Articles: Taskforce moves ahead on suicide prevention initiatives, including training for psychologists & Sex therapy begins with asking about sex life {Below}

Taskforce moves ahead on suicide prevention initiatives, including training for psychologists

By Chuck Nelson, Associate Editor

October 15, 2020

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Barbara Van Dahlen, Ph.D., already had a day job when the Veterans Admin- istration came calling in 2019.

Someone had seen comments she made regarding Executive Order 13861, better known as the President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide (PREVENTS), and wanted to know if she’d be interested in directing the effort. 

“I said I was impressed with the idea,” said the founder of Give an Hour, which had worked with prior administrations on mental health issues, including resources for members of the military,

veterans and their loved ones.

After some discussions, Van Dahlen accepted the role of executive director of the PREVENTS task force in June 2019, anxious to have an impact on “a huge area of need.”

“They handed me the keys and said, ‘Build your team,’ ” said Van Dahlen, a clinical psychologist who has practiced in the Washington, D.C., area for more than 20 years. “I feel really grateful and really inspired by the work we’ve done already.”

While the executive order focused on veterans, Van Dahlen said she felt it needed to be broadened to address suicide in general to make the program workable. Government statistics show 132 Americans dying by suicide each day with the suicide rate among veterans 1.5 times higher than the general population (after adjusting for age and/or gender). There were 47,173 suicides in 2017 with an estimated 1.4 million suicide attempts. The Pentagon said last year

that the suicides by active duty service members rose an average of 6 percent a year over the prior five years.

The task force – which is situated between the VA and the White House has a three-year term. It’s expected to “weave together efforts by the federal government with state, regional, business, nonprofit, faith-based, academic and community efforts,” according to a press release on  Van Dahlen’s appointment.

Van Dahlen said the first year was spent gathering data and building relationships and partnerships.

“It’s extraordinary. Pretty much every conversation I had with every outside group, they said ‘Yes, we want to get involved,’ ” Van Dahlen said.

Next up will be implementation of programs and strategies followed by evaluation of those efforts, Van Dahlen said.

One of the first programs – REACH– was launched this summer. The website

(wearewithinreach.net) was designed to raise awareness and “encourages everyone to

reach out to vulnerable populations and see how they can be of help,” Van Dahlen said.

Another effort involves partnerships with mental health organizations -- including

APA – to develop new suicide prevention training.

Jamie Diaz-Gransado, Ph.D., deputy CEO and acting chief scientific officer for APA, said the group was excited to be part of the project, “especially in these difficult times when it has become more apparent than ever that suicide prevention needs to be a national priority.”

“We know that not all psychologists have training on suicide prevention,” said Van Dahlen. “Now more than ever, we need our field to be engaged in these issues.”

Van Dahlen said work with APA was just beginning as the COVID-19 pandemic began to unfold.

“We are literally circling back with APA in the next week to discuss next steps,” she said recently. “We would like to have this material completed and ready to disseminate by the end of 2020,” but disruptions from the pandemic could change that timeline, she said.

Van Dahlen said the task force also is working with corporations to help bring information to their employees.

“They recognize the influence on their bottom line and morale,” she said. The effort also has received help from technology partners that are figuring out how to share data and track the impact the program is already having, Van Dahlen said.

The task force’s work may be even more important as the pandemic continues. A recent report from the Centers for Disease Control noted “considerably elevated mental health conditions associated with COVID-19. Younger adults, racial/ethnic minorities, essential workers and unpaid adult caregivers reported having experienced disproportionately worse mental health outcomes, increased substance use and elevated suicidal ideation.”

In polarized Washington, Van Dahlen sees suicide prevention as one of the few issues on which everyone agrees.

“We’ve had members of Congress on both sides who have said, ‘If anyone tries to politicize this, let me know,’ ” Van Dahlen said. “Everyone has really respected the work.”

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Sex therapy begins with asking about sex life

By Candice Nicole Hargons, Ph.D.

October 19, 2020

I started my well-attended sex therapy workshop at a Kentucky Psychological Association Convention with an activity, I use in my courses at the University of Kentucky. You have one minute. Write down as many names as you can think of for female genitalia.

Distanced Couple

You have another minute. Write down as many names as you can think of for male genitalia.

After two minutes of exciting brainstorming, I required participants to yell out some of the names.

As I laughed and processed with the large group, we discussed the differences in the themes of male versus female genitalia names, as well as the cultural differences in how we describe

genitals based on region, religion and race.

Finally, I asked the psychologists how they felt saying the names aloud.

I explained that if we are unable to match our client’s language, at least initially when they describe their sexual concerns with us, we risk rupturing the relationship before we have had a

chance to establish rapport. Since sex is such an intimate topic, strong rapport is essential.

However, many psychologists never even get to the point of talking about sexual concerns with clients because they do not ask. The first step in sex therapy is to ask your clients about sex.

If you are interested in seeing clients with sexual concerns, there are two easy questions to help you broach the topic. If you’re uninterested in doing sex therapy, these questions are still important because they can facilitate the normalization of sex and your appropriate referral process.

The questions are: How has your sex life been affected by (insert their stated presenting concern)? Are there any sexual concerns you would like to discuss?

Most clients have at least one sexual concern, but psychologists and other health professionals often hesitate or avoid asking about sex because of personal discomfort, perceived/ assumed client discomfort or assuming there is no con- nection to the presenting problem.

Here’s the takeaway: Clients actually want us to initiate the discussion.

Once you initiate the discussion and the client shares a sexual issue, your training determines the next steps. Many psychology programs do not require a sex-therapy course, so few of us have the training to do sex therapy because it is so specialized. If you haven’t completed any continuing education, you may want to simultaneously enroll in an in-person or online training and seek consultation if you choose to see clients for sex therapy.

The American Association of Sexuality Educators, Counselors and Therapists (AASECT) offers certification for sex therapists already licensed in a mental health field. You can practice sex therapy without the certification, but you may still choose to attend the conferences and trainings to strengthen your skills. (See more about getting certified at aasect.org/aasect-requirements-sex-therapist-certification.)

If you have completed some training in sex therapy, you have a number of options

to treat sexual concerns. Among them, Sensate Focus integrated with Teyber

and McClure’s Interpersonal Process Therapy is my preferred orientation.

I ground this work in an intersectional framework, meaning I consider the client’s privileged and marginalized identities in conceptualizing and intervening in the sexual lives. Because certain identities have associated sexual stereotypes, this framework is an important way to tailor treatment.

Detailing the process of Sensate Focus is outside the scope of an article of this length, but I briefly identify the steps that you can read more about in “Sensate Focus in Sex Therapy” by Linda Weiner, MSW, LCSW, and Constance Avery-Clark, Ph.D. 

I like their process because it is intentional, pragmatic, structured, evidence-based and it allows you to integrate homework and cultural considerations in the parts where you discuss the relationship. It incorporates elements of mindfulness as well.

Sensate Focus Sex Therapy has seven elements, six steps and five foci that inform the 14 weeks of work for the Sensate Focus 1 process.

The seven elements are:

* Mutual responsibility between partners for addressing sexual needs and concerns;

* Information and education about sexual function and sexual activity;

* Willingness to change attitudes about sex;

* Getting rid of sexual performance anxiety;

* Helping couples improve communication around sex and sexual techniques;

* Reducing problematic behaviors and sex roles in the relationship; and

* Homework to help couples change their sexual relationship for the better.

The six steps are: non-genital touching; genital touching; mutual touching; genital contact without insertion; genital contact with insertion; and lying next to each other.

These steps are self-focused, rather than partner-focused, to remove the pressure of providing pleasure.

Lastly, in order to redirect attention from pleasure pressure, the five foci are temperature, pressure, texture, natural distractions and correcting judgments and emotions. The first three are for the client to focus on during the at-home work. The latter two are for the therapist and client/clients to discuss during the therapy session.

Other forms of sex therapy may incorporate some of these elements, but this has been the most comprehensive modality I’ve found. Sex therapy is a necessary, but underrepresented, niche in psychology. There is ample opportunity for psychol- ogists to obtain training and specialize in an area that affects the well-being of our clients, and the first step is to simply ask clients how their sex lives are going during intake. In this way, we begin to normalize talking

about sex as another part of our health.

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Candice Nicole Hargons, Ph.D., is an assistant professor at the University of Kentucky where she studies sex, social justice and leadership – all with a love ethic. She is a member of the APA Council of Representatives and an executive board member of the Society of Counseling Psychology. She was previously a Kentucky Psychological Association board member. Her email is candice.crowell@uky.edu.

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