Tag Archives: Professional Issues

Professional Issues

@TechCounselor: A better way to email, Part II

By Adria S. Dunbar and Beth A. Vincent January 4, 2018

Last month, we asked readers, the following question:

Which inbox issue are you trying to solve?

  1. a) I write emails during nonworking hours (e.g., 4 a.m., weekends, holidays).
  2. b) The number of emails I get each day is out of control.
  3. c) I need to translate my emails into tasks on a to-do list.
  4. d) My email signature leads people nowhere.
  5. e) I write the same email over and over again.

For those who answered, “I write emails during nonworking hours,” we suggested that you try a Google add-on called Boomerang. Sidenote: Boomerang just released an email app, so if you took our suggestion and like what you found, you might want to check that out.

If your email issues aren’t solved yet, keep reading. This month we are tackling answer b) The number of emails I get each day is out of control.

How many times a week are you asked the question, “May we have your email address?” This has resulted in fewer ads to toss from our mailboxes, but so much junk cluttering our inboxes. Here are some strategies for tackling this clutter. We hope that one or two of these suggestions will work for you.

1) Use a different email address. Maybe you have an old Yahoo address lying around somewhere. It used to be your go-to email address, but then Gmail came along, and your Yahoo account has long since been abandoned. Put that address back in the rotation. When the clerk at the grocery store asks for your email address and promises a 5 percent incentive for providing one, give out the email address that you rarely use. This separates the promotions and junk mail from email that is personally addressed to you.

2) File email in folders. Many email services now offer different folder options for social and promotional email. They will even automatically “move” emails into these folders for you based on the sender and number of recipients. Some people also set filters to automatically send specific emails to named folders.

3) Use email apps. One approach to try is to use different email apps for your different email addresses. Rather than including all of your email accounts in one place, keep them separate. For example, you could use Inbox to manage your personal email and the native Mail app on your iPhone to manage your work email. This also helps you not to see work emails on weekends and evenings when you are searching for emails like the buy one, get one sale at your favorite store.

4) Stop the notifications. We read somewhere that we are becoming a bit addicted to “breaking news.” It used to be that a notification meant something, but now notifications happen constantly. Take back your peace. Stop the email notifications (or pause them temporarily) until you need them. Want to know if a flight is delayed? OK, maybe keep that one. Notifications from your bank about deposits and withdrawals? OK, that seems important too. But think long and hard about some of the other nonurgent notifications you may be receiving and make a conscious choice to turn them off. You can always turn them back on if you miss them.

5) Unroll.me. If you’re already drowning in email and are weeding through promos and notifications, you can use Unroll.me to see all of your email subscriptions in one place. You’ll be shocked to see how many subscriptions you receive! Knowing how many email subscriptions you have is half the battle. You can use this tool to unsubscribe from various email lists all at once, or create a “Rollup,” which allows you to get one email per day featuring all the emails and promos you’ve selected. Unroll.me creates an email digest so that you can look at all of the information once a day, saving you time and energy while keeping your inbox clean.

6) Say no thank you. As counselors, we tell our clients all the time to set better boundaries. It’s OK to decline when a company asks for your email address.

Clerk: “What’s a good email address for you?”

Us: “No thank you.”

That’s one less email we have to delete on a regular basis!

We hope these email tips will help you spend less time clearing out email and more time on what is important to you. Check back next month to learn strategies to translate your email into a to-do list.

 

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Adria S. Dunbar is an assistant professor in the Department of Educational Leadership, Policy and Human Development at North Carolina State University in Raleigh. She has more than 15 years of experience with both efficient and inefficient technology in school settings, private practice and counselor education. Contact her at adria.dunbar@ncsu.edu.

 

Beth A. Vincent is an assistant professor at Campbell University in Buies Creek, North Carolina, in counselor. She is a counselor educator, licensed school counselor and former career counselor who is driven to learn everything there is to know about innovative productivity software so that she can help counselors be their most present selves. Contact her at evincent@campbell.edu.

 

Our Instagram is @techncounselor (instagram.com/techcounselor/).

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

2017’s most-read articles

January 3, 2018

What were counselors reading in 2017?

The year’s most-read post at Counseling Today online was a first-person article that shared insights on recovering from — and avoiding — practitioner burnout. Readers were also interested in pieces that shared professional insights on social issues, strengthening the therapeutic relationship, client issues such as trauma and anxiety, navigating technology, counselor licensure and other topics.

Interestingly, the top five search terms that brought online searchers to the Counseling Today website were “countertransference,” “self-care for counselors,” “multicultural competence,” “empathy fatigue” and “dual relationships in counseling.”

More than 150 articles, both online-exclusive pieces and articles that also appeared in Counseling Today’s print magazine, were posted at ct.counseling.org in 2017.


Most-viewed articles posted in 2017 at ct.counseling.org

  1. A counselor’s journey back from burnout” (Member Insights, April magazine)
  2. Yalom urges ACA attendees to hold fast to self-care and the therapeutic alliance” (Online exclusive coverage of Irvin Yalom’s keynote speech at ACA 2017 Conference & Expo in San Francisco; posted in March)
  3. Informed by trauma” (Cover story, October magazine)
  4. Facing the fear of incompetence” (Feature, April magazine)
  5. ACA continues push forward for licensure portability” (Feature, July magazine)
  6. Fetal alcohol spectrum disorders (FASD): A guide for mental health professionals” (Member Insights, July magazine)
  7. Living with anxiety” (Cover story, June magazine)
  8. Facing the realities of racism” (Cover story, February magazine)
  9. The (misguided) pursuit of happiness” (Feature, February magazine)
  10. Creative and novel approaches to empathy” (Knowledge Share, February magazine)
  11. Mental health implications of undocumented immigrant status” (Knowledge Share, April magazine)
  12. A protocol for ‘should’ thoughts” (Online exclusive, posted in October)
  13. Technology Tutor: Revisiting the ethics of discussing clients online” (Column, November magazine)
  14. Nonprofit News: Self-care for caregivers” (Online column, posted in March)
  15. When brain meets body” (Cover story, March magazine)
  16. Key concepts from Gestalt therapy for non-Gestalt therapists” (Knowledge share, June magazine)
  17. Becoming shameless” (Cover story, May magazine)
  18. The selfish act of forgiving” (Feature, May magazine)
  19. Observations from a licensing board” (Online exclusive, posted in July)
  20. Conversion therapy: Learning to love myself again” (Online exclusive, posted in February)

 

 

 

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What was your favorite article of 2017? What would you like to see Counseling Today and CT Online cover in 2018? Leave a reply in the comment section below, or email us at CT@counseling.org

 

 

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Follow Counseling Today on Twitter @ACA_CTonline and on Facebook: facebook.com/CounselingToday

 

The role of value in adult self-esteem and life satisfaction

By Harvey Hyman December 19, 2017

While reflecting on my clinical experiences with adult clients during my postgraduate internship, I discerned a common thread. The thread was that the feeling of being valueless was at the root of my clients’ depression, anxiety, anger and substance abuse, as well as the violence and verbal abuse experienced within couples.

Although the immediate cause of the perception of being valueless varied (e.g., pervasive childhood neglect or specific episodes of childhood physical, sexual or emotional abuse), the consequences were the same in each case — chronic dysphoria of one kind or another. It is simply not possible to esteem oneself, to be vulnerable with others, to feel able to positively impact the lives of others through relationships or achievements, or to expect an enjoyable and meaningful future when one is convinced that she or he lacks value.

During the past few months, I have been learning about and practicing a technique involving mindful self-compassion designed to increase my sense of personal value, and I have been working with willing clients to teach them the same technique. I have written this article to voice my perspective on how self-perceived valuelessness is the major factor in transdiagnostic client suffering and to share a technique for building belief in your clients that they possess value as human beings.

 

The meaning of value and valuelessness in human life

In common parlance, the word “value” signifies having such positive qualities as worth, goodness, merit, effectiveness, usefulness, importance, attractiveness and desirability. People who perceive themselves as possessing value are much more likely to have self-esteem, self-efficacy and life satisfaction than are people who appraise themselves as lacking value. Believing oneself to be valuable is associated with resiliency and posttraumatic growth because external hardships and adversities do not destroy value but, rather, reveal it.

To lack value means that one is not lovable, desirable or worthy of mattering to and belonging with others. There are few, if any, sources of emotional pain greater than believing that you lack value. I believe that clients who are convinced that they lack value are the ones most likely to suffer from depression and to engage in self-destructive behaviors such as alcohol or drug abuse, the self-sabotage of relationships, cutting, burning, eating disorders and suicide attempts. When you are certain you lack value, it is equally certain you will hate yourself and will consider or perpetrate acts of self-harm. You may even want to end yourself to stop the pain of living with this certainty and being your own worst enemy instead of your own best friend.

I understand that genetic abnormalities that cause bad brain neurochemistry, especially during times of stress, can trigger self-hate, depression and self-destructive behavior. However, I am convinced that most of the time distorted thinking about the self (as being bad, incompetent or certain to fail at everything) and maladaptive coping behaviors arise from our clients’ belief that they are valueless.

Believing that you are valuable but constantly berating yourself for being a piece of crap or sitting in a squalid room injecting heroin into your veins with a used needle are totally inconsistent. Believing that you are valueless also rears its ugly head in interpersonal relationships. People who know they are valuable can shrug off the unfair accusations, attacking comments, insults and rejecting behaviors of others by recognizing that they come from ignorance, mistaken assumptions, implicit biases, defensiveness or fear. On the other hand, people who see themselves as valueless will perceive dire threat and react with fight, flight or freeze when exposed to these things because they confirm their inner sense of valuelessness.

 

The association between value and triggering

A very common bit of psychological jargon that I hear today is the word “trigger.” It is used in the sense that some statement, action or inaction of one person set off an intense, immediate and automatic emotional reaction in another person who felt unsafe. This person responds with crying, threats of violence, actual violence, emotional contraction, fleeing the scene and the like.

When one spouse says “Shut the hell up” to the other, strikes the other or gets in the car and drives off to parts unknown following a dispute, we can say that he or she was triggered, but what really happened? I think what happened is that the spouse who acted out had a thin, fragile scab over his or her self-perception of being valueless and something the other spouse said tore it off.

Whether we remind ourselves that we are valueless through our own inner critic (the usual way) or someone else reminds us by their statements or conduct, it hurts just as much. And when that pain sets in, our self-esteem plummets from whatever shaky height we had lifted it up to. We then temporarily lose our effectiveness as people because we turn away from the world to soothe ourselves with substances or punish ourselves with self-attacking words or deeds.

 

Intrinsic versus extrinsic value

According to sources as diverse as the Judeo-Christian Scriptures, the philosophers Immanuel Kant and Martin Buber, and the Declaration of Independence, human beings have intrinsic value. Theologists may see intrinsic value as coming from people being created by a perfect Creator, whereas philosophers might see intrinsic value as coming from our possession of rationality and our capacity to act ethically by choosing the good.

To believe in the intrinsic value of the individual is to believe that our value is not contingent upon externals such as one’s most recent successes, the current size of one’s bank account or the current level of one’s physical attractiveness. For Viktor Frankl, value becomes evident when a person establishes an authentic meaning for his or her life. For Abraham Maslow, it is when a person self-actualizes his or her potential.

Despite so many sacred and secular voices in favor of intrinsic value, virtually none of the people I have met buy it. Rather, they engage in constant self-evaluation in relation to internal standards of achievement and attractiveness, as well as external comparisons with family members, friends, co-workers, professional colleagues and even star athletes, movie actors and celebrities.

Freud described this long ago as checking one’s self-evaluation in the mirror of one’s ego ideal and getting judged harshly by one’s superego for every discrepancy. Today we talk about the voice of the inner critic instead of the superego, but the process and consequences are the same. There is a constant need to reassure oneself of one’s value, and a failed attempt to do so is followed by self-attack, ego deflation and suffering. Kristin Neff, who has done pioneering research on self-compassion, has pointed out that self-attack is accompanied on a somatic level by release of cortisol and adrenalin, which make us feel sick.

 

Value and secure attachment

Why is it that a handful of people seem certain that they possess value while everyone else sees their value as questionable, fluctuating or even absent? The work of John Bowlby on attachment helps to shed light on this phenomenon.

Bowlby said that how infants and toddlers were treated by their parents, especially their mothers, had a huge impact on their sense of self. Infants and toddlers who received a consistent flow of love, caring, warmth, gentle touch, soothing vocalization and affirmation would develop what Bowlby called a “secure attachment” composed of feeling welcomed, loved, valued and wanted. The secure attachment was the germ of self-acceptance and self-confidence that fueled these children’s exploration of their environment and their ability to self-soothe when they experienced fear, physical pain or other adverse consequences.

In Bowlby’s framework, infants and toddlers who received love, warmth and caring in an unstable, episodic and inconsistent manner would develop an insecure or approach-avoid attachment style associated with a reduced sense of personal value and trust in others. The most damaged infants and toddlers were the victims of pervasive abuse or neglect who received the message that their caregivers hated them or did not care about them. These children developed an avoidant attachment style in which they reacted to others by distancing themselves emotionally and physically.

 

Therapeutic approaches to correcting self-perceived valuelessness

If secure attachment is the foundation of the self-perception that one has value, then the most effective therapy for clients who doubt their value or regard themselves as valueless should be some form of reparenting that has the effect of strengthening a weak attachment to others. Unfortunately, this type of therapy is demanding, prolonged and expensive, and is by no means guaranteed to work.

Cognitive behavior therapy is great at showing the falsity of automatic, negative thoughts about the self, but until the deep-seated conviction (the core belief) that one is valueless is gone, these thoughts will continue to arise. Trauma therapies work to desensitize, contextualize and reinterpret memories of adverse childhood experiences, but the conviction that one is valueless, resulting from pervasive abuse or neglect, is very tenacious. This conviction can represent the foundation of personality and self-identity and the form the ego took from parental shaping in childhood.

If it is not possible to remove and replace the psychological foundation of self-image, what can be done to solve this problem? My hunch is that behind the conveyance of a sense of value to the infant/toddler through parental holding, touching, warmth and affirmation is a programming of the brain (“I know I am loved”) and the heart (“I feel that I am loved”). Abuse, neglect or inconsistent parenting can confuse the brain of the infant/toddler (“I’m not sure I’m loved and lovable”) or program it to believe that “I am neither loved nor lovable.” These things can make the child’s heart feel the same message.

So, how can clients in therapy reprogram their brains to know and their hearts to feel that they have value? At this point in my investigation, I have only anecdotal evidence and nothing like the kind of systematically collected empirical evidence developed in the course of a randomized, controlled clinical trial based on an experimental design. Thus, my proposal is based on isolated experiences in the therapy office and is nothing like the sort of evidence-based protocol that an insurance company would want to see. On the other hand, positive clinical experiences can be the germ of subsequent studies to confirm or deny a hypothesis about those experiences.

The method I have been trying out on myself and some of my clients derives in part from what Kristin Neff and Christopher Germer call “mindful self-compassion.” The basic practice is to combine deep, slow, meditative breathing with eyes closed; an attitude of genuine compassion toward the self; the tender placement of hands upon one’s body (e.g., placing one open hand over your heart); and the inward repetition of chosen affirmations in a soothing voice.

I have tried out such affirmations as “I am worthy,” “I am valuable,” “I matter,” “I know my own goodness,” “I feel loved and included,” “I love and include,” “I am connected with all other beings and they with me,” “I trust that the universe supports me” and “the universe is unfolding in and through me, and I have an important role to play.” Individuals using this practice can create and try out different mantras until they have found some that resonate in a deep and profound way with them.

The meditative breathing serves to produce a trancelike, mildly euphoric state in which the parasympathetic nervous system is activated, the voice of the inner critic is switched off and there is a sense of warmth and expansive possibilities. The role of tender self-touch is to provide mammalian comfort and reassurance — to put oneself in a place of safety and trust.

The combination of meditative breathing with eyes closed and self-touch enables clients to become attuned to themselves in a way that could not happen in the therapy office with the distraction of glances, conversation, pauses and concern over the counselor’s opinion. When imbibed in this atmosphere of self-compassion and self-attunement, the self-affirming mantras take on the ring of truth, not New Age phoniness. Doing this exercise with sincerity is a form of self-reparenting that features the three elements that Dacher Keltner considers essential in loving mammalian connection: warmth, gentle touch and soothing vocalizations.

At this point, I have no evidence that this particular practice by itself can convert individuals who are convinced that they are valueless to people who know and feel they possess value. However, I am observing in myself and my clients that combining this practice with another therapy has a powerful, synergistic healing effect and that this practice has clinical promise.

 

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After 25 years of law practice, Harvey Hyman retired, studied Buddhism and world religions, and entered graduate school to obtain a master’s degree in mental health counseling. He graduated this past October and is now registering for a counseling internship in the Sacramento, California, area. He hopes to work in the field of trauma psychology. Contact him at harveyhyman56@gmail.com.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

@TechCounselor: A better way to email, Part I

By Adria S. Dunbar and Beth A. Vincent December 11, 2017

Most of us have a love-hate relationship with email. Luckily, there are many software solutions to help counselors and counselor educators handle email more efficiently. Let’s begin by identifying the email issues you want to fix. If you choose more than one, don’t worry. We will take it one step at a time.

 

1) Which inbox issue are you trying to solve?

  1. a) I write emails during nonworking hours (e.g., 4 a.m., weekends, holidays).
  2. b) The number of emails I receive each day is out of control.
  3. c) I need to translate my emails into tasks on a to-do list.
  4. d) My email signature leads people nowhere.
  5. e) I write the same email over and over again.

 

We will spend the next few months addressing each of these types of email issues, one at a time. For those who chose “I write emails during nonworking hours,” we suggest an email add-on that might save you a lot of time and energy. It’s called Boomerang (boomerangapp.com/), and it just might make your life with email a little easier.

 

Counselors, meet Boomerang

We are all trying our best to set boundaries with work and work-related tasks. Maybe you like to spend your Saturday mornings catching up on work, but sending an email on a Sunday evening or Saturday morning alerts people to the fact that you are available and working. Or perhaps you are a night owl who writes emails at 3 a.m. The meta-communication of when we send our emails says something to the recipients.

Regardless of your counseling role, email is a reality of the working world. Now that the majority of people have a smartphone, our emails tend to follow us everywhere — even when we are not physically present at the office. Everyone manages his or her connectedness differently, but as counselors, it can be challenging to set boundaries when it comes to responding to emails from clients, students or co-workers. Unfortunately, it can be easier to just go ahead and respond immediately rather than risking the sometimes unavoidable reality of forgetting to follow up at a later time.

Boomerang is a helpful tool that allows you to schedule when your emails get sent. What this means is that you can write and respond to an email whenever you choose — maybe that is at night after your children have gone to bed, or on the weekend when you said you weren’t going to be checking your email. Regardless, you can schedule the email to be sent to your client’s inbox at 8 a.m. on a Tuesday morning during normal “business” hours. This can help us as counseling practitioners or counselor educators to model better communication boundaries to our clients and students (i.e., suggesting that we are not instantly accessible) by limiting communication times and creating a culture of self-care.

In addition to setting boundaries, Boomerang allows you to schedule emails ahead of time, whether that is hours, days, weeks or months in advance. For example, perhaps you are planning a workshop or group event that is a month away, but you already have a list of attendees who have RSVP’d. Using Boomerang, you can write your email reminder now and schedule that email to be sent to attendees a week before your event takes place. This takes the pressure off of you to remember to send a reminder email.

Boomerang does come with some limitations. The tool is accessible both for Gmail and Outlook users. However, currently, you can schedule only 10 emails per month using the free version. Once you hit your 10-email limit, you are unable to schedule additional emails until a new month begins (unless you pay a monthly fee for the service).

In our view, there are definitely benefits to the paid services. For $5 a month, you can schedule messages to return to the top of your inbox at a set date, while also including a note to yourself with next steps or reminders. You also receive mobile access to the application. For additional fees each month, other features are available, including unlimited emails with Boomerang, recurring messages (e.g., weekly, monthly, yearly), a setting that allows you to pause email notifications and a setting to prioritize a VIP list of senders.

Whether wishing to disconnect a bit more, wanting to be more organized with your recurring messages or just needing reminders of the emails you sent that no one replied to, Boomerang can be a tool to help counselors reduce some of the mental clutter that we all experience because of our very full inboxes.

 

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Adria S. Dunbar is an assistant professor in the Department of Educational Leadership, Policy and Human Development at North Carolina State University in Raleigh. She has more than 15 years of experience with both efficient and inefficient technology in school settings, private practice and counselor education. Contact her at adria.dunbar@ncsu.edu.

 

Beth A. Vincent is an assistant professor at Campbell University in Buies Creek, North Carolina, in counselor. She is a counselor educator, licensed school counselor and former career counselor who is driven to learn everything there is to know about innovative productivity software so that she can help counselors be their most present selves. Contact her at evincent@campbell.edu.

 

Our Instagram is @techncounselor (instagram.com/techcounselor/).

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Raising awareness of suicide risk

By Jerrod Brown and Tony Salvatore December 6, 2017

Suicides have increased steadily in the United States during the past decade. Suicide research has also grown, but pertinent findings are sometimes slow to reach mental health professionals and providers. Many misconceptions and gaps in the knowledge base remain. The role that mental illness plays in suicide is an area of research that both the public and many clinicians must better understand. This article touches on 10 aspects of the relationship between suicide and mental illness that mental health professionals should be aware of and should be able to share with others.

1) Serious and persistent mental health disorders sometimes contribute to suicidal behavior, but they generally are not the cause of suicides on their own. A suicide risk factor is a personal or demographic attribute found to be prevalent among suicide victims; a cause is a condition that brings suicide about. When suicide and serious and persistent mental illness are inappropriately linked, it can result in enhancing associated stigmas and misdirecting the focus of suicide prevention. Mental illness is sufficient to contribute to suicide but not absolutely necessary. Myriad factors and reasons, separate and aside from mental illness, can account for suicidal behavior. Keep in mind that antidepressants and other psychotropic medications may effectively reduce suicide risk only for the psychiatric disorder for which they are prescribed.

2) Many individuals who die by suicide do not have a diagnosed serious and persistent mental illness at the time of death. The Centers for Disease Control and Prevention’s National Violent Death Reporting System has found that just over 40 percent of those who die by suicide have a mental health diagnosis.

Despite methodological flaws, psychological autopsy studies that attempt to assign psychiatric diagnoses post-mortem through interviews of those who knew the deceased have routinely found that an overwhelming number of victims of suicide had a diagnosable, although perhaps not documented, mental illness. Nonetheless, this mode of research may sometimes exaggerate the role that mental illness plays in suicide. Mental health providers must understand that although mental health services are a critical component of suicide prevention, they should be only part of a comprehensive approach to deterring the onset or progression of suicide risk.

3) The rate of suicide and suicidal behavior has been found to be higher among people with a serious and persistent mental illness than in the general population, but the majority of those with a serious and persistent mental illness neither attempt nor complete suicide. Every mental health professional and provider organization must be sensitive to the potential for suicide risk and behavior in their clients regardless of their psychiatric histories. Retrospective studies of those who have died by suicide have found that not all of these individuals possessed discernible signs of any form of mental illness as identified by family members or friends. Therefore, outpatient providers must be careful not to minimize signs of possible suicide risk in the absence of mental illness.

4) Psychiatric hospitalization may stabilize and ensure the safety of people who are acutely suicidal. However, it does not in and of itself constitute long-term treatment or reduce the risk of suicidality in the future. Inpatient settings can reduce suicide risk through appropriate use of psychotropic medication when indicated. Psychoeducation about suicide and support groups should also be part of a treatment plan for a client who is suicidal. Community-based providers accepting referrals from inpatient facilities should review the attention given to a potential client’s suicidality while hospitalized and make sure that a predischarge suicide risk assessment was performed.

Suicide prevention must also be part of aftercare in the community. Outpatient providers should engage the client on this objective prior to discharge. Outpatient providers should be thoroughly familiar with the client’s discharge plan, and particularly those elements relating to ongoing suicide risk. If appropriate and with the client’s consent, the outpatient provider should consider a family conference to ensure that the client’s support system understands the individual’s ongoing suicide risk, the family’s role in managing it and what family members should do if the client shows signs of suicidality.

Most important, outpatient providers must maintain continuity of care and resume treatment as soon as possible. When short-term resumption of treatment cannot be accomplished, contact should be initiated by telephone or other means to support the client.

5) The first 30 days after discharge from inpatient psychiatric care is a period of high suicide risk irrespective of the reason for admission. Suicide risk has been found to be especially high in the first week after discharge. This must be acknowledged in outpatient discharge plans. Patients and families must be made aware of this risk, and providers must ensure that patients returning to the community engage quickly with outpatient services and adhere to medication regimens as applicable. Those leaving hospitals must be made aware of 24/7 hotline and crisis services that they can turn to if needed. The National Suicide Prevention Lifeline (at 800-273-8255) is one such resource.

6) Contracting for safety is a technique in which at-risk clients agree to notify their mental health providers or take other steps (e.g., calling a hotline or 911) rather than making an attempt on their life if they have thoughts of suicide. Many counselors, therapists and mental health practitioners continue to use this technique despite an absence of research supporting its efficacy. At best, safety contracts give mental health providers a questionable, if not groundless, sense of security regarding their clients’ potential risk.

Providers are better advised to use thorough suicide risk assessments and personal suicide safety plans with patients and clients. Providers and clients can collaboratively develop personal suicide prevention safety plans, and they have therapeutic value. These plans generally document factors such as warning signs, triggers, coping methods, supports, providers and sources of emergency help.

7) Many mental health providers do not have suicide prevention policies that mandate routine training or outline requirements for client and patient suicide risk assessment. In some instances, mental health providers lack guidance on what should be done in the event of the suicide of a client. This is a serious deficit given our exposure to potential client suicides. Agencies should have a formal suicide prevention policy stating the measures to be taken to prevent suicide and postvention actions to be initiated with staff affected by a client’s suicide. Providers should encourage licensed staff to include suicide prevention trainings among their required continuing education.

A client suicide is perhaps the most traumatic experience that a mental health provider can endure. Taking a risk management stance after a suicide is not sufficient and may be harmful to all concerned. Providers should supply grief support resources, such as Survivors of Suicide, to both staff members and to the deceased client’s family members.

8) Care of individuals who are suicidal has been delegated to the mental health system for evaluation and treatment. This has resulted in many at-risk individuals being assigned one or more diagnoses from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. These diagnoses often become the focus of subsequent care, which may overshadow the person’s ongoing suicide risk and the need to address his or her suicidality. The mental health field has access to some evidenced-based therapies that can assist in reducing suicide risk and deterring future suicidal behavior, but more research and education are needed.

Those who survive a suicide attempt have an elevated short-term suicide risk and a continuing lifelong suicide risk. It is imperative for treating mental health professionals not only to provide therapeutic services but also to connect these clients with available community resources to reduce the likelihood of subsequent suicide attempts. Support groups made up of survivors of suicide attempts are optimal, but these groups are appearing only slowly in communities. In the absence of peer groups or provider-led support groups, consideration should be given to warm lines, chats and other online resources, or to videos and texts created by survivors of suicide attempts.

9) Effective treatment of serious and persistent mental health disorders may lessen suicide risk among impacted individuals. However, treatment for these disorders may not be the only answer. It is imperative for mental health professionals to also address other issues such as substance misuse, traumatic loss, shame, social disconnectedness, feelings of hopelessness or the belief that one is a burden to others when present. Suicide risk should be assessed whenever clients experience any adverse life events, regardless of clients’ adherence to therapy or counseling regimens. Assessing for risk of suicide may require ongoing attention throughout the entire treatment process.

10) The intense and persistent desire to die is experienced by some individuals with serious and persistent mental illness. However, by itself, desire to die is insufficient to bring about a potentially fatal suicide attempt. The person in question must also have overcome the inherent resistance to lethal self-harm. The mitigation of this resistance can occur through life experiences such as abuse, a history of violence, self-injury or traumatic grief, any of which individually can create a capability for significant self-harm up to and including suicide.

Conclusion

Certainly, some individuals with serious and persistent mental illness die as a result of suicide. Nonetheless, suicide is preventable. Mental health treatment providers are well-positioned to minimize the impact of suicidality after onset and to address any ongoing suicide risk. Several steps can be taken to accomplish this.

Every provider should have a suicide prevention policy that outlines measures to identify suicide risk in clients and appropriate responses to such risk. Such a policy should detail what must be done in the event of a client suicide. A suicide risk assessment should be considered as part of new client intake depending on prescreening responses. This involves both clinical judgment and an evidence-based risk assessment instrument.

All staff need to be able to recognize possible warning signs of suicide in clients. We recommend requiring all clinical staff to complete a continuing education course on suicide prevention on a regular basis. Providers might also consider participating on suicide prevention task forces at the city, county or state level. Participation may provide additional access to suicide prevention experts and other resources.

Finally, clinicians must adopt what might be called suicide prevention literacy. They must rely only on evidence-based reports about suicide from researchers in their disciplines and related fields. They must be able to assess these sources and use them to develop evidence-based treatments and programs. Suicide prevention literacy means employing these skills to make suicide prevention a practice reality. It goes beyond participating in suicide prevention walks and runs, conferences and trainings to create a provider mentality that is prevention-oriented. It means using what is available to try to mitigate suicide risk and amplifying suicide protective factors in clients and in the community — not just talking about it.

 

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Jerrod Brown is the treatment director for Pathways Counseling Center Inc., which provides programs and services for individuals impacted by mental illness and addictions. He is also the founder and CEO of the American Institute for the Advancement of Forensic Studies and the editor-in-chief of Forensic Scholars Today and The Journal of Special Populations. He holds graduate certificates in autism spectrum disorder, other health disabilities and traumatic brain injuries. Contact him at Jerrod01234Brown@live.com.

Tony Salvatore is the director of suicide prevention at Montgomery County Emergency Service, a nonprofit crisis intervention and psychiatric emergency response system in Norristown, Pennsylvania. He has a particular interest in post-psychiatric hospital suicide prevention and has served on a number of suicide prevention task forces at the state and county levels in Pennsylvania.

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Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

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