After the Attempt: Parents, Teens, and Suicide

back-1822702_1920Part of my job as a mental health counselor involves receiving calls from parents concerned about their teenagers following a suicide attempt. Parents sometimes call seeking help for their teens and other times they are looking for help for themselves to manage feelings.

A teen’s suicide attempt can significantly impact the whole family. Because there is often a stigma around suicide (a feeling of humiliation or shame) families find themselves wondering how to move forward following the incident. Parents feel unsure about whether they should talk to school personnel, how they should explain their teen’s absence from school or family functions when the teen has been hospitalized, and how to talk about the incident with the other children in the household. Parents call in a state of alarm, often fearful that their teen will try to commit suicide again or to discuss how powerless they felt in the aftermath of the attempt. Teens present for therapy usually wanting to examine ways to not be suicidal anymore.

According to the Centers for Disease Control and Prevention, suicide is the third leading cause of death for young people age 15-24 years old and results in more than 4,600 deaths every year. My goal in this post is to identify some risk factors and warning signs of suicidal behavior and offer some ideas for getting help.

Risk factors that may increase the likelihood of suicide

These are some of the conditions that may increase the chances of a suicide attempt.

  • Having a mental health condition such as depression
  • Conflict with friends or family members
  • Abusing alcohol or drugs
  • Exposure to the suicide of a friend or family member
  • History of trauma, physical abuse, sexual abuse, or neglect
  • Being bullied
  • Having a family history of suicide
  • Previous history of suicide attempts

Warning signs of possible suicidal intention

Although there is no guaranteed method for predicting suicide, the following mnemonic phrase created by the American Association of Suicidology can be used to help identify warning signs for suicide potential. Keep in mind, however, that each person is different and some people with suicidal intentions may not show any of these symptoms.

  • “IS PATH WARM”
    • “I” is “ideation.” Is the teen actively thinking about suicide or expressing thoughts about suicide by saying such things as “I’m going to kill myself” or frequently talking about wanting to die?
    • “S” is “substance abuse.” Has the teen started using alcohol or drugs to cope or have a history of problems using substances excessively?
    • “P” is “purposelessness.” Does the teen think there is no reason to keep living or seem concerned about not having a purpose?
    • “A” is “anger.” Is the teen showing moments of rage or finding anger difficult to control? Is the teen looking for revenge on someone perceived to have caused their problems?
    • “T” is “trapped.” Does the teen talk about feeling like there aren’t any other choices or options except for death?
    • “H” is “hopelessness.” Is the teen negative about themself, others, or the future and seem reluctant to change in positive ways?
    • “W” is “withdrawing.” Is the teen withdrawing from from family, friends, and social interactions or talking about wanting to?
    • “A” is “anxiety.” Does the teen seem more anxious than usual or have trouble sleeping or relaxing?
    • “R” is “recklessness.” Is the teen engaging in life threatening activities without thinking about consequences? Teens do engage in risky behavior as part of this phase of human development, however, do the teen’s actions seem excessively dangerous or represent a change from the teen’s usual behaviors?
    • “M” is “mood.” Does the teen’s mood shift dramatically or excessively? Teens often have mood swings but do the mood changes seem out of the ordinary for the teen’s personality?

Protective Factors, Prevention, and Treatment

While there are circumstances that increase the likelihood of a suicide attempt, there are also conditions that may help protect people from such incidents.

  • A sense of connection with family or social supports
    • Connection with a healthy support network can decrease feelings of isolation
  • Medical and mental health treatment
    • Receiving professional help can add to sense of support and stability
  • Conflict resolution skills
    • Teens with abilities to solve problems may be less likely to consider suicide as an option
  • Cultural or religious beliefs against suicide
    • Beliefs about what may happen to one’s soul following suicide may deter a teen from taking their life
  • *Medication
    • *While medication may be an option to help stabilize moods and emotions, there may be an increased risk of suicide for teens with some medications. Teens may require additional medication management and supervision by a physician or psychiatrist. Parents and teens should be alert and observe any increases in suicidal thinking while taking medication.
  • A suicide hotline is available for those needing someone to talk to immediately. Parents and teens should call 911 in the United States if there is an immediate threat of suicide.
    • Suicide Prevention Lifeline 1-800-273-TALK (8255)

Counselors, parents, trusted adults, friends and other supportive people are available to you if you are a teen struggling with suicidal thoughts. Help is also available if you are a parent or family member of a teen who has made a suicide attempt. In my work with teens and parents, seeking counseling after a suicide attempt has helped individuals move forward as they process the incident and examine their experiences.

Feeling disconnected?

Connection can be defined as an interaction between two or more people where each person feels empowered and understood. It is commonly thought that people are born with a need for connection. Research in neuroscience shows that our brains can actually grow through healthy connections!disconnect

Disconnection, on the other hand, is a type of interaction where misunderstanding, lack of empathy, or even a sense of danger occurs. Disconnection can happen in many ways. We might experience an acute disconnection when we feel like the other person in the relationship is not responding to our attempts to connect. For example, if one partner says, “this is a great view!” and the other person doesn’t respond or simply says “mm hmm” the first partner may feel like their partner isn’t responding very well to their attempt at connection. If the second partner were to answer “yeah, I think so too” or even “I disagree, our last hike had much better views” chances are that the first person will feel heard and more connected because there is more room for ongoing dialogue. Moments of disconnection are common in relationships and many are minor and can be repaired.

A second type of disconnection is chronic, where the sense of disconnection escalates and one person in the relationship exercises power over another person who feels increasingly hurt and disconnected. The less powerful person begins feeling unsafe sharing parts of themselves and becomes fearful of bringing their true self into the relationship. As the disconnection increases it becomes less and less likely that growth will occur within the relationship and repair becomes more difficult. Examples of this might include a teen who changes to fit in due to a desire to be part of a group or an abusive relationship where one partner has power over the other and the less powerful partner tries to change to appease the more powerful partner.

Traumatic disconnection is a third form of disconnection. In traumatic disconnection a person with a history of trauma feels triggered by a sense of disconnection and becomes unavailable for connection because of a heightened emotional state that leaves them feeling unsafe. The triggered person may remain in a state of disconnection until a sense of safety can be restored. For example, someone who has been emotionally abused may experience traumatic disconnection when a friend says something that feels hurtful and immediately leads the abuse survivor to feel unsafe.

If disconnection occurs repeatedly and without repair, a person may experience a feeling of what is known as condemned isolation in which they sense that they are alone and excluded from the social community. A person experiencing condemned isolation often blames themselves for the situation and feels unworthy of healthy relationships.

Through Relational-Cultural Therapy (RCT) a counselor can create a safe environment to begin exploring connection and disconnection in various relationships. A therapeutic relationship can help identify thoughts and behaviors that lead to growth and connection and those that lead to disconnection and hurt feelings. Through the therapeutic relationship it becomes possible to rework ideas about relationships. As people in therapy gain a sense empowerment and connection they increasingly experience what are referred to as the five good things: zest, worth, clarity, productivity, and desire for more connection. These five good things are qualities that encourage growth within relationships. Once people have experienced growth and positive change in their personal lives, they sometimes want to share these newly discovered qualities with others in the community. They may build relationships with neighbors or coworkers or through volunteer work. In doing so, the community benefits from the changes made at the individual level. Personal growth becomes community growth!

Jbmti.org has more on Relational-Cultural theory and therapy.

 

Inspired by the Daily Prompt: Connected

10 Tips on Finding a Counselor

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April is Counseling Awareness month! Entering counseling can feel like a scary or daunting process. You may have a number of questions. Maybe you’ve given some thought to seeing a counselor but have felt uncertain about what to do. Or, maybe you’ve avoided the process because it feels too overwhelming trying to decide where to begin. This post provides some tips to help you find a counselor who will be a good fit for you and hopefully eliminate some of the uncertainty around getting started.

Here are 10 tips on finding a counselor who is a good fit for you:

  1. Check therapist directories such as PsychologyToday and GoodTherapy.org Both sites allow you to filter the type of counselor you’re looking for by zip code, insurance coverage, issues of concern, and more. These sites promote counselors with verified credentials.
  2. Contact your health insurance company and ask whether mental or behavioral health is covered, there is oftentimes a phone number for these services on your insurance card, or you may visit your insurance company’s website and search for a provider there.
  3. Talk with friends and family, chances are someone you know is already seeing a counselor or has seen one in the past and they might have recommendations
  4. Talk to your doctor, they may have a go-to provider or a list of providers to refer you to.
  5. Check to see if your employer offers an Employee Assistance Program that provides a limited number of free mental health sessions for employees.
  6. Do a Google search for counseling or therapy in your area using specific key words you want help with such as “depression” or “teen counseling.”
  7. Call a few counselors. Many counselors offer a free initial consultation either in person or over the phone. Speak with a few of them to help you decide who you might feel most comfortable with and to get a sense of what you’re looking (and not looking) for. If a counselor wants to schedule you while you’re still trying to decide, just let them know you’re not ready to schedule yet and you’d like more time to think about it.
  8. Visit counselors’ websites. You can shop around and learn about the counseling services you’re interested in before you pick up the phone to call anyone. On many websites you can find out information about fees, insurance, and the counselor’s approach to helping.
  9. If you schedule with a counselor and discover afterward that it’s not a good fit you can always let your counselor know you don’t think it’s working. Your counselor may be able to refer you elsewhere, adjust the treatment to better meet your needs, or explore with you where the feeling of disconnection might be coming from. Unless you’ve been court-ordered to attend counseling, you have a right to stop going whenever you want and for whatever reason.
  10. Check your local colleges, places of worship, mental health agencies, or family crisis agencies to see if they offer counseling and if you are eligible for services.

Uncertainty and avoidance are two possible barriers to getting started with counseling and can prevent you from getting the help you need. Since April is Counseling Awareness Month, hopefully this post has increased your awareness about how to find a counselor and given you some suggestions to help you feel more confident when you’re ready to reach out and begin the counseling process.

Employee Assistance Programs: A Free Counseling Resource

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Did you know that many employers offer programs for counseling as part of the benefits to their employees? Employee Assistance Programs or “EAPs” provide temporary, brief counseling services that are meant to help employees manage problems that might interfere with job performance. EAP counseling services are usually provided at no cost to employees and oftentimes include other members of the household as well.

EAP providers can address many common problems employees have that are personal or work-related such as depression, anxiety, conflict with coworkers, difficulty performing job duties, substance use, and relationship problems. In some instances, such as when job performance is suffering, employees may be mandated or strongly encouraged by their employer to attend EAP services.

The following are some examples of companies providing EAP services:

  1. Magellan
  2. First Choice Health
  3. ComPsych
  4. Aetna
  5. Life Services

If you’re unsure whether your company offers EAP benefits you can check with coworkers, your employer, your human resources department, your company benefits package or policy manual. Many organizations have brochures, posters, or fliers around with the EAP phone number you can call.

Once you contact the EAP you will be provided a name or list of names for mental health, behavioral health, or chemical dependency providers in your area who help with the specific concern you have. Depending on the EAP, you will either contact the mental health counselor yourself or the EAP representative will call the provider, authorize services, and connect the provider with you. The number of sessions typically authorized is between 3-8. The services you receive are confidential. In instances where you’ve been mandated to attend EAP services, your employer may be informed of whether or not you participated as requested and informed of the status of your progress by the EAP representative. Confidentiality is also limited if you threaten to harm yourself or someone else.

You may wish to continue services beyond the authorized number of EAP sessions, in which case you can choose to use your health insurance coverage or pay for ongoing services yourself. Check with your counselor and insurance company to determine whether the counselor is a provider with your insurance if you want to continue meeting using your health coverage. Not all counselors accept insurance and some only accept specific ones. Another option is to pay for the services out of pocket and then ask your counselor to provide you with a document that you give to your insurance company for reimbursement.

EAP services can be a helpful way to address personal or occupational problems in a short amount of time. A common barrier to receiving the service is that many employees are unaware that the benefit is available. Services are generally brief, solution-focused, and can help you maintain your work-life balance.

When I grow up…

When you think back to when you were 10 years old what did you dream of being when you grew up? Did you achieve that dream or did you take another path? How does what you became connect with what you wanted to be as a 10 year old?forkintheroad

When I was 10 years old I discovered music and knew I was going to grow up to be a great musician. I pursued my dream up into college and, based on the feedback I received from others, was a pretty great musician. I practiced diligently and consistently but found I was losing interest as a music major after a couple of years at the college level. I felt disappointed and reluctant to let go of something I had poured so much time and effort into and part of me felt like I was letting go of a part of my identity when I decided to take a break from college and musical performance.

I eventually decided to pursue an interest in studying psychology and returned to college. I immediately loved the class content and found that I thrived on reading, studying, taking tests, and writing papers! Of course, I needed to do something with a psychology degree and decided that I wanted to pursue a path as a counselor, which meant more school. Grad school was grueling but incredibly rewarding and transformative for me. Leaving behind my musician-identity allowed me to discover new talents I never realized I had. I found that letting go was both scary and rewarding. Now, I enjoy helping others explore their own identities and paths.

I think my two paths are connected with a desire for creativity. Music allowed me to create new compositions and interpret notes in my own way. Counseling allows me to meet hundreds of different people and help create positive changes as we work toward goals together. Counselors can use different theories and dozens of techniques to help people which provides an ideal environment for creativity. Among many other things, counseling can be a helpful way to explore your identity, interests, strengths, and feelings about facing life’s transitions. I’m happy to be a part of so many people’s lives whose personal journeys have crossed paths with the professional path I chose.

Inspired by a prompt from: Ballerina Fireman Astronaut Movie Star

Abusive Relationships Booklet

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Click on the booklet link above to view a PDF file and learn about the abuse cycle, different forms of abuse, how abuse might affect victims and their children, how survivors may cope in healthy ways during and after an abusive relationship, five qualities found in healthy relationships, and some tips for safety planning in an unhealthy or abusive relationship. There are areas for reflection and journaling in each section.