Teen Suicide: Practical Interventions for Adolescents in Crisis

On the last track, we discussed 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.

On this track, we will discuss myths five through eight that the families of suicidal teen clients may have about suicide.  These four myths are, once a person is suicidal he or she is suicidal forever, suicide is inherited, all suicidal people are mentally ill, and suicide occurs exclusively among the poor or the famous.

4 More Myths about Suicide

Myth #5 - Suicidal Forever
A fifth myth that a teen client’s family might have is that once a teen is suicidal, he or she is suicidal forever. Clearly, parents who believe that a teen who becomes suicidal once will remain so forever may have a very bleak outlook regarding their child’s recovery.  Recent studies have indicated that as many as 10 to 13 percent of teens have attempted suicide at one point.  Perhaps as many as 40 percent of adolescents have seriously thought about it. 

I explain to parents that it is possible, and in fact very probable, that a teenager can find himself or herself in a crisis, consider suicide as an alternative, find another solution, and work through the crisis effectively.  I encourage parents to recognize that teens who wish to kill themselves are usually suicidal for a limited period of time.  The decision to commit suicide can always be redecided.  Just because a teen has a suicidal crisis does not mean she or he will always respond to a crisis situation with suicidal behavior.

Myth #6 - Suicide is Inherited
A sixth myth that a teen client’s family might have is that suicide is inherited.  There is, of course, evidence that once a suicide occurs in the family, other family members are at higher risk of suicide.  The suicide victim leaves a legacy that includes permission to choose suicide as an escape from painful experiences. This does not, however, mean that suicidal behavior is predetermined by genetic structure. Becky, 16, felt haunted by her family’s legacy of suicide.

 Her grandfather, a great uncle, and an aunt had died by suicide.  Becky stated, "My mom says our family is doomed or cursed. She says it’s just our family’s fate. More suicides are going to happen to people I love, and there’s nothing I can do. I mean, it’s probably going to happen to me too, even though I’m in therapy."  Becky did not realize that suicide is an individual choice. 

Becky had learned from her aunt, a role model, that suicide is an acceptable solution.  This, combined with her mother’s belief that the continuation of the trend was inevitable, reduced Becky’s ability to see alternative solutions in her crisis. 

Empty Chair Technique - 3 Steps
As my sessions with Becky continued, we uncovered a resentment which Becky felt towards her mother, Ellen, for Ellen’s continued messages of helplessness. Ellen’s sense of fatalism was preventing her from being a supportive ally to Becky during her crisis. I decided to invite Becky to try the Empty Chair technique developed by Fritz Perls, the founder of Gestalt therapy. As you know, the empty chair is used to make explicit hidden aspects of an internal dilemma. 

-- Step 1. In Becky’s case, we used the empty chair to represent Becky’s mother.  I seated Becky in the center of the room, facing the empty chair, and asked her to imagine her mother sitting in the chair. 
-- Step 2. I then asked Becky to switch chairs, and take the role of her mother. Playing her mother, Becky stated, "This is so horrible!  My poor Becky!  Now I’m going to lose you too, and there’s nothing either of us can do!"  
-- Step 3. Next, I asked Becky to switch back to her chair, and respond to her mother’s statements.  Becky stated, "Mom, I’m going through a rough time right now, and I could really use your help.  Just because I’ve been considering killing myself doesn’t mean I’m doomed!  I’m choosing to work to get better, and you should recognize that I can get better!" 

Think of your Becky.  Would the empty chair gestalt technique be helpful to her or him?

Myth #7 - All Suicidal People are Mentally Ill
In addition to the myths that once a person is suicidal he or she is suicidal forever, and that suicide is inherited, a seventh myth that a teen client’s family might have is that all suicidal people are mentally ill.  I explain to parents that the myth that suicide is always the act of a psychotic person arose from the idea that anyone who would seek death must be ‘crazy.’  Clearly, when psychosis is present, the risk for suicide increases.  However, not all teens who experience suicidal ideation or behavior in the midst of a crisis are psychotic, nor does the teen necessarily need to be in a mental institution.

Myth #8 - Suicide Occurs Exclusively Among Poor and Famous
An eighth myth that a teen client’s family might have is that suicide occurs exclusively among the poor or the famous. I have found that many parents of suicidal teen clients express confusion about their son or daughter’s desire to die. 

May, whose son Robert had recently attempted suicide, stated "Robert has everything he needs!  He’s got a nice roof over his head, new clothes, he never goes hungry. I understand that someone who has to struggle to get the basic necessities might want to give up on life, but Robert is well cared for!"  I explained to May that suicide occurs in teens of all socioeconomic statuses. 

Certainly an individual may become suicidal due to stress and anxiety because they cannot pay the bills and are hungry.  But across socioeconomic statuses, suicidal ideation and behavior are more likely to be the result of relationship problems.

On this track, we have discussed myths five through eight that the families of suicidal teen clients may have about suicide.  These four myths are, once a person is suicidal he or she is suicidal forever, suicide is inherited, all suicidal people are mentally ill, and suicide occurs exclusively among the poor or the famous.

On the next track, we will discuss four barriers to communication between adolescents and parents that may compound a teen’s suicidal crisis.  These four barriers are labeling, mixed messages, over or underreacting, and nonverbal messages.

Peer-Reviewed Journal Article References:
Buchman-Schmitt, J. M., Chiurliza, B., Chu, C., Michaels, M. S., & Joiner, T. E. (2014). Suicidality in adolescent populations: A review of the extant literature through the lens of the interpersonal theory of suicide. International Journal of Behavioral Consultation and Therapy, 9(3), 26–34.

Levi-Belz, Y., & Feigelman, W. (2021). Pulling together—The protective role of belongingness for depression, suicidal ideation and behavior among suicide-bereaved individuals. Crisis: The Journal of Crisis Intervention and Suicide Prevention. Advance online publication.

Madjar, N., Sarel-Mahlev, E., & Brunstein Klomek, A. (2020). Depression symptoms as mediator between adolescents' sense of loneliness at school and nonsuicidal self-injury behaviors. Crisis: The Journal of Crisis Intervention and Suicide Prevention. Advance online publication.

Moskos, M. A., Achilles, J., & Gray, D. (2004). Adolescent Suicide Myths in the United States. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 25(4), 176–182.

Till, B., Wild, T. A., Arendt, F., Scherr, S., & Niederkrotenthaler, T. (2018). Associations of tabloid newspaper use with endorsement of suicide myths, suicide-related knowledge, and stigmatizing attitudes toward suicidal individuals. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 39(6), 428–437.

Online Continuing Education QUESTION 8
What percentage of adolescents may have considered suicide? To select and enter your answer go to CEU Test.