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Discussion of MI in Suicide Prevention

When we give in to our anxiety about our clients’ suicidal ideation, we make it more — not less — likely that they will kill themselves.

From the great Talking to Change podcast, here’s a frank discussion about the best ways we can actually help people find their motivation to live:

Talking to Change attcnetwork.org Talking to Change: An MI Podcast. Episode 24: MI for Suicide Prevention, with Emma Braconier - Addiction Technology Transfer Center (ATTC) Network

Daniel P. Brown Sacred Sundays

I had the pleasure of sharing a meal with the late Dan Brown, Ph.D. when he came to Chicago to present on hypnosis in the treatment of attachment disorders.

In addition to being a very important writer and researcher in the field of clinical hypnosis, he was also a highly accomplished practitioner and translator of Tibetan Buddhist texts.

This 2-hour talk is one of the best nutshell descriptions of several thousand years of Buddhist empirical wisdom, through a lens deeply informed by modern psychology, and with a very powerful guided practice.

Listening for transference

When we listen for transference, we listen for the poetry in the patient’s words.

  • Jon Frederickson, Psychodynamic Psychotherapy: Learning to listen from multiple perspectives

Our crisis of the soul

“Are we so spiritually diminished, so enervated, to suffer our crisis of the soul in such trivializing fashion?”
-James Hollis, What Matters Most

Interpersonal Boundaries

Interpersonal boundaries are not something that can be imposed on others. They can only be upheld for oneself. The only power I have over anyone else is their access to me.

Seinfeld on the Cheapness of Life

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On an episode of Comedians in Cars Getting Coffee, Jerry Seinfeld talked about how in the old days nobody wore helmets. “Nobody cared. Remember when life was kind of a cheap, throwaway thing? Was it more fun? Of course it was!”

This hit me, actually. He’s right. For ages life was nothing special, you expected to die at any moment, and seeing other people die wasn’t considered traumatic – it was actually a popular form of entertainment.

What does this mean? We’ve come to agree that “life is precious,” and this prevents us from really being able to play with it. It’s an age of anxiety because it feels like there’s so much at stake, “You only live once!”

But this is all a flash in the pan. We’re only here for a moment. It doesn’t really change anything or mean anything. We should be able to play with it. Why not?

Max Planck on Matter & Consciousness

“I regard consciousness as fundamental. I regard matter as derivative from consciousness. We cannot get behind consciousness. Everything that we talk about, everything that we regard as existing, postulates consciousness.”
-Max Planck

Meeting destiny

Things that keep me awake at night…

“A person often meets his destiny on the road he took to avoid it.”
- Jean de La Fontaine

Treatment planning with the VA

The chief of psychology at a local VA medical center asked me the discharge plan for a patient who is still symptomatic. I said the plan is to treat them until they’re better.

Incredulously, she exclaimed “We can’t just keep treating everyone until all the symptoms are gone!”

Moralizing

Nancy McWilliams wrote:

“Moralization is a close relative of [the defense of] rationalization… rationalization converts what the person already wants into reasonable language; moralization puts it in the realm of the justified or morally obligatory”

Moralizing is the way you defend yourself against the scary reality that you are selfish and that the fulfillment of your desires will often lead to someone else’s pain.

The show is about nothing

How I feel explaining client-centered, psychoanalytic, and mindfulness-based intervention to psychotherapy trainees:
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What really works in psychotherapy

Here’s a great keynote presentation by Bruce Wampold, who has been one of the key researchers comparing the efficacy of different psychotherapies and identifying common factors shared between psychotherapy approaches:

(For the curious, here are his slides from that presentation)

Main takeaway: Better THERAPISTS get better results, not better treatment modalities.

Things that barely have any effect on treatment outcome:

  • The specific treatment methods used
  • How well the therapist adheres to the treatment model being used

The key factors in therapy effectiveness are:

  • Working alliance (mutual agreement and collaboration on goal.)
  • Empathic relationship
  • Positive regard / affirmation
  • Therapist congruence / genuineness

Key factors in therapist effectiveness:

  • Verbal fluency (how fluently and interestingly you can express yourself)
  • Affective perception (How well you can perceive affect, even if the patient is avoiding it or not aware of it)
  • Affective expressiveness and modulation

So, if you want to get better as a therapist, the things to focus on are improving your ability to perceive, modulate, and express emotion; to foster working alliance; to respond empathically and affirmingly; and to cultivate your own genuineness and congruence.

Developing new intervention tools and techniques has, for the most part, not been shown to significantly improve your treatment outcomes.

Certainty betrays a rejection of ambiguity

Certainty betrays a rejection of ambiguity.

BMJ Antidepressants Should Not Be Used

Wow!

BMJ Evidence-Based Medicine:
“Antidepressants should not be used for adults with major depressive disorder…. Based on current evidence, antidepressants seem to offer more harms than benefits."