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On the last track, we discussed three warning signs for teen suicide. These three warning signs are verbal clues, behavioral changes, and situational clues.
On this track, we will discuss three aspects of addressing thoughts and feelings with a suicidal teen client. These three aspects are communicating feelings, separating thoughts and feelings, and active listening. I will also describe how I used the thinking and feeling statements technique with Denise.
At 11:30 at night, Denise, age 15, called me and indicated that she was sitting on the edge of her bed with a bottle of her mother’s sleeping pills in her hand. Denise stated, "No one understands! If my parents would only listen, but all they do is tell me what to do and that I’ll get over it! I don’t think they care! I’m not ever going to get over it, and I just can’t face another day at school!"
Clearly, Denise was experiencing intense feelings of shame, anger, and fear, and needed to share those feelings. I felt that Denise’s lament that "no one understands" was actually a statement indicating that she felt no one understood her emotions. I felt that my role as a therapist at that moment was to listen to Denise’s feelings, both those directly expressed and implied feelings, and to help Denise realize she was in fact understood.
#1 Understanding Communication of Thoughts & Feelings
Denise explained that during the day preceding her suicidal crisis, she had come home from school, slammed the kitchen door, thrown her backpack in the corner and yelled "I hate school!!" to her mother. Denise’s mother, Betty, responded by stating, "Don’t ever let me hear you say that again. You’re not supposed to hate. And don’t slam the door, young lady!"
By telling Denise that she should not hate, Betty expressed to her daughter that her anger was an unacceptable feeling. Betty’s further admonition that Denise should not slam the door further pushes Denise and her experience aside and blocks Denise off from a much needed opportunity to express herself.
#2 Separating Thoughts & Feelings
In our first session after Denise’s suicidal crisis call, I worked with Denise on expressing her feelings clearly in an attempt to improve communication between Denise and her parents. I stated to Denise, "Sometimes, it can be tricky to tell whether something I am trying to say is a thought or a feeling. One clue I use is to listen for words such as "like" or "that" after I say the word "feel". For example, If I say, ‘I feel that my dad is being unfair,’ I’m expressing a thought that my dad is being unfair, but I’m not really coming out and saying how I feel about it. How might I feel if I thought my dad was being unfair?"
Denise stated, "Well, you might feel angry." I stated, "That’s a good example. To express my anger, I could take away the word ‘that’ and insert a feeling word. I could say, ‘I feel angry when I think my dad is being unfair. That way, someone listening to me can clearly hear how I am feeling."
"Thinking and Feelings Statements" Technique
Think of your Denise. Would practicing separating thinking and feeling statements help her or him improve her or his communication skills?
#3 Active Listening
I stated, "No one wants a loved one to feel negative feelings. When a loved one expresses a strong negative feeling, it can be tempting to try to change the negative feeling someone expressed by saying something like, ‘don’t feel that way’ or ‘there’s nothing to be scared of.’ However, these statements are disrespectful of the person expressing the feelings. Another instinct is to question the negative feeling by asking ‘why do you feel that way?’ But feelings don’t need to be justified. They just exist. A better way to communicate your understanding and willingness to listen to Denise is to concentrate on identifying, accepting, and reflecting the feeling. Try to avoid stating that you understand or asking questions. By instead demonstrating your understanding, you will encourage Denise to keep talking to you and explaining what happened to evoke those feelings."
I decided to invite Betty to engage in some active listening role play to improve her ability to communicate better with Denise. Playing the part of Denise, I stated, "I can’t stand that teacher at all!" Betty stated, "What I want to say is, ‘what happened?’ But I guess a better thing to say would be, ‘You are certainly upset at her.’" Think of your Betty. Would practicing active listening techniques help her or him be more supportive of a teen in a suicidal crisis?
On this track, we have discussed three aspects of addressing thoughts and feelings with a suicidal teen client. These three aspects are communicating feelings, separating thoughts and feelings, and active listening.
On the next track, we will discuss a four step crisis intervention model for a suicidal teen client. The four steps in the crisis intervention model are to establish rapport, explore the problem, focus, and seek alternatives.
Peer-Reviewed Journal Article References:
McManama O'Brien, K. H., Singer, J. B., LeCloux, M., Duarté-Vélez, Y., & Spirito, A. (2014). Acute behavioral interventions and outpatient treatment strategies with suicidal adolescents. International Journal of Behavioral Consultation and Therapy, 9(3), 19–25.
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