Healthcare Training Institute - Quality Education since 1979
Psychologist, Social Worker, Counselor, & MFT!!

Section 1
Track #1 - Contracting

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Welcome to the Home Study Course sponsored by the Healthcare Training Institute, homestudycredit.com.  This course is entitled, Teen Suicide: Practical Interventions for Adolescents in Crisis

Our primary intent for this home study course is to provide quality education to foster your professional growth.  The Institute has provided quality education since 1979.
 
We appreciate that you have chosen us as a vehicle for you to earn your Continuing Education Credit.

The purpose of the course is to assist you in increasing your knowledge regarding how to treat patients, clients, etc. dealing with teen suicide.  As each case study is given, if the concepts seem to be applicable to your situation, I encourage you to turn your CD player off and make a few notes regarding the application of the principle to your setting.  However, these notes are for your purposes only and are not to be sent to the Institute.  Also each track is very content dense.  So feel free to replay the track to review the content either for your own purposes, or if you feel appropriate play the track in an individual or group session for client education.  Also permission is granted to reproduce this CD.  We encourage you to duplicate and give copies of this CD to colleagues, clients, etc. as you deem appropriate. We feel the information on our CD's is valuable.  Thus, we have an interest in distributing CD's in as many ways as possible, to benefit the greatest number of people, who have a need and are receptive to this practical information.

The questions in your Answer Booklet are sequential and deal with the section of content that preceded it.  For this reason, to facilitate the answering of each question, you might read the question from the Answer Booklet prior to listening to that CD track.  By knowing what the question is ahead of time, you will then know the content to listen for that contains the answer.  So just a hint, after you write down the answer to a question in your Answer Booklet, read on to the next question in order to give you a “heads up” to listen for the content that contains the answer to the next question.

Merely write the correct letter on the corresponding blank line in your answer booklet. Each answer is only used once. Keep in mind there is nothing tricky or hard about these questions.  They are merely intended to verify the playing of this CD.

For the purpose of brevity, most generally, I will use the term “therapists” or “mental health professional.”  However, don’t let these terms deter you from applying the concepts to your situations.  When you hear the word “therapists,” if your job title is social worker, psychologist, marriage and family therapist, mental health counselor, professional counselor, resident director, program assistant, etc. merely substitute the appropriate term that is the most meaningful to you. In short, don’t let my use of the term “therapists” cognitively set you off track from hearing the content because your job title is school counselor, for example.  I will also use the term “client” for the purposes of brevity.  However, if you deal with patients, residents, students, consumers, etc., transpose “client” for the term that is the most meaningful to you in your work setting. 

On this CD set we will discuss such topics as: contracting, warning signs, the thinking and feeling statements technique, dos and don’ts for supportive others, the round robin family technique, the hook technique, the speaking directly technique, the empty chair, passive listening for parents, parenting skills for setting limits, parenting skills for fostering independence, the safe place technique, communication after the attempt, and choice points.

So  let’s get started

On the rest of this track, we will discuss five theories why adolescents choose suicide.  These five theories are, motivations for suicide, depression and mental illness, rebellion and escape, low-self esteem and lack of communication, and suffering a loss.  I will also describe how I used a simple contracting technique with Marcon

As you are well aware, during the past couple of decades, the teen suicide rate has skyrocketed.   The most recent information from the Centers for Disease Control and Prevention, or CDC, indicates that the current teen suicide rate is close to 7.3 teenagers per 100,000.   This translates to 4600 deaths per year, which of course does not include the far higher number of attempted suicides.

I would like to open our discussion of this national mental health crisis by reviewing several of the theories behind teen suicide.  A first of these theories is motivations for suicide.  We know from crisis theory that in most cases, suicide is seen to accomplish one main thing, an end to the emotional pain that the teen in crisis is suffering.  However, the act or attempt may serve different purposes for different clients.  Some teens may plan that his or her final act in life will be one of defiance and revenge.  Ted, 15, stated, “My parents will be sorry when I’m gone!”  Ted wanted to hurt his parents as he was hurting from their growing lack of acceptance of his behavior and independence.  Other teens may find that a suicide threat or attempt is a way to manipulate others into getting a desired result.  Although this realization may not be conscious, the teen may realize that self-destructive behavior results in gaining attention or love that was withheld or not communicated. 

Other teens may attempt suicide as a cry for help.  For these teens, suicidal behavior is a form of communication, a way of telling others that things are not okay inside, and that the teen feels hopeless to do anything about it.  Rina, 16, stated.  “The other night I cut my wrists.  I don’t really know why.  When the bleeding stopped, I bandaged them.  But no one said anything the next day.  Mom didn’t ask, my friends at school didn’t ask…”  Rina had been hoping that someone would pay attention to her to give her an opportunity to share her feelings.  Like most teens who attempt suicide, Rina did not want to die, but rather to accomplish something else to ease her suffering.

A second theory of suicide involves depression and mental illness.  As you have seen in your practice, the most common reason clients give for wanting to die is unhappiness.  Although not every suicidal client is depressed, I have observed that most young people who commit or attempt suicide exhibit some symptoms of severe depression.  Adolescent depression, schizophrenia, and bipolar disorder are currently the most common mental illnesses among adolescents that lead to suicidal behavior.

In addition to motivations for suicide and depression and mental illness, a third theory of teen suicide involves rebellion and escape.  A teen in rebellion against an unacceptable world and a perceived nonproductive phase of life may unleash antisocial behavior that alienates him or her from former support networks.  A rebellious, runaway, drug-using, or sexually promiscuous teen may create a life for him or herself that has few bonds to a supportive community and few dreams for the future. 

A fourth theory of suicide concerns low self esteem and a lack of communication.  Clearly, if a teen receives messages at home such as ‘don’t be who you are’ or ‘don’t exist,’ and the message is repeated often enough, the teen may come to the conclusion that his or her life is not worthwhile.  When this feeling of worthlessness becomes combined with the life stresses of adolescence, the outcome may be suicide.  Teens who learned early on from their parents that their life had value, on the other hand, are able to be much more resilient in the face of a maturational crisis.  I have found that a real or perceived lack of unconditional love and acceptance in the home are strong contributing factors in teen suicidal behavior.  Would you agree?

A fifth theory of suicide in teens involves suffering a loss.  Marco, 14, lost his grandmother when he was seven.  Marco’s parents decided that it would be best if Marco was not exposed to the funeral and burial experience, so Marco was sent to stay with a neighbor during the traditional grieving process.  As a result, Marco was not permitted to develop a coping method that would help him face a loss.  Although Marco’s experience was of a loss through death, clearly these safe feelings of grief may be precipitated by any end to a relationship, or a failure in which the teen experiences a loss of self esteem.  When Marco recently broke up with his first girlfriend, he had no built in mechanism to help him handle his feelings of loss, and went into a crisis which culminated in Marco’s taking a bottle of his mother’s sleeping pills. 

When I met with Marco in the hospital immediately following his suicide attempt, I used a simple contracting technique in order to make an agreement between Marco and myself that would provide for his safety.  I stated, “Marco, I would like to see you in three days in my office so that we can talk about what has happened.  I would like you to make a contract with me that states that you will not attempt to harm yourself until our meeting.  Will you agree to that?”  Marco agreed.  I also indicated to Marco that as my side of the agreement, I would provide him with a number he could call any time of the day or night if he needed immediate help.  Together we prepared two copies of the agreement, and both signed each sheet.  I gave one copy of the contract to Marco, and indicated that I would keep my copy in his file. 

Think of your Marco.  Would a simple contracting technique be useful in encouraging her or him to take an active role in assuring her or his own safety in between your crisis intervention meetings for her or his suicide attempt?

On this track, we have discussed five theories why adolescents choose suicide.  These five theories are, motivations for suicide, depression and mental illness, rebellion and escape, low-self esteem and lack of communication, and suffering a loss.

On the next track, we will discuss three warning signs for teen suicide.  These three warning signs are verbal clues, behavioral changes, and situational clues. 

QUESTION 1
What are five theories regarding why an adolescent may choose suicide? To select and enter your answer go to Answer Booklet.