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Treating a Suicidal Teen with the Four-Step
Crisis Intervention Model
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In the last section, we 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 this 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.
I first met Ben, 17, after he had attempted to hang himself. Ben ’s suicide note had stated that he could not stand being separated from his girlfriend of two years, Ally. Ally had been forced to move to another state when her father’s company transferred him.
4-Step Crisis Intervention
♦ Step #1 - Establish Rapport
My first step in the crisis intervention with Ben was to establish rapport. Identifying feelings and active listening were the main topic in this first step. Identifying Ben’s feelings laid the foundation for the rest of our conversation, and helped to establish a trust relationship between Ben and myself.
As you are well aware, when a suicidal teen’s feelings are discussed and listened to with acceptance and respect, the sharpness, intensity, and overwhelming aspect of the teen client’s emotions are reduced. The issues behind the suicidal crisis become more clear, and the person in crisis can reason and problem solve more effectively. By helping Ben separate thoughts and feelings, I proved my understanding.
♦ Step #2 - Explore the Problem
A second step in the crisis intervention model is to explore the problem. During this step, I continued to reflect both the feelings and content of Ben’s explanation by using the model "you feel…. because…"
Ben stated, "My parents really wanted me to go to college after I graduated, but all I want is to marry Ally and get a job. When Ally told me she had to move, I started panicking. I didn’t know who to go to or what to do. I knew mom and dad wouldn’t understand, they wanted me to dump Ally anyway. I knew I was just going to get a job after school, so my grades dipped a lot. Mom and Dad didn’t understand, they blamed my relationship with Ally. They never understood how much I love Ally. The thought of losing her was just more than I could take."
I stated, "You feel lost and hopeless because Ally is moving 1,000 miles away" in order to reflect both Ben’s feelings and his explanation of the events that precipitated his suicidal crisis.
♦ Step #3 - Focus
In addition to establishing rapport and exploring the problem, a third step in the crisis intervention model is focus. Clearly, Ben was facing several difficulties, including his slipping grades at school, the fact that he disagreed with his parents over his goals after graduation, and the loss of Ally. In this stage of the crisis intervention, my goal was to help Ben decide what immediate change he wanted to see.
Clearly, trying to solve all of these problems at once would be too overwhelming, and trying to handle all of Ben’s problems at once would be unproductive. With guidance, Ben chose to focus on dealing with Ally’s departure. Thus my focus as a therapist began helping Ben learn coping mechanisms for handling loss.
♦ Step #4 - Seek Alternatives
A fourth step in my crisis intervention for Ben’s suicidal crisis was to help Ben seek alternatives. I focused first on assessing Ben’s available resources. We first discussed Ben’s sources of social support, including his friends at school. Since active listening had helped reduce the sharpness of Ben’s feelings, Ben was able to react with more logic and reason.
Our discussion turned to Ben’s breakup with his previous girlfriend, and identifying the coping mechanisms he had used in that situation. Together we developed a step by step outline of what to do about his feelings about Ally’s move. I encouraged Ben to recognize that while suicide is always an available option, there are other options that can be explored first.
"Do’s and Don’ts of Crisis Intervention" Technique
Ben’s best friend, Greg, expressed a desire to help Ben through his crisis. I provided Greg and other members of Ben’s interpersonal support system with the "Do’s and Don’ts of Crisis Intervention" technique. As I describe the Do’s and Don’ts technique I used with Greg, compare it to the guidance you are currently giving to individuals helping in your client’s suicidal crisis.
1. Be aware. Learn the warning signs. I reviewed with Greg the warning signs discussed in Section 2.
2. Get involved. Become available and show interest and support.
3. Ask specifically if your loved one is thinking about suicide. Use specifically words like ‘suicide,’ ‘die,’ or ‘kill’. Use a question like ‘Do you want to die?’ rather than ‘You’re not thinking of killing yourself, are you?’ Questions like this will offer your loved one a source of relief and set you up as a person willing to listen.
4. Be direct. Talk openly and freely about suicide.
5. Be willing to listen. Allow expression of feelings and accept the feelings. Don’t tell him or her to feel better.
6. Be nonjudgmental. Don’t debate whether suicide is right or wrong, or feelings are good or bad. Don’t lecture of the value of life.
7. Don’t dare him or her to do it.
8. Don’t give advice by making decisions for someone else. Don’t tell her or him to behave differently.
9. Don’t ask why. That encourages defensiveness.
10. Offer empathy, not sympathy.
11. Don’t act shocked. That will put distance between you.
12. Don’t be sworn to secrecy. Seek support.
13. Offer hope that alternatives are available but do not offer glib reassurance. It only proves you don’t understand.
14. Take action. Remove the means to commit suicide from the loved one’s environment. I provided Greg and other members of Ben’s support system with 24-hour crisis resources they could call if I was not available to help.
Think of your Ben. Would providing the Do’s and Don’ts technique to her or his support system strengthen the resources available to your suicidal teen client?
In this section, we have discussed 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.
In the next section, we will discuss six risk factors for teen suicide. These six risk factors are abuse, childhood loss, school performance, personality traits, parental relationships, and family patterns
What are four steps in a crisis intervention model for a suicidal teen client?
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