Therapist Eric Stroo interviews Dr. Jeffrey Sung, our consulting psychiatrist, who is an experienced educator in the field of suicidality and suicide prevention.

Jeff, how did you become interested in the phenomenon of suicide as a focus for your professional work?

Sung: In our psychiatry residency training program at the University of Washington, we often worked with people with long histories of suicidality. And as can often happen in these settings, clinicians with the lowest level of training are often paired with the patients with the highest level of severity—people with very desperate and complicated circumstances. Like other psychiatry residents, I had patients who died by suicide. And it had some deep shock associated with it. In the face of it, the response from and work with my colleagues and supervisors was extremely helpful and supportive.
And so I became interested in this question of how we as clinicians understand our responses, knowing that someone might die by suicide or that someone has died by suicide. In particular, I wanted to understand how our responses influence our ability to persist in the clinical work and still find some sense of meaning and purpose.

Afterwards when I started working for UW through a Health Care for the Homeless Network program, I continued to encounter patients with complicated circumstances, often with high levels of suicide risk. And over time, I grew convinced that it’s possible to work with people who are suffering at that level if we are organized and structured with a framework in our minds so that we can sit comfortably and listen to a story with that level of pain.

Interviewer: Given this longstanding interest in suicide care, how have you seen the field evolve over the years?

Sung: Management of suicide risk has the goal of making sure people stay alive and can survive suicidal crises. An important shift in the field has been a move beyond a focus on assessment and immediate management, towards a focus on the treatment of suicide risk. Treatment of risk is working to develop a collaborative relationship so that patients can start to understand what contributes to their having suicidal thoughts and behaviors. Then they can recognize their own suicidality, intervene on their own behalf, and feel more confident in responding to their suicidal thoughts and urges with healthy coping strategies.

Interviewer: In your work as an educator in clinical suicidology, what messages do you believe to be the most important to convey?

Sung: Some of the best research in the field demonstrates the importance of connectedness as an intervention that can prevent suicide. By connectedness, I am talking about conveying general or specific messages of belonging, value, and hope. That might mean remaining quiet and reflective as someone tells the story of how they came to think about or attempt suicide. That’s a way of conveying belonging, value and hope.

Or it might mean simply saying directly, “I’m so glad we’re here. I’m glad we’re talking about this. You’re important to me, and I have hope that things will get better in your life. I want to work with you so that we have time to address the problems and pain in your life.”

Interviewer: You have thought a lot about the role of faith leaders in caregiving for people considering suicide. What do you see in that?

Sung: One entry point is simply that as a faith leader, some of the people you are speaking with might be thinking about suicide or might have attempted suicide. Frame your language and your thinking to be welcoming and open, so that someone in your community would consider confiding in you.  A great way to convey this openness is to have willingness to share your own personal experiences with mental health and mental health care, and those of others who have given permission to have their stories told. Are you seen to be open to talking about mental health conditions, about suffering, about suicidal thoughts and behavior?

As with clinicians, connectedness is critical. For faith leaders, that can mean acknowledging that you don’t necessarily have immediate solutions to someone’s problems.  Facilitating connectedness means that even without solutions, you can still commit to joining a person on their difficult pathway. This is actually a very important and unique role that faith leaders can play—finding connection or communion in suffering, instead of isolation. Finding a way to have meaning and purpose in suffering rather than believing that one’s pain is wasted. Finding a way to have hope versus despair, gratitude versus resentment. Faith leaders have these really amazing skills and a set of traditions to offer. When someone brings a problem that has no solution or no immediate solution, faith leaders can help grapple with suffering and enter into mysteries—to help find a viable pathway.

There is a resource that is supported by the National Action Alliance for Suicide

Prevention: the Faith, Hope, Life campaign for faith leaders. It details different suicide prevention competencies that faith leaders can develop for prevention, intervention, and postvention.

Interviewer: If you could change some aspects of our US culture that exacerbate the rate of suicidal behavior, what comes to mind?

Sung: It’s a great question. So many people in clinical and public health think about it, including the Surgeon General of the United States, Dr. Vivek Murthy. I recommend his recent reports about social media and youth mental health, and about social isolation and loneliness.

These reports bring us back to connection, the importance of relationships with people, family, friends, and the importance of social connection between individuals in

different community settings. It fits together with the role of healthy faith communities as places where people have an organizational level of connection, where a person can form relationships with other people and then develop internal connections and beliefs.

Interviewer: Finally, Jeff, what sustains you personally and professionally, given this challenging choice of focus in your life’s work?

Sung: Clearly, I think that the work is extremely meaningful—confronting these existential questions around finding a reason to go on when one feels that one has lost everything. Important, meaningful questions that need an answer at some point. In my own work, I’ve lost patients to suicide and I’ve had patients make amazing recoveries. And that actually helps me stay in the work, knowing that we need answers not only for patients to get better, but also for the people who survive the suicide of their friends and family members. Answers that can help all of us find community, meaning, purpose, hope, and courage in the face of profound pain and loss.

Sources referenced in this article can be found here.

In February, we spoke with Jim Furrow, who has worked closely with our clinical staff over the last five years as a trainer and consultant. Jim is an internationally recognized leader and contributor to the practice of Emotionally Focused Therapy with couples and families. Together with EFT originator Susan Johnson, he coauthored seminal works on EFT as it is practiced for couples and families. Jim maintains an active research program examining the process and effectiveness of the model.

Interviewer: What was it that drew you to psychotherapy and particularly to therapy with couples and families?

Furrow: I’ve always been a bit of a curious person. I grew up in a family of scientists—a biologist and chemist who were often pursuing a deeper understanding of the nature of things?

Relationship stood out to me in this regard in particular how important relationships are in shaping people’s lives. I found people intriguing. While relationships are significant in shaping our experience of the world, they are also complicated—whether that’s a parent-child relationship or a romantic relationship. People in relationships are often seeking something more and often finding it challenging to get what they most need.

All these factors sort of pushed me in the direction of seeing what I could do to be helpful for others in the relationships that mattered in life.

Interviewer: We appreciate that you’ve engaged your work in a variety of ways: teaching, consulting, clinical practice, research, publishing books and papers. I wonder if you see a certain thread that ties together all those ways of working?

Furrow: Yes, I love the question because the work I do is truly multifaceted. There is a core however and for me that is discovery, whether I am thinking about my teaching, writing, research, or practice I am curious how to foster discovery learning It’s one thing to tell somebody some helpful information. It’s a whole different experience when you can help them find it for themselves.

When they see something new about their relationship, or something new about their partner or about themselves—it’s like a light bulb moment. Whether it’s with a student or a client or another professional, what I find most energizing and what I’m passionate about is this idea that through experience we find new understanding. We see ourselves more clearly, we see the world more vividly, we see those we love more endearingly.

It requires some amount of what I know, but also being invited into what I don’t know, and finding discovery there. This is where the curiosity comes in—I’m always learning. It’s a huge privilege, whether it’s a student in a classroom or a couple in my office, or even a research subject: Somebody shares from their experience, and I see the world in a new way. Those moments are a gift and opportunity.

Interviewer: What has made EFT so central to your work and to your career?

Furrow: What’s been interesting to me, especially in my 30 plus years in the field, is to see emotion move from the background to the foreground. And the more that we learn about the neuroscience , the more we understand that emotion provides an important integrating element between cognition and behavior.

As a model, EFT sees emotion as a resource for change and also as a target to focus on. It gives me a map for the work that I’m doing, but also a means for change– which is a powerful combination. It’s enabled me to be effective in moving toward both transformation and reconciliation in relationships: transformation—how people grow, how they become; and reconciliation—how people are brought together, which is about belonging.

Interviewer: At Samaritan Center, we have a commitment to spirituality as a dimension of therapy. And in working with you, we’ve found that to be a shared commitment. Could you say a bit about how that also informs your work?

Furrow: Absolutely. One way to think about spiritual integration is to talk about soul care, the care for people’s sense of meaning and purpose in the world. For a lot of folks, that has a spiritual or religious expression.

The questions that come up routinely in therapy, whether they relate to parenting or to marriage and couple relationships, are at their heart questions about purpose, about direction. What are we doing here and why are we doing it and what’s the value here? Is it just satisfaction? Is that all I’m looking for, or is there some deeper meaning? I think it’s essential that we have a way to talk about these existential questions in the client’s language and from their perspective—honoring the importance of communities, religious communities, for example.

And for me, there is something more, something that comes from my core, from my own Christian understanding. And that is that there is a promise. It’s not just purpose, it’s not just a direction, but there’s a promise that gives hope.

Of course, one thing I’m quick to say in a conversation around faith is that it can be a resource, but it can also be a risk. There are ways that it’s been hurtful in people’s lives, ways that it’s been constraining. And yet where it brings freedom and hope, I do believe that it can lead to transformation and reconciliation.

Interviewer: Finally, Jim, on this subject of hope, I wonder if you would share a bit more about what gives you hope, professionally and personally?

Furrow: Well, I think it’s twofold. One way is very much from the ground up: The people that I work with give me hope because I see the efforts that they bring to seek something better in their lives, to seek understanding, to seek compassion, to seek caring, to seek repairing, to seek growing. I see courage every day and the work that I do. The risk to be vulnerable in a relationship with another person in marriage, in family life, in friendship. You see and find courage, and you see the human spirit.

And I think you often see the presence of Christ in the midst of these moments, which is a second source of promise and hope that is vitally important, at least for me. It’s not a generic hope, like “hopefully” this is going to get better; there is a confidence that comes in knowing that we’re in this together and ultimately held in the love and mercy of God.

The critical question is, are we alone in our suffering, or can we find others who can walk that journey with us with a sense of hope and promise? That’s where I would like to show up—to provide a sense of presence, holding on to a hope that for me is based in God’s promise.

One of the strengths of Samaritan is that we are available to help people in an ongoing way with the problems that inevitably arise in life. Created in 1960, with therapists who stay with us for 10, 20, and 30 years, we serve families in a variety of ways—often beginning with individual or couples therapy, sometimes including additional family members, and when it’s indicated, referring them to another therapist with specific expertise. Clients sometimes come with a specific issue that is resolved in a few sessions, but frequently they find that the issues are more complicated and they engage in deeper, longer-term work.

An example of Samaritan as an ongoing family resource is a couple in their mid-40s who came to Samaritan for the first time 10 years ago. The problem was the “out of control” behavior of their two teenagers. They wanted to know how to set limits and provide support for their adolescents, both of whom were taking risks that could have serious long-range consequences. Their therapist helped them examine and make changes in how they were parenting and, at the same time, focused on protecting and strengthening their marital relationship.

A second round of therapy occurred when one of their aging parents needed to move from home to an assisted living facility.  The loss of independence was devastating for the parent and put our clients in the position of making hard but necessary decisions while being viewed as “the bad guys.” The therapy setting created space for them to voice their grief and frustration without appearing weak or unfeeling.

Later, health issues for each of the couple coincided with the husband’s planned retirement.  It brought them face to face with questions of their own mortality and an urgent need to re-think their financial expectations.  Again, having a therapist who could listen deeply to their fears, bringing both her history with the family and her training in life transitions, helped them move forward.  The couple pulled together their considerable resources—among them their love for each other, their strong Christian faith, their experience of meeting adversity with determination, and a soul-saving sense of humor.

The belief that both the couple and the therapist held as they worked together, once again, to find a way through very difficult circumstances is what Samaritan has always offered our community. A belief in our ability to care for one another and to create positive change.

Life isn’t always easy to navigate or easy to understand. Samaritan Center exists to help people cope, rebound, and heal from the unexpected difficulties life can bring.

In the third year of pandemic-driven change, we are determined to continue to live vibrantly into that mission. No matter their ages or their circumstances, our clients tell us they are weary, worn thin by the stress of isolation, unpredictability, and the incessant troubling news. For example, there is the woman in her 70s who meets with her therapist every other week. She lives alone in low-income housing, is largely estranged from her adult children, and worries continually about her health, her finances, and the uncertainty of the future. She talks about her faith and experience of decline: ‘You’re the only one I have to talk to,” she says. “I don’t know what I would do without being able to meet with you.’

Those of you who so generously support this ministry make it possible for us to continue to be a healing presence for people who are in need of care. Without these donations from our spiritual partners – church congregations and individuals – helping those in need simply can’t be done. We pray that you will stand beside us in this difficult time. We thank you.”

Archbishop Desmond Tutu, who died on December 26, believed in and actively lived the South African principle of ubuntu. The word ubuntu is part of the Zulu phrase “Umuntu ngumuntu ngabantu” which literally means, “A person is a person through other people.”

In The Book of Joy, which the Archbishop wrote with the Dalai Lama and Douglas Abrams, he said: “Ubuntu says when I have a small piece of bread, it is for my benefit that I share it with you.… In a very real sense we’re meant for a very profound complementarity. It is the nature of things. You don’t have to be a believer in anything. I mean, I could not speak as I am speaking without having learned it from other human beings…. I learned to be a human being from other human beings. We belong in this delicate network. I am, because you are. It is actually quite profound.… We are bound up and can be human only together.”

At Samaritan, we are deeply aware of how foundational it is to wellbeing to have reliable, caring relationships with others.  Mind, body, spirit, and relationship are bound up together, and healing occurs as we give attention to each of these elements of our humanity and actively seek to integrate them. We are grateful for the example of those, like Desmond Tutu, who have faced adversity without losing their ability to identify with others and live, not in separation but in solidarity with them.

As the pandemic has stretched now from months to years, we all have experienced the significant, sometimes catastrophic impact that it has had on relationships. Stress that arises from multiple directions can drain away the ability to connect with one another in meaningful ways. It affects everyone, parents and their children, husbands and wives, friends, work colleagues, and casual acquaintances. Reaching out to one another in nurturing ways is sometimes simply more than we can do. In the resulting isolation, our sense of the warmth of human connectedness – ubuntu – withers.

How are we to respond to the unchosen stress of this time and the fears that arise in our mind, our body, and our spirit?  Ubuntu tells us that, as individuals and in community, we can choose to intentionally express to one another respect, dignity, reciprocity, compassion, and mutuality.

When we feel overwhelmed by circumstances, it’s hard to know what that would look like. What can just one person do?  Mindfulness suggests that, first of all, we should simply pause, taking time to acknowledge what we’re thinking and feeling. As we’re able to accept and calm our anxiety, we will see the situation more clearly. We’ll see the possibilities, where we have some control or influence and how we can use that. We’re more able to let go of the things that are beyond our control.

As our minds become quiet, refraining from worrying and judging ourselves and others, we are able to respond to the problems in more creative and confident ways. We find that we can act with the energy and compassion of ubuntu, secure in the experience of our common humanity, our interconnectedness and our responsibility to one another.

And Now… How Do We Think About Re-entry?

It’s spring. We can feel the changing, evolving season. Light that lasts longer. New growth appearing. A taste of warmer days to come. People venturing out of hibernation.

It’s been a long winter, a long year, and we’ve become accustomed to the many ways in which we’ve been separated from one another. Many of us are wondering what this season of re-entry–the emerging from separation–will look like. There’s a feeling of uncertainty, a forgetting of how everyday relationship with the outside world is done. Used to be done. Should be done. Can be done.

Some of us feel the questions more intensely than others. Instead of embracing the new freedom, we look at it with a raised eyebrow. Our habits of caution outweigh our impulse to engage. That can lead us to wonder in a self-critical way–about ourselves, our resilience, our ability to adapt.

We know that distressing situations can trigger our feelings of anxiety and depression. When this happens, we do well to remind ourselves of strategies that can help manage these feelings. We may have learned some of them through Cognitive Behavioral Therapy and the practice of Mindfulness. While they’re simple skills, they’re not easy to maintain when we’re feeling stressed. Our efforts, however, can be rewarding.
Here is a reminder of some of those useful strategies:

• Stay in the present–don’t ruminate about the past or try to predict the future
• Focus on what you can control and set aside what you cannot
• Appreciate those things that are going well
  Maintain healthy habits of eating, sleeping and exercising
• Seek out pleasurable activities and meaningful connection with others
• Extend an attitude of generosity, both to yourself and to others

It seems fortuitous that our emerging from this highly restrictive year of the pandemic coincides with our calendar’s emergence from winter into spring. Access to vaccines and lower numbers of serious illness and death from the virus are allowing us to move about more freely. Sunny days are inviting us to come outdoors, shedding our raincoats and boots and woolen scarves.

So, is there a way to step into this re-entry, this emerging from separation into reconnection, with lightness, the spirit of spring? Can we bring what we’ve learned in this past year, about ourselves and others and reality itself, to a clearer and more compassionate understanding of what life is about? Will our inner conversations and our relationships with others thrive in this warmer climate? Will our sense of gratitude and hope speak to our experiences of loss and grief? Will we agree to move forward with a smile – one that may still at times be hidden by the masks we agree to wear but will surely be visible in our eyes.