Content Note: This article explores topics of suicide and suicidal ideation. Help is always available. Dial 988 if you are experiencing suicidal thoughts or need help supporting a loved one.
Suicide and suicidal ideation are difficult to talk about. It’s many parents worst fear that they might lose their child to suicide after a prolonged struggle with depression, anxiety, or substance use. This fear can keep people from talking about it openly.
Approaching the subject without stigma or shame, however, is more important than ever. Today, suicide is the second leading cause of death for teens and young adults, and suicide rates increased approximately 36% between 2000–2021.
“Not having the space to be able to talk about what’s going on increases the risk of suicidal ideation,” says The Dorm’s Assistant Director Alexa Connor, LMSW. “Young adults need a space to be who they are, and process what’s going on for them.”
As an intensive outpatient treatment specializing in young adult treatment, many of our clients enter treatment with suicidal ideation (SI). On average, 32% of our admitting clients express thoughts of self harm or suicide upon admission to The Dorm.
During treatment, however, we see promising trends that show that recovery is possible for those who struggle with SI. At discharge, our outcomes show a 78% decline in psychiatric emergencies (versus prior to admission) and a 48% increase in well-being, encompassing perceived quality of life and renewed joy in activities.
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We attribute this, in part, to the strength of our integrative community model, which incorporates several research-backed protective factors, including:
- Intentional community integration, guided by licensed therapists
- Individual & group therapies that target effective coping skills, problem-solving skills, and building a strong sense of personal identity & agency
- Ongoing family support and psycho-education
In this article, discover the specific modalities and interventions that can support young people in need, including those we incorporate at The Dorm.
Key Article Takeaways:
Young adults experiencing suicidal ideation are not alone – suicide is the second leading cause of death in the US and an urgent international health issue.
It’s important to talk to young people experiencing suicidal or self-harm thoughts openly, with curiosity, and without judgement.
We share several evidence-based therapies that help young adults find relief from and prevent suicidal ideation.
Evidence-based Treatment for Suicidal Ideation
There are several established treatments for young people struggling with suicidal thoughts or plans. Some treatments are used for longer-term recovery from passive suicidal ideation, while others are employed during acute periods of crisis, to de-escalate suicidal urges.
Below, we outline several evidence-based treatment options we use to help young adults in any stage of the continuum of suicidality.
Community Integration
Over the past several decades, community integration models have gained popularity for suicide prevention in response to widespread mental health crises. Research supports a community-based approach to suicide prevention, showing that friendships correlate with levels of depression. Likewise, impaired friendships predict a greater risk of attempted suicide.
However, forming new relationships and friendships can be difficult in young adulthood, especially for those struggling with depression & anxiety, trauma, disordered eating, or neurodivergence. At The Dorm, we offer an place for youth struggling with a variety of mental health challenges to come together and connect through shared goals, experiences, and downtime between group & individual therapy.
“The Dorm provides a safe space for clients to connect with others struggling with similar feelings and to feel less alone in their thoughts,” says Senior Therapist Cristina Escobar, LMSW.
“The ability to build community and connect in the midst of struggling with suicidality can be immensely helpful to our clients with suicidal ideation. That connection, along with the work they do individually and in group therapy, allows them to work towards decreasing their suicidal ideation and to begin living a more fulfilling life and seeing more hope for their future.”
From a strong emphasis on in-person treatment that fosters day-to-day connection, to regular social activities, we encourage friendships within our client base because we know recovery happens through relationships.
Established communities help clients feel that they are a part of something and provide a sense of belonging. In The Dorm’s Community Clubhouse, for example, “clients have the opportunity to engage in meaningful friendships, which can help contribute to an overall bigger sense of support and feelings of acceptance, while also reducing feelings of rejection and isolation,” says Alexa Connors, LMSW. “The events in the clubhouse are so fun so they also provide a space for clients to take breath or a break in between groups that often be emotionally taxing.”
Group Therapy for Suicidal Ideation
A Safe Space for Sharing, Free of Stigma or Shame
As a more formalized extension of community integration, group therapy is often the core pillar of recovery for young adults experiencing suicidal ideation, helping them feel less alone and isolated.
Many treatment centers, including The Dorm, are now encouraging people to not shy away from using specific language surrounding suicidal ideation as they once did. This can be an enormous relief for young adults who have never been able to voice their thoughts and find community through honesty and transparency.
“Not being able to communicate your thoughts can perpetuate feelings of shame or taboo,” explains Alexa Connors, LMSW.
“We need to put an emphasis on honesty and naming what you’re dealing with very openly. For many of our clients, this might be new — there’s a common myth that talking about topics such as a suicide is problematic — but at The Dorm it is welcomed, if in the group setting it can talked about openly with the support of a clinician, then I think that automatically makes people feel safer and brings a lot of relief.”
Group settings also offer clients an opportunity to work on building core coping and problem solving skills that have been shown to be a key suicide protective factor.
Group Therapy for Building Coping Skills
Group therapy offers an environment to learn new skills from licensed experts, and then practice them within a supportive peer community. Some of those groups available at The Dorm include:
Intensive & Comprehensive DBT
Following Marsha Linnehan’s standard DBT curriculum, DBT groups implement the evidence-based, cognitive behavioral treatment methods focusing on four sets of skills: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. “Intensive DBT allows clients to manage intense emotions, utilize coping skills, and communicate effectively, all which can help them navigate and manage suicidal thoughts,” says Cristina Escobar, LMSW.
Urge Surfing
Exclusive to The Dorm, this group is for clients overcoming addictive behaviors beyond substance use. Clients learn to “ride out the wave” of urges and minimize them using specific techniques, including behavior chain analysis, diary cards, skills and process work. “Our urge surfing group allows space for clients to discuss their suicidal thoughts and urges and get support from others who experience similar thoughts and feelings,” explains Cristina.
Seeking Safety
Trauma and PTSD may go hand in hand with suicidal ideation. For this reason, our trauma-informed groups can offer an ideal environment for supportive community connection and processing. The Seeking Safety Program, developed by Lisa Najavits, creates an environment of safety and follows an established curriculum for processing trauma as a group.
Group Therapy for Developing Personal Identity & Agency
Identity and self-acceptance are huge components of recovering from suicidal ideation, and people who are in minority groups experience higher rates of suicide. Young adults struggling with SI can often benefit from finding affinity groups specifically tailored to their gender, ethnicity, age, race, or cultural background.
At The Dorm, for example, we offer several processing groups specific to a client’s gender, sexuality, race, or mental health struggle, like Transgender Nonbinary Process Group, or the Affinity Group for Clients of Color. Process groups like these provide clients with an opportunity to safely discuss, explore and process issues directly related to each group’s socio-emotional needs and health-related issues.
Therapies & Coping Skills for Suicidal Ideation
Therapists have identified several targeted ways to address and treat suicidality. The American Foundation for Suicide Prevention recommends the following therapies, several of which we employ with clients at The Dorm in group therapy, individual therapy, clinical coaching, and family therapy.
Dialectical Behavior Therapy (DBT)
This evidence-based psychotherapy has proven effective at treating multiple clinical diagnoses, and Dorm therapists draw from several DBT Skills to help clients with suicidal ideation. These skills are designed to help individuals regulate their emotions, interact interpersonally, and effectively cope with crises. Below, find a few examples of coping skills that can help alleviate symptoms of suicidality.
DBT Skill: Accumulating Positives
“‘Accumulating Positives’ is a skill where clients learn to identify and take part in pleasant activities which make them feel good, such as going on a walk, ordering takeout, hanging out with friends, going to the movies. As clinical coaches we try to actually go do these things with the client, exposing them to things that increase positive emotions,” explains Alexa.
DBT Skill: The TIPP Method
The TIPP method (temperature, intense exercise, pace breathing, and progressive muscle relaxation) helps people move beyond an urge of suicidal feelings or self harm, through altering their heightened emotional state into a more manageable one using a change in the immediate environment and interior state to calm down.
“When someone is feeling intense suicidal ideations and they’re at an ‘activation level of 100,’ the TIPP method will get them down to a level 50 or 60 where they’re more willing to open their mind to different ways of thinking,” explains Assistant Director Alexa Connors, LMSW.
DBT Skill: Radical Acceptance
“‘Radical Acceptance’ is one that therapists often use, but isn’t the easiest one to master. It basically means finding acceptance in things you just can’t control, or accepting a situation in the way that it is and finding one part of it you can control, or what part of yourself you can control,” she says.
Collaborative Management and Assessment of Suicidality (CAMS):
Developed by Dr. David Jobes, CAMS is a framework that helps client identify the problems or triggers that are making them consider suicide, then work collaboratively on an ongoing basis with a therapist to navigate impulses in non-harmful ways.
Prolonged Grief Therapy (PGT):
Developed by Dr. Katherine Shear, PGT is for clients whose suicidal thoughts are connected to complex grief after the loss of a loved one. According to AFSP, “When the process of grief is complicated by trauma or other individual factors, healing can get “stuck” and the person finds themselves experiencing intense yearning for the lost loved one, and prolonged, intense, unremitting grief with guilty ruminations and feeling that life lacks meaning.” The ultimate goal is to help a client move through grief in their own way and ultimately find joy again.
Attachment Based Family Therapy (ABFT)
Based on attachment theory, ABFT aims to strengthen family bonds to prevent suicide. “After controlling for depression and stressful life events, adolescents who described their family members as mutually involved and supportive, were three to five times less likely to be suicidal than their peers from less cohesive families,” states one study.
Cognitive Behavior for Suicide Prevention (CBT-SP/ CT-SP)
CBT for Suicide Prevention is a model combining elements of cognitive behavior therapy, dialectical behavioral therapy and targeted therapies for suicidal, depressed youth. CBT-SP lasts an average of 12 sessions and includes safety plans, skill building, psychoeducation, family intervention, and relapse prevention.
Safety Planning
When clients are experiencing acute periods of suicidality, it’s helpful for them to have a safety plan in place, or a list of steps and coping skills they will use if they have suicidal ideation. It should be written in their own words, brief, and easily accessible.
At The Dorm, we work with young adult clients individually to form their own safety plans, and also provide clients with a flow chart of coping skills, on-call clinicians, and what to do in acute moments of distress.
Parent Coaching & Family Therapy for Suicide Prevention
Studies show that strong connections with family and community decrease suicidal thoughts and behaviors. However, families of young adults experiencing SI often are not sure how to approach the topic.
As mental health professionals, parents, or loved ones of someone grappling with suicidal ideation, the most important thing is to approach the person with openness and curiosity instead of panic, our clinicians explain. Research shows that acute suicidal feelings do pass, and having a support system in place allows them to pass more quickly.
At The Dorm we offer comprehensive family therapy and parent coaching to help parents best support their child during difficult times.. In parent coaching, parent support groups, and our psychoeducation group for parents, The Parent Collective, clinicians provide families with following “dos and don’ts” about approaching teens and young adults with suicidal ideation:
Do be open, curious, reflective, and accepting when approaching the topic.
“The biggest thing for parents to know is that it’s okay to talk about suicide,” says Senior Therapist Cristina Escobar, LMSW. “When your child or loved one is struggling, you want to be someone they feel they can turn to for support, without judgement. It’s important to open up conversations about suicide, to listen to them and not try to immediately search for a way to fix things.”
Do practice and model self care.
Parents can model self care to their child through their own health & mental health practices, finding their own therapist and support system, and making sure they are nurturing themselves as well as their family during these times. “It can be hard to hear that someone you love is having suicidal thoughts, and can be equally as important for parents to have supports in place for themselves to help manage the feelings that come up,” says Cristina.
What not to do when someone is suicidal.
“Whenever you hear that your child is struggling with suicidal ideation, it can be really, really scary. As parents, though, it’s important not to be reactive or panic,” add Alexa.
“As clinicians, we understand that that’s a tall order. But the more that parents can approach their child with curiosity instead of panic, the better, because it will decrease the shame that comes from talking about suicide. Shame will keep an issue stuck in that person’s head, making it bigger and bigger. When people have the floor to talk about these things openly, it actually reduces the likelihood of them acting on it.”
Instead, parents can as open-ended, nonjudgemental questions, practice active listening, and encourage their young adult treatment to seek treatment and therapeutic support.
The Protective Element of Community & Connection
Destigmatization, community, family support, and comprehensive wrap-around care will make a difference in a young person’s life, as long as they are able to voice the thoughts and feelings surrounding suicide. Beyond the early stages of treatment, being a part of something greater than oneself is a game changer, explains Alexa.
“This is a theme with a lot of our treatment plans for clients – the emphasis on giving back to the community and volunteering – it has a huge impact on suicidal ideation and depression. The more people are able to get outside and give back, the less likely they are to have SI,” she says. “Even if you can’t tackle all of our symptoms through individual or group therapy, there are other ways to reduce symptoms by nutrition, health & wellness, finding a meaningful job, or volunteering.”
Today we are fortunate to live in an era of reduced stigma around suicide, and newfound therapies that can treat suicidal ideation in young people. The most important thing to remember when working with or parenting a suicidal young adult is that it’s ok to talk about how they’re feeling, and that suicidal impulses do pass, and that there is hope for future connection and fulfillment beyond symptoms of depression and suicidal ideation.
