Helping the Suicidal Person: Interview with Stacey Freedenthal, Ph.D., LCSW

[Episode 119] Today's episode of the Social Work Podcast is an interview with Stacey Freedenthal, Ph.D., LCSW about her book, Helping the Suicidal Person: Tips and Techniques for Professionals. 

I was excited to talk with Dr. Freedenthal because she's come up with 89 tips and techniques that you can start using right away with suicidal clients.

In today’s episode, we talk about five of them:

Tip #10 – Embrace a Narrative Approach: “Suicidal Storytelling”
Tip #35 – Know When and Why to (and not to) Pursue Hospitalization
Tip #36 – Know Why not to Pursue Hospitalization
Tip #64 – Incorporate a Hope Kit
Tip #88 – Propose a Letter to the Suicidal Self

Dr. Freedenthal has been a faculty member at the University of Denver School of Social Work since 2005 and maintains a private practice. She’s the creator of the massively popular blog, SpeakingOfSuicide.com, and her writings have appeared in academic journals and media outlets like the New York Times. You can find her on Twitter @SFreedenthal. 

Download MP3 [32:24]

The Arc of Therapy: Beginnings (Part 1)

Sven Scheuermeier

[Episode 110] Today's episode of the Social Work Podcast is the first of a three-part series on the arc of therapy – the beginning, middle and end.  In today’s episode I’m going to talk about the beginning phase of therapy. I'll talk about some conceptual issues like what do people want when they come to treatment, and how should you be with clients? I’m also going to review some of the more concrete aspects of the beginning of treatment like biopsychosocial and DSM assessment, talking about confidentiality and billing. I want this episode to be interesting whether you’re a first year social work student or a 35 year veteran of the field.

I’d like to thank TheraNest for sponsoring this three episode series. TheraNest is simple and affordable practice management software. To start your free 21-day trial and save 20% on your first 3 months, sign up at theranest.com/socialworkpodcast.


Download MP3 [46:28]

Death and Grief in the Digital Age: Interview with Carla Sofka, Ph.D.

[Episode 109] Today’s episode of the Social Work Podcast is about Death and Grief in the Digital Age. I spoke with Dr. Carla Sofka, professor of Social Work at Siena College. Dr. Sofka has been studying and writing about the intersection of technology and death and grief since the earliest days of the world wide web. Her edited 2012 text, Dying, Death and Grief in an Online Universe, looks at how changes in communication technology have revolutionized the field of thanatology.

In today’s episode we talk about the role of social media in how, why, where and when, who we grieve. She shares stories of people whose loved ones have died, only to find out that because of social media they are the last to know. Carla provides some digital literacy around death and grief in the digital age. She talks about social media posts as death notifications, about establishing digital advance directives and thinking about our digital dust.

She talks about STUG reactions which are Sudden Temporary Upsurges of Grief. I had never heard of a STUG reaction, but I actually had one during our conversation. You’ll hear me talk about college friend of mine who died several years ago and during the interview start to tear up as I recalled getting a Facebook notification that it was her birthday.  We then talked about internet ghosts, memorial pages, memorial trolls, how and when people should respond to death notices online and what that means for the loved ones. She suggests that just as we provide sex education to kids, we should be providing death education.  She also recommends including technology assessment in the standard biopsychosocialspiritual assessment. We ended our conversation talking about resources for mental health professionals who want to learn more.

Download MP3 [34:14]

Critiques of the DSM-5: Interview with Jeffrey Lacasse, Ph.D.

[Episode 101] Today's episode of the Social Work Podcast is a critique of the  Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5.

The most basic critique of the DSM-5 is the same critique that has been levied against psychiatry for decades: that it does nothing more than medicalize or pathologize normal behavior. So is it ever ok to say that someone isn’t normal? Are there ever situations where giving a diagnosis is good? As it turns out, yes. And I’m not just talking about diagnosis as a means to finance treatment. Yes, third party reimbursement hinges on diagnosis. But I’m talking about something less institutional and more personal. There are people who like labels, who find comfort in being able to name or label what is wrong. The label draws a boundary around an experience. Labels can even draw up boundaries around a group of people. According to psychologist Gary Greenberg, “[the label] Asperger’s syndrome gave people whose primary symptom was isolation a way to belong and provided resources to those who were diagnosed” (Reese, 2013).

Download MP3 [37:19]



So, I know what you are wondering - is DSM diagnosis good or bad? Well, today’s episode won’t be the definitive answer to that question. But, it will give you cause to pause when you think about the role of DSM-5 in the professional life of social workers and the people we serve. My guest is social work faculty member from Florida State University, Jeffrey Lacasse, Ph.D. Dr. Lacasse has published several critiques of the changes in DSM-5. In today's episode, Dr. Lacasse critiques the definition of mental illness, the empirical support for and reliability of most diagnoses, the politics associated with the DSM and the implications for social workers who represent the single largest group of professionals who provide DSM diagnoses.

Kudos to @socworkpodcast & @JeffreyLacasse for their critiques of #DSM5. "Normal is a social construct." https://t.co/KxG2eH1fBt #Socialwork

— Elaine Eisenbaum (@eeisenbaum) January 26, 2016

Attachment-Based Family Therapy (ABFT) for Depressed and Suicidal Youth: Interview with Guy Diamond, Ph.D., and Suzanne Levy, Ph.D.

[Episode 96] In today's Social Work Podcast I speak with two of the three developers of Attachment-based Family Therapy (ABFT), Guy S. Diamond, Ph.D. and Suzanne Levy, Ph.D. The third developer Gary M. Diamond (no relation to Guy Diamond) lives in Israel and was unavailable for the interview.

ABFT is the only family-based psychotherapy with empirical support for reducing suicidal ideation in youth. In today's interview, Dr. Diamond and Dr. Levy discuss the theory and practice of Attachment-Based Family Therapy. Dr. Diamond mostly covers theory and concepts, and Dr. Levy addresses the question of "what does the therapist actually do in the therapy room."

Download MP3 [50:36]


If you're interested in learning more about ABFT, you can buy the treatment manual Attachment Based Family Therapy for Depressed Adolescents, watch a free webinar http://youtu.be/KcwHznzq-S4, or attend a workshop (details on their website: http://drexel.edu/familyintervention/attachment-based-family-therapy/overview/)

ABFT is listed on the National Registry of Evidence-based Programs and Practices, also referred to as NREPP. According to NREPP, 

"Attachment-Based Family Therapy (ABFT) is a treatment for adolescents ages 12-18 that is designed to treat clinically diagnosed major depressive disorder, eliminate suicidal ideation, and reduce dispositional anxiety. The model is based on an interpersonal theory of depression, which proposes that the quality of family relationships may precipitate, exacerbate, or prevent depression and suicidal ideation. In this model, ruptures in family relationships, such as those due to abandonment, neglect, or abuse or a harsh and negative parenting environment, influence the development of adolescent depression. Families with these attachment ruptures lack the normative secure base and safe haven context needed for an adolescent's healthy development, including the development of emotion regulation and problem-solving skills. These adolescents may experience depression resulting from the attachment ruptures themselves or from their inability to turn to the family for support in the face of trauma outside the home. ABFT aims to strengthen or repair parent-adolescent attachment bonds and improve family communication. As the normative secure base is restored, parents become a resource to help the adolescent cope with stress, experience competency, and explore autonomy. 

ABFT is typically delivered in 60- to 90-minute sessions conducted weekly for 12-16 weeks. Treatment follows a semistructured protocol consisting of five sequential therapy tasks, each of which has clearly outlined processes and goals:

1. Task 1: The Relational Reframe Task, with the adolescent and parents (or parent) together, sets the foundation of the therapy. After an assessment of the history and nature of the depression, the therapist focuses on relational ruptures. This shift pivots on the therapeutic question, "When you feel so depressed or suicidal, why don't you go to your parents for help?" The progression of this conversation leads parents and the adolescent to agree that improving the quality of their relationship would be a good starting point for treatment.
2. Task 2: The Adolescent Alliance Task, with the adolescent alone, identifies relational ruptures in the family and links them to the depression. The adolescent is encouraged and prepared to discuss these often avoided feelings and memories with his or her parents.
3. Task 3: The Parent Alliance Task, with the parents alone, explores their current stressors and their own history of attachment disappointments. These conversations activate parental caregiving instincts to behaviorally and emotionally protect their child, which helps motivate parents to learn and use new attachment-promoting parenting skills.
4. Task 4: The Attachment Task, with the adolescent and parents together, creates an opportunity for the adolescent to directly express his or her thoughts and feelings about past and current relational injustices. Rather than defending themselves, parents help the adolescent fully express and explore these emotionally charged topics. This conversation helps the adolescent work through trauma, address negative patterns in the relationship, and practice new conflict resolution and emotion regulation skills.
5. Task 5: The Autonomy Task, with the adolescent and parents together, helps consolidate the new secure base. In solving day-to-day problems, parents provide support and expectations and the adolescent seeks to develop autonomy while remaining appropriately attached to his or her parents." (http://legacy.nreppadmin.net/ViewIntervention.aspx?id=314)

Objective Structured Clinical Examination (OSCE) Adapted for Social Work: Interview with Marion Bogo and Mary Rawlings

[Episode 94] Today’s episode of the Social Work Podcast is on Objective Structured Clinical Examination (OSCE) for social work. My guests, Marion Bogo and Mary Rawlings, and their co-authors Ellen Katz and Carmen Logie, are pioneers in the development, implementation, and evaluation of OSCE adapted for social work.


The audience for today's episode is social work faculty, specifically practice instructors who are interested in learning more about how to objectively evaluate their student's skills. Today's episode reviews the origins of OSCE adapted for social work, how it is implemented in different types of social work programs, some findings from the research that has been conducted on OSCE, and some recommendations for faculty who are interested in learning more about this approach.

Disclosure: I served as a CSWE Council on Publications liason with Marion Bogo for the text Using Simulation in Assessment and Teaching: OSCE Adapted for Social Work (Objective Structured Clinical Examination). 

Perinatal Loss: Interview with Sarah Kye Price, Ph.D.

[Episode 79] Today's Social Work Podcast is on perinatal loss. Perinatal loss includes ectopic pregnancy, spontaneous abortion (which most people call miscarriage), late-pregnancy loss or stillbirth, and neonatal or newborn death.

In today's episode, I spoke with one of the profession's leading scholars and experts on perinatal loss, associate professor of social work at Virginia Commonwealth University, Dr. Sarah Kye Price.


We talked why it is important to do a thorough assessment of pregnancy and pregnancy-related loss during a biopsychosocialspiritual assessment. She talked about the importance of allowing mothers / parents to tell their story. She pointed out that, although no loss is worse than any other, there are different intensities and needs depending on the loss.  She also noted that families in which there was a perinatal loss, there can also be growth. We talked about the different types of interventions and treatment approaches for individuals and families who experience perinatal loss. We ended our conversation with resources for people interested in learning more.

Proposed Changes in DSM-5: Interview with Micki Washburn, LPC-S and Danielle Parrish, Ph.D.

There’s an old saying, “What’s the fastest way to cure mental illness in an entire group of people? Get rid of the diagnosis.” The proposed changes to DSM-5 get rid of some diagnoses and add others. But that's not all. If you're like me, you have lots of questions about changes to DSM-5. When I posted the question “what would you like to know about the DSM-5” to the Social Work Podcast Facebook page 11 people responded in less than an hour and 20 people responded by the end of the day. So, what did they want to know? Jessica, Shelly, Sandy, Spring, Paul, and Suzannah wanted to know about autism, depression, and personality disorders. Shylah and Jen wanted to know about addictions. Lisa wanted to know what was up with ADHD. Ciarrai and Lyndon posed some great questions about the merits of DSM diagnosis in social work practice.

In today's Social Work Podcast, I speak with Micki Washburn, MA, LPC-S, NCC and Danielle Parrish, Ph.D. about proposed changes in DSM-5. We talked about the cross-cutting dimensional assessment, changes in the organization of the DSM-5, and changes in diagnoses such as ADHD, Asperger’s, Autism, Depression, Substance Use, and personality disorders.  We talked about some of the intended consequences such as greater accuracy for diagnosis, and some of the possible unintended consequences such as loss of funding for diagnostic-specific services.  We end with some thoughts about social work’s role in the new DSM.

Update: DSM-5 was published on May 27, 2013. Social work licensure exams in the USA (ASWB) required DSM-5 starting in 2015.

The Chronological Assessment of Suicide Events (CASE) Approach: Interview and Role Play with Shawn Christopher Shea, M.D.

[Episode 74] Today’s Social Work Podcast is an interview with Shawn Christopher Shea, M.D., developer of an approach to uncovering suicidal ideation and intent called the Chronological Assessment of Suicide Events (CASE) approach. In today’s episode, Shawn takes us through the CASE approach. He explains the value of assessing for suicidal content at different time points and emphasizes that eliciting suicidal ideation and intent is a difficult and sensitive topic. He talks about how moving through the CASE approach to help establish a therapeutic alliance and rapport with suicidal clients. He emphasizes the art of the interview, using validity techniques, and how we use words as central to uncovering suicidal ideation and intent. He talks about how the CASE approach is useful for any mental health provider. Shawn makes the argument that the CASE approach is an ideal approach to for assessing for suicidal risk that doesn’t sound like a pat suicide assessment. He emphasizes that the CASE approach is one-third of a thorough suicide assessment, the other two parts being identifying risk and protective factors, and the final part being developing a clinical formulation.

This figure represents the three components of a thorough suicide assessment. The CASE approach  provides a framework for assessing the information in the red square (ideation, plan, behaviors, desire, and intent).

Shawn has written that a thorough suicide assessment has three parts: 1) Gathering information related to risk factors, protective factors, and warning signs of suicide; 2) Collecting information related to the patient’s suicidal ideation, planning, behaviors, desire, and intent; and 3) Making a clinical formulation of risk based on these 2 databases. He writes that in the “clinical and research literature, much attention has been given to the first and third tasks (gathering risk/protective factors/warning signs and clinical formulation). Significantly less attention has been given to the second task—the detailed set of interviewing skills needed to effectively elicit suicidal ideation, behaviors, and intent. But in many respects, it is the validity of the information from the second component that may yield the greatest hint of imminent suicide.” (Shea, 2009, p. 1).

My interview with Shawn is a single episode in two continuous parts. In Part I Shawn and I talk about the CASE approach, including some of the validity techniques he has developed or uses to elicit suicidal ideation and intent. In the second part Shawn and I do a role play where he uses the CASE approach. 

Non-Suicidal Self-Injury (NSSI): Interview with Jennifer Muehlenkamp, Ph.D.

Today’s Social Work Podcast looks at the issue of non-suicidal self injury, or NSSI. According to the International Society for the Study of Self-Injury, NSSI is the intentional destruction of body tissue without suicidal intent and for purposes not socially sanctioned. I spoke with Jennifer Muehlenkamp, Ph.D., associate professor at the University of Wisconsin - Eau Claire, and one of the world’s leading experts in NSSI. In today’s episode, Jennifer and I talked about the definition of NSSI,  the intersection between suicidal and non-suicidal self-injury, and some things that clinicians should and should not do when working with clients who self-injure. We ended our conversation with some speculation on the future of NSSI as a stand-alone psychiatric disorder in the DSM-5.

Adoption Policy and Practice in the U.S.A.: Interview with Ruth McRoy, Ph.D.

[Episode 63] Today's Social Work Podcast is a broad overview of current policies and practices associated with adoption in the United States. According to the Evan B. Donaldson Institute, 6 in 10 Americans have had experience with adoption, meaning you, or a family member or close friend was adopted, adopted a child, or put a child up for adoption. Although most Americans have experience with adoption, as you'll hear in today's interview, the world of adoption is incredibly complex. For example, is it ever acceptable to consider the race of a prospective adoptive family when making placement decisions? For example, you're looking to place an African American child. You have three prospective adoptive families - two African American and one White. Assuming all things are equal, could you use race as an exclusionary criterion? What about if the child was White, Latino, or Native American? If you know the answer - congratulations. If not, keep listening. And even if you know the answer, keep listening.

Social Skills Training with Children and Adolescents: Interview with Craig LeCroy, Ph.D.

[Episode 60]Today’s Social Work Podcast is on social skills training with children and adolescents. My guest, Craig Winston LeCroy defines social skills as “a complex set of skills that facilitate the successful interactions between peers, parents, teachers, and other adults” (LeCroy, 2009, 653). Social skills include everything from dress and behavior codes, to rules about what, when, and how to say or not to say something. Social skills training is a form of behavior therapy, and as such focuses on behaviors, rather than thoughts or feelings, as the targets for change. Traditional behavior modification is often thought of in terms of task completion, for example, using star charts to get kids to clean their rooms or do homework. But in social skills training, behavior modification principles are used to teach people skills that help them to be successful in social situations.

Download MP3 [28:42]

Incorporating Religion and Spirituality into Social Work Practice with African Americans: Interview with Nancy Boyd-Franklin, Ph.D.

[Episode 59] Today’s Social Work Podcast is on incorporating religion and spirituality into social work practice with African Americans. Or at least that’s the official title. The unofficial title is, “If my client brings God into the conversation, what should I do?” I spoke with Nancy Boyd-Franklin, best-selling author, multicultural researcher, family therapist and clinical trainer, and recipient of awards from the American Psychological Association, Association of Black Psychologists, and the American Family Therapy academy.

When I was a social work intern, I worked with an African American mother who had AIDS and whose 6 children were HIV+. The father of her children had been an IV drug user who had died of AIDS. The mother was in poor health, and rarely sought her own treatment. I had a hard time tracking her down because she spent most of the day, every day, on public transportation with one child or another taking them to and from medical appointments. I remember being on the bus with her one day (because that was only place I could meet with her), listening to her talk about how she had successfully fought hospital administration to get treatment for one of her kids. Being the eager social work student that I was, fully prepared to acknowledge my clients strengths and resources, I told her that I was in awe of her strength. “How do you do it?” I asked her. Her response totally caught me off guard...

Communities that Care: Interview with Richard F. Catalano, Ph.D.

[Episode 57] Today's Social Work Podcast is on community-based prevention services for children and adolescents. I spoke with Dr. Richard F. Catalano, who along with J. David Hawkins, developed Communities That Care, a prevention-planning system that promotes the positive development of children and youth and prevents problem behaviors, including substance use, delinquency, teen pregnancy, school drop-out and violence. It is a system for identifying community needs, matching those needs to evidence-based prevention programs, and evaluating the outcomes. The system has been used in dozens of communities around the United States, and has demonstrated effectiveness in reducing problem behaviors and promoting positive youth development.

Download MP3 [30:47]

Psychoanalytic Treatment in Contemporary Social Work Practice: An Interview with Dr. Carol Tosone

[Episode 54] Today's Social Work Podcast, Psychoanalytic Treatment in Contemporary Social Work Practice: An Interview with Dr. Carol Tosone, addresses two questions: First, is psychodynamic treatment relevant in contemporary social work practice? In other words, does it meet the needs of the clients, the agencies, and the funding sources? Second, has clinical social work abandoned social work's historical commitment to advocating for social change? I think they are questions worth thinking about.

Well, in order to answer some of these questions, I spoke with Dr. Carol Tosone about contemporary psychoanalytic treatment. Dr. Tosone completed her psychoanalytic training at the Postgraduate Center for Mental Health, where she was the recipient of the Postgraduate Memorial Award. She is an Associate Professor at the Silver School of Social Work at New York University, the recipient of the NYU Distinguished Teaching Award and is a Distinguished Scholar in Social Work in the National Academies of Practice in Washington, D.C. In 2007, Dr. Tosone was selected for a Fulbright Senior Specialist Award for teaching and research at the Hanoi University of Education in Vietnam. She is the editor-in-chief of the Clinical Social Work Journal, and the executive producer and writer of four social work education videos. And she is an expert in shared trauma – which is when a client and therapist experience the same traumatic event. I interviewed Carol about shared trauma in Episode 90: http://www.socialworkpodcast.com/shared-trauma.html.

Prochaska and DiClemente's Stages of Change Model for Social Workers

[Episode 53] Today's podcast is on Prochaska and DiClemente's (1983) Stages of Change Model. This model describes five stages that people go through on their way to change: precontemplation, contemplation, preparation, action, and maintenance.
The model assumes that although the amount of time an individual spends in a specific stage varies, everyone has to accomplish the same stage-specific tasks in order to move through the change process (Prochaska & Prochaska, 2009). There is an unofficial sixth stage that is variously called "relapse," "recycling," or "slipping" in which an individual reverts to old behaviors. Examples include having a beer after a period of sobriety, or smoking a cigarette a year after quitting. Slipping is so common that it is considered normal. Social Workers are encouraged to be honest with clients about the likelihood of backsliding or reverting to old behaviors once the change process has started, not because we expect our clients to fail, but because it normalizes the experience and takes away some of sense of failure and shame.

Theories for Clinical Social Work Practice: Interview with Joseph Walsh, Ph.D.

[Episode 52] Today's podcast looks at the relationship between theory and clinical social work practice. I spoke with Joseph Walsh, professor of social work at Virginia Commonwealth University (VCU), and author of the Brooks/Cole text, Theories for Direct Social Work Practice, which came out in a third edition in 2014. We talked about why social workers should learn practice theories, the differences between practice, developmental and personality theories, the difference between a theory and a model, and why there are so many different practice theories. We talked about how knowing theory makes for better social work practice and how being "eclectic" isn't about eschewing theory, but being well grounded in a few theories and making intentional choices about when and how to draw from them. Joe suggested that social workers in the field can contribute to theory refinement by thinking seriously about how well the theories they use work with the clients they serve. We ended our conversation with some information on resources for social workers who are interested in learning more about practice theories.

Social Work with Immigrants and Refugees: Interview with Dr. Elaine Congress and Fernando Chang-Muy, J.D.

[Episode 48] In today's podcast, I speak with Dr. Elaine Congress, and Fernando Chang-Muy, JD about their 2008 text from Springer publications, Social Work with Immigrants and Refugees: Legal Issues, Clinical Skills and Advocacy (note: a second edition was published in 2015). We talk about why they thought it was important to have legal and social work perspectives in a book on working with immigrants and refugees. We also talk about the interface between social services and legal system, how social workers and lawyers can work together when helping immigrants and refuges, and some of the ways that professionals can advocate for immigrants and refugees at a policy level. Elaine and Fernando ended our conversation with some ideas about how the concepts discussed in today’s podcast and the book can be applied to people who live in countries other than the United States. Related podcast: Listen to Elaine Congress talk about using her visual assessment tool, the Culturagram, when working with immigrants and refugees.

Visual Assessment Tools: The Culturagram - Interview with Dr. Elaine Congress

[Episode 46] In today's podcast I speak with Dr. Elaine Congress about her creation, the Culturagram. Elaine and I talk about how and why she developed the culturagram, the ten assessment areas of the culturagram, and how social workers can use the culturagram to improve their services. We end the podcast with a discussion about research and resources about the culturagram.

Dr. Congress has provided a copy of the Culturagram that you can look at while listening to the podcast, or when thinking about your clients. Please see below to view the Culturagram.

Schizophrenia and Social Work: Interview with Shaun Eack, Ph.D.

[Episode 45] In today's podcast, I speak with Shaun Eack about schizophrenia and social work. We talk about some basic information that social workers need to know about the diagnosis of schizophrenia; Shaun identifies and describes the positive, negative and cognitive symptoms that are often present in people with schizophrenia. Around 13 minutes into the conversation we switch the focus from diagnosis to the role of the social worker in working with people with schizophrenia. We end our conversation with a discussion of treatment approaches, including a new approach that addresses cognitive content.