Walkin' and talkin': caring one person at a time.
Article Type: Column
Subject: Students (Psychological aspects)
Author: Reidenberg, Daniel J.
Pub Date: 09/22/2011
Publication: Name: Annals of the American Psychotherapy Association Publisher: American Psychotherapy Association Audience: Academic; Professional Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2011 American Psychotherapy Association ISSN: 1535-4075
Issue: Date: Fall-Winter, 2011 Source Volume: 14 Source Issue: 3
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 277270193
Full Text: I think back to high school and try to remember your principal. What was his/her name? What do you remember most about him/her? Did you ever have the chance to talk with this person (not about something that you were in trouble for)? I'm guessing most of us don't even recall our high school principal, let alone anything significant about them and what they did for us. For the fewer of us that do remember, I'd suspect it was for something we might want to forget. I want to introduce you to the principal you wish you would have had. More than that, this principal is one you wish your children had. He has a lot to teach therapists everywhere about caring, one person at a time.

Mike Farley, or Mr. Farley as most of his students know him, is the principal of a very large suburban high school. One of the largest districts in the Minnesota with over 28,000 students, Anoka High School sees 2,400 students pass through its doors each year, is diverse, leads in academics and sports, and is filled with pride. The school's mascot, ironically, is a tornado and for the last two years Anoka High School has been through the storm of its life that has been weathered with the leadership of Mr. Farley. Mr. Farley is not the principal you remember and probably isn't the typical principal buried in administrative paperwork, emails and meetings. Instead, he is out with his students. Present. Available. Interested in them, the good, the bad, and everything in between.

When you run any business that has dozens of direct reports and employees you are bound for challenges. Rarely does everyone agree with your decisions. Less frequently are you seen as popular. Nonetheless you still lead and you still have followers. Your time is spent meeting competing demands of (in this case) union rules and regulations, your desires for results, meeting outcome measures, and making people happy. Imagine trying to do this every year and you now have a small sense of what Mr. Farley has to face each year as the student body changes. While you can plan for problems and challenges, you can never plan for everything, and two years ago Anoka High School and other schools in the district were in the direct path of a storm not of natural forces, but of multiple suicides.

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I was called in as a consultant by the district office after two students had taken their lives. My job was to help the district assess what might be happening, reduce the risk of contagion (a particularly significant problem for youth and in school settings), and get a message out to the faculty and students in the district that suicide can be prevented. As planning and funding was sought to get everything ready to be implemented, additional suicides tragically occurred in the district. In the age of new technology, youth spread many messages about their friends who had died, some accurate, many not. By the time we were able to get things underway, 5 or 6 students had taken their life in a few months and contagion was apparent in this community. Suicide attempts and ideation were a regular occurrence for youth and hospital beds were filling with youth from this community who were deemed at risk of suicide. Local, regional and national media picked up on "the story" and to this date hasn't let it go.

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I went to the schools and held debriefings for the faculty of each school. I arranged for speakers to talk to the youth and we conducted an in-service training for faculty, counselors, administration, etc. Feelings were intense in every school. Teachers were on edge, waiting for the next suicide to occur. People were "afraid to answer the phone" and hear "who died now." Youth that I spoke with told me they felt that "school was becoming a place where people just killed themselves whenever they had a problem." But one man, Mr. Farley, stood up and out and said no more: "I am not having this happen in my school again." He felt that the school was like a family and, as a member of the family in the community, something needed to be done.

Mr. Farley was clearly frustrated by what was happening. More than being frustrated, he was sad and concerned and he wanted this to stop. He also wanted his students to know that not only was school a safe place to be, but that people there cared about them. Yes, Mr. Farley set out to create an environment that was going to be a safety net for his students. Despite all that had happened already to them, he was insistent on learning everything he could about suicide, mental health, resiliency, self-esteem and positive behavior change. After consulting with experts, reading and researching best practices, and relying on his own experiences as a coach and parent, he set out to make a difference.

He started by taking a simple "thumbs approach" to finding out where the students were. What did he mean by this? At any moment, in any location, he would ask his students for a thumbs assessment. Thumbs up meant they were ok or better. A thumb in the middle or pointing down meant there was cause for concern. Most often the kids would give him a thumbs-up, but occasionally it would be in the middle or down. If it was not up, Mr. Farley's next intervention was what I believe has made the difference for the students as they lived through the storm.

When Mr. Farley didn't get a thumbs-up, he would walk right over to that student or call them over and ask them "What's up? How are you doing?" It was really simple and clear, but what struck me most about this approach was what happened next. If the student was hesitant or reluctant in answering him, or they admitted things weren't so great, at that moment he would say to them "C'mon, we're walkin' and we're talkin." And that was it. He didn't just send them to someone else. He didn't say to the student come see me after your next class. He didn't tell them he had a meeting to go to and to stop by his office later. Instead what he did was say to them right here, right now, you are my priority and I'm listening to you. We're spending time together and working on this problem, whatever it is, until you can give me a thumbs-up.

If you ask Mr. Farley about this, he will tell you he was just doing what anyone else would do. He would tell you that this approach might not work for someone else, but for him it was all that he could do and he wasn't going to give up on it. He would tell you that some of the students just didn't have anyone at home that would do this and while he wasn't their parent, he did care and he wanted them to know that someone in their life did. For real. For now. For whatever reason they needed them to. And Mr. Farley's approach spread among the people who worked for him and throughout his building a sense of community grew. A pseudo, but real family who cared about everyone developed and going beyond what he ever envisioned, and it even spread to some of the students who started helping other students. His plan was working and the beauty of this was that he never really planned on it to turn out as it did. Rather, he did what he thought was right and made a difference. A lifesaving difference to many, all at the same time as maintaining a clear expectation that when they were in school they were there to learn. In the time since Mr. Farley began this approach there have not been any suicides in his school and after the storm that hit his community, this is something he can be proud of even though he never thought he was going into the business of saving lives.

1. Anyone can make a difference in someone's life. In a therapeutic relationship that might be you, but it also might not be you and that is ok too. What is important is that you help your client's figure out who that person is and how they can be helpful to them. If it is you, realize how important you are to them. Remember that your act of caring, being sensitive, open and real with them might be what they need to get by and get better in a difficult time in their life. Maybe it is more than one person, and I would suggest that it should be. Help them build a support network of people who can be there for them for all kinds of things that happen in their life. It is also important to help them understand that X or Y person can in fact make a difference for them. Some clients discount certain people in their lives (parents, siblings, neighbors, etc.) and we can help them see the benefits that anyone can bring to their lives. (Of course we want to be mindful that in most cases we don't know these other people and we are relying on their report(s) of them to help us determine the good/bad they might bring to our client's life.) The most important thing is that they learn to be open to anyone being someone who can make a difference. In Mr. Farley's case, the students never thought the principal would care or spend the time with them. They thought that would be saved for their counselor. Mr. Farley showed them that anyone can and will be there for you if they commit to doing so.

2. Sometimes it's the simple things that make a big difference. Often I hear therapists analyzing and over-analyzing a session or statement a client made. Sometimes therapists look deeper into things that happen in their clients' lives and while at times that might be important, other times we just need to see and hear things for what they are. At those times we can be very helpful to our clients by letting them know that 'it is what it is' and it might just not be any more than that. This is a double-bind therapists get into when they look too deep and/or the clients do. So be ok seeing that the problem or the solution might be much simpler, and help your clients see this as well.

3. Give every client your full attention. I've written about this before and will say it again ... if you can't fully attend to your client, you should not see them. You will do them the responsible and ethical thing by referring them to someone who can. If it is just that day and for whatever reason(s), cancel and reschedule. Again, this will be better for your client in the long run than trying to fake being attentive or being caught by your client in your distraction. Therefore, just as Mr. Farley put everything aside when he came across a student who wasn't able to give him a thumbs-up, recognize that you must give your clients everything that you have focused on them when they are in your office.

4. Develop a way to monitor your clients on how they are doing. From the beginning of your work with them, talk with them about what their baseline is and how they can share where they are at relative to that baseline so you have a sense of this easily and over time. You don't need to use a thumbs-up or down approach, but you can, especially with children. Another simple way to do this are the old fashioned "where are you today on a 1-10 scale" approach. There is nothing wrong with this and there are many new technological approaches to getting clients to assess themselves just like this on a daily basis through text messages so they can chart their progress on a daily/weekly/monthly basis. I recommend you have a similar way of communicating this between you and your clients to chart their progress in therapy. For some it offers a non-threatening way of sharing where they are at any one particular time.

5. Remember that progress in therapy can be redirected at any moment in the process, and this too can be ok. Mr. Farley's day never started thinking he would come across a student who needed him. Rather, he thought each day would be something different and he was prepared for that. I have talked with a number of therapists that seem to think/want their clients to come in and keep moving forward with their treatment plan and that is good, as we would like it to be. However, when something in their client's life has derailed that progress they try and keep bringing them back "on track." Therapists have a funny way of seeing distractions in client's lives as a defense mechanism. Sometimes that is true, other times it is not and we must be ready every day for the reality of what is happening in our client's lives outside of their treatment plan.

Finally, always be conscious of the fact that what your client sees as being significant, regardless of what it is, is incredibly important to them. We should be aware that if a client is struggling with someone, something or anything and it is a "10" for them, our job is to help them get it to be more manageable whether that is a relationship, an insecurity or any one of hundred problems clients bring to us. Regardless of what it is, remember that you too are (always) "walkin' and talkin" with your patients helping them to better navigate their life.

By: Daniel J. Reidenberg, PsyD, Fellow, American Psychotherapy Association, Board Certified Professional Counselor, Master Therapist

DANIEL J. REIDENBERG, PsyD, FAPA, DAPA, MTAPA, is the chair of the American Psychotherapy Association's Executive Advisory Board and has been a member since 1997. He is a Fellow and Master Therapist of the American Psychotherapy Association and executive director of Suicide Awareness Voices of Education (SAVE) in Minneapolis, Minnesota. Contact him with your thoughts at dreidenberg@save.org.
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