderman are so outspoken about the potential deleterious effects of diagnosis, I think maybe they take it too far. For example, “Shall we pretend that we should provide the same intervention for panic attacks as we provide for conduct disorder, autism spectrum disorder, and gender dysphoria?”

That’s me talking now . . . and as I discussed this with Rita, she amplified that, of course, if you have a student who’s intentionally engaging in violent acts that harm others, we’re not treating them the same as a student who’s suffering panic attacks. Obviously.

Psychiatric diagnosis is a great example of a dialectic. Yes, in some ways it’s meaningless and overblown. And yes, in some ways it provides crucial information that informs our treatment approaches.

This leads me to my final point, and to my handouts.

What’s our School Counseling take-away message?

Let’s keep the baby and throw out with the bathwater.

Let’s de-emphasize labels – because labelling, whether accurate or inaccurate and whether self-inflicted or other inflicted, are possibly pathology-inducing.

Instead, let’s focus on specific behavior patterns, as well as abilities, impairments, stressors, and trauma experiences that interfere with academic achievement, personal and social functioning, and career potential.

In case you’re interested in more on this. My handouts for the workshop are below.

The Powerpoints: MFPE 2019 Belgrade Final

Managing fear and anxiety:Childhood Fears Rev

Student de-escalation tips: De-escalation Handout REV

Why Kids Lie and What to Do About It

 

 

Personal Reflections, Suicide Assessment and Intervention

Op-Ed Piece — Suicide prevention in Montana: We must do better — In today’s Bozeman Daily Chronicle

Leave a comment

Boze Coop

It’s a short piece, but given that I’m in Bozeman tomorrow evening for a public lecture on suicide and spending the day on Friday doing a day-long suicide workshop for professionals, the timing is good.

You can read the Op-Ed piece in the Chronicle: https://www.bozemandailychronicle.com/opinions/guest_columnists/suicide-prevention-in-montana-we-must-do-better/article_0607e973-2b96-500f-93ba-bf9e85f2a7a8.html

Or you can read it right here . . .

In 1973, Edwin Shneidman, widely recognized as the father of American suicidology, was asked to provide the Encyclopedia Britannica’s definition of suicide: He wrote: Suicide is not a disease (although there are those who think so); it is not, in the view of the most detached observers, an immorality (although . . . it has often been so treated in Western and other cultures).

Shneidman’s definition captured two elements of suicide that many of us still get wrong. First, suicidality is neither abnormal nor a product of a mental disorder. At one time or another, many ordinary people think about suicide. Wishing for death is a natural human response to excruciating psychological, social, or emotional distress.

Second, suicidal thoughts or acts are not moral failings. Shneidman noted that society and religion often harshly judge and marginalize anyone who experiences suicidal thoughts and feelings. People who struggle with thoughts of suicide are already feeling immense shame. Adding more shame makes people feel worse, increases the tendency toward isolation, and serves no preventative function.

If you live in Montana, you’re probably aware that news about suicide in the U.S. and suicide in Montana is nearly always bad news. By some estimates, suicide rates have risen 60% over the past 18 years, and Montana has the highest per-capita suicide rates in the nation. Although national and local efforts at suicide prevention have proliferated, these efforts haven’t stemmed the rising tide. There are many reasons for this, some of which are sociological or political and consequently not responsive to suicide prevention programming.

But, as Shneidman emphasized, we need to stop equating suicide with mental or moral weakness. Suicide prevention and intervention efforts shaped around quick, superficial questions or influenced by pathology orientations are unlikely to succeed, and in some cases, may do harm. Compassionate, collaborative, and strength-based models constitute the best path forward for improving the effectiveness of our prevention efforts. If we want people who are in suicidal crisis to open up, talk about their pain, and seek help we must make absolutely sure that we’re communicating the following message—that suicidal thoughts are natural responses to difficult life circumstances, that opening up and talking with others will be met with compassion, not judgment, and that people who seek help from others should be respected for having the strength to reach out and be vulnerable.

To help the Bozeman community learn more about a strength-based model for suicide prevention and treatment, the Big Sky Youth Empowerment Project (BYEP) is sponsoring a free public lecture on Thursday, May 16th from 6:30pm to 8:30pm in SUB Ballroom D on the campus of Montana State University. Please join me for an evening of thinking differently about suicide—with the goal of saving lives in Montana.

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

John Sommers-Flanagan is a Professor of Counselor Education at the University of Montana, a clinical psychologist, and the author of over 100 professional publications, including eight books. He has a professional resource and opinion blog at https://johnsommersflanagan.com/

 

Counseling and Psychotherapy Theory and Practice, Parenting, Suicide Assessment and Intervention

The Pediatric Sleep & Wellness Conference in Seattle and The Suicide Prevention and Intervention in Bozeman: Informational Flyers Flying

2 Comments

In the coming weeks I’m honored to be able to present on two of my favorite topics: Parenting and Suicide Assessment.

These two upcoming events (in Seattle, April 27 and in Bozeman, May 16 and 17) have nice landing urls for information and registration.

If you happen to be in one or both of these areas, I’d be happy to see you. Please let me know, so we can say a real, non-virtual hello.

The links.

Seattle: https://pediatrictrainingacademy.com/conference/?fbclid=IwAR0ov1b6RgqIY3qHRG7qPAC2Nf9PyHpkbI5fOodtp8umUUTMbDW2sh9v438

Bozeman: https://www.byep.org/saw

Boze Coop

Happy Wednesday! JSF

 

Clinical Interviewing, Suicide Assessment and Intervention

The Montana Suicide Assessment and Treatment Planning Model is Coming to a Location Near You

3 Comments

While hanging out on Twitter, I noticed that E. David Klonsky, a fancy suicide researcher from the University of British Columbia tweeted about a brand new article published in the Journal of Affective Disorders.

The article, titled, “Rethinking suicides as mental accidents” makes a case for what the authors (Drs Ajdacic-Grossab, Hepp, Seifritz, and Bopp from Switzerland) refer to as the starting point for a “Rethink.”

Aside from their very cool use of the term rethink—a term I’m planning to adopt and overuse in the future—the authors’ particular “rethink” has to do with reformulating completed suicides as mental accidents, instead of mental illness. They concluded, “The mental accident paradigm provides an interdisciplinary starting point in suicidology that offers new perspectives in research, prediction and prevention” (p. 141).

For those of you who follow this blog and know me a bit, it will come as no surprise that I commend the authors for moving away from the term mental illness, but that I also think they should move even further away from even the scent of pathologizing suicidal thoughts and behaviors.

All this brings me to an important announcement.

Starting on the evening of May 16 and continuing onto May 17, in partnership with the Big Sky Youth Empowerment Project (thanks Pete and Katie), I’ll begin the launch of some public and professional suicide trainings in Montana. These trainings will include evening public lectures (starting May 16 in Bozeman) and professional trainings on suicide assessment and treatment planning (starting May 17 in Bozeman).

Going back to the “rethink” of suicide as a mental accident, I want to emphasize that my goal with these lectures and workshops is to reshape discussions about suicide from illness-focused to health and wellness focused. Rethink of it as a strength-based approach to suicide assessment and treatment planning. And you can also rethink of it as no accident.

For more information on the public lecture, check out this flyer: BYEPSAWpublic (1)

For more information on the professional suicide assessment and treatment planning workshop, check out this link: https://go.byep.org/advances and flyer: BYEPSAWclinical (1)

And if you can’t make these events, no worries, as I mentioned, this is a launch . . . which means there’s more coming later this year . . . in Billings, in Great Falls, and in Missoula.

Finally, if you want a workshop like this in your city, let me know. The good people of Big Sky Youth Empowerment are committed to delivering a more positive message about suicide assessment and treatment planning to other locations around the state; maybe we can partner up and do some important work together.

Thanks for reading and happy Sunday evening!

data or data

Parenting, Tough Kids Cool Counseling

The Fantastic Road to MBI in Bozeman

Leave a comment

The RoadHenry James once wrote that you should never begin a letter with an apology. Oh well. Rules are made to be broken.

That’s not really true. Rules aren’t made to be broken. Yes, they get broken. But rules are made to be followed. Whoever said they’re made to be broken was clearly wanting to break the rules and engaging in some clever rationalizing to justify breaking them.

Which leads me to my apology.

I want to express my sincere apologies to the 200+ participants in my “Strategies for Dealing with Challenging Parents and Students” day-long workshop at the Montana Behavioral Initiative (MBI) in Bozeman. After you all left, I was in the SUB Ballroom A at MSU, packing up my computer, when suddenly I was hit with the realization that I’d gone 15 minutes overtime. Very embarrassing.

Even though I knew (all day) that the workshop ended at 4:15pm, I just kept on talking until 4:30, when, in that particular moment, I thought I was ending right on time.

I’m still embarrassed. Mostly I’m embarrassed because I hate it when presenters go overtime and so I try very hard to end on time or a few minutes early.

My best explanation, which may be a convenient after-the-fact rationalization, is that I was having such a nice time with you all that my unconscious just decided (on its own and without consultation with my conscious brain), that we should spend a little more time together.

Or . . . maybe rules are just made to be broken.

At the bottom, I’ve inserted links to the ppt slides from the workshop and a link to the Practically Perfect Parenting Podcast.

As I said in closing yesterday. You are all fantastic and I am immensely grateful for the work you do with Montana students.

https://www.facebook.com/PracticallyPerfectParenting/ [Please like the podcast on Facebook]

https://itunes.apple.com/us/podcast/practically-perfect-parenting-podcast/id1170841304?mt=2 [Please rate on iTunes]

http://practicallyperfectparenting.libsyn.com/

 

Challenging Parents and Students MBI Handout

Clinical Interviewing, Suicide Assessment and Intervention

Three Strategies for Conducting State-of-the-Art Suicide Assessment Interviews

2 Comments

Tomorrow is the first day of the MUS Statewide Summit on Suicide Prevention in Bozeman, Montana. From 2:30-3:45pm I’ll be participating on a panel: “Screening and Intervention Options with the Imminently Suicidal.” During my 10-12 minutes, I’ll be offering my version of what I view as essential strategies and skills for face-to-face suicide assessment interviewing. Below is the handout for the Summit. I think it’s a great thing that we’re meeting in an effort to address this important problem in Montana. Thanks to Lynne Weltzien of UM-Western in Dillon and Mike Frost of UM-Missoula for the invitation. Here’s the handout . . .

Three Strategies for Conducting
State-of-the-Art Suicide Assessment Interviews
John Sommers-Flanagan, Ph.D.
University of Montana

I. To conduct efficient and valid suicide assessment interviews, clinicians need to hold an attitude of acceptance (not judgment) and use several state-of-the-art assessment strategies.

II. If clinicians believe suicide ideation is a sign of psychopathology or deviance, students or clients will sense this and be less open.

III. Asking directly about suicide is essential, but experienced clinicians use more nuanced assessment strategies.

a. Normalizing statements

  • I’ve read that up to 50% of teenagers have thought about suicide. Is that true for you?
  • When people are depressed or feeling miserable, it’s not unusual to have thoughts of suicide pass through their mind. Have you had any thoughts of suicide?

b. Gentle assumption (Shea, 2002, 2004, 2015)

  • When was the last time you had thoughts about suicide?

c. A solution-focused mood evaluation with a suicide floor

1. “Is it okay if I ask some questions about your mood?” (This is an invitation for collaboration; clients can say “no,” but rarely do.)

2. “Please rate your mood right now, using a zero to 10 scale. Zero is the worst mood possible. In fact, zero would mean you’re totally depressed and so you’re just going to kill yourself. At the top, 10 is your best possible mood. A 10 would mean you’re as happy as you could possibly be. Maybe you would be dancing or singing or doing whatever you do when you’re extremely happy. Using that zero to 10 scale, what rating would you give your mood right now?” (Each end of the scale must be anchored for mutual understanding.)

3. “What’s happening now that makes you give your mood that rating?” (This links the mood rating to the external situation.)

4. “What’s the worst or lowest mood rating you’ve ever had?” (This informs the interviewer about the lowest lows.)

5. “What was happening back then to make you feel so down?” (This links the lowest rating to the external situation and may lead to discussing previous attempts.)

6. “For you, what would be a normal mood rating on a normal day?” (Clients define their normal.)

7. “Now tell me, what’s the best mood rating you think you’ve ever had?” (The process ends with a positive mood rating.)

8. “What was happening that helped you have such a high mood rating?” (The positive rating is linked to an external situation.)

This protocol assumes cooperation. More advanced interviewing procedures can be added if clients are resistant. The goal is a deeper understanding of life events linked to negative moods and suicide ideation and a possible direct transition to counseling or safety planning.

 

IV. When students or clients disclose suicide ideation clinicians should:

a. Stay calm

b. Express empathy

c. Normalize ideation

d. Move to conducting a full suicide assessment interview (i.e., R-I-P-SC-I-P*) or refer the student/client to someone who will do a full assessment along with safety planning

e. Use suicide interventions as appropriate

 

V. Using Shneidman’s “Alternatives to Suicide” approach is a parsimonious way to simultaneously assess and intervene to reduce danger to self

 

VI. IMHO: All health and mental health providers should be trained to use these clinical skills and strategies when working with potentially suicidal students/clients.

 

Adapted from: Clinical Interviewing (6th ed., 2016), Wiley. Feel free to share this handout as long as authorship is included. For more information or to ask about professional workshops for your organization, contact John Sommers-Flanagan: john.sf@mso.umt.edu or 406-721-6367.

 

IMG_2481