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Treating Male Suicide & Depression
Male Suicide & Depression  continuing education social worker CEUs

Section 9
Behavioral Guide Depression

CEU Question 9 | CE Test | Table of Contents | Depression
Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs, Nurse CEUs

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On the last track we discussed how depressed men, possibly at risk for suicide, who are narcissistic, often fail to recognize their partners' feelings. Women then feel their opinions are not being heard. Thus, the couple engages in a power struggle.

Divorced or separated men are more than twice as likely to commit suicide than men who remain married.Narcissists abhor and dread getting emotionally intimate. The cerebral ones regard sex as a maintenance chore, something they have to do in order to keep their source of Secondary Supply. The somatic narcissist treats women as objects and sex as a means to obtaining narcissistic supply.

On this track, we'll look at five techniques to help depressed male clients deal with conflict in relationships. The five techniques are: the “time-out technique,” the “power technique,” the “I was wrong technique,” the “counting technique,” and the “letting go technique.” As you listen, think of how you can use these strategies in your next session with a depressed male client who may be at risk for suicide.

A colleague, Susan, told me about a couples’ therapy session she had with Kyle and Wendy, both 28. Kyle, a restaurant manager, was having difficulty ending conflicts with Wendy. Kyle was in an ongoing battle with depression and said he could never win their arguments. Wendy, an accountant, said that Kyle never listened to or cared about what she had to say. Kyle stated, “I sometimes rehearsed my side of the argument in advance, and I often felt an 'adrenaline rush'during my conflicts with Wendy.”

Both Wendy and Kyle admitted to bringing up problems from the past. It was a classic power struggle fueled by Kyle’s depression and suicidal theats.

Technique # 1 - "Time-Out"
Susan gave Kyle and Wendy some advice for fighting fairly to help them cooperate instead of attack each other. Since Kyle was depressed and had trouble controlling his anger, Susan told Wendy and Kyle about the time-out technique first. Let’s go over the three steps in this time-out technique:

Step One - The first step is to physically separate from each other during the argument. For anywhere from 90 seconds to five minutes, couples should go to different rooms in order to break the old pattern of aggression.
Step Two - Next, both should relax his/her body. As you know, one cannot be tense and relaxed at the same time. So simple breathing exercises can help calm down both partners.
Step Three - Finally, each person should use positive self-talk to facilitate change. Like in the fishbowl technique we discussed on the last track, you must first realize that your self-talk is harmful.Susan told Kyle that as he was separated from his wife during a time-out, he could begin to adjust his self-talk to become more positive. For instance, instead of rehearsing an upcoming argument, the man can tell himself, “I can get my point across without yelling,” or “I can argue with her without losing my temper; I don’t have to be like my father in this way,” or “She means more to me than winning this argument.” Other examples include “I will not take this provocation personally,” and “If I feel myself getting angry, I’ll be able to shift my focus to something more pleasant.”

In the next session, Kyle and Wendy told Susan they liked the time-out technique. Both said they at least liked doing something different in their arguments. Imagine your next session with a male client who is having a power struggle. Would it be beneficial to tell him about the time-out technique?

Technique # 2 - 6-Step Power Technique
Now that we have discussed the time out technique, let’s discuss the “power technique.” Susan gave Kyle and Wendy this strategy to try during the time-out technique. After the two have separated, this allows them to feel more energetic and more in control of their anger.
Step One - “First,” Susan explained to them, “you get comfortable and refocus your attention inward to your feelings and bodily sensations. Close your eyes and begin to breathe slowly and deeply. As you release your breath, say to yourself, ‘Relax. Let go.’
Step Two - "Continuing this breathing exercise, scan your mind and body to locate the tension you feel.
Step Three - "Then take another slow, deep breath and hold it for five seconds. As you release this breath, you are freeing yourself of all the unnecessary tension that has built up. You should feel more peaceful and in control.
Step Four - “Now relax for a little bit. Enjoy the inner strength and peace you have gained and imagine yourself in a tranquil place. Your muscles should feel relaxed and heavy.
Step Five - Finally, it’s time to energize your mind and body. You should notice a surge of energy flowing through your head, neck, shoulders, arms, and so forth until the energy reaches your toes.
Step Six - When you feel ready, count from one to five, saying the number as you exhale. Gradually, you should feel lighter and more alert. By the time you reach five, you are completely energetic and have the power and self-confidence you need to return to your partner and resume your argument.”

Technique # 3 - "I Was Wrong"
Now that we have discussed the Time Out and Power Techniques, as a means of coping with the depression you feel regarding your arguments; let’s next look at the “I was wrong” technique. Susan gave the couple another technique for better arguing, the “I was wrong” technique. As you know, this exercise asks both partners to talk openly and honestly about their own mistakes and say nothing of the other person’s mistakes.

3 Rules for 'I Was Wrong'
The rules in this technique are extremely important:
-- Rule # 1 - First, one person begins by saying, “I was wrong to…” and says something he/she did to contribute to the current conflict.
-- Rule # 2 - After this, the other person makes a similar statement.
-- Rule # 3 - Then, they must go back and forth two more times. The idea behind this technique is that each statement becomes more revealing and more helpful in stopping the argument.

Here’s an example of an argument Kyle and Wendy started in this way:
-- Kyle: “I was wrong to slam the door when I came home.”
-- Wendy: “I was wrong to roll my eyes right away.”
-- Kyle: “I was wrong to not tell you what was bothering me.”
-- Wendy: “I was wrong to not consider how you were feeling.”
-- Kyle: “I was wrong to ignore what you were saying.”
-- Wendy: “I was wrong to get defensive and assume you were trying to hurt me.”
After this kind of talk, Kyle and Wendy could go back to their argument. Do you have client for whom sharing the “I was wrong” technique would be beneficial?

Technique # 4 - Counting
During the next session, Susan suggested the counting technique. This technique involves counting during an argument. While listening to Wendy talk, for instance, Susan suggested to Kyle that he count silently in a calm, even rhythm. He had to maintain focus on Wendy in order to really hear what she was saying, but he could also stabilize his emotions by creating a steady rhythm in his head. The counting technique is an easy way to buy time and to maintain your emotional energy.

Technique # 5 - "Letting Go"
Finally, Susan gave Kyle and Wendy some advice for recovering after an argument. Kyle was having trouble letting go of his anger and forgetting an argument after it occurred. Susan told him to do the letting go technique, and here are the steps. Susan said to Kyle:
-- Step 1 - “First, make a tight fist and keep it tight as you count out 60 seconds. When you reach 40 seconds, intensify your squeeze with each count. Continue to hold your fist tighter and tighter, even as the pain gets stronger. This physical pain is like the emotional pain of his anger.
-- Step 2 - “Now, once you reach 60 counts, you can begin to relax your grip very slowly.
-- Step 3 - Take about 15 seconds to open your hand, and you’ll notice the pleasant feeling of the tension melting away. You are freeing your hand of discomfort, just as letting go of your anger can free yourself of emotional pain and suffering.”

Susan reminded Kyle and Wendy, “It is your choice to either cling to their anger or let go of it.” Letting go of anger would help with Kyle’s depression and would strengthen their relationship. Would a male client of yours benefit from the ‘letting go technique?’

ABCs of Change
Susan told Kyle and Wendy that the ABCs of change are affect, behavior, and cognition. For “affect,” developing empathy was the key. Kyle had learned to listen to Wendy and try to understand her feelings. For “behavior,” it helped to physically calm down, engage in positive self-talk, and begin statements with “I was wrong.” And for “cognition,” little reminders of what he wanted to do, like stay in control of his anger, helped Kyle to fight more fairly. Kyle later stated, "Fighting more fairly seems to make me feel less depressed."

Think of a male client who is experiencing depression with possisble suicidal ideations who might benefit from any of the time-out technique, the power technique, the “I was wrong” technique, the counting technique, and the letting go technique. I sometimes find it helpful to modify these exercises depending on the individual client, and you can add your own strategies to the list.

In the next track, we will look more in-depth at anger and how it relates to masculine depression adding to their risk for suicide.

Peer-Reviewed Journal Article References:
Beshai, S., & Dobson, K. S. (2010). Review of The Core Program: A cognitive behavioural guide to depression [Review of the book The core program: A cognitive behavioural guide to depression, by R. J. Paterson, L. E. Alden & W. J. Koch]. Canadian Psychology/Psychologie canadienne, 51(1), 67–68. 

Marroquín, B., & Nolen-Hoeksema, S. (2015). Emotion regulation and depressive symptoms: Close relationships as social context and influence. Journal of Personality and Social Psychology, 109(5), 836–855.

Ogolsky, B. G., & Gray, C. R. (2016). Conflict, negative emotion, and reports of partners’ relationship maintenance in same-sex couples. Journal of Family Psychology, 30(2), 171–180.

Rimes, K. A., Ion, D., Wingrove, J., & Carter, B. (2019). Sexual orientation differences in psychological treatment outcomes for depression and anxiety: National cohort study. Journal of Consulting and Clinical Psychology, 87(7), 577–589.

Simon, K. A., Vázquez, C. P., Bruun, S. T., & Farr, R. H. (2020). Retrospective feelings of difference based on gender and sexuality among emerging adults. Psychology of Sexual Orientation and Gender Diversity, 7(1), 26–39.

Westbrook, S. R., Hankosky, E. R., Dwyer, M. R., & Gulley, J. M. (2018). Age and sex differences in behavioral flexibility, sensitivity to reward value, and risky decision-making. Behavioral Neuroscience, 132(2), 75–87.

Online Continuing Education QUESTION 9
What are five techniques for fighting fairly? To select and enter your answer go to CE Test

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