Paying Attention to Suicide


Statistically speaking, 50% to 90% of those who commit suicide suffer from a depressive disorder (Stolberg, Clark & Bognar, 2002; van Praag, 2005 as cited by Butcher, Menika, & Hooley, 2010) . However, those suffering from schizophrenia, substance use disorders, and personality and anxiety disorders also experience suicide ideation (Oquendo, Baca-García, Mann, Giner, 2008). Still others with no diagnoses at all succumb to feelings of hopelessness and sadness to the point of suicide. Suicide is the third leading cause of death among persons aged 10-14 and the second among persons aged 15-34 years. In the year 2013, over 41,140 people lost their lives by suicide in the United States (Centers for Disease Control and Prevention, 2015). Understanding the signs and symptoms of depression and suicide ideation can be a preventative measure to combat such a horrific and permanent solution to a temporary problem.

Those in the mental health field must be ever vigilant in picking up on subtle cues, symptoms, and signs of suicide ideation and actions associated with such behavior. One way to look for symptoms and signs of suicide and assess client stability is to conduct a Mental Status Exam (MSE) and a risk assessment (RA).  If a counselor can gather enough information to assess such a risk, then he or she may be able to help save a life. A MSE is a useful checklist to guide a counselor in verifying a client’s diagnosis. By noting items such as appearance (is grooming acceptable?), manners and behaviors (is eye contact suitable for cultural and ethnic background?), thought processes (is he or she aware of the day of the week, the month?), and mood (are they abnormally anxious or sad?), a counselor can begin to get a better picture of the client, his or her presenting issues, and the history and managing skills he or she brings to the table.

An assessment such as the RA proposed by O’Conner, Warby, Raphael, and Vassallo (2004) helps to “improve detection and increase referral” of suicide while also helping to find an “appropriate plan of management” (p. 352-353). By knowing certain triggers a client may possess, along with understanding specific demographics, such as if the client belongs to a special risk group, has a past or present situation of concern or alcohol or drug abuse, homelessness issues, legal problems, and/or a prison record, a counselor may be able to detect other pressure points of instability guided by the RA. This also includes checking for at risk mental states, such as agitation, anger, guilt, and depression (O’Conner, et al., 2004). If there is any question as to the possibility of suicide, it must be addressed immediately.

O’Connor, et al., (2004) indicated that over 40% of people who commit suicide had seen a health professional prior to their death. Still others will never be a “client” or even see a doctor. Clients may not even realize they are at the point of acting on their suicidal thoughts until it actually occurs. Treating suicide ideation and the possibility of suicide under the guise of another disorder, intervening in a crisis situation, and working with groups at high risk are the only true preventions those in the field have at their disposal at this time and even then, it is not a guarantee. When labeled with another disorder, clients can be treated for depression associated with suicide through cognitive and psychotherapy interventions and medication (Butcher, et al., 2010). Crisis intervention may also occur through a suicide hotline in which the person at risk has someone to talk to during times of distress. Crisis intervention may be even in the hands of a loved one. Emergency treatment and referrals for inpatient care and involuntary hospitalization can possibly occur if someone else is involved and concerned about the person at risk.

Suicide is a serious epidemic. Being aware is the first step to prevention. Common warning signs of suicide that should not be ignored are threats of hurting oneself, preoccupation with death, changes in eating or sleeping habits, loss of interest in activities that were once important, marked changes in personality, persistent feelings of gloom and helplessness, and the action of giving away valued possessions (Cavanaugh & Kail, 2007).

If you are having these symptoms yourself or are worried about a loved one who may be exhibiting these behaviors, please call the Suicide Prevention Hotline at 1-800-273-8255, call 911, or for non-emergency situations, please call a medical profession or counselor for help.


American Psychiatric Association (APA). (2000). Diagnostic statistical manual of mental disorders – text revision. Washington, DC: Author.

Butcher, J. N., Mineka, S., & Hooley, J. M. (2010). Abnormal psychology (14th ed.). Boston, MA: Allyn & Bacon

Centers for Disease Control and Prevention. (2015). Retrieved from

Cavanaugh, J.C. and Kail, R.V. (2007). Human Development: A Life-Span View (4th Ed.). Belmont, CA: Thomson Higher Education.

María A. Oquendo, M.A., Baca-García, E. Mann, J.J. & Giner, J. (2008). Issues for DSM-V: Suicidal Behavior as a Separate Diagnosis on a Separate Axis. Am J Psychiatry 165:1383-1384. doi: 10.1176/appi.ajp.2008.08020281

O’Connor, N., Warby, M., Raphael, B., & Vassallo, T. (2004). Changeability, confidence, common sense and corroboration: Comprehensive suicide risk assessment. Australasian Psychiatry, 12(4), 352–360.


Group Therapy for Kids: What Both Counselors and Parents Need to Know


Working with children and teens definitely takes a special kind of person. A child or teen group leader has to know the rules and laws (both national and state) and understand the nuances of confidentiality and ethics when it comes to working with kids. Understanding laws regarding abuse and the chain of command in reporting anything suspect needs to be understood before ever beginning a children’s group. Being properly trained to work with children such as understanding the psychological and biological growth of children in general is incredibly helpful and, in most situations, required (Corey, Corey, & Corey, 2010). Being educated in Piaget’s Cognitive Theory and the ideas regarding symbolic function and egocentricism will truly come in handy when understanding children’s viewpoints versus teens and adults. Understanding important roles in each age and stage is important as well. For example, accepting that caregivers are incredibly important to young children while social networking is more important to teens will help gear the goals, exercises, and directed activities in a group.

And let’s face it. A group leader also has to be a pretty darn good salesperson – one has to sell his or her self to the kids as well as the parents/legal guardians/caregivers and the school system (if working in such a capacity). Certainly having the caregivers on board is going to make a world of difference. Collaboration is key. One suggestion is to have an ongoing group for the caregivers that coincides with the kid’s group. If at all possible, this would benefit everyone involved. The families could come together –  the children would be getting the support they need from both those who brought them and the group while the caregivers have an hour to themselves to discuss their own concerns and find support as well (Corey, et al., 2010). However, as Marianne Corey (2010) explains, the child’s welfare is of the upmost importance and if that means not involving the caregiver, than that is perfectly acceptable as well.

Everything from the proper name (the word “club” works much better than “group,” for example, per Karen Kram Laudenslager, as cited by Corey, et al., 2010) to explaining confidentiality must be geared toward a child in hopes that he or she will want to interact and be involved. Certain considerations have to be looked at such as the group’s purpose, the age of the children and even the physical size and grades of participants. The more cohesive you can make the group on the outside before it gets started, the better off it will be on the inside. Setting is important as well – large rooms that are adequate for screaming and yelling and just having fun are the best choice. Activities that are both structured and purposely unstructured are always a must (Corey, et al., 2010).

Once the group is established, then the real work begins – being the best group counselor and leader one can be by building rapport, trust, and cohesion in the group. Children are the toughest crowd – they can see right through the charade and will call a person out with no problem. So, honesty is crucial. Many of the suggestions that Corey, Corey, and Corey (2010) use to explain working with kids and teens in groups are very much like working with any adult group. Being neutral, paying attention to both nonverbal and verbal cues in the members, and preparing group for termination a few weeks before the end are things that should be done regardless of the age of group members.  A bit of tweaking, of course, will be needed with younger groups. Acknowledging that the leader is a different adult than the adult in the child’s life is a strong tactic, such as if a member is looking for an alley or someone to tattle to, or is worried about trusting or abuse or deceit. Using more time, empathy, and examples to help kids understand how confidentiality works is another. Having a graduation of sorts – even a party- for termination is another way to make it more child specific (Corey, et al., 2010).

A lot of nondirective play therapy should be involved when working exclusively with children. Corey, et al., explained that “play is the natural language that children most readily speak” (p. 295) and helps the childrens’ processing of what is learned in group. Of course with any members, you need to gear the goals in a direction in which they gain a sense of identity and self esteem and work toward a connection with others. As Aronson explained, “In addition to a very healthy sense of humor, the ability to provide consistency, stability, constancy in the face of provocation, an even aggression is critical [in a adolescent group therapist]” (p. 162).

Regardless of what age group one works with, the main goal should be to give the group members a sense of self in which they can make decisions, feel confident and able, and understand that they are important. Group leaders must be the one thing that a member can rely on to help them grow and expand and realize their potential.


Aronson, S. M. (2004). Where the wild things are: The power and challenge of    adolescent group work. Mount Sinai Journal of Medicine, 71(3), 174– 180. Retrieved November 2, 2010, from the Academic Search Premier database.             (AN 13126160)

Corey, M. S., Corey, G., & Corey, C. (2010). Groups: Process and practice (8th ed.). Belmont, CA: Brooks/Cole.