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Teen Suicide: Practical Interventions for Adolescents in Crisis
10 CEUs Teen Suicide: Practical Interventions for Adolescents in Crisis

Section 14
Self-Injurious Thoughts and Behaviors

CEU Question 14 | CEU Test | Table of Contents | Crisis CEU Courses
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

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On the last track, we 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 this 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.

Sara, 16, was a high-performing A student.  Sara’s parents were very strict, and insisted on grades no lower than an A- average.  Sara was not allowed to participate in any extracurricular activities, and she was under constant pressure for high academic achievement.  During the fall of her junior year, Sara began struggling in her pre-calculus course.  Sara was too ashamed to ask for help, and consequently failed her midterm

Sara’s parents were furious, and Sara was made to feel that she had not applied herself.  Sara’s parents announced that she would not be allowed to participate in social activities until her grades improved.  One week later, Sara attempted suicide by slashing her wrists.  Fortunately the injuries were superficial, and Sara was willing to enter therapy and sign a Behavioral Contract agreeing to keep herself safe in between sessions.

Sara stated, "I just feel like the biggest loser on the planet.  I’ve never failed anything before!  No matter what I did, I couldn’t get away from the horrible feeling that I was worthless.  I just had to do something to get away from those feelings!"

Four Concepts for Coping with Negative Self-Thoughts

Concept #1 - Negative Thinking is a Bad Habit
A first concept I discussed with Sara is the idea that negative thinking is a bad habit.  Sara clearly was being tormented by her negative thoughts, and felt powerless to control them.  I stated to Sara, "Thinking is so natural, that it is very easy to forget that you are doing it.  But for some people, thinking negatively without realizing it can become a bad habit.  Without realizing it, you lock yourself into a pattern of bad thoughts you can’t escape from. I’d like for us to start by working together on some strategies for breaking this habit of thinking negatively."

Technique: Self-Observations
To help Sara begin to recognize her negative thinking, I invited her to try the Self-Observation Technique. First, I asked Sara during the session to close her eyes for two minutes, and simply pay attention to the thoughts that came to her mind.  Sara stated, "I didn’t like doing that.  It was like some part of me just keeps reminding me of my failure and calling me bad names.  So then I start thinking how I’ll never get in to college now…"  I asked Sara to continue with the Self-Observation technique during the next few days, and to keep a journal of her thoughts throughout the day. 

Concept #2 - Breaking the Habit of Negative Thinking
A second concept I discussed with Sara was strategies for breaking the habit of negative thinking. 

Technique: Partner Monitoring
The first strategy for breaking the habit of negative thinking is the Partner Monitoring technique.  In the Partner Monitoring technique, I ask the client to enlist a trusted friend in helping them break the negative thinking habit.  The client asks the friend to monitor what they say for at least two days.  Sara chose her best friend Nancy as her partner. 

I stated to Sara, "Tell Nancy you don’t want her to let you say anything negative or self-defeating.  Although sometimes it’s perfectly okay to complain or say negative things, for these two days ask Nancy to interrupt you without exception.  By having Nancy interrupt you, you can start practicing stopping your negative thinking in its tracks, by consciously identifying and ignoring the negative thoughts."

Technique: What am I thinking?
I also encouraged Sara to try the simple What am I thinking? technique.  I gave Sara a four by six inch index card, and asked her to write the words "What am I thinking now?" on the card in big, bold letters. 

I stated to Sara, "I’d like you to try and carry this card with you everywhere for a month.  Keep it in a pocket, or somewhere where you will notice it frequently.  As often as possible, look at the card and notice what you are thinking.  If you are thinking negative thoughts, practice ignoring the thought by consciously thinking about something else, even if you just sing a favorite song in your mind.  With practice, you will be able to start ignoring these negative thoughts without looking at the card."

Concept #3 - Choice Points Technique
In addition to negative thinking as a bad habit and strategies for breaking the bad habit of negative thinking, a third concept which I discussed with Sara is the Choice Points technique.  I stated to Sara, "Now that you have learned how to identify your negative thoughts, let’s talk about Choice points.  Choice points are isolated moments in time when you have an opportunity to choose between healthy thinking and negative thinking.  For example, what is an exampling from your journaling activity of a time when you have had negative self-thinking?" 

Sara stated, "Well, the other day my dad made a comment about my pre-calculus grade, and at first I got mad that he would bring it up.  Then I started telling myself I deserved it, and I started feeling like a loser again."

I stated to Sara, "When your father says something to you wish he hadn’t, concentrate on recognizing that moment as a choice point.  You have the power to choose negative thinking, or to choose to let negative thoughts pass by and replace them with positive thoughts.  If you feel you might have trouble thinking of a positive thought, you might try making a list of favorite images or memories, and keep the list with you throughout the day." 

I also helped Sara practice active and passive relaxation techniques focused on letting her negative thoughts pass by.  Think of your Sara.  Would the choice points technique be helpful to him or her?

On this track, we have discussed four brief techniques to help suicidal teen clients cope with negative self-thoughts.  These four techniques are, the self-observation technique, partner monitoring, what am I thinking?, and the choice points technique.

Peer-Reviewed Journal Article References:
Ali, A., & Gibson, K. (2019). Young people's reasons for feeling suicidal: An analysis of posts to a social media suicide prevention forum. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 40(6), 400–406.

Braun, M., Till, B., Pirkis, J., & Niederkrotenthaler, T. (2020). Suicide prevention videos developed by and for adolescents: A qualitative study. Crisis: The Journal of Crisis Intervention and Suicide Prevention. Advance online publication.

Fox, K. R., Harris, J. A., Wang, S. B., Millner, A. J., Deming, C. A., & Nock, M. K. (2020). Self-Injurious Thoughts and Behaviors Interview—Revised: Development, reliability, and validity. Psychological Assessment, 32(7), 677–689. 

Franklin, J. C., Fox, K. R., Ribeiro, J. D., & Nock, M. K. (2017). Understanding the context of novel interventions for self-injurious thoughts and behaviors: A reply to Nielsen et al. Journal of Consulting and Clinical Psychology, 85(8), 831–834.

Nock, M. K., Prinstein, M. J., & Sterba, S. K. (2010). Revealing the form and function of self-injurious thoughts and behaviors: A real-time ecological assessment study among adolescents and young adults. Psychology of Violence, 1(S), 36–52.

Online Continuing Education QUESTION 14
What are four brief techniques that may help suicidal teen clients cope with negative self-thoughts? To select and enter your answer go to CEU Test.

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