THRIVE Episode 19: Interview with Stephanie Coker, LCSW-S, LCDC, CDWF
We are in the middle of a series about mental health. May is Mental Health Awareness month. I am so excited about this series. I hope to debunk myths about mental health issues, provide resources, help you gain insight that will help you understand mental health issues. We’re going to be talking about addictions, bipolar, suicide, and childhood mental illness.
Last week, we heard from Dr. Rhonda Johnson about children and mental health. Be sure to go back and listen after today’s interview if you didn’t get a chance to listen.
Today we will continue the conversation with a dear friend, Stephanie Coker. We’re diving into a sensitive but necessary topic about suicide and suicide prevention.
Before we dive in, I want to give a few facts to note the urgency and importance of this conversation:
Suicide is the 10th leading cause of death in the US for all ages.
Every day, approximately 123 Americans die by suicide.
There is one death by suicide in the US every 12 minutes.
Depression affects 20-25% of Americans ages 18+ in a given year
Stephanie Coker, LCSW-S, LCDC, CDWF has been helping people find freedom from the struggles of perfectionism, codependency, addiction, and toxic relationships for 25 years. She has her Bachelor’s degree in Psychology from Baylor University and her Master’s in Social Work from UT Arlington. She’s worked in various settings including community clinics and psychiatric hospitals and currently has a private practice in Plano, TX. She utilizes psychodrama, Narrative Therapy and Brene´ Brown’s Daring Way and Rising Strong curriculums among other creative ways of engaging clients to explore their story and create deeper level change in their lives. She offers Christian counseling for clients who want to use their faith to facilitate healing and is recently trained Narrative Focused Trauma Care through the Allender Center. To know more about organizations she’s involved in, visit www.cokercounseling.com or check out her Facebook page, @cokercounseling for resources and upcoming events.
A note from Stephanie: THANK YOU MELISSA for this opportunity! I’d like to express my gratitude also for my interns, Abby Hansen, Brian Meggers and Haleigh Morris who helped me prepare for today. I also got insight and input from my therapist and one of my clients, who has an adult child who has struggled with suicidality for many years. So great appreciation to all of them for their ideas that I have included today as well.
MC: Who is at risk for suicide?
SC: As far as demographics:
According to the American Foundation for Suicide Prevention, the CDC, and WHO, middle aged white males are largest demographic that complete suicide; though attempts are much higher among females of all age groups.
Worldwide, suicide is the 2nd leading cause of death for ages 18-24, aka “millennials”.
Depression is an automatic risk factor for suicidal thoughts and feelings because like any other medical illness, if left untreated it will worsen. Sometimes the severity of the depression and its effect on the person’s thinking alone is the most significant risk factor, but when depression combined with substance use, a history of trauma or abuse, and social disconnection and isolation, the risk is increased. Perfectionism combined with a high stress work environment also increase risk for suicide. Having a family history of suicide, having someone you know personally (or don’t know as well but feel a connection to) who has completed suicide, or the anniversary of such an event also increase risk.
Smiling depression (Listen in to the Podcast for more thoughts)
MC: What are some of the warning signs indicating suicide?
SC: Sudden changes in a person are a big red flag. That can be someone who is typically “even keel” becoming suddenly more impulsive in different areas of life, or sudden increase in substance use. When someone is putting a lot of effort into isolating themselves from others, (such as not returning calls, canceling plans at the last minute, not going to work, etc.) that is also potentially a red flag.
When people begin to either give away things that are important to them, suddenly shift from being very down and lethargic to highly energetic, even euphoric, or suddenly begin to “burn bridges” with others, these are significant signs that something has changed and you should get them help right away.
As far as some resources that can help with identifying warning signs, the Suicide and Crisis Center of North Texas website, and Kay Warren’s website are great starting points.
MC: What should you do if someone tells you they are thinking about suicide?
SC: First stay calm and let them know you take them seriously. Do as much as you can to help them feel safe to talk with you about it. There is a myth that talking about it will create an increased desire to follow through. This is not true. Showing that you are afraid to talk about is much more harmful. Ask them what you can do to help at that moment and what kind of support they may need from you. Ask the Spirit to guide you in your response and to know if this the time to give encouragement or the time to listen.
I recently learned about a wonderful tool for family members, loved ones, support people to use called the Columbia Protocol. It’s based on the research about suicide risk and helps equip you with what to ask and what to do. You can go to https://cssrs.columbia.edu and check out the “Columbia Protocol for Family, Friends and Neighbors” – keep following the links to find the screening tool that best fits the situation for you. It gives you step by step the questions to ask and then what you should do in response to the answers the person gives, including when to seek immediate help.
Depression wants to hide. Hopelessness, Helplessness, and Excessive guilt can be signs there is a problem.
MC: What are some ways to prevent or protect against suicidality?
SC: Connection with others is our most significant tool against suicide - social media. Anything that gets in the way of connection should be addressed. Managing depression effectively might involve taking medication or at least getting counseling or being a part of a support group. Dealing with past trauma, current substance use, and any current stressors that are getting in the way of self-care or connecting with others is very important as well.
Grant Halliburton Foundation, another local resource has great resources related to prevention.
MC: How are you seeing COVID affect suicidality and mental health?
SC: Disconnection and loneliness are major risk factors for suicide and we do tend to see suicide rates increase after major crisis or economic downturns. As far as the current data, we are seeing calls to crisis hotlines for suicide, domestic violence and child abuse all increase by record breaking amounts. At the same time, many of my colleagues are telling me that local psychiatric hospitals don’t have the same number of patients that they typically do because people are fearful of being in a situation where they will contract COVID. I was reading the other day that other kinds of medical care (heart surgeries, for example) and PCP visits in serious decline and some in the medical field are asking “where are these patients? What are they doing instead of seeking treatment?” The answer is likely that they are getting more ill and therefore, the need will be greater when they do seek care. I am hopeful more people can consider how they can attend to their mental health now, in the midst of this, instead of waiting for things to go “back to normal”. Many therapists, psychiatrists and treatment programs are utilizing telehealth so the help is still out there.
As far as general mental health, people are experiencing change, loss, transition and uncertainty in every area of their life: social, emotional, physical, spiritual, and occupational/financial and all these changes are happening simultaneously, and at the moment, seemingly continuously. The isolation measures in particular are concerning because of how that effects connection with others as well as access to typical coping activities (going to the gym, for example). For people with a history of PTSD or childhood trauma, the isolation, uncertainty and loss are likely very triggering for them. I’m also concerned about people who are living in stressful or abusive relationships – they now have no or fewer respites away from.
MC: I have seen a genuine faith and Hope in Christ help so many but religiosity brings shame and stunt growth. I’m curious about your thoughts on the impact of a religious-shame impacting an individual’s willingness to reach out for help.
SC: Religiosity dictates that we keep certain rules and fulfill certain tasks in certain ways in order to please God. We can also buy into the idea that the pay off for all this work on our part is that God will be pleased with us, and therefore we will be inoculated from pain, sadness, disappointment and loneliness.
We end up creating these ideas, either spoken or implied that “if you just pray about it, it will go away” or “if you really have faith in God, you won’t feel upsetting feelings”. Or, perhaps worse, “if you do all the right things/activities/service to and for others, you will only feel joy.” Thinking that “a good Christian wouldn’t have these thoughts or feelings” is a subtle way of comparing ourselves that leads to feeling shame when we do in fact have those thoughts and feelings, and can even make us feel disconnected from our spiritual community. We become driven prove to others that everything is going “fine”, hiding any emotional pain or problems we are having. We can get to the point that it feels threatening to even admit we have problems of any kind because it feels this will deem us as “failing” in our faith, and not measuring up. This all leads to more shame, more hiding, more disconnection.
The starting point of all these assumptions, the religiosity, is faulty though because it excludes grace.
God, as I understand it, because of Jesus, is not measuring you up against a standard, He is calling you to receive love – from Him, from yourself and from others. The Bible gives us many stories of prophets and others God used who were clearly experiencing depression and even at times wanted to die. There is not one word of scripture where these stories are told that shows God condemning them. Depression is part of the human struggle and God has compassion on our humanity and is able to handle the complexity of it. The more we grow in being able to handle our authentic selves, the easier it is for us to cope with and heal from our wounds and afflictions, rather than hide them.
I would encourage anyone struggling with mental health issues or a family member of someone who is to check out some resources of grace that the church does offer: Mental Health Grace Alliance is a great organization that has groups at various churches and has a peer led curriculum for families and for those with mental health issue. A book one of my clients recommends is “Grace for the Afflicted” by Matthew Stanford. Many churches have a care pastor that can meet with you and answer questions as you wrestle with how to live out your faith while having a mental health issue.
Also, I put together a play list on youtube of “songs of pain” that might be a good resource for someone. I just found that there are not many songs of lament or grief or pain that also hold truth and hope and those kinds of songs have helped me and others through some difficult times. It’s like a feeling of being validated when you here someone else pouring their heart out to God in these ways.
I also like a lot of the resources from the Allender Center regarding recognizing authentic pain along with our hope for redemption and healing.
MC: If someone is struggling with suicidal thinking, what would you tell them?
What’s one thing they can do right now?
SC: This would depend a lot on the situation, the person, etc. I think I might say that it makes sense that it’s probably hard to see beyond this current pain and they may be feeling weary with carrying it, and encourage them that people are here for them and want to help them carry it. I’d want to ask about anything that they can look to, cling to, reach for that gives them hope or at least keeps them from following through on those thoughts. I’d want them to know that they matter, and their pain matters, and it can be shared.
One thing they can do right now is keep talking about it, keep reaching out and allow themselves to accept help, even if the very doing of that is an act of faith.
MC: If someone’s loved one is struggling with suicidal thinking, what would you tell them?
What’s one thing they can do right now?
SC: Don’t take their mental state personally – it is not a reflection on you, it’s a reflection of the illness they are dealing with. Get comfortable, within your own capacity, with sitting with them and just being present with them, where they are in their pain and listening.
Saying aloud simple things that you feel they “should” know, such as “I am here for you” and “we’ll get through this together” or “this is hard right now”, is perfectly okay. Understand that one of the symptoms of depression is excessive guilt which means that many of your observations or counterpoints to their feelings will result in increased guilt and shame and push them farther into hiding how they feel. For example, if you respond with, “But you seemed so much better lately”, or “I had no idea you felt this way”, or “you know we love you”, a severely depressed person will hear “you have failed and I’m disappointed in you.” So keep your words brief, focused on them, and check often for understanding by saying “what do you hear me saying?”
Don’t be afraid to do something that your loved one might not like in order to keep them safe. Keep in mind that part of the illness they are experiencing can cause them to not want to do things to help themselves, so don’t get trapped into feeling you have to have their agreement in order to act. Give them as many choices as possible, but not the choice to do nothing.
Make sure you are getting support for yourself also, no one expects you to handle this all alone and keeping it a secret is only going to make it more difficult to cope with, not less. Again, the Mental Health Grace Alliance groups have been really valuable for some of my clients.
One thing they can do right now is focus on safety management and remove any means of harm from the home, especially any firearms as this is the most lethal means. Plan for different scenarios and what you will do, where you would take your loved one (other than ER if it’s an emergency) and discuss with them as many choices they can have as possible. There are treatment options in between being hospitalized and only going to one hour a week counseling appointment, which are called Partial Hospitalization and Intensive Outpatient There are several area hospitals and facilities that can complete assessments 24/7 and/or by appointment. One in our area that can do an assessment and also offers a Christian focused curriculum is called Carrollton Springs. Right now, they are even offering virtual assessments and virtual programming. You can find their number on their website and call and get the process going.
MC: What is getting you excited right now?
SC: Immediate answer: Instacart and instant pot – life changers right there
More thoughtful answer: I just joined a “Let’s Talk about Race” group that focuses on how the church can be educated and create change in racial reconciliation so that is exciting because it helps me to create some action towards a very significant problem that otherwise can feel powerless to address. I’ve also been trying to teach myself watercolor painting through youtube and my kids got me an easel for Mother’s Day so I’m excited to try that. And of course I am excited about my son’s upcoming High School Graduation.
MC: What podcasts are you into right now?
SC: Brene Brown and Dan Allender
Both are amazing and have a mix of insight and application so I love that.
Brene has a great recent one titled “settle the ball” that has been very helpful lately.
Allender center one has a great series on Spiritual Abuse that mirrors Narcissistic Abuse so I recommend that to a lot of clients.
I also love checking in on what Passion City Church is talking about from time to time.
MC: What book are you reading or recently read that you’re loving?
SC: I’m re-reading (for the 4th time maybe?) Gifts of Imperfection and I think it has a lot to say about how we can create grounding for ourselves in the midst of all this uncertainty. I’m also reading Be the Bridge by Latsha Morrison about racial reconciliation; Untamed by Glennon Doyle, the Road Back to You by Susanne Stabile, and about to start The Soul of Shame by Curt Thompson
MC: Where can we find you?
SC: Check out my facebook page: @cokercounseling
Pinterest Boards with some cool infographics: @stephiecoker
Website: www.cokercounseling.com
RESOURCES
Helpful Websites:
Podcasts:
Brene Brown, Unlocking Us:
https://brenebrown.com/unlockingus/
Allender Center Podcast:
https://theallendercenter.org/category/podcast/
Websites:
https://brenebrown.com
https://theallendercenter.org/resources/
Real Pain YouTube playlist:
https://www.youtube.com/playlist?list=PLdm9ZT9CR-lAF8C7KoPhX4bFYtMRk4dfL
Books:
Grace for the Afflicted
Trauma and Grace
Gifts of Imperfection
Daring Greatly
The Healing Path
The Cry of the Soul
To Be Told
Emotionally Healthy Spirituality
https://www.amazon.com/Emotionally-Healthy-Spirituality-Impossible-Spiritually/dp/0310342465
The Soul of Shame
Thank you for joining me this week on the Thrive: Mental Health and the Art of Living Free. Make sure to visit my podcast where you can subscribe to the show on iTunes or Stitcher so you never miss a show.
Hey, while you’re at it, help me out by adding some stars to the rating and tell a friend about the show.
Be sure to stop by next Friday, where we conclude our series about Mental Health.
Have a great week!