Being alone with your own mind

As far as being left with one's own mind goes, the biggest barriers and obstacles to facing oneself is fear and guilt. In our psychiatric discourse, fear is described as "anxiety" and is medicated, and guilt is described as "trauma" and "PTSD" and is subject also to medications and EMDR and CBT.

Guilt, though, is a fundamental existential awareness that we have separated ourselves from our Transcendent Source and that Source will punish us for our egotistical belief that we can be the author of our own lives. This fear of punishment for our separation contributes to all kinds of psychiatric symptoms, the greatest of which is the feeling of being victimized for whatever reasons we can conjure up to blame others for our unhappiness.

In AA people are encouraged to face themselves in the fourth step which few people do unless they are interested in actually working the twelve step program.

Peace, which we all yearn for, is based on facing ourselves and joining once again with our Transcendent Source whatever we conceive that Transcendent Source to be. Psychotherapists are walking with people as we all go home. 

Tension is a characteristic of an emotional system

The systemic tension is in the system not in solely in one part although one component is sometimes known as the "symptom bearer." But the symptomatic member of the system can change rapidly as in "hot potato, hot potato, who's got the hot potato."

One person in the system is sometimes scapegoated because it serves the other parts of the system and maintains system homeostasis. Systems, to main homeostasis, often engage in human sacrifice.

Having been trained as a strategic family therapist, I was taught to ask, "What is the function of the symptom for the system?" When we look at the high levels of systemic tension in the United States today where fingers point to many scapegoats, as therapists looking at the system dynamics, we might ask where we can best intervene to jog the system onto a better level of functioning? When we make these interventions, they may cause, initially, an increase in stress because the system is destabilized and thrown into disequilibrium, which is a good thing if change is to occur, but as the therapist, we need to professionally and responsibly guide this restabilization to a more constructive, healthy way of functioning.

Nonviolent advocacy is the better way to go than further violence or even resistance alone. So the question we might ask ourselves is what do we love and how do we bring it about. Martin Luther King, Jr. was not against racism per se, but was an advocate for justice the arc of which bends slowly but inevitably to making heaven on earth when everybody loves everybody all the time.

How do we do this? One person at a time. I can love the sinner, but hate the sin. We can commit ourselves to stop wringing our hands and do something good today to somebody who crosses our path. This can be challenging in difficult times, but something that we psychotherapists are committed to.

Who should I love? - Watch Video

Social safety net involvement to lower anxiety and stress

One of the four quadrants in Ken Wilber's AQAL metaphysical model is the scientific quadrant.  The other quadrants are the subjective, the cultural, and the institutional. Looking at the problem of "insecurity" defined as people and groups feeling unsafe and vulnerable contributing to hypervigilance, reactivity, and chronically high levels of stress from the perspective of culture and institutions, we might wonder what it takes to reduce the high levels of tension in the system? We do this by introducing mechanisms that promote security and the decrease in fear both in individuals, in small groups, in communities, and in larger societies.

This reduction of fear and nurturing of security takes what we colloquially call the provision of the "safety net." Safety net infrastructure is being eroded and eliminated by those who want to control the society through autocratic leadership that enriches the few at the expense of the many. Finding social means of increasing equity, justice, and compassion contributes to a heightened sense of public safety and individual safety. These social means of increasing equity, justice, and compassion are more likely to be realized through mutual aid in our current autocratic political system rather than through governmental support.

So the answer to the question of how to help people lower their insecurity and stress levels in our current political environments is the encourage the befriending of neighbors and volunteering to nonprofit organizations in one's community that address the meeting of basic needs such as food, housing, health care, education, and public safety. Each person has a finite amount of time, talent, and treasure which they can contribute to the common good. It is in providing mutual aid in these basic domains to enhance equity, justice, and compassion that will lower the tension level in our social systems. There are plenty of social science studies which demonstrate the benefits of this focus and activity, but they are not well known, taught, or implemented.

What social programs do you know of, support, or have benefited by?

Social safety net involvement to lower anxiety and stress - Watch Video

states with lower gun ownership and stronger gun laws have the lowest suicide rates.

For National Suicide Prevention Week, which is held each year during National Suicide Prevention Awareness Month, we released our annual analysis of state-by-state suicide rates. Year after year, the analysis reveals that states with lower gun ownership and stronger gun laws have the lowest suicide rates. Conversely, the states with higher gun ownership and weaker gun laws have the highest suicide rates 

For more click here.

Some might say that gun violence is as American as Apple Pie. This idea is indicated by the fact that there are more guns in the US than people and Americans possess more guns than any other people in the world.

When gun violence occurs the politicians ask for people's "thoughts and prayers," as if thoughts and prayers will address the tragedy that continues to occur in any meaningful way. How about if instead of thoughts a prayers the politicians focus on gun safety laws like we do with automobiles, planes, and the misuse of substances.

The mortality rate from guns in the US is a significant public health problem and until it is managed as such the gun mortality rate is not likely to change.

New York State has the third lowest suicide rate in the U.S.

When I was in graduate school getting my MSW in the early 70s our class was divided into groups and we had to pick a social problem area to research, study, and report on to the whole class. My group picked suicide.

In my career I worked for 18 years as a "psychiatric assignment officer" in 3 large urban hospitals doing mental health and substance abuse evaluations and dispositions. I estimate over those 18 years I did over 14,000 suicide evaluations.

Over my 56 year career I have continued to follow the suicide data and recently found the suicide rate for 2022.

The states with the lowest suicide rates are NJ with 7.7/100,000 followed by MA with 8.3, NY with 8.5, ML with 9.5, and CA with 10.4.

The states with the highest suicide rates are MT with 28.7, AL with 27.6, WY with 25.6, NM with 24.7 and ND with 22.5

It is very interesting that suicide rates vary by as much as 3 - 4 times as much in the highest rate states from the lowest rate states. It is interesting that suicide rates are much higher in red states than in blue states.

Why do you suppose the rates vary so significantly from state to state?

Open letter to mental health professional colleagues as they witness the pain of their clients.

A colleague wrote in part : “This has been an ugly week of multiple clients upset with the executive orders. The thing that continues to strike me is how der Trumpenfuhrer embodies the sum of all fears…..I spent two hours on Zoom today with crying people in the midst of the total meltdown of their lives, having lost jobs in the past several months and now worried about the ways in which the executive orders will effect them and the world. It was an ugly day.”

My reply is below:

It seems very important for therapists to support one another in what they are observing and experiencing. Vicarious trauma may be on the rise in our profession when therapists witness and describe days like the one you just had.

Psychopaths like pain. Inflicting pain is the point because it makes them feel powerful. Perhaps one of the most challenging things for therapists to observe and attempt to mitigate is cruelty and sadism.

In recent days not only is cruelty and sadism being perpetrated but it is being normalized with "pardons" that lift external constraints and restrictions and allows those so inclined to behave in further cruel and sadistic ways with impunity.

As I learned working on inpatient psych units and psych ed, what works best with these behaviors is injections of Haldol and four point restraint with a skilled team trained to exert a "show of force". These tactics are used only after de-escalation techniques have failed.

After such interventions staff always met for a brief de-debriefing so that calm could be restored and confidence in maintaining safe order was reinforced.

As therapists we need to find ways to keep each other safe so we can keep our clients safe as best we can.

Remember, cruelty is not a byproduct of what is being perpetrated, but the cruelty is the point to dominate, coerce, and subjugate. It is important for us as MH professionals to confront it head on, lean into it, and mitigate it. Some of us will be harmed in the process, but in the end justice, compassion, dignity, and peace will be achieved.

Keep the faith. Stay strong. Be courageous, Do the right thing. Focus on what matters.

Psychotherapy outcomes for suicidality based on modality type

There is an interesting article published, 07/02/25, in the Clinical Psychology and Psychotherapy Journal reporting on a meta analysis of the effectiveness of individual, group, and family therapy on suicidality.

The topic is of great interest to me because in my career of 56 years as a Psychiatric Social Worker I estimate I have done over 15,000 suicide evaluations, as many as 11 in one day when working as a Psychiatric Assignment Officer in a large urban hospital in Rochester, NY.

Based on my clinical experience and observation I already realized that a combination of modalities is the most effective treatment plan in most cases and in fact that is what the meta analysis found. When individual therapy was combined with group and/or family therapy outcomes were better.

This meta-analysis highlights that combined psychotherapy approaches, integrating individual sessions with group or family sessions, yields significantly higher effect sizes, reducing the risk of suicide attempts by 50%. These findings support the adoption of combined therapeutic strategies in clinical settings to effectively address suicidality. (https://onlinelibrary.wiley.com/doi/10.1002/cpp.70112?af=R, accessed on 07/03/25)

I am currently working with a family where the mother has been hospitalized twice in the last year for suicide attempts. I have used a combination of individual sessions with the four family members as well as combination sessions.

The therapeutic work has taken many twists and turns and what one might expect has turned out to not be accurate and what one might not expect emerged. Murray Bowen describes families where there is a schizophrenic member in which roles can change and the person labeled “schizophrenic” turns out to be one of the healthier members of the family whereas the “healthier appearing” family member starts showing signs of significant psychiatric symptoms.

Dr. Bowen’s teaching led to the appreciation of the system’s view of mental illness and contributed to an understanding of the strategic family therapy phrase, “What is the function of the symptom for the system?”

So what does suicidality in a family member indicate about the family system? Can the family system be ignored as we focus on the symptomatic member alone? If we ignore the social context of our client will we achieve as good an outcome ameliorating the suicidality of the identified patient? Now we have some research that validates practice wisdom which indicates that focusing on the individual’s suicidality alone will not get as good an outcome as taking into account the individual’s interpersonal relationships.

Lastly, and it's a whole other topic, how do we chart and bill for such work and how does compliance with a medical model and its practice hamper and constrain effective therapy?