On the last track, we discussed guidelines for parents regarding intervention during a teen’s suicidal crisis in four situations. These four situations are, an emergency life threatening attempt, a non-emergency life-threatening attempt, possible suicide, and a low-risk situation.
On this track, we will discuss two focus areas for family change following a teen client’s suicide attempt. These two focus areas are what to say about the attempt and realistic expectations.
In the months leading up to his suicide attempt, Danny, 14, had become increasingly truant from school. He had also begun having disruptive outbursts at home and at school which included swearing, punching, physical harassment of friends, and punching walls. Danny father Bob, a strict disciplinarian, had never tolerated deviation from his rules, and responded by grounding Danny for weeks at a time.
Danny’s mother Mary was also strict, but tended to treat Danny like a young child. Mary still chose Danny’s school clothes, and laid them out for him in the evenings. Mary’s response to Danny’s disruptive behavior was to screen all Danny’s phone calls and search his room on a daily basis. Recently, Danny had attempted suicide by hanging.
During my initial crisis intervention with Danny, he stated, "No matter how hard I try, I’m not good enough, so why try any more? Even when I do try, the rules are always changing! Mom and Dad say if I mow the lawn, I can go out Friday. But I mow the lawn, then find out I can’t go out after all because I didn’t clean my room last Tuesday! I’m not allowed to do anything on my own, I’m not allowed to do anything that could prove I can be responsible, and if I try talking about it, they just don’t understand me! No matter what I try, I lose."
Since family issues clearly played a role in the crisis that led to Danny’s suicide attempt, I asked Bob and Mary to meet with me to discuss strategies for reducing Danny’s future risk.
Mary and Bob were eager to whatever it took to help Danny, but also exhibited defensive behavior regarding being asked to meet with me. I stated to Bob and Mary, "I don’t mean to imply that you are the cause of Danny’s suicide attempt. Teenagers’ lives are very much influences by parents, and this is why I try to involve parents in the therapeutic process for teens who have attempted suicide. A suicide attempt is often a signal that something within the family is not providing the teenager with the support he or she needs, and I’d like for us to work together to see if there are any areas for change which could help Danny in his recovery."
2 Focus Areas
Area #1 - What to say about the Attempt
A first focus area for family change that I addressed with Bob and Mary is what to say about the attempt. One of Mary’s first questions was, "What do I say to a son who has tried to kill himself?!" I used this question as a point of introduction for a focus on communication changes. I stated, "One simple thing you can say to Danny is just, ‘I love you, and I want to understand what happened."
Try to let Danny do most of the talking, and listen to what he has to say. You might feel an urge to defend your actions to Danny. I strongly suggest you keep a journal where you can write down these defensive reactions, and we can talk about them in our sessions together."
Five Communication Guidelines
I provided Bob and Mary with Communication Guidelines for family communication after a suicide attempt. This technique provides specific do’s and don’ts for parents regarding talking to their teenager after the attempt. As I read over the steps in my communication guidelines technique, think of how these guidelines compare to those you give to parents of a teenager who has recently attempted suicide.
Guideline 1. Do not tell the teenager how lucky he or she is to have what they have, what they have to look forward to, or how much he or she has hurt loved ones. These statements add to the guilt the teen is already feeling regarding his or her suicide attempt, which increases the teen client’s stress levels and increases risk for another suicide attempt.
Guideline 2. Stay away from "why," "you," or "we" statements. These statements tend to put teenagers on the defensive and close down communication. I stated to Mary, "Asking Danny, for example, ‘why did you try to kill yourself?’ implies that there is a single reason. There may be several complex reasons, and Danny himself may not yet know exactly why he attempted suicide. Saying, ‘we can’t do things like that’ implies that the you are speaking for Danny and implies he has no say in his own feelings."
Guideline 3. Voice your acceptance of the teen’s feelings. Remember that a suicide attempt is often the result of a perceived failure at verbal communication. Some teens attempt suicide as a way of behaviorally communicating the pain they felt they could not successfully communicate any other way.
Guideline 4. Communicate accurately. I stated to Bob and Mary, "Sometimes, parents and children come away from a conversation with two different ideas of what is expected. One way to avoid this when talking to Danny about his suicide attempt is to use active listening. Repeat important ideas from your conversations by repeating what you understand Danny to be saying."
Guideline 5. Respond to the teenager in a calm, even tempered manner. Keep your rate of speech and volume at a conversational level. Try to use a calming tone. Keep eye contact comfortable, don’t avoid looking directly at the teenager. Try to stay close to the teenager with nothing between you, such as a chair or desk.
I stated to Mary and Bob, "Keeping calm can be very difficult, but it is vitally important during this early recovery that you try to keep an even temper. Feeling anger and other strong emotions is natural. If you feel strong anger, or other feelings, towards Danny, you might try writing a letter to express your feelings, which you do not show to Danny at any point. You might burn or shred the letter once you finish. Or, you could bring the letters in to one of our sessions so that we can discuss them."
Area #2 - Realistic Expectations
A second focus area for family change I addressed was realistic expectations. Clearly, both Bob and Mary displayed unrealistic expectations for Danny. I stated to Bob and Mary, "Danny, like all teenagers, has positive points and negative points. It’s often much easier for parents to verbalize and express the positive points, but in order to have realistic expectations for Danny, it’s important to talk about and accept the negative points as well. Accepting realistic expectations for Danny will help you provide healthy goals, behavioral guidelines, and support for his recovery."
Technique: Realistic Assessment
I asked Bob and Mary to try the Realistic Assessment technique to help them develop a clear image of Danny’s strengths and weaknesses. Some questions I include on the realistic assessment technique are:
-- 1. ‘what can you realistically expect from your teen in terms of school grades, social behavior, home behavior, chores, attitude, and emotions?’
-- 2. ‘What is your teen like on a good day? On a bad day?’
-- 3. ‘How does your child express positive emotions? How does she or he express negative emotions such as anger?’ and
-- 4. ‘What are some areas in which your teen has demonstrated an ability to successfully problem solve?’
Think of your Bob and Mary. Would the Realistic Expectations technique help them develop a healthy starting point for addressing the needs of a son or daughter who has recently attempted suicide?
On this track, we have discussed two focus areas for family change following a teen client’s suicide attempt. These two focus areas are what to say about the attempt and realistic expectations.
On the next track, we will discuss four brief techniques to help suicidal teen clients cope with negative self-thoughts. These techniques are, the self-observation technique, partner monitoring, what am I thinking?, and the choice points technique.
Peer-Reviewed Journal Article References:
Asarnow, J. R., Berk, M. S., & Baraff, L. J. (2009). Family Intervention for Suicide Prevention: A specialized emergency department intervention for suicidal youths. Professional Psychology: Research and Practice, 40(2), 118–125.
Comans, T., Visser, V., & Scuffham, P. (2013). Cost effectiveness of a community-based crisis intervention program for people bereaved by suicide. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 34(6), 390–397.
De Silva, S., Parker, A., Purcell, R., Callahan, P., Liu, P., & Hetrick, S. (2013). Mapping the evidence of prevention and intervention studies for suicidal and self-harming behaviors in young people. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 34(4), 223–232.
Kaslow, N. J., & Gilman Aronson, S. (2004). Recommendations for Family Interventions Following a Suicide. Professional Psychology: Research and Practice, 35(3), 240–247.
Spirito, A. (1997). Family therapy techniques with adolescent suicide attempters. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 18(3), 106–109.
Online Continuing Education QUESTION 13
What are two focus areas for family change following a teen client’s suicide attempt?
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