How Do People Change?

Written by Mary Fitzgibbons, Ph.D.

Why would anyone choose to spend the money and time in going to therapy? It can be costly if your insurance doesn’t apply and it can be emotionally painful. Generally, by the time clients make the effort to find someone who they hope that they can trust and who will help them in resolving the problem, they are experiencing a good amount of pain or inner turmoil. Most clients come into this setting with varying amounts of hope and confusion. Their medical doctor has prescribed different types of treatments. One, of course, is prescription drugs. But many feel as though medications may not be the only option. Referring someone to therapy is becoming a more common phenomenon, but that can also be problematic. What kind of therapy am I going to need? What is going to work? One can easily become really confused over different types of therapy, such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT) or Emotionally Focused Therapy (EFT). There are many other psychological treatments, but the question remains, “What is going to help me change?”

While each theory has its pros and cons, it is important that the therapist be clear as to how he or she approaches the work. The reason is that it is the therapist’s job to help the client create change, and the change should be lasting change. This would be very difficult to do if the therapist didn’t eventually come to a belief as to how this should be done. Hoping that this theory or that theory may work but not being sure is akin to going to a surgeon for a hip operation and the surgeon questioning which procedures will be most effective as he begins the surgery.

One of the better known therapies today is Cognitive Behavioral Therapy (CBT), which is derived from behavioral and cognitive psychology. Its purpose is to address current issues by developing good coping strategies. One of the ways it does this is by changing thoughts and cognitions, beliefs and attitudes. Its purpose is to treat specific problems, so it becomes a problem-focused, action-oriented approach. CBT’s focus is to help the client challenge his or her beliefs and replace present ways of thinking, which include overgeneralizations, self-defeating thoughts, and the tendency to minimize the positives and maximize the negatives, with more realistic and balanced ways of thinking. The therapist and client work together to come up with strategies and goals that will help the client achieve some resolution of the problems. The goal is to decrease the symptoms that the client is presenting. Its advocates say that it is effective in treating depression and anxiety, along with Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder, and aggression and Conduct Disorder in children and youth.

There are certain clients that can be very difficult to treat. Dialectical Behavior Therapy was created by Marsha Linehan with the express purpose of working with “non-motivated” patients. Some of these people had been raised in severely invalidating families. Thus their trust level with the therapist is difficult to obtain. DBT strives to make the therapist an ally to the client. The focus of the therapist is to accept and validate the client’s feelings, even when they may be very difficult. It is the therapist’s role to confront the client when the latter’s feelings are maladaptive. This theory draws from other traditions such as cognitive behavioral therapy and assertiveness training. The therapist and client address the client’s issues on a hierarchical basis, going from the most serious behaviors such as self- injurious or suicidal ideation to quality of life issues. The client is taught various skills. Often group therapy is used to hone these skills. Mindfulness is an important component of this theory, in that it helps individuals accept and tolerate the strong and difficult emotions that challenge their lives. This contributes to helping the client emotionally regulate emotions. DBT is often used in cases of depression or Borderline Personality Disorder.

Many clients may assume that most theories focus on emotion. In fact, many people hesitate before they decide to see a therapist because the fear is that, “I’m going to feel feelings I don’t want to experience,” or, “I’m afraid if I feel those negative feelings I’ll never be all right again.” While this may sound like an exaggeration, it is often the reason many people hesitate or refuse to come to therapy. It would surprise most people that emotion has not been the central aspect in most therapeutic models until the last twenty years. Behavior and cognition had been the focus in the past. Yet when we look at making changes in our life, the reason for wanting to change is often that we are not happy with the way we are feeling. We may be sad because a relationship that we value is ending. Or we may feel helpless because our child is making decisions that are risky and we are at a loss as to how to deal with it. No one feels the need for therapy unless they are feeling sad, frightened, angry, helpless, or depressed and, most importantly, they don’t know how to change these emotions so that they feel better. It is all about feelings. While many therapies discuss emotions, the emphasis is not directly on changing those emotions.

Most therapists acknowledge that they are eclectic in their therapeutic approach. This means they may use various techniques from different therapy modalities. While this is true for most of us, this author would like to share what she has found to be an effective theoretical model in her years of doing therapy. It is called Emotionally Focused Therapy (EFT). EFT is based on the premise that emotions are connected to human needs and, when we work through these emotions, problematic emotional states and interpersonal relationships can be changed. EFT is based on Carl Rogers’ empathic attunement. That is, the therapist “gets” the client and is attuned to the client. Clients feel as though they are understood by their therapist. The emphasis is on engaging the client in an emotional experience that is in the present – what is going on with me right now? The theory is that we become more likely to change only after we can access the most primary emotion that we are experiencing. For example, Jane is angry because it seems as though a couple of her good friends aren’t including her in their regular nights out. She flies off the handle with others at the least provocation. Her anger is always present. After her sessions with her EFT therapist, she is able to access her deeper feelings of being truly sad because she has never felt as though she was special to anyone. The therapist, in this process, is validating the negative feelings that she entered into therapy with which is called a secondary emotion but then is able to reprocess her deeper feelings (her sadness) which are called primary emotions. Within EFT, this is what creates the change.

There are some key elements that are critical in creating this change:

  •  Carl Rogers believed that the relationship between the client and therapist is critical to the therapeutic process. There has to be a trustworthiness between the two. The client has to have the sense that the therapist sees the value in the client and the therapist understands the client.
  • The attachment process is an important component. This refers to the original relationship between mother and child. If this bond does not develop securely in infancy and early childhood, it will have emotional ramifications at a later time. This is often the basis of the emotional issues that we may have twenty or thirty years from now. For example, Tom’s mother had a serious illness following his birth. For a number of months, she was unable to hold him or feed him. Though no one’s fault, Tom developed an insecure attachment style. This meant that he was never secure or safe in his attachment relationships, such as with a partner or close friends. He becomes highly anxious when he realizes that a relationship is falling apart. In order to resolve this anxiety, he has to allow himself to experience the emotion in order to change. It is through the therapeutic process that he begins to be able to develop a sense of safety and security in his serious relationships.
  • The focus of the EFT therapist is on the present. While the issue may have begun in the past (Tom’s lack of early nurturing from his mother) the present feelings are what the therapist deals with. It is a highly experiential approach. The client becomes aware of his deepest primary feelings and how he experiences them. The EFT therapist will help the client not only identify the emotion but where this feeling is being felt in the body. It is in this experiential process that people change. This is because change comes about when one emotion replaces another emotion. Tom goes from feeling anxious to being secure and confident in the relationship.

The reason why the EFT approach seems effective is that is has been this therapist’s experience that long-lasting change does not come about when we attempt to change the other person’s thought patterns. It is the emotions that must change. This may be a more difficult process, but it is longer lasting. When EFT achieves its goals, the emotional changes are longer lasting and they become a part of the client’s emotional fabric.

Mary Fitzgibbons, Ph.D

Dr. Mary Fitzgibbons is a licensed psychologist and the Director of West County Psychological Associates. Before beginning her career as a psychologist, Dr. Fitzgibbons was in education for 20 years, in both elementary and secondary levels.

Care Team 2.0 *
Revitalizing Your School’s Response to Today’s Generation of High-Risk Students

30 Hours of Comprehensive Training:
Monday, June 4th ~ Friday, June 8th, 2018
9:00 a.m. to 4:00 p.m. daily

At times today, the world seems to be spinning out of control. Many of us find ourselves struggling to cope with feeling overwhelmed and worried by how to respond to all the changes. No doubt, schools are forced to cope, too. Our students are coming to school more anxious, dependent, entitled, and depressed. Suicide rates are climbing rapidly, even preschoolers come to school traumatized and anxious, and ever more students simply refuse to come to school at all.
Today, more than ever, teaching is not for the weak. It’s critical that our teachers and school professionals have a means to receive collegial support, brainstorm solutions, and assure follow-through for the most high-risk students. Of course, any program that takes time and resources must be highly effective. To that end, training and support is available to make sure that your school’s Care Team is creating a real difference for your students and staff alike.

Care Team 2.0 Training Topics Include:

  • Attachment, the core of all relationships, and its application in the school
  • Student mental health, including anxiety, ADHD, self-harm, suicide prevention and others
  • Vaping and today’s substance use crisis
  • The effects of today’s technology on our students’ mental health, relationships and behavior
  • Dealing with difficult parents
  • Motivating the unmotivated student
  • Strategies, habits, and ethics that create a healthy and effective team
  • Finding solutions when the team feels stuck

Who Should Attend: Whether you are considering how to start or restart your school’s team, wish to revitalize a struggling team, or just need some fresh ideas for your team that is already successful, you are welcome. All Care Team members and education professionals are encouraged to attend.

Cost: $450 per attendee Title II funds may apply. Continuing Education certificate provided.

Date and time: June 4 – 8, 2018 9:00 a.m. – 4:00 p.m. daily. Lunch 12:00 – 1:00 on your own.

Location: West County Psychological Associates 12125 Woodcrest Executive Dr. St. Louis, MO Suite 120

REGISTRATION: Online registration is available at: Payment is expected at time of registration. Questions? Call WCPA at (314) 275-8599. Register Today – Space is Limited.

* This training is also available for school groups at your site. Call for information.

Juuling: What Every Parent and Educator Must Know

Written by Tony Tramelli, M.A., L.P.C.

There has been a trend sweeping across the country over the past few years, causing widespread concern among parents, schools, and medical professionals from every field. This trend is known as vaping, and it refers to the use of electronic cigarettes. The term itself – vaping – is quite misleading. Vaping sounds as if e-cigarettes produce water vapor, which they most certainly do not. Vaping actually creates an aerosol consisting of very fine particles. Electronic cigarettes, which have been on the market since 2003, were first introduced as a safe alternative to traditional cigarettes. Cigarette smokers would be able to switch to a product that provided a similar experience to smoking without all of the harmful carcinogens. Electronic cigarettes are used by many as a method to quit smoking, although the jury is still out on the efficacy of this method. It is not surprising, though, that the e-cigarette market has extended far beyond former smokers.
One group which these products have been very successful in attracting is adolescents, and there is one product in particular that has really taken hold among middle and high school students. This product is the Juul, and the use of it is commonly referred to as “Juuling.” The Juul is a vaping device that resembles a flash drive, and can be charged using a USB port. Since its release in June of 2015, Juul has seen a 700 percent increase in sales and as of January, 2018 it accounts for almost half of the e-cigarette market. It is difficult to say how much of its success can be attributed to underage vaping. The legal age for the purchase of tobacco and e-cigarette products in St Louis City and St. Louis County is 21.
JUUL Labs, which produces the Juul, claims that their products were designed specifically for former adult smokers, and that they in no way advertise to a youth market. Whether they intentionally do so or not, it is clear that a large number of teens who are using vaping products are choosing the Juul. Because of their sleek design and resemblance to flash drives, Juuls are easy to conceal and to use in a number of locations: school, bedrooms, cars, etc. Students even admit to Juuling in the classroom unbeknownst to teachers. The “smoke-like” substance that is exhaled is also quite minimal, which allows for an even greater ease of use. Juul may also be appealing to underage users because of the different flavors that are available. Juul Pods (small plastic containers filled with flavored nicotine liquid) come in traditional tobacco and menthol flavors, but users can also choose from a very wide variety of flavors, including mango, cool cucumber, fruit medley, and crème brulee. The Juul starter pack, which includes a battery, charger, and a 4 pack of pods, retails on their website for $49.99 and refill pods sell for $15.99 (4 pods per pack).
Each Juul pod, which lasts about 200 puffs, contains 59 mg of nicotine, which is equivalent to a pack of cigarettes. It should be noted that this is one of the highest concentrations of nicotine among all e-cigarette products. Only customers 21 and older are able to buy Juul products from their website. They claim to have a “state of the art age verification process” to make sure that no underage customers are able to purchase their products. This process is simply typing in a name and date of birth. Underage customers can use someone else’s name and DOB; a brother/sister, friend, or even a parent. Juuls are also available at a number of brick and mortar stores throughout the St. Louis area. Along with purchasing Juuls online and from stores, there are thriving black markets for illegal purchases in many of our schools. One student stated, “All of the drug dealers in my school stopped selling drugs and started

selling Juuls; there is more money and less serious consequences if they get caught.”
One of the major draws of Juuls and other vaping products are the claim that they are safe. Most users believe that there are few to no health risks involved with vaping. These claims are coming from the same industry that made similar claims about cigarettes. The fact is that it is not yet clear the extent to which these products are harmful. This is because there is so little long-term data on the subject. But it is clear that many teenagers and adults alike are under the assumption that vaping is a harmless activity.

While Juuls may contain fewer toxic substances than a traditional cigarette, they still contain:

  • Nicotine
  • Ultrafine particles that are inhaled deep into the lungs
  • Flavorings such as diacetyl, a chemical linked to serious lung disease
  • Volatile organic compounds
  • Heavy metals, such as nickel, tin, and lead

These products are being widely used by older children and teenagers. The claim that they are safer than cigarettes may or may not be true, but should that matter to us? E-cigarettes contain nicotine, one of the most addictive drugs in existence. Exposure to this substance during adolescence is dangerous and should be avoided at all costs. The part of the brain that is responsible for decision making and impulse control is not yet fully developed during adolescence; young people are more likely to take risks with their health and safety than adults.

Adolescents are uniquely at risk for long term, long lasting effects of exposing their brains to nicotine. These risks include addiction, mood disorders, and permanent lowering of impulse control. Nicotine changes how the synapses in the brain are formed, which can harm the parts of the brain that control attention and learning. E-cigarette use among adolescents is also strongly linked to the use of other tobacco products, such as cigarettes and chewing tobacco. Some evidence suggests that e-cigarette use is linked to the use of alcohol and other substances. It should be noted that some vaping devices can also be used to smoke marijuana concentrates, such as oils and waxes.

Juuling does not appear to be a passing trend among teenagers. This is due in part to the fact that these products are so highly addictive. If nicotine addiction is something you or someone you know is struggling with, there are resources available and safe, proven methods for quitting. For more information on this issue, please contact West County Psychological Associates at or call us at 314-275-8599.

Tony Tramelli, M.A., L.P.C.

Tony Tramelli, MA, LPC provides therapy to individuals, couples, and families on a number of issues, including depression, anxiety, grief, behavioral issues, and academic problems. Tony especially enjoys working with young adults and their parents toward financial and emotional independence during the launching process. In addition, Tony provides therapy for individuals, couples, and families struggling with issues around technology and addiction. He provides presentations and seminars to schools and parents on a number of different issues, including vaping.

Divorce and the Sense of Personal Identity

Written by Jennifer Van Luven, MSW, LCSW

When you think of “trauma” you may imagine Big Trauma experiences: serious accidents, natural disasters, assault, or life-threatening illnesses. These kinds of events obviously and in a very public way transform the foundation of who you are and how you live. Other incidents can feel equally traumatic and life changing. Divorce is one of them.

When the life and world you have built falls apart due to a divorce or separation, whether amicable or not, the way you see the world and your place in it changes. Accepting and evolving into a new person can feel distressing and painful as you give up a portion of your lifestyle, home, family, financial security, love, and dreams. To manage the shock of the change, you might find yourself letting go of activities you once enjoyed and implementing coping mechanisms geared toward reducing emotional pain, fear of the future, and the sense of loneliness and uncertainty that takes up space in your head. In fact, coping after divorce may have taught you to live with thoughts of being “less than.”

A main factor in how you define yourself is the context in which you understand where and how you belong. Your identity will change during and after divorce because your understanding of who you are and the world in which you live has dramatically altered. Losing a sense of safety, control, and certainty shifts you into a feeling of vulnerability. You may see yourself today as someone robbed of innocence, trust, love, well-being, and the feeling of being able to protect yourself. You may deeply feel that you are undesirable, physically damaged, emotionally or psychologically disfigured. This new self-definition impacts how you see the world, think about yourself and others, and make choices and take actions. If that’s the case, then it’s time for an identity makeover.

When considering how you can create a new, post-divorce identity, it helps to understand the characteristics of identity in general. Identity relates to the idea of who you are and what defines you as a person in this world. Identity is how you describe yourself and the characteristics that make you unique. Identity development can change in a moment as you experience the divorce process and divorce becomes the lens through which you and others view yourself and the world around you. Your only choice at this point is to continue to move forward, make new choices about the direction you wish to move and create a post-divorce self that combines all of your best features and attributes.

Though your current identity may seem diminished, another part of you sees the bigger picture. This is the part of yourself that inspires and motivates you to move toward (re)claiming a more positive, solid, stable, and proactive sense of self. While your “less than” self may dictate who you are today, your “more than” self gains ground every time you work toward restoring yourself. It is your “more than” self that forms the basis of who you will become when you continue to create your new identity.

It is impossible to go back to who you were previously as wife or husband. Right now decide: “I will stop looking back.” Though this process may feel uncomfortable, being forward thinking works to your advantage.

Your personal identity develops according to your perception of the experience. You are an individual and your perspective of the world is your own; what feels traumatizing to you may not feel that way to someone else. Likewise, what feels traumatic to someone else may seem trivial to you. If perception plays a key role in trauma, then it can also play a key role after trauma. While it doesn’t feel this way at first, how you perceive yourself becomes a choice. Who you are during and after divorce is… who you decide you are.

Jennifer Van Luven, MSW, LCSW

Jennifer Van Luven has extensive experience in family law and court room testifying. She assists couples in a peaceful resolution, where continued communication is imperative for raising healthy children. Along with private therapy services, Jennifer provides services to families who are in the midst of transition, as a Parent Coordinator, Co-Parent Counselor, Custody Evaluator and a Divorce Consultant.

The Power of Play

Written by Katie Taggart, MSW, LCSW

From the outside, it can simply look like every day play. We play with Play-Doh; we make a mess; we laugh, and sometimes cry. Some people, including parents, may be surprised that a therapeutic process is occurring.

Play therapy is defined as a form of counseling or psychotherapy in which play is used as a means of helping children express or communicate their feelings. It can be used individually, with a group, or even as a family. It can be an effective therapy for all ages but is especially effective in ages 3-12. In play therapy, “toys are like the child’s words and play is the child’s language” ( Engaging children in play allows the therapist to have a glimpse into their world. Children often don’t have the words to express their feelings, so play with toys is their form of expression. It is great for kids who can’t verbalize or simply don’t want to talk. Children display emotional distress through behavior. Some things are too difficult to understand as a child or they don’t have the life experience to make sense of a traumatic event. When children don’t have the words to ask questions or express their feelings, play is their form of expression.

What does play therapy look like? A few examples of play therapy are Sandtray Play, puppets, and board games. Sandtray Play allows the child to re-create her world using the sand along with miniature toys. It provides the opportunity for both the child and therapist to gain insight to any difficulties, obstacles, or trauma that may have occurred. The use of puppets can provide the child with the opportunity to act out her feelings. For example, the child may re-create an argument at home. When the therapist sees the child’s reaction to the involved emotions, a discussion can begin. Board games are often used in play therapy as they can help build rapport, demonstrate decision making, and allow assessment of strengths as well as areas where there is room for growth.

A play therapist is a licensed mental health professional with a Master’s or Doctorate degree in a mental health field. They should also have extensive training and experience in the area of play therapy. A registered play therapist (rPT) receives even further education, training, and supervision through the Association of Play Therapy. Play therapists take one of two approaches—directive or non-directive play. Nondirective play therapists are trained to trust that children are capable of directing their own process rather than the therapist imposing their own ideas of what the child needs to do in therapy to work through any challenges they may be facing. This requires the therapist to enter the emotional world of the child rather than expecting the child to understand the therapist’s world. A directive play therapist uses instruction, or directives, to guide the child through play. They do this with the belief that providing directives will cause a faster change than is generated by nondirective play therapy.

Play therapy can be used to address several issues, such as grief and loss, anxiety, temper tantrums, aggressive behavior, trauma, abuse, and fears or worries. The wonderful benefit of this type of therapy is the connection made between the child and therapist. When trauma occurs, the verbal part of the brain shuts down and all experiences are stored at a sensory level where words are inaccessible. Using play therapy, the child can play out his or her problems. The child is in control and sets the pace of therapy, depending on the way he interacts with the toys. He is able to project his feelings onto the toys which creates a safe distance from the traumatic event.

Play therapy provides children with an easy, comfortable form of expression. It allows children to explore feelings, address fears and concerns, and discuss the way they think. Sometimes, the best part of play therapy is that the children don’t even realize it is therapy. They don’t feel the same level of reluctance or uncertainty as they might with talk therapy. For some children, they don’t have the physical or mental ability to sit still for 50-60 minutes for a typical therapy session. This is when play therapy is the clear answer. Other benefits include learning new skills, discovering solutions to problems, and understanding their own feelings and the feelings of others. Play therapy is often a treatment of choice with children because it provides good results and helps the therapist enter into the child’s world.

If you would like more information about play therapy or would like to schedule services for your child, you may contact Katie at the West County Psychological Associates office, (314) 275-8599.

Katie Taggart, MSW, LCSW

enjoys working with both children and adults. She has extensive experience serving clients with chronic and terminal illness as well as grief and loss. She frequently utilizes play therapy with her child clients to address issues surrounding trauma, grief and loss, anxiety, aggression, and abuse. As a component of her clinical practice, she provides therapy to seniors and their caregivers throughout the continuum of senior living.

Children, Terrifying Events, and the Trauma Response

Written by Angela Cook, MSW, LCSW

Imagine a world in which Columbine High School alumni have no memory of April 20, 1999, because it was just an ordinary day. In which moviegoers in Aurora, Colorado, emerged from seeing The Dark Knight on July 20, 2012, with their only haunting image being Heath Ledger’s portrayal of the Joker. Imagine that the devastation and subsequent terror from hurricane Katrina did not affect generations to come in New Orleans. Unfortunately, the pleasant wistfulness of these three scenarios can exist only in our imaginations. The terrifying truths are now an ugly part of American history. Affected families, friends and communities mourn the victims of the natural disaster in Louisiana, the shootings in Columbine and Aurora, and too many other events to name. As for the survivors, they have been forced to deal not only with feelings of intense grief, but also, for many, deep trauma.

Terrifying events feel all too common. Just turn on the TV and you are bombarded with horrific stories of traumatic loss and violence. But what makes an event traumatic? And why do some children become traumatized, while others are more resilient? Children, like adults, often deal with extremely stressful situations. What sets trauma apart is how the child reacts and the subsequent psychobiological impact on behavior, emotional regulation, and brain functioning. A trauma is often sudden, shocking and unexpected; one’s perceived sense of safety and/or life is threatened. A perceived sense of intense fear or horror is often present. To a child, the world is no longer a good and safe place. Examples can include one-time events, such as natural disasters, a severe car accident, crime victimization, or sexual assault. Ongoing situations can also create trauma. These can include exposure to domestic violence, food scarcity, parental addictions or mental illness, abuse or neglect, medical hospitalization or procedure, bullying, or ongoing community violence.

Research validates what therapists have known for a very long time: children exposed to trauma are, in many ways, forever changed. Now scientific research works to explain the effects on the brain and body that have lasting effects and put one at risk for heart disease, dementia, depression, anxiety, learning problems, and relationship issues. Everyone has a built-in “survival switch” in his or her brain that is turned on when feeling threatened in some way. The classic example is the caveman who gets a surge of adrenaline, which helps him get to safety when chased by a predator. The stress hormone Cortisol is released and the fight, flight or freeze response is activated, which helps the caveman get to the safety of his cave. Small amounts of this neural hormone is helpful in dangerous situations – but bathing in high levels of Cortisol for long periods of time is detrimental and results in malfunction of the on/off survival switch. The emotional regulation ‘thermostat’ struggles to adjust and gets stuck in overdrive. The brain finds it hard to differentiate true emergencies from everyday reminders of the traumatic situation, so the survival switch is easily triggered. Flashbacks, nightmares, smells, pictures, situations and sounds can elicit the same fight, flight, or freeze response.

Not all children who experience terrifying events will experience traumatic reactions. Despite the negative impact on the brain, healthy supports, coping skills, and validation of the trauma can reduce the negative impact of the event and shorten trauma-related symptoms. Symptoms of trauma, such as sleep disturbance, acting out, frustration intolerance, depression, excessive anxiety, flashbacks, memory and concentration impairments, hyper-vigilance and poor emotional regulation, can be resolved. Research has come a long way and can now verify how the brain circuitry can be reversed to the way it was prior to the traumatic event, with the right treatment. Current treatment protocols are evidenced-based and are proven to be successful at helping kids learn how to self-regulate their emotions, trust people again, and gain the coping skills needed to fully process the unresolved trauma.

Being trauma informed can help you know what signs and symptoms to watch for that would indicate a need for counseling. Keep in mind, you do not need to be a trained therapist to help a trauma-exposed child. You can help by promoting a strong sense of safety and a positive environment. Know that, as a parent, teacher or friend, the best thing to do is just to listen and be supportive of whatever the child wants to disclose and to remain as nonjudgmental and non-reactive as possible.

Angela Cook, MSW, LCSW

Angela Cook, MSW, LCSW is a Licensed Clinical Social Worker with over 20 years of experience in the mental health field. She has worked in both public and private counseling settings, helping kids & adults of all ages, families, and couples attain peace within themselves and their relationships. Angela has success in resolving issues related to ADHD, mood, anxiety, relationship conflicts, trauma, pain and behavior problems. She uses a compassionate approach, empowering clients to empower themselves.

Suicide Awareness and Prevention in Schools

Training available for the staff of your school or district

Highly Engaging – Practical, Best Practice Strategies – Meets Legal and DESE Standards
Suicide among adolescents and young adults continues to increase every year and is now the second leading cause of death in individuals of middle school, high school, and college age, exceeded only by accidents. Suicide is responsible for more deaths of adolescents each year than all natural causes combined. It is vital that all school personnel have up-to-date information regarding suicide warning signs and prevention strategies.

Consistent with this ethical obligation, Missouri statute now requires suicide awareness and prevention education for all school staff members. Training and professional education sessions available through WCPA include:

Suicide Awareness and Prevention in Schools (2 hour training for all school staff members)

  • The most recent statistics on suicide
  • Youth suicide risk factors and warning signs
  • Suicide myths vs facts
  • Protective factors: helping students find hope
  • How to identify at-risk students
  • The gatekeeper model: identify and report
  • What to say and what not to say to an at-risk student
  • Understanding the three tiers of prevention: universal, selective and indicated prevention
  • Discussion and resources

Suicide Prevention, Intervention and Postvention in Schools (Full day training for key staff)

  • For school mental health professionals, nurses, administrators, and crisis team members
  • In addition to the topics listed above, full day training also includes:
  • Completing the comprehensive suicide risk assessment
  • The step-by-step process to use with students assessed to be at risk
  • Intervention methods, including developing the safety plan
  • Re-integrating a student who has attempted suicide back into school
  • Postvention: procedures to prevent contagion in your school community after a suicide death

Materials Available for Your Use: After attending the full day Suicide Prevention, Intervention and Postvention in Schools training, school mental health professionals, school administrators and school nurses are eligible to become qualified presenters of the two hour Suicide Awareness and Prevention in Schools program for their own school staff. Materials are licensed, for a fee, to schools/districts for use by qualified presenters to train their school staff members. Inquire through the contact information below.


Presenter: Amy V. Maus, MSW, LCSW specializes in school consultation, providing faculty training and seminars, parent presentations, principals’ consultation groups, and Care Team facilitation to dozens of schools each year. She is co-author of The Care Team Approach: A Problem Solving Process for Effective School Change.

For more information or to schedule, please contact Amy at the West County Psychological Associates office, 314.275.8599, or visit

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