The Board is unbelievable–a real dream team for family systems fans:

Barbara Fiese, Ph.D., Syracuse University
Nadine Kaslow, Ph.D., Emory University
William Pinsof, Ph.D., Northwestern University
Harry Reis, Ph.D., University of Rochester (Liaison)
Frederick S. Wamboldt, M.D., National Jewish Medical Center
Karen Weihs, M.D., University of Arizona

Given the stature and brilliance of this audience, I was both nervous and eager to get their feedback about our clinical service and about the work that has grown out of it. Here are my notes, and some reflections, from the discussion that followed my presentation:

— One board member shared an experience she had many years ago working with a prominent family therapist as her supervisor. She recounted the following experience:

She worked with the family of an adolescent who had attempted suicide. She wanted to do a suicide risk assessment as part of her session with the family. Her supervisor, at first, discouraged her because it wasn’t “systemic.” She persisted and ultimately prevailed by offering to do a suicide assessment for each person present (not just the child) and to invite others present to provide input on the others’ assessment! The supervisor allowed this as sufficiently systemic.

Reflection: This is a fascinating story that highlights the tension inherent in melding an activity that has traditionally been part of an individualistic medical model with a family systems view of people, their problems, and their strengths. I think few family therapy supervisors nowadays would advise against suicide risk assessment. Suicide risk assessment is taught (with a range of how much) in every family therapy training program. But I’m not sure if we’ve developed a lot further in terms of the actual how-to. My impression is that most of the time, there continues to be a one-dimensional linear approach to training suicide assessment that implicitly assumes individual therapy and interviewing.

– Other thoughts:  One key to resolving the potential tension is to think about suicide as residing in a family system. This view goes beyond thinking about family members a “collateral informants”, which is how family involvement is often described in the suicide literature. Instead, we need to develop conceptual AND CLINICAL models for assessing risk through the lens of interactions, relationships, roles, and family myths. For example, how does the hopeless that registers in the individual grow out of family roles and interactions…or from a strength-based approach how might shifts in the family give greater hope to the individual experiencing suicidality.  It is not that this is never talked about, it’s just that the focus on individual psychopathology and personality often overshadows this dimension–and perhaps more so than with other behaviors we assess and intervene with because the act of suicide is ultimately unilateral and done when alone.

– One member asked about me “sharing” what I’m working on. This is an important question to me on several levels:

1. Blog. This blog is one mechanism I’m using to share thoughts and discoveries.
2. Planned publications. I am on the cusp of conducting an evaluation of my risk assessment workshop and plan to publish the results. I am also working on another publication in which I’m collaborating with two faculty members of the Deaf-Wellness Center.
3. Career Direction. If what I’m doing turns out to be helpful to clinicians and to families, I want to share it widely. That brings up interesting questions about how I spend my time professionally. Given the range of my interests (in terms of content (peds primary care, suicide) and professional activities (teaching, writing, clinical work), it is hard to know the right direction. A career in research is appealing in ways it hasn’t been in the past. This is probably a dilemma many of my readers (especially those in academia) are familiar with. I’ll be focusing on discerning this over the next year or so.

– After I talked about this blog, a board member recommended using it as a way of helping to disseminate science to general audience. I have done this a little (such as here), but could probably do more.

– A board member suggested that, in light of how heavy it is to focus on suicide (an adverse outcome), it would be advisable for our clinical service to also gather stories and data about positive outcomes of family therapy. This is a perceptive and appreciated comment because prevention of a bad outcome does have a peculiar emotional tone for an individual or group. I named this blog “Commitment to living” in part to cast this work in a positive direction. This comment is a good reminder to do that kind of thing in many ways also at a system level.

All of that in 30 minutes! I appreciated the opportunity to consult with such bright and experienced senior experts in our field.

Related posts:  Commitment to Living featured on PsychSplash

A few reflections on this conversation, which took place on Friday.

1. We spent a fair amount of time on definitional ambiguities around the word “blog.” I had never realized that the word can evoke lots of different images in people’s minds. At different points, it morphed between meaning “anything RSS,” “Web 2.0,” “collaborative Internet”, and “discussion board.” That happens with any word (I say “chair” and think of this and you might think of this), but it is especially true of word describing emerging concepts.
2. I became aware of how personal my blog is to me, and how much I resist efforts to legislate aspects of it. I didn’t like ideas that entailed requiring people to commit to post once a week or something like that.  I’m sure corporate blogs do something like that, but for a blog that is about idea development, I think the frequency should match the idea generation and can’t be forced.
3. I had never thought before about how to get “buy-in” from people to blog. My recommendations to those involved in this project was that the only way to cultivate bloggers is to get people reading blogs first. Get them understanding RSS and some of the benefits to blogging (including in clinical or academic communities) from a reader’s standpoint. I think it’s hard to imagine why spending time writing posts would be useful to oneself or others until you’ve seen it in action.
4. My other thought about “buy in” is that you have show people how any project that will require time and effort will promote their careers, not just promote a concept.  For faculty, it’s about intellectual development.  You’d have to show and provide examples of how writing thoughts that are still under-development to a wide audience can be helpful.
5. I found myself thinking a lot about (and mentioning to my colleagues in our discussion) the Merlin Mann’s quote that I have referenced here before, in which he describes a blog as “only incidentally a publishing system…At its heart, your blog represents the evolving expression of your most passionately held ideas…”
6. Web 2.0 is all the rage right now.  Articles like this one in InfoWorld talk about the growth of vendors who are trying to profit from this. There are a lot of ways leaders can go wrong when trying to jump on the Web 2.0 bandwagon. These 23 steps for learning Web 2.0 have gotten a lot of attention lately. Seems like a thoughtful approach, perhaps a prerequisite “course” for anyone interested in how a particular institution might benefit from the new web.
7. It’s important to consider which tool is right for which purpose. Blogs are great for pushing content to interested audiences, wikis for collaboration on specific projects, etc. When is it best to use multiple individual blogs and when is it better (as I think they’re going to try here) to have one blog with multiple contributors?  My personal preference as a consumer is for the individual blog because part of my interest is watching the creative process take shape in an individual over time.  But maybe that’s just the clinician in me.

It was fun to be part of the discussion at this early stage.  I’m excited to see where the initiative goes.

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