I have found that working with teenagers in biblical counseling involves a unique set of challenges. With the added complexity of a young man or woman who has suicidal thinking, those challenges multiply. This situation provides even more reason to consider factors like building trust, taking great care not to assume, and family dynamics. I have found the following principles helpful in working with teens and particularly with teens struggling with suicidal thinking.
Connecting before Correcting
“And we urge you, brothers and sisters, warn those who are idle and disruptive, encourage the disheartened, help the weak, be patient with everyone” (1 Thess. 5:14).
When someone struggles with suicidal thinking or behavior, it can create fear and a feeling of walking on eggshells for the family and caregivers. It might be tempting to see this more as disruptive behavior than an opportunity to come alongside a disheartened teen. But for the person struggling with these feelings or thoughts, the word disheartened is most often very appropriate. They are often suffering from pain or shame that feels inescapable and unbearable. As you pray in preparation for this first session, try to imagine being the teen coming to counseling. Typically, they feel vulnerable, forced to come against their will, and embarrassed. We want to be warm and caring but at the same time not patronizing and to empathize without acting as though we know how they feel. Teens often don’t know how to articulate their feelings; others are very guarded. Add the trauma and embarrassment of a suicide threat or attempt, and we have a pretty tight knot. We must take our time to create a redemptive atmosphere and a safe place.
Recognize the implicit conflict of interest that underlies most teen counseling. Parents want to get their child help, but teens often feel like we are hired as their parent’s agent and thus answer to them, share their agenda, and likely won’t be someone they can confide in. Letting both parents and teens know what to expect in counseling is important. After we obtain the parents’ perspective and clarify the goals and expectations related to confidentiality and care, our focus should turn to working with their teen.
Assess Risk by Asking a Specific Set of Questions
As we ask questions to determine the risk, we want to know the severity and frequency of suicidal thoughts. Do they think about hurting themselves often? Do they have a plan? Are means readily available? Who else knows about their temptation to harm themselves? Try to determine whether they are 1. “not wanting to live” or 2. “wanting to die.” In the first category, we have low-risk counselees who are feeling depressed or somewhat hopeless, who may have occasional suicidal ideation. They typically have no plan and no real intent to hurt themselves, but any threat still should be taken seriously. The urgency of our plan is based on the answers to the questions above. The category “wanting to die” includes moderate to high risk. They have a growing obsession with death to escape pain, shame, or stress with various levels of intent and premeditation. The development of a clear plan of how they would take their life, easy means, along with increased isolation or mood changes move things into the high-risk category. Our care must be focused on mitigating risk immediately and may involve a referral to a treatment facility, if not a call to 911. Our counsel may have to wait, but stay in touch and help the family through this stage.
Assess Root Issues by Hearing Their Story
“The purposes of a person’s heart are deep waters, but one who has insight draws them out” (Prov. 20:5).
Often all we will know going into counseling is the presenting problem. Early on, we will want to assess the ongoing risk of self-harm in each session. But once things are stable, that is not our main goal. We want to hear their story. This might take two or three sessions to accomplish. Listening is a huge part of the early sessions, but always give hope through the Scriptures. We should target fear and despair as we give assignments. Look for easy wins early on.
See Them Beyond the Problem
They will likely come in believing we see them as a freak. Try to get to know them in a way that puts their extreme thinking or behavior in perspective. Ask them what was it like growing up in their home, who are their closest friends, and how do they relate to their parents? What has been good, hard, and bad in each chapter of their life? What do they like to do? What are music preferences, hobbies, and talents? Ask them to share their testimony and talk about their church experience. Help them see that we want to know them as a person, not as a problem child. At the same time, if we sense risk for self-harm is still active, we’ll want to zero in on factors that increase their hopelessness like loss, others they know struggling with self-harm tendencies, family conflict, drugs or alcohol use, stress, isolation, bullying, or abuse.
Respond with Truth and Grace
“Brothers and sisters, if someone is caught in a sin, you who live by the Spirit should restore that person gently. But watch yourselves, or you also may be tempted. Carry each other’s burdens, and in this way you will fulfill the law of Christ” (Gal. 6:1-2).
For our purposes, we will assume risk has either decreased or is relatively low at this time. Many times, it will be clear that they struggle with depression, but is this the root or is it a fruit of something else (Luke 6:45)? As we have traced heart themes in their life story, we will likely find the struggle is a mix of fear and despair. How does their fear drive or accentuate hopelessness? Our counsel and where we go in Scripture depend more on the root issue.
A huge part of good biblical counsel is giving hope and getting them in the Word of God through heart-targeting homework. Teens are especially keen at discerning false hope or platitudes. Telling them, “it will get better,” or “it could have been worse” when they are depressed is a sure way to discourage them further. Instead, break isolation with an invitation toward Christ and community. Address shame with the grace of the gospel. The goal for community and discipleship needs to be more than Bible knowledge. That said, praying through the Word, seeing how the Word gives direction and can be applied, and teaching them to counsel themselves biblically will be transforming (Rom. 12:1-2).
Having them reading though the Psalms throughout counseling is often eye-opening and hopeful for teens to realize they can doubt, cry out, and even get frustrated. Instead of looking around at circumstances, they can look up and express their fears and discouragement. Teaching a teen to lament to God is a way to help them see just how attentive and longsuffering God really is.
Help the Family Know How to Respond
“But we have this treasure in jars of clay to show that this all-surpassing power is from God and not from us. We are hard pressed on every side, but not crushed; perplexed, but not in despair; persecuted, but not abandoned; struck down, but not destroyed” (2 Cor. 4:7-9).
The stigma of suicide is real and will need to be talked about in a way that helps move from shame to a testimony of God’s grace. Family needs to be surrounded by a wise and caring community. Even after the family understands risk factors, how to talk about suicide with their teen, and how to get help, they may need ongoing counsel and care from the church. The tendency is to get them through the crisis and then lose touch. Encourage them to talk openly about fears and feelings of being overwhelmed. Let them know that their feelings are normal (1 Cor. 10:13) but that God is faithful. Counseling will often focus on reestablishing an open relationship with their teen, healthy boundaries, communication, and habits at home.
Questions for Reflection
How might you engage a teen with more sensitivity to connecting if you think they are struggling with suicidal thoughts?
How might you use the Psalms and other Scriptures to help them lament vertically in a way that opens up a deeper hope in Christ?
