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mechanisms associated with the reduction of suicidality in adolescents (Pineda & Dadds, 2013). Although not surprising to family therapists, these findings direct us to carefully consider how relationships can be restructured to protect against suicide.
While there are many systemic approaches to treating suicidal youth
to date, there are only a few systemic approaches that have gained research support. One of these approaches, the resourceful adolescent-parent program (RAP; Shochet, Wurfl, & Hoge, 2004) helps parents to create a stronger home and family environment to promote healthy development. This model has psychoeducational and training materials for multiple systems: child, parents, and school. Another approach, attachment- based family therapy (ABFT; Diamond, Diamond, & Levy, 2013) focuses primarily on changing the quality of relationships within the family system. Specifically, ABFT uses the parent-child bond to protect against suicide.
RAP is a psychoeducation and skills- based approach that targets change in the family and school environments. RAP-A (adolescent) is focused on building personal strengths, support, and problem-solving skills among
youth (Shochet et al., 2004). Cognitive- behavioral techniques are used to teach adolescents how to calm themselves during times of distress. The parent component (RAP-P) is also strengths- based and helps parents increase self-esteem for themselves and for their adolescents (Pineda & Dadds, 2013). Parents are taught skills in order to
help them regulate their emotions and reduce conflict in the home. RAP also involves larger systems in the treatment. Specifically, in RAP-T, teachers can promote connectedness in school and create a strength-based protective environment. All elements of RAP are grounded in ongoing research.
ABFT is an empirically-supported intervention specifically for depressed and suicidal youth (National Registry
of Evidence-based Programs and Practices [NREPP], 2013). It is the only emotion-focused, family-based approach specifically developed for this population. The aim of this therapy is to improve the family’s capacity for problem solving, affect regulation, and organization.
Building family competence in these areas strengthens family cohesion—a buffer against depression, suicidal thinking, and risk behaviors (Garber, Robinson, & Valentiner, 1997; Restifo
& Bögels, 2009). ABFT is rooted in structural family therapy (Minuchin, 1974), multidimensional family therapy (Liddle, 2001), and emotionally-focused therapy (Johnson, 1996), and shares many of their conceptualizations and strategies. Attachment theory (Bowlby, 1970), however, provides the over- arching framework for understanding and intervening in the clinical process. The model has been successful with youth struggling with a history of
sexual abuse, parental depression, and parental rejection of sexual identity (Diamond, Diamond, Levy, Closs, Ladipo, & Siqueland, 2012). Whereas minority adolescents have been remarkably absent from many of the clinical trials testing interventions for suicide (Bernal, Jiménez-Chafey, & Rodríguez, 2009), ABFT has a history of success working with African American, Latino/a and multiracial families as well as lesbian, gay, bisexual and questioning (LGBQ) youth (Diamond, Creed, Gillham, Gallop, & Hamilton, 2012; Levy, Russon, & Diamond, 2016).
Building clinical competence
Family therapists are in a unique position to use suicide prevention tools and approaches within a systemic context. Many of the empirically- supported tools and practices discussed in this article are focusing on individuals. Family therapists must help to understand how to engage families and larger systems while using these intervention strategies. In order to achieve this goal, the first step is building your suicide prevention competence. Attending trainings regularly allows family therapists to stay in touch with new research and clinical findings that can help enhance practice. Through continuing education, it is vital to become acquainted with the content and language of suicide (thoughts, intent, plan, non-suicidal self-injury, attempt)
in order to differentiate levels of risk. It is also important for family therapists
to understand the family processes that may be associated with suicide (problem denial, neglect, familial pressure to achieve, abuse, unresolved loss). It is the
integration of content and process that places family therapists in the position to bring unique contributions to the prevention of youth suicide. Rather than only focusing on helping youth learn to cope with family dysfunction, systemic thinkers believe that families are the cure that youth need to make long-term therapeutic gains. By building our knowledge and skills, we can act as catalysts and guide families to better help themselves. Families are our best allies in the prevention of youth suicide.
Jody Russon,
PhD, is a research associate, project manager and adjunct faculty member
in the Couple and Family Therapy Department at
Drexel University. Her research interests involve the implementation of family interventions for suicidal, LGBTQI youth. She is a Pre-Clinical Fellow of AAMFT.
Quintin Hunt, MS,
is a pre-doctoral fellow in the Couple and Family Therapy Department at Drexel University and PhD student
at the University
of Minnesota. His research interests involve best practices in family-based psychotherapy, the process of suicide bereavement, and the development of secure attachment relationships. He is a Pre-Clinical Fellow of AAMFT.
References
American Association of Suicidology (2016, November 10). Retrieved from http://www.suicidology.org/resources/warning-signs.
Berman, A. L. (2011). Ethical and legal issues in the treatment of suicidal youth. Presentation at the Pennsylvania Youth Suicide Prevention Symposium.
Bernal, G., Jiménez-Chafey, M. I., & Rodríguez, M. M. D. (2009). Cultural adaptation of treatments: A resource for considering culture in evidence-based practice. Professional Psychology: Research and Practice, 40(4), 361-368.
Bishop, M., Tedeschi, L., & Caldwell, B. (2015). Ethical decision- making: Four basic rules: Some thoughts from the AAMFT ethics committee, Family Therapy Magazine,15(5), 22-27.
Bowlby, J. (1970). Disruption of affectional bonds and its effects on behavior. Journal of Contemporary Psychotherapy, 2(2), 75-86.
Brent, D. A., Bridge, J., Johnson, B. A., & Connolly, J. (1996). Suicidal behavior runs in families: a controlled family study of adolescent suicide victims. Archives of General Psychiatry, 53(12), 1145-1152.
Diamond, G., Creed, T., Gillham, J., Gallop., & Hamilton, J. L. (2012). Sexual trauma history does not moderate treatment outcome in attachment-based family therapy (ABFT) for adolescents with suicide ideation. Journal of Family Psychology, 26(4), 595-605.
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