Working with the Family of the Suicidal or Self-Injuring Child

When their child or adolescent requires an inpatient psychiatric hospital admission, parents often are left feeling blame, guilt, anger, and frustration, and statements such as “Where did we go wrong?” can be a common experience through this process. It’s important early on to expect the unexpected and work as best as you can with the family in providing them with as much support and psychoeducation as possible.

This is not an easy task to complete at times because there may be multiple barriers involved in regard to their comprehension of their child’s symptoms, coming to terms with the fact that a problem exists, their child’s diagnosis, or even comprehending the mindset of their child who may have tried to kill themselves or is engaging in ongoing self-injurious behaviors that were hidden from the family.

The clinician’s role is to identify and provide the support they need. I have found it beneficial to use the family systems model by Robert Schwartz since it allows the clinician to dissect the family dynamic and break it into working parts. Providing families with adequate coping strategies is especially useful in situations when the identified child or adolescent is experiencing ongoing selfinjurious behavior as a way of finding relief from their mix of emotions. This can, in some cases, feel debilitating and give rise to feelings of helplessness for parents and families because it’s not something they themselves may comprehend. This is where the family intervention is extremely helpful in exploring what is triggering the behavior and why.

Many times during the evaluation process we ask the patient, “What makes you cut?” Their response at times is the inability to cope with all their emotions within one given moment. We also evaluate what is their intent when they cut, what they use, how often they cut, if they hide it from family, school, or friends, how deep was the cut, and whether it was superficial or they required any suturing? Once we have explored this further, it takes away the stigma and embarrassment, which helps the patient to feel empowered to actually open up about their emotions. Parents and families often are open to these techniques, and it helps to replace feelings of helplessness with feeling empowered.

There are several techniques, such as the use of the rubber band, which focus on helping the child to cope with a desire to injure themselves. I like using some of the newer toys, such as “loom bracelets,” for this purpose. Many of the kids and even the adolescents have enjoyed using these. Loom bracelets use a plastic loom that allows the child to weave colorful rubber bands into bracelets and charms. I tell the child to pick a series of colors they believe represents strength, and encourage the parents to participate in the process, which helps to elicit more support to the patient and family interaction. The use of crayons for drawing is a useful tool in evaluating children in the ER. It helps them to open up especially in cases of trauma. It is fairly economical to carry around a pack of crayons and paper if it means this technique will help your patient.

Remember with children and adolescents we must meet them where they are at if we expect them to discuss establishing any sort of adaptive change.

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