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Section 3
Suicidal Adolescent

Question 3 | Test | Table of Contents

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In the last section, we discussed three warning signs for teen suicide.  These three warning signs are verbal clues, behavioral changes, and situational clues. 

In this section, we will discuss three aspects of addressing thoughts and feelings with a suicidal teen client.  These three aspects are communicating feelings, separating thoughts and feelings, and active listening.  I will also describe how I used the thinking and feeling statements technique with Denise.

At 11:30 at night, Denise, age 15, called me and indicated that she was sitting on the edge of her bed with a bottle of her mother’s sleeping pills in her hand.  Denise stated, "No one understands!  If my parents would only listen, but all they do is tell me what to do and that I’ll get over it!  I don’t think they care!  I’m not ever going to get over it, and I just can’t face another day at school!" 

Clearly, Denise was experiencing intense feelings of shame, anger, and fear, and needed to share those feelings.  I felt that Denise’s lament that "no one understands" was actually a statement indicating that she felt no one understood her emotions.  I felt that my role as a therapist at that moment was to listen to Denise’s feelings, both those directly expressed and implied feelings, and to help Denise realize she was in fact understood. 

Thoughts and Feelings - 3 Aspects

♦ #1 Understanding Communication of Thoughts & Feelings
I have found that a first aspect of addressing thoughts and feelings with a suicidal teen client involves understanding the communication of thoughts and feelings.  I find that this first aspect involves discussing communication with the suicidal teen client’s family.  I find that the feeling side of a child’s experience is often ignored or squelched by parents, teachers, and others.  As you know, this prevents the child from learning how to label and process her or his strong feelings, which reduces the coping strategies available to the teen client in a suicidal crisis. 

Denise explained that during the day preceding her suicidal crisis, she had come home from school, slammed the kitchen door, thrown her backpack in the corner and yelled "I hate school!!" to her mother.  Denise’s mother, Betty, responded by stating, "Don’t ever let me hear you say that again.  You’re not supposed to hate.  And don’t slam the door, young lady!" 

By telling Denise that she should not hate, Betty expressed to her daughter that her anger was an unacceptable feeling.  Betty’s further admonition that Denise should not slam the door further pushes Denise and her experience aside and blocks Denise off from a much needed opportunity to express herself. 

♦ #2 Separating Thoughts & Feelings
A second aspect of addressing thoughts and feelings with a suicidal teen client involves separating thoughts and feelings.  Denise had stated that no one understood her.  Although Denise identified this statement as a feeling of not being understood or supported, clearly the statement that she is not understood is a thought.  My goal as a therapist was to identify the strong feeling behind Denise’ statement.  I stated, "You sound frustrated and desperate because you think that your parents are not giving you the support you need, or even caring about what you want, or trying to understand." 

In our first session after Denise’s suicidal crisis call, I worked with Denise on expressing her feelings clearly in an attempt to improve communication between Denise and her parents.  I stated to Denise, "Sometimes, it can be tricky to tell whether something I am trying to say is a thought or a feeling.  One clue I use is to listen for words such as "like" or "that" after I say the word "feel".  For example, If I say, ‘I feel that my dad is being unfair,’ I’m expressing a thought that my dad is being unfair, but I’m not really coming out and saying how I feel about it.  How might I feel if I thought my dad was being unfair?" 

Denise stated, "Well, you might feel angry."  I stated, "That’s a good example.  To express my anger, I could take away the word ‘that’ and insert a feeling word.  I could say, ‘I feel angry when I think my dad is being unfair.  That way, someone listening to me can clearly hear how I am feeling."

"Thinking and Feelings Statements" Technique
To help Denise refine her feelings communication skills, I invited her to try the "thinking and feeling statements" technique.  I gave Denise a list of statements, and together we discussed whether the statements were thinking or feeling statements.  In the case of thinking statements, I encouraged Denise to reword the statements to express a feeling.

-- Statement One: "I feel pushed around."  Denise stated, "Well, that’s not really a feeling.  You think you are being pushed around.  Maybe a better way to say that would be, ‘I feel upset when I think I’m being pushed around."
-- Statement Two: "I feel happy when I hear that song."  Denise stated, "That’s pretty clear.  I think that’s a good feeling statement."
-- Statement Three: "I feel like I haven’t got a friend in the whole world."  Denise stated, "That statement uses the word ‘like.’  I think that a better way to say that would be to say, ‘I feel really sad, because I don’t think I have any friends."

Think of your Denise.  Would practicing separating thinking and feeling statements help her or him improve her or his communication skills?

♦ #3 Active Listening
A third aspect of addressing thoughts and feelings with a suicidal teen client involves active listening.  As you are well aware, active listening is vitally important when intervening with a teen client during a suicidal crisis.  I practiced active listening during Denise’s suicidal crisis by identifying the feelings behind her statement that "no one understands" and reflecting those feelings back to Denise.  As part of my intervention with Denise, I spoke with Betty and explained the active listening process to her. 

I stated, "No one wants a loved one to feel negative feelings.  When a loved one expresses a strong negative feeling, it can be tempting to try to change the negative feeling someone expressed by saying something like, ‘don’t feel that way’ or ‘there’s nothing to be scared of.’  However, these statements are disrespectful of the person expressing the feelings.  Another instinct is to question the negative feeling by asking ‘why do you feel that way?’  But feelings don’t need to be justified.  They just exist.  A better way to communicate your understanding and willingness to listen to Denise is to concentrate on identifying, accepting, and reflecting the feeling.  Try to avoid stating that you understand or asking questions.  By instead demonstrating your understanding, you will encourage Denise to keep talking to you and explaining what happened to evoke those feelings."

I decided to invite Betty to engage in some active listening role play to improve her ability to communicate better with Denise.  Playing the part of Denise, I stated, "I can’t stand that teacher at all!" Betty stated, "What I want to say is, ‘what happened?’  But I guess a better thing to say would be, ‘You are certainly upset at her.’"  Think of your Betty.  Would practicing active listening techniques help her or him be more supportive of a teen in a suicidal crisis?

In this section, we have discussed three aspects of addressing thoughts and feelings with a suicidal teen client.  These three aspects are communicating feelings, separating thoughts and feelings, and active listening. 

In the next section, we will discuss a four step crisis intervention model for a suicidal teen client.  The four steps in the crisis intervention model are to establish rapport, explore the problem, focus, and seek alternatives.
Reviewed 2023

Peer-Reviewed Journal Article References:
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.

McManama O'Brien, K. H., Singer, J. B., LeCloux, M., Duarté-Vélez, Y., & Spirito, A. (2014). Acute behavioral interventions and outpatient treatment strategies with suicidal adolescents. International Journal of Behavioral Consultation and Therapy, 9(3), 19–25.

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. 

van Vuuren, C. L., van der Wal, M. F., Cuijpers, P., & Chinapaw, M. J. M. (2020). Are suicidal thoughts and behaviors a temporary phenomenon in early adolescence? Crisis: The Journal of Crisis Intervention and Suicide Prevention. Advance online publication.

QUESTION 3
What are three aspects of addressing thoughts and feelings with a suicidal teen client? To select and enter your answer go to Test.

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