Before the Crisis: Recognizing the Causes of Teen Suicide and Precursors to Suicidal Ideation
Suicidal ideation rarely arises in a vacuum. In this episode, we dive deep into the underlying factors that can lead to suicidal ideation in teens. Our expert guests, Allison Jenkins, LCSW, and Reggie Wilson, LCSW, discuss the role of mental health conditions, substance abuse, and trauma in shaping suicidal thoughts. We explore the influence of social media and technology, behavioral changes that may indicate a deeper problem, and common misconceptions parents might have. Join us as we offer guidance on how to create an open, supportive environment where teens feel safe discussing their struggles.
Having a teen who is struggling with their mental health and with suicidal ideation can leave parents feeling extremely worried and lost. This episode will explore effective strategies for engaging teens in therapy conversations, making informed decisions when choosing an outpatient therapist, and the crucial role of active parental involvement in the therapeutic process. We will also address understanding and managing suicidal ideation, emphasize the hopeful possibilities for recovery, and guide on seeking additional support if needed. If your teen is facing a mental health crisis, OASIS Ascent offers a compassionate, structured environment to help them stabilize and begin their path to healing.
In this episode, therapist Tiffany Herlin, LCSW, along with Clinical Directors and therapists Allison Jenkins, LCSW, and Reggie Wilson, LCSW, from OASIS Ascent, will discuss:
- Engaging Teens in Therapy Conversations: Strategies for including teens in discussions about consequences and therapy, ensuring they feel heard and included in decision-making.
- Choosing the Right Outpatient Therapist: Key considerations for parents when selecting a therapist, include expertise in specific therapeutic approaches and the importance of family involvement.
- Active Parental Involvement in Therapy: The necessity of parents being actively involved in their child's therapy, and how to balance confidentiality with staying informed about the therapeutic process.
- Understanding Suicidal Ideation: The difference between suicidal thoughts and a genuine desire to die, and the importance of creating a supportive environment for open communication.
- Hope and Recovery: Emphasizing that healing is possible, even with trauma or severe challenges, and what steps to take if therapy alone isn't improving the situation, including exploring residential treatment options at OASIS Ascent.
If you are a parent of a teen who is experiencing a mental health crisis, we are here to help. OASIS Ascent provides a safe, structured, and therapeutic environment where teens can stabilize and begin their journey toward healing. With a team of experienced therapists and clinical staff, we offer individualized care designed to address the unique needs of each teen. To learn more about how you can help your child, call us at 855-701-2721.
Introduction
Tiffany: Welcome back to episode three. My name is Tiffany Herlin, and I’m a licensed clinical social worker. Today, I’m once again joined by Allison Jenkins, LCSW, and Reggie Wilson, LCSW, both from OASIS Ascent. This short-term residential program provides stabilization and comprehensive evaluations for teenagers aged 12 to 17 who may qualify for insurance coverage.
Please remember, this podcast is not a substitute for therapy. Always seek the advice of a mental health professional for your specific situation.
In this episode, we’re going to explore the factors that can lead to suicidal ideation. We want to equip our listeners with an understanding that it’s rarely just one thing—it’s complex. We’ll discuss what parents should be aware of and look out for. So, what are some of the underlying factors that contribute to suicidal thoughts in teens?
Reggie: One major factor is when teens feel disconnected. We mentioned this earlier, but it’s worth revisiting. Sometimes, teenagers feel misunderstood by their families, so they turn to peers for support. If they don’t have strong peer connections, they can feel isolated. And I think isolation plays a big role in suicidal ideation.
Self-harm as a Coping Mechanism
Reggie: Another factor is the loss of relationships or identity, which we touched on before. When teens experience these losses, they may feel like their environment isn’t safe or supportive. This can lead to feelings of hopelessness and helplessness, which often result in thoughts of self-harm.
Additionally, we also see self-injurious behaviors. While these teens may not want to die, they may engage in behaviors like cutting to feel something—anything. When they’re numb, harming themselves becomes a way to confirm they’re still alive and capable of feeling. These are some of the warning signs we look for.
Tiffany: And I think cutting can baffle some parents who have never had those kinds of thoughts or desires. They might think, "Why would you do that?"
Reggie: It’s scary.
Tiffany: Exactly. It seems strange, but it makes sense when you think of it as, "I’m numb and I need to feel something." Sometimes it’s also about control, like, "I get to decide when I feel pain. I’m the one inflicting it, not someone else."
Allison: Or, it can be a way to escape their thoughts. Instead of being consumed by what’s happening in their head, they focus on the pain of self-harm. It can distract them from emotional distress. This ties into DBT’s biosocial theory—some kids are just hardwired with heightened emotions.
You can see this in families where one child might be highly emotional, like rolling around on the floor during a tantrum at age two, while another child is just sitting in the car, smiling and happy. Some kids are simply born with these intense emotions, and if they grow up in invalidating environments—like if their parents are divorced, struggling with substance use, or dealing with their mental health issues—the child’s needs may not be fully met.
When you combine an emotionally sensitive child with an invalidating environment, it creates a perfect storm. These big emotions escalate because the child isn’t being validated, not necessarily because of anything the parents are doing wrong. Most parents just don’t know how to validate their child’s feelings because we’re not taught that.
Tiffany: Yeah, it’s not something that comes naturally or instinctively.
Allison: Exactly.
Tiffany: There’s a term that’s been gaining attention for these kinds of kids—'highly sensitive child.'
Allison: Yes, HSP—Highly Sensitive Person.
Adverse Childhood Experiences and Their Impact
Tiffany: Yeah, it's not a diagnosable term yet, but it’s getting a lot of attention, and I think it might eventually become one.
Reggie: I’d also like to mention another factor, which I’m sure you both are familiar with—adverse childhood experiences, or ACEs. These are situations where children grow up in unhealthy environments. For example, if a parent is incarcerated, there’s a divorce, or if mental health issues are present in the family, those children are more likely to develop mental health problems, including suicidal ideation and a sense of hopelessness. So, we need to consider ACEs in this conversation.
Allison: Yes, and the higher the ACE score, the more likely they are to experience suicidal thoughts.
Tiffany: It’s really interesting.
Allison: Yeah.
Tiffany: Some kids just seem to have the odds stacked against them from an early age, and that can shape their mental health. Speaking of that, how do mental health conditions like depression, anxiety, or bipolar disorder relate to suicide risk?
Reggie: They have a huge impact on suicide risk. When you think about depression, it’s often characterized by feelings of hopelessness, helplessness, and thinking that they don’t matter.
Allison: Or feelings of worthlessness.
Reggie: Exactly, worthlessness. Anxiety also plays a big role. Anxiety is very real, and it often leads kids to isolate themselves, making it harder to step out of their comfort zones. Those two conditions—depression and anxiety—are incredibly heavy to deal with, and when teens struggle to make connections, they start to feel like giving up. They think, "This is too hard. I can’t do this. I might as well give up."
Allison: Yeah, most of the kids I’ve worked with deal with both depression and anxiety. To put it simply, depression is being stuck in the past, and anxiety is worrying about the future. When they’re facing both at once, it can feel overwhelming, and without the right tools, suicide starts to feel like the only way out—they just want to escape their minds.
It’s also important to consider genetic predisposition. That’s why when we do assessments with new students, we ask about family history. There’s a reason for that—mental health issues like depression and anxiety can be passed down genetically. Often, it’s not just one person in the family; it’s multiple people across generations, and along with that comes learned behaviors that get passed down as well.
Tiffany: There are so many factors to consider, but ultimately, it often comes down to the path of least resistance, right? Our brains are wired to take the easiest way out, to avoid pressure and stress. So, parents need to understand that sometimes, kids don’t necessarily want to die.
Allison: Exactly.
The Desire to Escape Pain
Tiffany: They just want to escape feeling depressed, anxious, or whatever other genetic factors are affecting them. They just want it all to go away, and that feels like an easy way out.
Reggie: Right. And I think the challenge is that many parents instinctively want to rescue their kids and fix those problems because it's hard to see them struggle. But by rescuing, they’re not encouraging their children to work through those difficult feelings. What I’d say to parents is that when you step in to rescue, you're taking away your child's chance to develop resilience. Instead, encourage them to push through those tough moments. That’s when real growth happens, and those skills they learn will stay with them for life. It shows them they can handle hard things.
Allison: Absolutely.
Tiffany: There’s a great analogy I remember from another podcast. If you help a butterfly get out of its cocoon...
Allison: It dies.
Tiffany: It dies.
Allison: Yes, if you cut open the cocoon while the butterfly is struggling, you kill it. But if you let it work its way out...
Tiffany: And let it struggle, exactly.
Reggie: That’s a perfect analogy.
Tiffany: Right? And as parents, it's hard to watch our kids struggle. We naturally want to step in and rescue them because seeing them uncomfortable makes us uncomfortable. And sometimes, without even realizing it, it’s a little selfish on our part. We want to avoid that discomfort. But it's important to let your kids struggle in a safe environment, knowing that you’re there to support them. This gives them the chance to grow and sends a powerful message: "You're capable, you're strong, and you can overcome this."
Reggie: I love that.
Substance Abuse and Its Connection to Suicide
Tiffany: What about things like substance abuse and trauma? How do they play into suicidal thoughts?
Reggie: Well, from the students I’ve worked with who struggle with substance abuse, nine out of ten times when I ask them, “What do you get out of it?” they say something like, “It makes me feel normal.”
Tiffany: It’s an escape.
Reggie: Exactly. They’ll say, “It makes me feel like I fit in. It changes my personality so I’m funny, and I laugh more.”
Allison: “It reduces my anxiety. It decreases my depression.”
Reggie: Right. So, when we talk about substance abuse, it does serve a purpose for them. But I don’t think of the students who come to OASIS Ascent as addicts—I think they’re masking something deeper. My goal is to help them find ways to feel good, manage their anxiety, or feel more confident without using substances. I often ask them, “If I could teach you ways to feel the same without using, would you be willing to try?” Many of them say yes. That’s when therapies like DBT and CBT come into play, challenging those thoughts of “I can’t do this.”
Tiffany: Cognitive behavioral therapy, right?
Reggie: Exactly—cognitive behavioral therapy. So, substance use does play a big role. But also, when someone is under the influence, they’re more likely to have suicidal thoughts.
Tiffany: And they might even act on those thoughts.
Reggie: Yes, exactly.
Tiffany: Substance abuse plays a double role—it can be a way to escape suicidal thoughts, but it can also make things worse. It can impair the frontal cortex.
Allison: Which reduces inhibition.
Tiffany: Yes, and that can make them brave enough to act on those thoughts. That’s why it’s called “liquid courage”—because it makes people do things they wouldn’t normally do when they’re sober and thinking clearly.
Reggie: If you think about someone with bipolar disorder, the risk of suicide is higher when they’re manic. When they're in a manic state, they have the energy to act on suicidal thoughts or ideations.
Tiffany: That’s a good point. Interestingly, people are often at greater risk when they’re experiencing an upswing, like during a manic phase, as you mentioned.
Reggie: Exactly.
Tiffany: Can you explain that a little more?
Manic Phases and Increased Suicide Risk
Reggie: Studies have shown that people who are depressed may express a desire to die, and while that’s concerning, many of them don’t have the energy to act on it. Some are so unmotivated that they can’t even get out of bed, let alone think about taking action. That’s why one of the key questions during an evaluation is, "What’s your level of motivation?" Many of them simply lack the drive. But when someone does have energy like during a manic phase or an upswing, they’re at greater risk because they have the energy to act on those thoughts.
Tiffany: Exactly, and I think there are theories suggesting that someone might reach that point of feeling good or energized but experience what’s called “foreboding joy.” It's the sense of, "I feel good now, but I know I’m going to crash later and become depressed again, so I’ll go through with my suicide attempt now to avoid feeling that way again." It’s a form of avoidance. So, one thing parents should be aware of—though not to the point of being on constant high alert—is that if their teen seems to be on an upswing, feeling happy and motivated, it’s still important to check-in. You can’t just relax and assume everything’s fine. Ask them directly, "Hey, you seem to be doing well, but are your thoughts of suicide still there? Have they gone away? Do you still have a plan?" You might be surprised, and that’s the best time to ask.
Reggie: Exactly, and to add to that, after a manic episode, teens can be terrified of falling back into that depressed state. Sometimes, when the crash comes, it feels even worse than before. It's not like they just return to the same level of depression—they often feel it even more intensely, which makes the thought of that drop especially frightening for our students.
Allison: Yeah, and with trauma, especially when we experience it at a young age, it rewires our brains. I often hear parents say, "Suddenly, at age 15, these big behaviors appeared. She’s a different child—suicidal, self-harming, acting out. Where did this come from?" When you dig deeper, often there’s trauma at the root. Trauma can lead to depression, anxiety, and a range of acting-out or internalized behaviors. A child who seems to be on a normal path can experience trauma, and suddenly these behaviors emerge. The good news is that trauma therapy can reduce these symptoms, but parents need to be aware: if you see a sudden change in your child, explore what might have happened. Was there trauma? I’ve worked with many girls who experienced sexual trauma, and it completely altered their emotional path. They weren’t suicidal before, but afterward, the shame and guilt became overwhelming, and they saw suicide as the only way to find relief.
Tiffany: Yeah, and often, trauma brings PTSD and triggers along with it.
Allison: Exactly.
Tiffany: The desire to quiet the mind and escape becomes overwhelming. I want to stress to our listeners, it’s not always that someone wants to die.
Allison: Right.
Tiffany: They just want to escape the unbearable pain they’re feeling. It seems like the only solution to end their suffering.
Allison: Yes, and whatever unknowns come with death can seem better than facing that pain at the moment.
Tiffany: Exactly. We didn’t touch on this in the last episode, but I wanted to circle back to something. You both talked about the questions you ask clients about death to help them think more deeply. Could you expand on that? I found that conversation interesting.
Allison: Yeah, one of the questions I always ask, maybe not right away but eventually, is, "What do you think happens when we die? Where do we go? What do you imagine it will be like?"
Tiffany: "What’s your belief around that?"
Allison: Exactly, "What is your belief?" I also do a pros and cons exercise with kids who have chronic suicidal thoughts, especially when they’re in a safe environment. We explore things like, "What do you see as the pros of completing suicide? What are the cons?" Often, they’ll say a pro is, "I’ll be out of distress." But then, when we talk about the cons, it helps them reflect: "I’ll miss my family," or "I don’t really know what happens after death," or even, "I’ll miss my pets and friends."
Tiffany: "My family might be sad."
Allison: "My family might be sad." It also helps them realize that suicide is irreversible—it’s not like missing a goal at a soccer game where you can try again.
Reggie: Yeah, and sometimes these kids have this idea that suicide idolizes them. They think they’ll get wings, fly away, and that people will immortalize them—talk about them at school.
Allison: Yeah, they imagine a big memorial.
Reggie: Right. But I read an article recently about a school that had several suicides, and one thing they did that I thought was helpful was to limit the memorials after a few days. They reduced the amount of pictures, talk, and stories. I think that’s important because our kids, with their limited teenage brains, often believe they’ll live on forever in people’s minds. The truth is, people mourn, but then they move on. And for the kids considering suicide, it’s important to understand what that means.
Exploring the Impact of Social Media on Mental Health
Reggie: Asking tough questions can be effective, such as, "What will happen to your best friend who might be sad if you're gone?" or "Who will take care of your dog the way you do?" These questions help us evaluate suicidal thoughts more creatively.
Tiffany: I love that approach. I want to shift gears a bit and talk about social media and technology. Do they make suicidal ideation worse in teens? If so, how?
Allison: That’s a great question. From my experience working in treatment centers, where phones are not allowed, we see that teens can still struggle with the same issues even without their phones. Social media can exacerbate problems by allowing teens to connect with others who are also struggling, which can create a cycle of negativity. When someone is feeling isolated and connects with another person who feels the same way, it often just feeds into their distress.
Reggie: Misery loves company.
Allison: Exactly. Teens might post pictures of their self-harm or share them with friends or ex-boyfriends, saying things like, "Look what you did." This creates a culture of competition over who is the saddest or who has experienced the most self-harm or hospitalizations. This culture can be harmful because it can make negative feelings more intense and create a contagious effect.
Tiffany: It’s like a contagion of suffering.
Allison: Yes, and it allows them to meet their needs in very unhealthy ways.
Tiffany: Very unhealthy.
Tiffany: I’ve been listening to the book The Anxious Generation, which discusses how electronics are rewiring kids' brains. It doesn’t specifically address suicidal ideation, but it does cover how mental health is affected by electronics, especially social media for teenage girls, and video games and pornography for boys. Technology plays a significant role.
Another issue is comparison. When you’re 14 or 15, your brain isn’t fully developed to process things like, “They’re only posting their best pictures,” or “They’re only showing a small part of their life.” So, many girls and boys compare themselves to these idealized images online and feel like their lives don’t measure up. As an adult, I’ve also taken social media breaks because comparing myself to others doesn’t make me feel good. Imagine how this impacts a teenager’s brain, which is still developing.
Allison: Absolutely.
Reggie: FOMO (Fear of Missing Out) is very real for teenagers. They only see the highlights of others' lives online. They don’t see the struggles, as people generally don’t post that. When teens compare their lives to these curated images, it can contribute to feelings of inadequacy and suicidal thoughts. They might think, “Everyone is having fun except me, which means nobody likes me. If nobody likes me, then nobody will miss me if I’m gone.”
Tiffany: And let’s not forget online and cyberbullying.
Reggie: Definitely. It happens all the time. Teens receive hurtful messages from others or get spammed by people they don’t even know.
Allison: I think it's important to talk about the culture of teenagers. I went to this conference and they shared statistics and talked about how it's becoming a huge part of the teenage culture to sext and send inappropriate pictures to each other. They will pressure each other into sending inappropriate pictures and then it gets blasted all around the school or it gets shared on social media.
Tiffany: It's used as blackmail. They will say something like, "If you don't do this certain thing for me then I'm going to share this with everybody.”
Allison: I think that's a big cause of suicidal ideation, especially in the girls I've worked with.
They say, "I trusted him. He sent me a picture and asked me to send him one and when I did, he shared it with his friends who shared it with other people at school. I didn't want to go to school because I was so embarrassed, I just wanted to be alone and not see anyone.” Imagine being a teenager and having that shared around your school.
Tiffany: That'd be devastating, you would not want to wake up the next day. I think it would be so horrifying.
Allison: They just describe walking down the halls and the looks they get. I think it is important for parents to know this too. It is becoming embedded in their culture that it is okay and appropriate. Parents should watch out for that. If you have a kid that just becomes suicidal and starts talking about stuff like that, you need to go check their phone.
The Role of Parental Control in Teen Technology Use
Tiffany: Yes, I’ve heard at several conferences—though I don’t have the exact research details on hand—that when teens take a break from social media and electronic devices, their symptoms of depression, anxiety, and suicidal thoughts often decrease or even disappear.
Allison: Interesting.
Tiffany: I’ve come across this information at multiple conferences, so it’s a good starting point for parents. It may be challenging, and your teen might react strongly, even saying they hate you or using harsh language if you take their phone away.
Reggie: Yeah.
Tiffany: But that’s a positive sign. It means you’re likely making the right choice.
Allison: Yeah.
Tiffany: As we discussed before, starting with a simple question such as, "What are you doing on your phone?" can be a good way to open up a conversation with your teen. Knowing what they’re doing and being open to discussing it with you can help. Also, it’s worth exploring how their behavior changes during a social media or electronic fast.
The book The Anxious Generation is excellent, and I recommend it to all parents. It suggests that kids shouldn’t have social media until they’re around 16 or 18. As for smartphones, I need to check the exact recommendation, but I believe it’s around age 14. Many of us might think it's too late if our child got a phone earlier, but it's never too late to set limits. You can still monitor their phone usage and have important conversations, even if your child got their phone at a younger age.
Allison: Right.
Tiffany: And remember to use parental controls. There are apps available that can alert you to concerning content without having to read every message. For example, some apps notify you if there are signs of suicidal thoughts or inappropriate content. While these tools won’t catch everything, they can provide a helpful buffer and open the door for important conversations.
Reggie: Yes, thank goodness for parental controls. I just want to add that nowadays, many kids feel like having a cell phone is a privilege they’re entitled to, almost as essential as food and water. The truth is, it’s not a necessity, and as a parent, you have the authority to set clear expectations for phone use. Don’t hesitate to set rules according to your values and standards. It’s your right to do so. If your child disagrees or thinks you’re being unfair, that’s okay. They still need to follow these rules. Of course, some things can be negotiated, but any agreements should still align with your expectations.
Allison: It’s about balance. Everything should be balanced. When a student of mine is transitioning out of treatment and we discuss how to reintegrate social media into their life, it’s important to consider how to balance it with other activities. Technology is here to stay, and in five years, it will likely evolve even further. The key is finding that balance between phone use, video games, and other activities like exercise.
I loved what you said, Reggie, about sticking to your values. Often, kids aren’t even sure what their values are. They might not understand what values like "not sending inappropriate pictures" mean. Helping them recognize and uphold their values is crucial.
Reggie: Yes.
Tiffany: I love that you mentioned not only the need for balance but also a parent’s right to set boundaries. I want to give our listeners permission—yes, you have the authority to check your kids' phones. Some parents feel uncomfortable doing this, thinking it’s an invasion of privacy. But it’s part of your job as a parent.
You don’t need to be overly controlling or read every single message, but you do have a responsibility to ensure your kids are safe. You can explain to them, "I’m not trying to micromanage. While you’re living under my roof and using the cell phone I provide, this is a privilege, not a right. As long as you follow the rules, I’ll guide you through this complex world. Even as an adult, navigating this can be challenging, and I want to prepare you. When you turn 18 and have full control over your electronics, you’ll remember what we’ve discussed. We’ll talk about difficult topics, like how to handle a request for inappropriate pictures or what to do if a friend expresses suicidal thoughts. It’s tough, but I’m here to help you navigate it now so you’ll be prepared when you’re on your own.”
Reggie: In family therapy, I often use the concept of three rings to illustrate boundaries. You have the parents’ values or boundaries, the child’s boundaries, and then a middle ring where the two overlap. Conflict often arises when someone crosses into the other person’s ring and violates their boundaries. Parents can do this too, not just kids.
The middle ring, where negotiation happens, is crucial. In this space, you can discuss what is negotiable. The boundaries and expectations in your ring are non-negotiable, but in the middle ring, you can have conversations about what can be flexible. It's important to communicate openly about these boundaries and be clear that safety concerns override these boundaries. If a safety issue arises, such as suicidal ideation, immediate action may be necessary, even if it means stepping into the other person’s ring.
Tiffany: Exactly. This ties back to the importance of maintaining open communication, trust, and mutual respect. It’s important to let them know in advance what will happen if there are safety concerns, so they’re not caught off guard.
Allison: Yes, it’s essential to set clear consequences ahead of time. This way, they’re aware of what to expect and won’t be surprised. For example, if I knock on your door and you don’t answer, I’ll come in. Sometimes, in negotiation sessions, I have students suggest their consequences. For instance, if a parent finds their child sending inappropriate pictures, the child might propose what they think the consequence should be.
Tiffany: I love that approach.
Allison: When you come up with consequences together, as a parent, you can then use that agreed-upon consequence if needed. For example, if a consequence was decided on together, you can say, "This was the consequence we agreed on, so I'm just following through." Involving the child in deciding their own consequences can make them more accountable.
Tiffany: The same approach can be applied to handling suicidal ideation. If someone is feeling suicidal and unsafe, discuss and plan what steps to take. For instance, set clear expectations: "Here’s what I expect, and here’s how I want to help. What support do you need?"
Reggie: Exactly.
Tiffany: If suicidal thoughts are a recurring issue in your family, have open conversations about creating a safety plan. Acknowledge that it’s okay to have these issues and plan accordingly. Make sure to set expectations so there are no surprises. For example, discuss how you’ll respond if you need to drive to the ER, call a therapist, or secure certain items that might be tempting.
Allison: For instance, if a teen expresses a desire to commit suicide, you might need to restrict certain privileges, like going out with friends, until they have proper support in place.
Reggie: Right.
Allison: By doing this, you ensure that the child understands their privileges may be limited until they have the necessary support.
Reggie: I’ll add that when kids are involved in the conversation about consequences, they’re more likely to follow through with them.
Tiffany: Oh, I love that. Yes.
Allison: When they’re part of the discussion, they feel like they have more control. They feel included in the decision-making process, rather than just having their parents and therapists dictate the consequences.
Reggie: Yeah, they need a seat at the table.
Allison: When they’re involved, they’re more likely to buy into the process.
Engaging Teens in Therapy Conversations
Tiffany: You’ve covered everything I would have mentioned, so thank you. To wrap up this episode, let’s address a few key points. For teens struggling with suicidal ideation, there may be various factors contributing to their distress. What should parents look for when choosing an outpatient therapist?
Reggie: One important factor is understanding what your child needs. Consider who your child connects with—do they respond better to a male or a female therapist? It’s also crucial to assess whether the therapist can maintain firm boundaries and challenge your child’s negative thinking. Additionally, evaluate the therapist’s expertise in specific therapeutic approaches like DBT (Dialectical Behavior Therapy) or CBT (Cognitive Behavioral Therapy). If there’s a suspicion of trauma, ensure they are skilled in trauma therapies, such as EMDR (Eye Movement Desensitization and Reprocessing).
Tiffany: That’s right. EMDR is a type of therapy used for trauma.
Reggie: Exactly. Also, consider the therapist’s field and initial impressions, including reviews and feedback from others.
Allison: My biggest piece of advice is to be actively involved in your child’s therapy. When I worked in outpatient therapy, parents would often just drop off their children and pick them up, but that’s not enough. It’s crucial to be part of the process. I would regularly invite parents to share their perspectives, either in person or over a call, before or after sessions. This helps keep everyone informed and involved. If necessary, I’d schedule family sessions to address any critical issues, such as finding suicide notes or other serious concerns. Make sure the clinician you choose values family involvement and doesn’t just conduct drop-off and pickup sessions.
Tiffany: I appreciate what you’re saying. I’ve had several friends reach out to me, saying, "Tiffany, my teen is seeing a therapist, but I have no idea what's happening in those sessions. I don’t want to invade their privacy or breach confidentiality." My response is, "They’re a minor; you should know what's going on in therapy. You don’t need every detail, but you should at least get an overview." I often advise them to ask the therapist if they can be involved, perhaps with a 10-minute session at the start or a family session periodically. If the therapist is not willing to include the family, it might be worth finding a different therapist. From my experience in residential settings, where families are deeply involved, it’s hard for me to imagine not including them. I’d hate to think of a teen just walking in, saying whatever they want, and having that taken at face value. It’s important to hear the parents' perspective on how the week has been before the teen comes in.
What do you wish parents understood about dealing with suicidal ideation? If you could leave them with one key message, what would it be?
Reggie: As we’ve mentioned before, sometimes kids don’t want to die; they just want their pain to end. Parents need to create an environment where their child feels comfortable coming to them when they’re feeling vulnerable.
Tiffany: Exactly—connection and vulnerability.
Allison: There is hope. Suicidal thoughts can be managed, and there are effective treatments available. Just because a child has suicidal thoughts doesn’t mean they will act on them. There are supports and treatments in place, and recovery is very possible.
The Possibility of Healing and Recovery
Tiffany: Healing is possible.
Allison: Absolutely, healing is possible.
Tiffany: Even with trauma, substance abuse, or adverse childhood experiences, healing can happen. We’ve seen it ourselves. In our next episode, we hope to share some success stories and examples of hope.
As we wrap up this episode, I want to thank our listeners for joining us. We’ve already touched on some of these topics, but we wanted to dive deeper into the signs parents should watch for. It’s a complex issue. While some individuals may have a genuine desire to die, often they are simply in intense pain, and there are many factors contributing to that pain.
In our next episode, we’ll address what to do if you’ve found a therapist, asked the tough questions, been open and vulnerable, and things still aren’t improving. What comes next? That’s when we explore residential treatment options, like those offered at OASIS Ascent. We’ll discuss what to expect from residential treatment and how parents can navigate this challenging situation. Stay tuned, and thank you all for joining us.
Reggie: Thank you.
Allison: Thanks, Tiffany.