Abstract
Suicide is the second leading cause of death among youth, and as many as one in five youth report having had at least one serious thought of suicide in the past year. Despite the enormous emotional pain and suffering associated with suicidal thoughts and behaviors, up to 40 % of suicidal youth never receive treatment. Given that social workers are employed in multiple settings where suicidal children and adolescents are encountered (e.g. schools, homeless shelters, emergency departments, outpatient mental health agencies, private practice), they play a critical role in the identification and treatment of suicidal youth. In the past decade, evidence has emerged that attachment-based family therapy, integrated cognitive behavioral therapy, and dialectical behavior therapy can reduce suicidal ideation and/or suicide attempt in youth. The purpose of this article is to review the theoretical assumptions, conceptual frameworks and key intervention techniques for these three interventions so that clinicians can integrate these approaches into their practice with suicidal youth and families. Implications for practice are integrated throughout the review.
Similar content being viewed by others
References
Ainsworth, M. S., & Bowlby, J. (1991). An ethological approach to personality development. American Psychologist, 46, 333–341. doi:10.1037/0003-066X.46.4.333.
Almeida, J., O’Brien, K., Gross, E., & Gironda, C. (in press). Development, implementation, and evaluation of a comprehensive course on suicide in a Masters of Social Work program. Journal of Social Work Education.
Asarnow, J. R., Porta, G., Spirito, A., Emslie, G., Clarke, G., Wagner, K. D., … Brent, D. A. (2011). Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents: Findings from the TORDIA study. Journal of the American Academy of Child & Adolescent Psychiatry, 50, 772–781. doi: 10.1016/j.jaac.2011.04.003
Bagge, C., & Sher, K. J. (2008). Adolescent alcohol involvement and suicide attempts: Toward the development of a conceptual framework. Clinical Psychology Review, 28, 1283–1296.
Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Saddle River, NJ: Prentice-Hall.
Barrio, C. A. (2007). Assessing suicide risk in children: Guidelines for developmentally appropriate interviewing. Journal of Mental Health Counseling, 29, 50–66.
Brent, D. A., McMakin, D. L., Kennard, B. D., Goldstein, T. R., Mayes, T. L., & Douaihy, A. B. (2013). Protecting adolescents from self-harm: A critical review of intervention studies. Journal of the American Academy of Child and Adolescent Psychiatry, 52, 1260–1271.
Brown, R. A., Strong, D. R., Abrantes, A. M., Myers, M. G., Ramsey, S. E., & Kahler, C. W. (2009). Effects on substance use outcomes in adolescents receiving motivational interviewing for smoking cessation during psychiatric hospitalization. Addictive Behaviors, 34, 887–891.
Calear, A. L., Christensen, H., Freeman, A., Fenton, K., Busby Grant, J., van Spijker, B., & Donker, T. (2016). A systematic review of psychosocial suicide prevention interventions for youth. European Child & Adolescent Psychiatry, 25, 467–482. doi:10.1007/s00787-015-0783-4.
Centers for Disease Control and Prevention. (2014). National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. Retrieved March 6, 2016 from http://www.cdc.gov/ncipc/wisqars.
Corcoran, J., Dattalo, P., Crowley, M., Brown, E., & Grindle, L. (2011). A systematic review of psychosocial interventions for suicidal adolescents. Children and Youth Services Review, 33, 2112–2118. doi:10.1016/j.childyouth.2011.06.017.
Council on Social Work Education. (2015). Educational Policy and Accreditation Standards. Alexandria, VA: Council on Social Work Education.
Daniel, S. S., & Goldston, D. B. (2009). Interventions for suicidal youth: A review of the literature developmental considerations. Suicide and Life Threatening Behavior, 39, 252–268.
Diamond, G. M. (2014). Attachment-based family therapy interventions. Psychotherapy, 51, 15–19. doi:10.1037/a0032689.
Diamond, G. S., Creed, T., Gillham, J., Gallop, R., & Hamilton, J. L. (2012a). Sexual trauma history does not moderate treatment outcome in attachment-based family therapy (ABFT) for adolescents with suicide ideation. Journal of Family Psychology, 26, 595–605. doi:10.1037/a0028414.
Diamond, G. S., Diamond, G. M., & Levy, S. A. (2013). Attachment-Based Family Therapy (ABFT) [National Registry of Evidence-based Programs and Practices (NREPP)]. Retrieved September 22, 2015 from http://nrepp.samhsa.gov/ViewIntervention.aspx?id=314
Diamond, G. S., Diamond, G. M., & Levy, S. A. (2014). Task I: Relational reframe. In G. S. Diamond, G. M. Diamond, & S. A. Levy (Eds.) Attachment-based family therapy for depressed adolescents (pp. 61–95). Washington: American Psychological Association. Retrieved from http://content.apa.org/books/14296-004
Diamond, G. M., Diamond, G. S., Levy, S., Closs, C., Ladipo, T., & Siqueland, L. (2012b). Attachment-based family therapy for suicidal lesbian, gay, and bisexual adolescents: A treatment development study and open trial with preliminary findings. Psychotherapy, 49, 62–71. doi:10.1037/a0026247.
Diamond, G. S., Reis, B. F., Diamond, G. M., Siqueland, L., & Isaacs, L. (2002). Attachment-based family therapy for depressed adolescents: A treatment development study. Journal of the American Academy of Child and Adolescent Psychiatry, 41(10), 1190–1196. doi:10.1097/00004583-200210000-00008.
Diamond, G. S., Wintersteen, M. B., Brown, G. K., Diamond, G. M., Gallop, R., Shelef, K., & Levy, S. (2010). Attachment-based family therapy for adolescents with suicidal ideation: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 122–131.
Donaldson, D., Spirito, A., & Esposito-Smythers, C. (2005). Treatment for adolescents following a suicide attempt: Results of a pilot trial. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 113–120. doi:10.1097/00004583-200502000-00003.
Donath, C., Graessel, E., Baier, D., Bleich, S., & Hillemacher, T. (2014). Is parenting style a predictor of suicide attempts in a representative sample of adolescents? BMC Pediatrics, 14, 1–13. doi:10.1186/1471-2431-14-113.
Erbacher, T. A., Singer, J. B., & Poland, S. (2015). Suicide in schools: A practitioner’s guide to multi-level prevention, assessment, intervention, and postvention. New York: Routledge.
Esposito-Smythers, C., & Goldston, D. B. (2008). Challenges and opportunities in the treatment of adolescents with substance use disorder and suicidal behavior. Substance Abuse, 29, 5–17.
Esposito-Smythers, C., Spirito, A., Kahler, C. W., Hunt, J., & Monti, P. (2011). Treatment of co-occurring substance abuse and suicidality among adolescents: A randomized trial. Journal of Consulting and Clinical Psychology, 79, 728–739.
Esposito-Smythers, C., Walsh, A., Spirito, A., Rizzo, C., Goldston, D., & Kaminer, Y. (2012). Working with the suicidal client who also abuses substances. Cognitive and Behavioral Practice, 19, 244–255.
Feldman, B. N., & Freedenthal, S. (2006). Social work education in suicide intervention and prevention: An unmet need? Suicide and Life-Threatening Behavior, 36, 467–480.
Fleischhaker, C., Böhme, R., Sixt, B., Brück, C., Schneider, C., & Schulz, E. (2011). Dialectical Behavioral Therapy for adolescents (DBT-A): A clinical trial for patients with suicidal and self-injurious behavior and borderline symptoms with a one-year follow-up. Child and Adolescent Psychiatry and Mental Health, 5, 1–10. doi:10.1186/1753-2000-5-3.
Galaif, E. R., Sussman, S., Newcomb, M. D., & Locke, T. F. (2007). Suicidality, depression, and alcohol use among adolescents: A review of empirical findings. International Journal of Adolescent Medical Health, 19, 27–35.
Garraza, L., Walrath, C., Goldston, D. B., Reid, H., & McKeon, R. (2015). Effect of the Garrett Lee Smith Memorial Suicide Prevention Program on Suicide Attempts Among Youths. JAMA Psychiatry, 72, 1143–1149. doi:10.1001/jamapsychiatry.2015.1933.
Goldston, D. B. (2004). Conceptual issues in understanding the relationship between suicidal behavior and substance use in adolescence. Drug and Alcohol Dependence, 76(Suppl), 79–91.
Harrington, R., Kerfoot, M., Dyer, E., McNiven, F., Gill, J., Harrington, V., … Byford, S. (1998). Randomized trial of a home-based family intervention for children who have deliberately poisoned themselves. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 512–518
Hawkins, E. H. (2009). A tale of two systems: Co-occurring mental health and substance abuse disorders treatment for adolescents. Annual Review of Psychology, 60, 197–227.
Huey, S. J., Jr., Henggeler, S. W., Rowland, M. D., Halliday-Boykins, C. A., Cunningham, P. B., Pickrel, S. G., & Edwards, J. (2004). Multisystemic therapy effects on attempted suicide by youths presenting psychiatric emergencies. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 183–190. doi:10.1097/00004583-200402000-00014.
Joiner, T. E., & Ribeiro, J. D. (2011). Assessment and Management of Suicidal Behavior in Children and Adolescents. Pediatric Annals, 40, 319–324. doi:10.3928/00904481-20110512-08.
Klonsky, E., May, A. M., & Glenn, C. R. (2013). The relationship between nonsuicidal self injury and attempted suicide: Converging evidence from four samples. Journal of Abnormal Psychology, 122, 231–237. doi:10.1037/a0030278.
Kuntsche, E., Knibbe, R., Gmel, G., & Engels, R. (2005). Why do young people drink? A review of drinking motives. Clinical Psychology Review, 25, 841–861.
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.
MacPherson, H., Cheavens, J., & Fristad, M. (2013). Dialectical Behavior Therapy for Adolescents: Theory, treatment adaptations, and empirical outcomes. Clinical Child and Family Psychology Review, 16, 59–80. doi:10.1007/s10567-012-0126-7.
Main, M., Hesse, E., & Kaplan, N. (2005). Predictability of attachment behavior and representational processes at 1, 6, and 19 years of age: The Berkeley Longitudinal Study. In K. E. Grossmann, K. Grossmann, & E. Waters (Eds.), Attachment from infancy to adulthood: The major longitudinal studies (pp. 245–304). New York: The Guilford Press.
Mazza, J. J., Dexter-Mazza, E. T., Miller, A. L., Rathus, J. H., & Murphy, H. E. (2016). DBT skills in schools: Skills training for emotional problem solving for adolescents (DBT STEPS-A). New York: The Guilford Press.
McConnell, M., & Moss, E. (2011). Attachment across the life span: Factors that contribute to stability and change. Australian Journal of Educational & Developmental Psychology, 11, 60–77.
Mehlum, L., Ramberg, M., Tørmoen, A. J., Haga, E., Diep, L. M., Stanley, B. H., … Grøholt, B. (2016). Dialectical behavior therapy compared with enhanced usual care for adolescents with repeated suicidal and self-harming behavior: Outcomes over a one-year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 55, 295–300. doi: 10.1016/j.jaac.2016.01.005
Mehlum, L., Tørmoen, A. J., Ramberg, M., Haga, E., Diep, L. M., Laberg, S., … Grøholt, B. (2014). Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: a randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53, 1082–1091. http://doi.org/10.1016/j.jaac.2014.07.003.
Miller, A. L., Rathus, J. H., & Linehan, M. (2007). Dialectical behavior therapy with suicidal adolescents. New York: Guilford Press.
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). New York: Guilford Press.
National Association of Social Workers. (1996/2008). Code of Ethics of the National Association of Social Workers. Retrieved from http://www.naswdc.org/pubs/code/code.asp.
Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: Results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry, 70, 300–310. doi:10.1001/2013.jamapsychiatry.55.
O’Brien, K. H. M., 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 and Consultation Therapy, 9(3), 19–25.
Ougrin, D., Tranah, T., Stahl, D., Moran, P., & Asarnow, J. R. (2015). Therapeutic interventions for suicide attempts and self-harm in adolescents: Systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 54, 97–107.
Pisani, A. R., Wyman, P. A., Petrova, M., Schmeelk-Cone, K., Goldston, D. B., Xia, Y., & Gould, M. S. (2013). Emotion regulation difficulties, youth-adult relationships, and suicide attempts among high school students in underserved communities. Journal of Youth and Adolescence, 42, 807–820. doi:10.1007/s10964-012-9884-2.
Ribeiro, J. D., Bodell, L. P., Hames, J. L., Hagan, C. R., & Joiner, T. E. (2013). An empirically based approach to the assessment and management of suicidal behavior. Journal of Psychotherapy Integration, 23, 207–221. doi:10.1037/a0031416.
Rizvi, S. L., & Ritschel, L. A. (2014). Mastering the art of chain analysis in dialectical behavior therapy. Cognitive and Behavioral Practice, 21, 335–349. doi:10.1016/j.cbpra.2013.09.002.
Robinson, J., Cox, G., Malone, A., Williamson, M., Baldwin, G., Fletcher, K., & O’Brien, M. (2013). A systematic review of school-based interventions aimed at preventing, treating, and responding to suicide-related behavior in young people. Crisis, 34, 164–182. doi:10.1027/0227-5910/a000168.
Rossouw, T. I., & Fonagy, P. (2012). Mentalization-based treatment for self-harm in adolescents: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 51(1304–1313), e3. doi:10.1016/j.jaac.2012.09.018.
Ruth, B. J., Gianino, M., Muroff, J., McLaughlin, D., & Feldman, B. N. (2012). You can’t recover from suicide: Perspectives on suicide education in MSW programs. Journal of Social Work Education, 48, 501–516.
Scheel, K. R. (2000). The empirical basis of dialectical behavior therapy: Summary, critique, and implications. Clinical Psychology: Science and Practice, 7, 68–86. doi:10.1093/clipsy/7.1.68.
Schilling, E. A., Aseltine, R. H., Glanovsky, J. L., James, A., & Jacobs, D. (2009). Adolescent alcohol use, suicidal ideation, and suicide attempts. Journal of Adolescent Health, 44, 335–341.
Scott, M. (2015). Teaching Note—Understanding of Suicide Prevention, Intervention, and Postvention: Curriculum for MSW Students. Journal of Social Work Education, 51, 177–185. doi:10.1080/10437797.2015.979095.
Sharma, T., Guski, L. S., Freund, N., & Gøtzsche, P. C. (2016). Suicidality and aggression during antidepressant treatment: Systematic review and meta-analyses based on clinical study reports. BMJ (Clinical Research Edition), 352, i65.
Shea, S. C. (2002). The practical art of suicide assessment: A guide for mental health professionals and substance abuse counselors. Lexington, KY: Mental Health Presses.
Sher, L. (2006). Alcohol consumption and suicide. QJM, 99, 57–61.
Sher, L., & Zalsman, G. (2005). Alcohol and adolescent suicide. International Journal of Adolescent Medical Health, 17, 197–203.
Singer, J. B., & Greeno, C. M. (2013). When Bambi Meets Godzilla: A practitioner’s experience adopting and implementing a manualized treatment in a community mental health setting. Best Practices in Mental Health, 9, 99–115.
Spirito, A., Esposito-Smythers, C., Wolff, J., & Uhl, K. (2011). Cognitive-behavioral therapy for adolescent depression and suicidality. Child and Adolescent Psychiatric Clinics of North America, 20, 191–204. doi:10.1016/j.chc.2011.01.012.
Stanley, B., Brown, G., Brent, D. A., Wells, K., Poling, K., Curry, J., … Hughes, J. (2009). Cognitive-behavioral therapy for suicide prevention (CBT-SP): Treatment model, feasibility, and acceptability. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 1005–1013
Swales, M. A., Taylor, B., & Hibbs, R. A. B. (2012). Implementing Dialectical Behaviour Therapy: Programme survival in routine healthcare settings. Journal of Mental Health, 21, 548–555. doi:10.3109/09638237.2012.689435.
Tanner-Smith, E. E., & Lipsey, M. W. (2015). Brief alcohol interventions for adolescents and young adults: A systematic review and meta-analysis. Journal of Substance Abuse Treatment, 51, 1–18.
Thyer, B. A. (2001). What is the Role of Theory in Research on Social Work Practice? Journal of Social Work Education, 37, 9–25. doi:10.1080/10437797.2001.10779034.
Ting, L., Jacobson, J. M., & Sanders, S. (2008). Available supports and coping behaviors of mental health social workers following fatal and nonfatal client suicidal behavior. Social Work, 53, 211–221.
Walrath, C., Garraza, L. G., Reid, H., Goldston, D. B., & McKeon, R. (2015). Impact of the Garrett Lee Smith youth suicide prevention program on suicide mortality. American Journal of Public Health, 105, 986–993. doi:10.2105/AJPH.2014.302496.
Wells, E. A., Kristman-Valente, A. N., Peavy, K. M., & Jackson, T. R. (2013). Social workers and delivery of evidence-based psychosocial treatments for substance use disorders. Social Work in Public Health, 28, 279–301. doi:10.1080/19371918.2013.759033.
Wong, S., Zhou, B., Goebert, D., & Hishinuma, E. (2013). The risk of adolescent suicide across patterns of drug use: A nationally representative study of high school students in the United States from 1999 to 2009. Social Psychiatry and Psychiatric Epidemiology, 48, 1611–1620. doi:10.1007/s00127-013-0721-z.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Singer, J.B., O’Brien, K.H.M. & LeCloux, M. Three Psychotherapies for Suicidal Adolescents: Overview of Conceptual Frameworks and Intervention Techniques. Child Adolesc Soc Work J 34, 95–106 (2017). https://doi.org/10.1007/s10560-016-0453-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10560-016-0453-5