High-Functioning Depression

A really great infographic was presented to me recently from BetterHelp.com, which connects trained therapists and counsellors with individuals seeking online support. They’re a paid service but I’ve heard really good things. This is not an affiliate link, I derive no benefit from linking you there, other than they’ve created this resource.

Click the link below to open the full copy, it’s a ~1.4MB PNG file so I’ve only included the first bit in the image. Also feel free to check out their Advice column, at https://www.betterhelp.com/advice/depression.

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Building Counselling Relationships


The most important element in a counselling relationship, whether a single session or long-term counselling, is the quality of the relationship between the counsellor and the client. For this reason, basic counselling courses spend a large amount of time on how to effectively build relationships.

There are five factors influencing the counselling process:

  1. Seriousness of the presenting problem (the more distressed a client is, the greater improvement they will experience)
  2. Structure (helping clients understand what counselling will involve, setting time limits and expectations, etc.)
  3. Client initiative or motivation
  4. The physical setting in which counselling occurs
  5. Client and counsellor qualities

Seriousness of Presenting Problem

The more distressed a client is when they first come in for counselling, the greater the reduction in distress they will experience during counselling. (Leibert, 2004)

Edwin Schneidman once said that the more intense the crisis, the less trained an individual needs to be to respond. This is why many individuals are talked down from bridges by totally untrained individuals while the management of low-level suicidal ideation requires extensive clinical training.


The structure of counselling helps build relationships by providing expectations. This involves setting practical limits like an understanding of the length of sessions, explaining what will happen during each session, letting clients know what they can do in emergencies or high-risk crisis situations, and other elements that impact the procedure of counselling.

Most clients experience anxiety before the counselling session so the more expectations will help.

Client Initiative

Clients may be reluctant to enter counselling or even mandated to attend because of the legal system, mental health treatment or other situations. Gladding and Alderson (2012) give several suggestions for how clients can help provide initiative to clients:

  • Anticipate the feelings a client may display
  • Demonstrate understanding, acceptance and a non-judgemental attitude
  • Try to persuade clients of the benefits of proceeding through counselling
  • Use of gentle confrontation (point out how client behaviours are moving them away from their goals)

Physical Setting

Pressly and Heesacker (2001) noted that physical elements in a counselling office can contribute to the development of the counselling relationship. For instance, brighter colours were associated with more positive emotions, while softer light was associated with more positive feelings than more intense light.

As well, physical barriers between client and counsellor (like a desk) has been associated with reduced perception of empathy.



Empathy is the ability to enter a client’s world and understand their perspective. (Rogers, 2007) Empathy may be separated into two categories: primary empathy and advanced empathy. Primary empathy is the ability for a counsellor to respond in a way that shows they’ve understood the situation a client is experiencing. (Singh, 2015) This is the level of empathy that crisis line workers aim for. On the Carkhuff and Truax Scale this is level 3 or Interchangeable or Reciprocal Level of Responding.

Advanced empathy is a more indepth procedure, helping to bring elements the client was holding subconsciously or below their awareness. (Veach, LeRoy & Bartels, 2003)

Building an Effective Working Alliance

While a counsellor can use empathy during their conversation during a client to begin building the relationship they need to continue establishing the 3 components required for an effective working alliance identified by Horvath (2001). Working Alliance consists of three components:

  1. Agreement about what goals to be accomplished in therapy
  2. Agreement about tasks (how will those goals be accomplished)
  3. Bond between counsellor and client

Attending Behaviour

Attending behaviour is the physical and behavioural choices a counsellor makes in order to show a client that they are paying attention. The acronym SOLER (Egan, 2007) is one acronym to remember how to show attending in person. The SOLER elements apply only to those in Western (North American or other British cultures) – it is important to modify your approach for other cultural backgrounds.

  • S – Sit Squarely
  • O – Open Posture
  • L – Learn Towards the Client
  • E – Eye Contact
  • R – Relax


Egan, G. (2007) The Skilled Helper: A Problem Management Approach to Helping. 8th ed. Thomson Brooks/Cole: Belmont, CA.

Gladding, S. T., & Alderson, K. G. (2012). Building counselling relationships. In B. Brandes (Ed.) (2016), Introduction to counselling (2nd Custom Edition) (pp. 113–140). Toronto, ON: Athabasca University/Pearson Education Canada.

Horvath, A.O. (2001) The Therapeutic Alliance: Concepts, Research and Training. The Australian Psychologist. 36(1). 170-176. doi: 10.1080/00050060108259650

Leibert, T.W. (2006) Making Change Visible: The Possibilities in Assessing Mental Health Counseling Outcomes. Journal of Counseling and Development. 84(1). 108-113. doi: 10.1002/j.1556-6678.2006.tb00384.x

Pressly, P.K. & Heesacker, M. (2001) The Physical Environment and Counseling: A Review of Theory and Research. Journal of Counseling and Development. 79(2). 148-160. doi: 10.1002/j.1556-6676.2001.tb01954.x

Rogers, C. (2007). The necessary and sufficient conditions of therapeutic personality change. Psychotherapy: Theory, Research, Practice, Training. 44(3), 240-248

Singh, K. (2003) Counselling Skills for Managers. Prentice-Hall: Delhi, India.

Veach, P.M., LeRoy, B.S. & Bartels, D.M. (2003) Responding to Client Cues: Advanced Empathy and Confrontation. In: Facilitating the Genetic Counseling Process. Springer, New York, NY

Cite this article as: MacDonald, D.K., (2017), "Building Counselling Relationships," retrieved on March 23, 2018 from http://dustinkmacdonald.com/building-counselling-relationships/.
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Suicide to Hope Workshop Review


Today I had the opportunity to attend the Suicide to Hope Workshop offered by LivingWorks. This course is a complete overhaul of the suicideCare Workshop that was previously offered by LivingWorks. The seminar takes 8 hours, and includes a participant workshop (like ASIST) and also some handouts that can be used with clients. The purpose of Suicide to Hope is to provide long-term suicide prevention work after the suicide crisis is over and immediate safety is secured.

Pathway to Hope

The key to the Suicide to Hope model is the Pathway to Hope or PaTH. There are three phases (Understanding, Planning and Implementing) and six tasks. These six tasks are:

  1. Explore Stuckness
  2. Describe Issues
  3. Formulate Goals
  4. Develop Plan
  5. Monitor Work
  6. Review Process

The purpose of the workshop involves understanding how to do this, moving through each phase. In contrast to the old suicideCare workshop, Suicide To Hope is much more concrete. The goal is to identify the “stuckness” – the elements that an individual was having trouble moving through in order to reduce their suicidality going forward.

Workshop Structure

Prior to attending the workshop some pre-reading on the theoretical and empirical underpinnings of the worksheet. Once the workshop starts, registration is completed and participants are directed to a Helper Qualities worksheet. This sheet contains 20 values like “Belief in suicide recovery”, “Courage to face the pain” and “Tolerance for risk.” These qualities are looked at throughout the workshop.

Next is a review of the workshop and the five principles of hope creation. These five principles are ways in which a client can experience growth and recovery. They include:

  1. Suicide
  2. Safety First
  3. Respect
  4. Self-Growth
  5. Take Care

Essentially these principles mean that the experience of surviving suicidal thoughts or suicide attempts may represent an opportunity for growth. Ensuring a client’s safety will ensure they’re in the right frame to begin recovery and growth work. Respect for the client is key to building a strong helping relationship with them. Self-growth refers to “walking the talk”, and being able to be true to yourself. The final principle involves being careful to apply the model and not oversimplifying or forgetting client’s uniqueness.

The Three Phases are reviewed, and video illustrations are included throughout. These include some short clips demonstrating individuals who are safe but still suicidal, followed by clips of their recovery and a 25 minute single-take demo to really cement the learning.

A short roleplay experience in a triad helps individuals become more comfortable with the variety of tools that are provided (such as the questions to ask and the worksheets that are available.)

The ABCs of Safety

One of the really useful elements is a sheet titled “The ABCs of Safety”, which is an excerpt from the Suicide to Hope Planning Tool provided to workshop participants. This includes some checkboxes under the headings “I am ready to start R&G work”, “I know how to keep myself safe while doing R&G work” and “I know how we will work together.” These elements ensure that clients entering into recovery work have a safety plan and understand informed consent elements related to the treatment or service provision they will be receiving.


I found the Suicide to Hope workshop a vast improvement over the old version. The materials would be extremely useful for case managers, counsellors, psychologists, social workers, therapists and other professionals that are providing support to individuals struggling with suicide.

To learn more about Suicide to Hope you can read about it on LivingWorks’ website or find available training opportunities here.

Cite this article as: MacDonald, D.K., (2017), "Suicide to Hope Workshop Review," retrieved on March 23, 2018 from http://dustinkmacdonald.com/suicide-hope-workshop-review/.
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Suicide Facts and Figures for Presentations


For those of you who don’t use it, the website Quora is an absolute goldmine for information on a wide variety of topics. It allows you to ask and answer questions by individuals who all use their real names, and who have to identify their area of expertise (their reason for knowing the answer.)

One of the questions asked was “What are some striking facts or figures about suicide?” My answer is the basis for this post. I identify a number of suicide facts and figures with citations. These may make useful additions to presentations that you do in the future.

Suicide Attempts

We know that in the United States, about 50% of suicide deaths are by firearm (CDC, 2016). This accounts for the startling statistic that 60% of people who attempt suicide will die on their first attempt (Bostwick, et. al., 2016)

Of those that survive, 70% of those who live will never go on to have a second attempt, hopefully because they get the help that they need. About 23% will go on to attempt again (sometimes repeatedly) and live, while 7% will die on a future attempt. (Owens, Horrocks & House, 2002)

Gun owners in particular at much higher risk of suicide. We know that gun owners are 57 times more likely to die by suicide within 7 days of their purchase (likely because they purchased it specifically intent on suicide), and 7 times more likely within the first year as non-gun-owners. (Wintermule, et. al., 1999)

Depending on the type of gun and other variables, 85-98% of firearm suicide attempts will end in death, while only about 2% of overdoses will end in death. (Elnour & Harrison, 2008).

Suicide Prevalence

Women attempt suicide about 3 times as frequently as men do (Vijayakumar, 2015) but tend to die 3 times more frequently (Varnik, 2012) chiefly because of their use of more lethal methods like firearm and hanging, when compared to women who more commonly use overdose.

Suicide is most common in the middle ages, accounting for 54% of suicides in Canada (Statistics Canada, 2013) and 51% of suicides in the United States (CDC, 2011).

Suicide Antecedents

It’s been suggested that up to 90% of those who die by suicide have a diagnosable mental illness (Bertole & Fleischmann, 2002). Although this figure has been challenged because it is based on psychiatric autopsies (reviews with those left behind) that might be vulnerable to bias, it is common enough to be valuable.


Did I miss any suicide facts and figures that you’d like to see? Let me know and I’ll update the article. Thanks all!


Bertolote, J.M. & Fleischmann, A. (2002) Suicide and psychiatric diagnosis: a worldwide perspective. World Psychiatry. 1(3): 181-185.

Bostwick, J. M., Pabbati, C., Geske, J. R., & McKean, A. J. (2016). Suicide attempt as a risk factor for completed suicide: Even more lethal than we knew. American Journal of Psychiatry, 173(11), 1094–1100.

Centers for Disease Control and Prevention (CDC). Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2013, 2011) National Center for Injury Prevention and Control, CDC (producer). Available from http://www.cdc.gov/injury/wisqars/index.html

Centers for Disease Control and Prevention. (2016) National Vital Statistics Report. 65(4). Retrieved on September 19, 2017 from https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_04.pdf

Elnour, A.A. & Harrison, J. (2008) Lethality of suicide methods. Journal of Injury Prevention. 14(1). 39-45. doi: 10.1136/ip.2007.016246.

Vijayakumar, L. (2015) Suicide in women. Indian Journal of Psychiatry. 57(Supp. 2). S233-S238. doi: 10.4103/0019-5545.161484.

Owens, D., Horrocks, J. & House, A. (2002) Fatal and non-fatal repetition of self-harm: systematic review. British Journal of Psychiatry. 181. 193-199.

Statistics Canada. (2013) CANSIM, table 102-0551 and Catalogue no. 84F0209X. Retrieved from http://www5.statcan.gc.ca/cansim/a26?id=1020551&

Varnik, P. (2012) Suicide in the World. International Journal of Environmental Research and Public Health. 9(3). 760-771. doi:  10.3390/ijerph9030760

Wintemute, G.J., Parham, C.A., Beaumont, J.J., Wright, M., & Drake, C. (1999) Mortality among recent purchasers of handguns. New England Journal of Medicine. 341(21):1583-9

Cite this article as: MacDonald, D.K., (2017), "Suicide Facts and Figures for Presentations," retrieved on March 23, 2018 from http://dustinkmacdonald.com/suicide-facts-figures-presentations/.
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Mobile Giving for Your Crisis Line


Hi all, after a summer hiatus, I’m back! Mobile giving is all-the-rage these days, especially after natural disasters. We’ve all seen advertisements that say “Text HAITI to 90999” in order to donate $5 to the Red Cross. (That’s a real number.) You might be wondering how you can leverage this concept for your own crisis line or organization.

How Mobile Giving Works

Mobile giving, or donate-by-phone is an easier way to engage your donors. They simply text an SMS short-code from their cell phones, and a pre-determined amount of money is added to their bill. It’s a snap for you and individuals who, in order to donate previously, would have had to sign up with organizations like CanadaHelps, PayPal, or deal with the administrative burden of trying to give you cash or cheques directly.


As already stated, mobile giving is easy. Most donors have SMS-capable cell phones and can take the 10 seconds to fire off a text message. In Canada, a mobile giving campaign can be set up that, after the payment of flat service fees, runs automatically. 100% of the money raised is given to your organization.

Mobile giving fundraising messaging is effortless. It can be distributed across social media like Facebook or Twitter, sent in a fundraising letter, or even included on a digital sign. This makes it ideal for almost any time of year, and any type of fundraising.


There are some disadvantages to mobile giving: namely, if your intended audience does not use a cell phone or does not use SMS texting, they may be more apprehensive. This means that organizations that traditionally solicit funds from an older adult or elderly clientele may prefer fundraising letters or other tangible ways of donating.

Secondly, you have less information provided to you by your fundraising clients. For example, in the simplest mobile giving campaign, you have only the individual’s phone number. This means that giving tax receipts or following up on fundraising is more difficult.

Implementing Mobile Giving At Your Crisis Line

This guide is based on my experience implementing mobile giving at Distress Centre Durham. We elected to run a short, 3-month campaign starting on World Suicide Prevention Day (September 9, 2017). In Canada, all Mobile Giving is managed by the Mobile Giving Foundation (MGF) of Canada, a project of the Canadian Wireless Telecommunications Association (CWTA).

The Mobile Giving Foundation has agreements with each of the major telecoms in Canada so that 100% of the money donated is given to the charities.

After going to the Mobile Giving Foundation website (http://mobilegiving.ca), we navigated to the “For Registered Charities” section of the website. There, we see the MGF Standards of Participation. These requirements which include being a registered charity, being in good standing with the CRA, operating for more than one year, and having a donor privacy policy, are required to ensure that the MGF only runs campaigns with reputable charities.

There is a short questionnaire in order to receive approval by the MGF to submit a more comprehensive campaign application. After submitting the campaign application, we were emailed the application.

In addition to the organizational information, we also had a few choices to make:

  • Donation amount
  • Which short-code
  • Length of campaign
  • Use of widgets
  • Use of MGF built-in technology or an ASP

These will be explored below.

Donation Amount

We had the choice of $5, $10, or $25 per text. We decided to go with $10 as that is a small enough that most individuals would be willing to make that donation without much thought, but large enough that a short campaign would still be effective. You can run multiple campaigns with different dollar amounts.

For example, you could have donors text SPRITE 5 to donate $5 or SPRITE 10 to have them donate $10. This is achieved through the use of keywords and sub-keywords.

Choosing a Short-Code

We had the choice of 5 short-codes to choose from. We decided to go with 41010, each of the short-codes is a similar 5 digit number (e.g. 21212 or 101010). In a campaign like this, your short-code should be memorable and not easily confused with another organization, if there are others fundraising in the same geographical area.

Choosing a Campaign Length

The MGF allows you to choose a 3-month, 6-month, or 12-month campaign. The service fees (which includes a $350 application fee and then small additional monthly fees for each additional keyword/sub-keyword or widget you use) will be based on the length of your campaign. Many of the add-ons are free with a 12-month campaign which makes this very economical.

Using Widgets

Widgets are follow-ups that you may add to your campaign after the individual texts in to donate. For instance, you might text them back with a Thank You that directs them to a contact page, or to another page on your website. Another widget allows your donors to opt-in to receiving up to 3 follow-up messages.

For the Distress Centre Durham campaign we elected not to use any widgets, preferring to keep the campaign simple.

Using MGF Technology or an Application Service Provider (ASP)

An ASP or Application Service Provider is an organization that can help you manage your campaign. They provide additional tools that allow you to track or manage your campaign more easily, for a fee. Distress Centre Durham elected not to use any ASP when running our first campaign as we wanted to see what was possible with the MGF technology. It turns out their built-in features are more than enough for our needs.

Choosing Keywords and Sub Keywords

A Keyword is the word that an organization texts to donate to you. For example, someone could text SPRITE to 21212 to donate $5 to your fundraising campaign. You might decide that if they text PEPSI to 21212 that they will donate $10, and you could establish these as two separate keywords for your 12-month campaign.

A sub keyword is an additional word that is added onto your keyword in order for you to more granularly manage fundraising. For example, while Distress Centre Durham decided on “SUPPORT” as our keyword, we added the sub keyword DURHAM for fundraising we ran within the Region. Since we have other Online Text and Chat (ONTX) community partners participating, they each have their own sub keyword for their area.

Cost of Campaign

The cost of a mobile campaign is minimal. After your questionnaire is approved, the MGF sends you a price list. Most of the add-ons are free when running a 12-month campaign, with the largest fee simply being the $350 application fee. This makes mobile giving an ideal fundraising campaign for even a very small charity.

I would recommend for a 12 month campaign using one keyword, that you set aside $1,000 for the application fee, and other administrative costs (including getting information like audited financial statements or others available) and paying for advertising to promote your campaign.


Did I miss anything? Do you have any other questions? Please let me know. If you’d like to support Canada’s Online Text and Chat (ONTX) Program or Distress Centre Durham you may text SUPPORT DURHAM to 41010.

Cite this article as: MacDonald, D.K., (2017), "Mobile Giving for Your Crisis Line," retrieved on March 23, 2018 from http://dustinkmacdonald.com/mobile-giving-crisis-line/.
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