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On the last track, we discussed six risk factors for teen suicide. These six risk factors are abuse, childhood loss, school performance, personality traits, parental relationships, and family patterns.
On this track, we will discuss the four step Hook technique for helping a teen client deal with the anger component of his or her depression. The four steps in the Hook technique are identify the hook, the hook book, identify the need, and fill the need.
Craig, 15, had been brought the crisis center by his school security guard and the school counselor after a classmate found him in the boy’s restroom holding a gun to his chest. When I asked Craig about what had happened, he stated, "My mom wants me to be the first person in the family to graduate high school, but this morning I found out I failed my English midterm and am in danger of flunking. Last night, my girlfriend Tasha told me she wants to see someone else. I hate everything. I just want it all to stop!"
Craig’s school counselor informed me that Craig had been having anger-related disciplinary problems at school over the past couple of months, mostly small incidents including punching lockers and shoving students who made fun of his gangly frame or shabby clothes. The school counselor also informed me that Craig was one of seven children, and although both his parents had steady employment money was very tight. Craig later stated, "Twice last year the gas company threatened to shut our heat off. Bill collectors are always calling."
My early interventions with Craig, of course, focused on contracting for his safety and assessing his suicide risk. As our sessions continued, it became clear that a primary precipitating factor for Craig suicidal thoughts was anger and frustration. I asked Craig to try the Hook technique for identifying and managing anger as a strategy to help Craig gain control over the thoughts and reactions that led to his suicidal ideations.
4 Steps for Effective Use of the Hook Technique
I next stated to Craig, "Now let’s try visualizing the anger that results in you feeling a need to self harm to relieve the pressure in a different way. Imagine yourself as a fish swimming through a ‘sea of life.’ As you are swimming along, you notice a hook with tasty looking bait on it drop down right in front of you. This hook is anything that could make you angry or upset for a good reason. If you take the bait, you get hooked into the feelings of anger and frustration that make you feel like a pipe about to burst."
I explained to Craig that there are two kinds of hooks, injustice and incompetence. Injustice hooks, of course, are minor or major stress situations characterized by the word ‘unfair.’ Incompetence hooks describe situations characterized by the feeling that you or someone else is inept, incapable, unqualified, stupid, or lazy.
Step #2 - Keep a Hook Book
An example that Craig came up with for an anger event is "Failed my English test." Craig described his hook in this situation as "I feel too stupid to finish school," which he identified as an incompetence hook. I asked Craig to carry his hook book in his pocket for a week, and bring it to our next session. In our next session, Craig and I used his hook book to identify the most common types of situations that precipitated his anger responses.
Craig stated, "When I do bad in school, I feel angry at myself because I’m letting myself and my family down. I need to respect myself, but how can I if I’m so bad at school that I’m failing?" I stated to Craig, "So you’re saying that you feel your need for self esteem and self respect is not being met?" I asked Craig to make a new Hook Book, this time with four columns instead of two. After the first two columns, ‘anger event’ and ‘hook’, I asked Craig to make a column marked ‘Need’.
Step #4 - Filling the Need
I stated to Craig, "Now that you’ve identified the need and desire behind your anger, we can start to work directly on filling that need. Let’s talk about some strategies for studying, managing your time, and talking to your teachers that can help you do better in school." Craig’s focus was now on taking direct, specific action, rather than on the ruminations and angry feelings that led to suicidal ideation. I asked Craig to continue using his four-column hook book over the next few weeks.
I found that having Craig keep the hook book helped reduce the intense anger and frustration Craig had been experiencing, and consequently I observed a reduction in the number of suicidal thoughts Craig reported. In addition, the hook book provided me with information about specific skills and situations to work on in my sessions with Craig. Think of your Craig. Would using the hook technique be helpful in helping him or her reduce incidents of ruminative thinking in response to anger? Would reducing anger and rumination help him or her reduce suicidal thoughts?
On this track, we have discussed the four step Hook technique for helping a teen client deal with the anger component of his or her depression. The four steps in the Hook technique are identify the hook, the hook book, identify the need, and fill the need.
On the next track, we will discuss the first four myths the families of suicidal teen clients may have about suicide. These four myths are teens who talk about suicide will not commit suicide, all suicidal people want to die, if you ask someone about suicide it might give them the idea, and suicide happens without warning.
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