Experiences of Suicide in Transgender Youth

This is where I talk about developments in the study of experiences of suicide in Transgender Youth with Dr. Jenifer McGuire, and Jory Catalpa.

https://drive.google.com/a/umn.edu/file/d/0B08spBDC3YUgUEgxZEItRFc4THc/view?usp=docslist_api

Britt McHenry and the Anger Iceberg

Britt McHenry and her manners have been trending on social media lately; it's a great example to talk about some of the things I am most passionate about as a Couple & Family Therapist.

First, I share her frustration with towing companies and I do actually think many are predatory.

Second, it is absolutely acceptable for her (or anyone) to get frustrated.

It is *not* acceptable to take this anger and direct it to berating and tearing down another person. I have a great amount of understanding for anger and frustration at towing companies but it is not acceptable to take this frustration and berate a person (looks, education, job, or anything about her).

Basically, Britt McHenry became a big bully and attempted to tear someone else down to make herself feel better. This is a common tactic and one of the biggest mistakes we make in relationships; rather than addressing the things that upset and make us angry we take our negative feelings and shove them onto another.

Anger is like an iceberg; (~90% of it is underwater and not visible). Anger is a reactionary emotion. We get angry because our car gets towed. We get angry because our feelings get hurt. Rather than talk about the things making us angry we push this anger out to other people to vent our steam. Britt, rather than simply admitting you did fail to take the high road I'd love to believe you will actually learn to understand and deal with your emotions. Somehow I don't think this is going to happen.

Suicide, Shame, Selfishness, and Matt Walsh

When I was 10 years old my father took me to see Mrs. Doubtfire.  It was a big deal because we didn't see movies often--and never had I then, nor now, seen another movie with just my father. Last month, my father died. Several days ago Robin Williams died.  It's an interesting connection to me...and maybe one of the reason's Robin William's death has been so difficult for me.  My heart goes out to his family.  I'm sorry for their loss; it must be so much harder for them than it is for me. He was an amazing and caring man.

One of the most popular articles I've seen shared since the passing of Robin Williams as been Matt Walsh's, "Robin Williams did not die from a disease, he died from his choice." And frankly, it upsets me. He is calling suicide what he thinks it is. "A terrible, monstrous atrocity...The complete, total, absolute rejection of life. The final refusal to see the worth in anything, or the beauty, or the reason, or the point, or the hope. The willingness to saddle your family with the pain and misery and anger that will now plague them for the rest of their lives..." He refers to suicide as a heinous deed and goes on to say, " We want to say nice things, I realize, but it isn’t nice to lie about suicide. It is not freeing. In suicide you obliterate yourself and shackle your loved ones with guilt and grief. There is no freedom in it. There is no peace. How can I free myself by attempting to annihilate myself?"

I have less of an issue with Matt Walsh calling suicide a choice--because it is--even though it does not feel like there is a choice. His post feels like he is walking a very fine line from calling suicide selfish (which many others have). Suicide is not about selfishness. Suicide is more about ending the pain that feels like it will never go away. It is not about shackling your loved ones with guilt and grief--it is about being exhausted and depressed and hopeless from the shackles that have bound you. I refuse to live my life believing my brother or Robin Williams refused to see the worth in anything or the beauty in life--because he (my brother) specifically made an effort to spend time with me.  I chose to believe that was because he cared for me.

I don't enitrely agree with the, "Genie, you're free" photos either--I think they trend towards idealizing suicide.  But you know what--for a lot of people that are suicidal it is ending your bondage to depression and hopelessness.  What kind of life is entirely devoid of happiness? But more important than the clinical professionals--what about the people that are dealing with depression and suicide themselves?  How do you feel about this "Genie, you're free" post? I think your opinion is just as (if not more) important.  Mat Walsh does end his article saying some more positive things but the message he gave over the course of the post is not reversed. As someone that studies suicide grief and has lived the majority of his life grieving over the loss of his own brother to suicide, Matt Walsh referring to suicide as heinous (sinful) offends me. It feels very shaming.

I wonder where this whole shame and stigma thing with suicide comes from. I wonder where this belief about suicide being selfish comes from. It actually feels like saying "Suicide is selfish," is selfish.  How? Because you are not concerned with the pain the person who thinks their life is not worth living--you are more concerned with your own. As said well by Katie Hurley, it is often because of the loved ones and thinking about these loves ones that someone that is suicidal hangs on for one more day.  This gets even more complicated when we take into account the fact people that attempt suicide often perceive themselves as burdens--so leaving would actually be (again) unselfish.

Again, I do believe there is absolutely hope for things to get better.  Talking about your pain is one of the best things you can do.  Dismissing or discounting another's is just about the worst.  Let's focus on mourning with those that mourn and comforting those that need comfort.  There is already too much pain and judgement in this world.

Sample Letter of Intent or Purpose Statement

Applying to graduate school is hard.  Sometimes I think it is harder than the graduate program itself.  It's easy to say that since I just finished my Master's program.  I was singing a different tune last semester and I bet I'll be singing a different tune next year in my PhD program. Each school has their own process and some are very different.  Some still require things to be mailed in almost entirely by snail mail--which I find hard to belief.

When my wife was applying to Physical Therapy programs many schools participated in an online system that would then send your application to each school.  No such luck within the Social Sciences :(

I have included the letters of intent or purpose statements that I used in my applications to UNLV's Master's of Marriage and Family Therapy and to the University of Minnesota's Family Social Science with a Couple and Family Therapy emphasis Ph.D. programs.  Both of which I was accepted to.

This is my purpose statement for UNLV's MFT program.

UMN's CFT program required two letters.  They are here and here.

I hope this goes without saying, but I'm going to say it.  Don't just copy these letters and turn them in.  Please use them however.  The purpose statement really is one of your best places to talk about you. So do it--copying someone else's makes little sense. I found it immensely useful to read other letters of intent for people that had been accepted into graduate programs.  Ideally within your own field.  Maybe someday I'll get some other examples within the social sciences and perhaps some in other fields.

Sample Informed Consent

Creating documents and forms and the formatting involved is one of my least favorite things in the world.  In hopes to provide some assistance to others in the same situation I have been creating paperwork for my own private practice I will include what I have.  I am not a lawyer so don't take these documents as ironclad.  Just a help.  I have included a few examples that I have and use in my own practice.

This document here (that is client information and informed consent)                        Or this one here

Reflective Listening Cheat Sheet

Throughout my training as a couple and family therapist I have learned the importance of getting people to talk to each other.  As we start in therapy most people typically talk about each other through the therapist. It seems to me that this is triangulation at its heart--though often a necessary part of the process; sometimes the relationship is just too volatile to allow deep emotions to be expressed to each other without a safe mediator between them (a therapist).

One of the tools that I have learned to get people to talk to each other is to do highly structured exercise.  It can be really difficult to just jump into reflective listening, so I have a cheat sheet that I have used with great success.  It helps in session and some even have success with it outside of session in their own "couch sessions."

Basically it is a fill in the blank exercise:

When _______________________________ I feel/think/_______________________________.

When _______________________________You feel/think_____________________________.


You can see the file uploaded on google drive here or the picture below.

Re-reconsidering Sleepovers

Recently, I had a friend post an article about reconsidering sleepovers. (The article can be found here)  I think the article makes some great suggestions about things to consider when having a sleepover, but something about the way the article is written rubs me a little wrong.  I grew up with a few kids that were not allowed to have or come to sleepovers but also went to more than a few myself.  I don't think one way or the other is "the right answer" for all people.  

My biggest concern with the article is that I get the feeling it is saying it's only safe to be at home--no one else is be trusted.  The article cites an article from the New York Times that reports only 8% of children are abused by strangers (and my understanding of this in the article is to not let your kids be alone with friends at their homes).  However, either article fails to acknowledge that most abuse happens within the child's own home. By family members. 

What are your thoughts?

Family Drawings

Throughout therapy family-of-origin issues (FOO) often arise and are often a source of conflict for couples.  One of the ways in which I like to address this topic is to ask clients to draw pictures of and discuss their families.  As an introduction to boundaries and bottom lines I like to introduce open and closed family systems to begin the process of reflection about appropriate and inappropriate behavior.

Every family system has a method by which it operates--this system has in impact on the development of the family members.  Though family systems can be very complex it is sometimes helpful to break them down into two types: open and closed.

Families are not always only open or only closed--many times families vary between the two.  Characteristics of OPEN families are:
1.  The family is flexible--change is welcome
2.  Feelings are allowed and shared
3.  Individual differences are allowed and encourages
4.  Mistakes are disciplined and forgiven
5.  Family and life roles are chosen by the individual
6. The family system serves/exists for its members
7.  The family supports and develops the individual

Characteristics of CLOSED families are:
1.  The family is rigid and secretive
2.  The family controls which feelings are allowed.
3.  Individual identity is lost in the family
4.  Mistakes are punished, judged, and shamed
5.  Family roles are assigned by the family
6.  The individual serves or exists for the family
7.  The family is more important than the individual



Note--I think some of these definitions are ethnocentric (of White, European families) and more about being individualistic or pluralistic.  I think that the exercise is still a good one.  I have attached the entire worksheet and prompts for drawings about certain experiences.

John Gottman's Love Map

One of my favorite homework assignments for couples is to assign the couple to go on a date and complete the Gottman Love Map exercise.  Basically it is an intense getting to know you questionnaire that ranges from favorite color to favorite sex position.  The questionnaire can be found here.

These questions can help a couple to spend some quality time together engaged in learning about one another.  Ideally, the questions lead to further conversation--at the very least there are 62 ideas for conversation.

Love Maps 20 Questions Sex Game

Rather than the full 62 item survey, sometimes it is fun to make a game out of it with just 20 questions with a little focus on sex.  A link to the this as explained on the Gottman Blog is included below:

Relationship and Marriage Advice | The Gottman Relationship Blog: Love Maps 20 Questions Game


And another link is provided here, just in case:

What is love?

A long time ago (almost 10 years) I had a girlfriend during my first year of college.  I was taking my first Human Development class and learned about attachment theory and the differing styles of attachment.  Basically the short version is that kids develop beliefs about interaction based upon the way their parents treat them.  When children cry and caregivers respond the children learn that when in need someone will help. Children that are overly protected and not allowed to learn independence develop an anxious style that means they are unable to handle separation from a caregiver and constantly seek reassurance of love and support. 

Back to my girlfriend, when he parents dropped her off at college and finally said goodbye, she cried and ran after their car for over a mile.  When she told me this I was totally appalled at her obviously anxious attachment style and have often though that in relationships such displays of emotion were "red flags."

Let's fast-forward 10 years to this weekend.  I am now trained as a Marriage and Family Therapist and this attachment theory is a basis of my therapeutic works with individuals, couple, and families.  When saying goodbye to my wife she began to cry and my first thought was back to this girlfriend I had that ran after he parents.  My instinct was to be appalled, but something didn't feel right about that.  I realized all these years that I had understood attachment incorrectly. 

My wife's tears do not mean she feels my love will not exist when out of sight.  Her tears mean that she loves and cares for me.  She will miss me when I am gone and will be happy when I return.  While I am sad to be gone from her, it feels good to know that she misses me.  It feels good to know that she wants me to return.  I hope that she knows how much I look forward to returning to her again as well (and yes, I do tell her).

AAMFT Reflections

Today is the last day of the annual American Association for Marriage and Family Therapy (AAMFT) that was in Portland, Oregon.  My wife and I enjoyed our trip to Charlotte, North Carolina last year that we named our daughter Charlotte!  No kid on the way this year, so I doubt we'll be naming one Portland, but I sure did enjoy this trip.  In a lot of ways I enjoyed this conference more, in some ways less.  The biggest thing that I enjoyed less was I didn't see any family and I've missed my wife and daughter.  The other reflections are:


1.  AAMFT made a shift to "go green" this year providing all handouts, evaluations, and conference guides primarily online (only on paper if you make a big stink about it).  While I totally support "going green" and am committed more than any of my family members would like to recycling, reducing, and reusing the "going green" effort at the conference seems less about helping the environment and more about helping the conference preparation--but this is a minor issue and not the focus of my point.  The point I have to make is that the AAMFT app that includes all useful conference information is not as easy as having a paper guide that is huge.  Half the time the app doesn't work because it is frozen or stuck and needs to be reset--which I learned how to do finally.  The biggest problem was the app requires an internet connection (or phone signal) to provide any useful information about the schedule or location of sessions.  This works well at your hotel room, but barely down in the rooms of the conference.  Seems like the schedule and room list could be included in downloaded content.  The other huge deal is that the app is annoying to navigate.  Each page should have an Ipad-like square that can be clicked on at any time to open it rather than having a wheel to cycle through that after one use bugs out so that you must cycle through it blindly.  It seems that the same team that built the AAMFT website built the app.  I avoid using both at all cost due to the annoyance factor.
Also, the AAMFT team kept pushing the site m.aamft.org as a guide which was very useful, but not when the was no connection in the bowels of the conference center.

2.  I volunteered this year and loved it.  Conference registration was much cheaper and I met a lot of other MFT students in the process.  I would absolutely recommend other students to volunteer if they have the chance.  In addition to meeting students it helped me to meet members of the AAMFT board and presenters at the conference.

3.  It seems that the schedule of the conference was a little erratic.  Sometimes we'd have 3 hours for lunch, others only an hour.  I'm sure there were other meetings going on, but not available to the general population attending the conference.  Along with this schedule issue:  The AAMFT Showcase of accredited programs was on Thursday night (the first night) and the "Cutting-Edge" poster session was on Saturday (the last night) and each was only 1 hour long, but the unattended "fun night" is 4 hours long.  Each year it is difficult to kick people out of the Poster session and the AAMFT showcase because there are so many people wanting to stay longer than an hour.  Why not give these a little more time?  I know I have never had enough time in these--especially during the AAMFT showcase where each program has a booth that's easy to find.

4.  Along with the poster session, it seems like there were fewer posters and a lot more posters from Professors and fewer from students.  What's up with that?  Also calling them "cutting-edge" doesn't mean more people are interested because research bores most clinicians (that make up the majority of attendees).

5.  Along with this topic of most of the population being bored.  Why is this the case?  Why are the keynote speakers not more familiar with MFT fields research?  (Because they are not in the field)  Some of the keynote speakers even seemed to bore themselves to sleep while presenting.  A lot of the presentations are boring lecture-like classes of being at college where paying attention in class OR reading the text allow the same outcome as doing both. 

6.  Network!  Last year I met a few people, and most that I did meet left no lasting impression because I was too timid to ask more probing questions.  This year, I came to the conference with a purpose--I want to get into a PhD program and I want to meet as many people as possible.  So rather than just having lunch and dinner and talking with friends that I already know, I did my best to constantly be talking to new people.  It was great!  Through talking to so many people I have really gained some direction in my PhD quest that was largely nebulous before this weekend. I think the best example of the benefit of my networking was shown to me during today's seminar when a PhD student tracked my down because he had talked to someone else that I had met at this conference.  It was great to see my network referring people to me without having to make any effort.


In summary, I have loved this year's conference and can't wait for next year in Milwaukee! 

Suicide Bereavement: I'm feeling a little angry/mad today

I am doing my thesis on suicide bereavement.  Grief and suicide are both great passions of mine and so I have combined the two into the culminating work of my Master's degree.  I am under a little bit of pressure to ensure that I get it done in time to graduate--having a baby kinda threw a wrench into my grand scheme of things.

Today I have spent hour reading and re-reading my transcribed interviews and I feel a little angry.  Several weeks ago, I had an emotional breakdown while looking at the data.  I wrote a bit about it on my personal blog, located here.  While I do not imagine I will ever stop missing my brother, today I am a little mad at him. My last memory of him is a trip to Four Peaks mountain in Arizona...the same mountain where he later took his own life.  I don't remember much about the trip except that I pretended to sprain my ankle to come home early--and that I was scared.  One of the key factors in my brother's suicide was the abandonment and rejection he felt from his birth father (my mother's first husband).  One of his last comments to my mother was, "I hope Quintin's (that's me) trust doesn't get broken like mine was."

Well you know what, it was.  And he was the one that did it.  He was so obsessed with his own issues of abandonment and rejection that he abandoned and rejected his eight-year-old brother that worshiped him.

Things I'm trying to learn how to teach

I have a couple of clients that punish their children for misbehavior and having a bad attitude.  (Not a big shocker, actually often this problem is the lack of consequences) My concern is not the rules that are being enforced--but how.  I'm struggling with approaching this subject in a way that will not trigger the parents to be defensive.  The issue is as follows:

When the children are in a bad mood they are put in a time out until they are able to talk to their parents when they are happy.

My struggle is that I actually really like this rule.  I don't want to talk to a stinker in a bad mood.  However, I wonder if this is teaching these kids that it is only acceptable to be happy.  Many clients I see (usually men) come in with really only two emotions they know:  mad and angry.  While I think that teaching children to self-soothe and emotionally regulate themselves is fantastic and a good thing, I think that there has to be a better way to teach children about emotions. 

We should be teaching children that it is okay to feel how they feel and help them to learn to identify why they are upset or grumpy.  While this may be beyond the scope of a 4-year-old kid, it certainly is not beyond the scope of a 10 year old.  Charts like the ones below can be very helpful in helping to learn to identify how and what we feel.

The biggest point I want is that we should be teaching that our emotions are ok.  It's ok to be happy and it's ok to be sad.  However, certainly it's not okay to behavior badly.

http://www.news.com.au/lifestyle/parenting/the-real-reason-why-our-kids-quit-sport/story-fnet08ui-1226645601355

LifeSTAR Pornography and Sexual Addiction Treatment in Las Vegas!

At the beginning of my graduate program at UNLV I had the opportunity to attend a 3 day training about running a sex and porn addiction program called LifeSTAR.  There had been some talk and attempt for our UNLV MFT program to start a LifeSTAR program in Las Vegas but that ended up not working out.  However several months ago a group of therapists at the Kayenta Therapy Center (9418 W. Lake Mead Blvd.) began the process of starting a sex/porn addiction program through the LifeSTAR network.  I have been able to work with the program for the last few months and am really glad to experience this awesome and powerful program. 

LifeSTAR is a three-phase out-patient treatment program designed to help individuals, couples, and families that struggle with addiction and/or compulsive behaviors pertaining to pornography and sexual activities. The phases of treatment build upon each other and help to promote individual and relational healing and to provide a strong support system.  The program begins with a "Getting Started Workshop" of six weeks that is educational and experiential.  It provides a basic understanding of issues that influence unwanted behaviors, and offer tools to help you stop those behaviors and replace them with healthier ones. It empowers your recovery process and help you to strengthen your significant relationships.


LifeSTAR is a nationally recognized treatment program run by licensed therapists who are trained in sexual addiction recovery. Participants receive workbooks and other materials to help them through the recovery process. The phases are specifically designed to gently uncover and heal patterns that create and maintain addictive behaviors.

The primary feature setting LifeSTAR apart from other treatment programs is the support offered to spouses and partners of addicts. A major focus in each of the three phases is providing spouses and partners with educational information and tools that help in the healing process. Couples are encouraged to attend together, but single adults and those who are married but would rather come alone are also welcome and encouraged to attend..

See the calendar below for dates of the The next Phase 1 "Getting Started Workshop."  If you are interested in the program call (702) 513-0508 or email KayentaLegacy.LifeStar@gmail.com.

How to signup for LifeSTAR in Las Vegas

Sign Up Instructions for the LifeSTAR Phase 1 "Getting Started Workshop"

1. Call 702-513-0508 and indicate that you are interested in tthe LifeSTAR program. 
2. Currently LifeSTAR meetings are held on Tuesday evenings.

This is a great article: http://news.harvard.edu/gazette/story/2013/02/money-marriage-kids/

The Vocabulary of Feelings

		Strong		Moderate		Mild
Confused		bewildered		mixed up		uncertain
		puzzled		flustered		unsure
		baffled		disconnected		bothered
		trapped		disorganized		uncomfortable
		confounded		troubled		ambivalent
		Strong		Moderate		Mild
Angry		furious		irritated		uptight
		enraged		hostile		disgusted
		seething		annoyed		put out
		infuriated		agitated		cross
		incensed		aggravated		impatient
		indignant		mad		stressed
		livind		offended		upset
		Strong		Moderate		Mild
Inadequate		worthless		incompetent		lacking confidence
		powerless		overwhlemed		unsure of self
		helpless		ineffective		uncertain
		inferior		lacking		weak
		failure		deafeated		inefficient
		insufficient		incapable		doubtful
		Strong		Moderate		Mild
Fearful		terrified		afraid		nervous
		frightenend		scared		anxious
		intimidated		apprehensive		hesitant
		horrified		jumpy		worried
		desperate		alarmed		self-concious
		threatened		distrusted		troubled
		Strong		Moderate		Mild
Caring		devoted		concerned		warm
		adoring		congenial		friendly
		cherising		fond of		like
		loving		respectful		positive towards
		captived by		admiring		appreciate
		honor		trust		enjoy
		Strong		Moderate		Mild
Depressed		desolate		distressed		unhappy
		dejected		sorrowful		down
		hopeless		discouraged		sad
		gloomy		miserable		glum
		in despair		awful		blah
		empty		tearful		disappointed
		grieved		rotten		disssatisfied
		Strong		Moderate		Mild
Lonely		isolated		alienated		left out
		abandoned		estranged		excluded
		all alone		remote		lonesome
		forsaken		alone		distant
		cut off		apart		aloof
		rejected		insulated		separate
		Strong		Moderate		Mild
Guilt/Shame		humiliated		ashamed		embarrassed
		disgraced		guilty		regretful
		degraded		remorseful		wrong
		horrible		crummy		at fault
		mortified		to blame		blew it
		sick at heart		lost face		goofed
				demeaned		flustered
		Strong		Moderate		Mild
Hurt		crushed		belitted		neglected
		ruined		overlooked		put down
		devasted		mistreated		overlooked
		destroyed		critized		let down
		wounded		laughed at		unappreciated
		anguished		ridiculed		taken for granted
		abused		scored		slighted
		Strong		Moderate		Mild
Happy		thrilled		cheerful		glad
		on clound nine		light-hearted		good
		ecstatic		serene		contented
		overjoyed		happy		satisfied
		fantastic		wonderful		fine
		terrific		in high spirits		pleasant
		delighted		glowing		pleased

Child-centered Play Therapy & Filial Play Therapy

The Miracle Question

Suppose tonight, after you go to bed and fall asleep, while you are sleeping, a miracle happens.  The miracle is that the problem or problems you are struggling with are solved!  Just like that!  Since you are sleeping, however, you don't know that the miracle happened.  You sleep right through the whole event.  When you wake up tomorrow morning, what would be some of the first things that you would notice that would be different and that would tell you that the miracle has happened and that your problem is solved?