The Handbook of Systemic Family Therapy, Systemic Family Therapy with Children and Adolescents: Systemic Family Therapy with Children and Adolescents by Wampler Karen S.;McWey Lenore M.;

Author:Wampler, Karen S.;McWey, Lenore M.; [Wampler, Karen S.]
Language: eng
Format: epub
Publisher: John Wiley & Sons, Incorporated
Published: 2020-06-04T00:00:00+00:00

14

Youth Suicide: Risk, Prevention, and Treatment

E. Stephanie Krauthamer Ewing, Quintin A. Hunt, Jonathan B. Singer, Guy Diamond, and Dara Winley

Laura, a 15‐year‐old African American female client, 1 was referred to therapy by her school counselor for episodes of non‐suicidal self‐injury (cutting) and feelings of anxiety and depressed mood. Laura had visited the counselor after attending an assembly at school focused on raising awareness about mental health concerns (particularly depression and suicide risk) and the importance of seeking help early.

Laura attended the intake appointment with both her mother and her father, who had recently finalized their divorce. During the intake, the therapist met with the family together for most of the session and gathered background information. Laura's parents expressed worry, guilt, and feelings of helplessness that Laura had not confided in them about her symptoms. Several times during the session, Laura's parents engaged in some blaming of one another for failure to notice Laura's symptoms earlier. The therapist was able to stop these occurrences in the moment and explore Laura's feelings around these interactions. Laura was able to express how her parents' conflictual interactions with one another exacerbated her anxiety and distress and how she often felt caught in the middle. The therapist used reframing and emotional deepening techniques to help the parents come to mutual agreement about Laura's distress and self‐harm risk as the most important initial treatment goal and that strengthening family support and healthy communication would be an important means to accomplish this goal.

The therapist also met with Laura alone for a portion of the session, during which she conducted a thorough risk assessment, including assessment of suicide intent and plan and the type, frequency, duration, and chronicity of suicidal thoughts. Laura reported having vague suicidal thoughts every night and during the week prior to intake, with no intent or specific plan. Although hospitalization was considered, without intent or plan, Laura may not have been admitted and would likely have been discharged quickly, even with an admission. Based on all available information from intake, the decision was made to treat Laura on an outpatient basis with a commitment from Laura and her parents to engage in treatment (twice per week at first), including phone check‐ins between sessions and to use the agreed upon stepwise safety plan for dealing with suicidal/self‐harm urges (i.e., coping strategies, teen agreement to disclose suicidal and self‐harm urges and to utilize emergency services if needed, parent agreement to remove any lethal weapons/agents from home). The therapist continued to work collaboratively with the family as she formulated case conceptualizations and implemented specific intervention strategies.

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