A teen patient texted her friends about suicidal thoughts, and her stepmother found out. How should I counsel them?

• October 7, 2013

Q: A teen female patient of mine texted several of her friends
disclosing that she felt suicidal. She did not disclose a plan, nor was there a
suicide pact for her group of friends. Her stepmother found out about
this text message several days later, and felt obligated to call the parents
of all the friends who received the text message. The teenager was outraged,
feeling increasingly isolated, as her stepmother’s contact had caused those
parents to revoke their own children’s social contact with her. My patient
did not understand why her stepmother contacted her friends’ parents,
expressing that “it was none of her business.” The stepmother felt
morally obligated, and even expressed a potential legal obligation, to contact
her stepdaughter’s friends’ parents directly. This proved a significant point
of contention between these two individuals, who asked for my direct opinion
regarding this scenario. How would you counsel this family?

~ Clinician in Portland, ME

A: Dear
Clinician,

Suicide among youth is a
serious issue—it is one of the top 3 causes of death in this age group.
Depression is the most prevalent chronic disease and adolescents won’t fully
develop their executive brain functions, including impulse control and future
thinking, for another decade. This can be a dangerous and volatile mix with
adolescents’ developmentally appropriate mood swings. No clinician, indeed no
person, who learns of suicidal thoughts in a young person can afford to protect
their privacy. As a pediatrician who discusses sex, drugs, and other risk
behaviors with my adolescent patients, I observe confidentiality, with one
exception: suicidal or homicidal thoughts. When a life is at stake, the child’s
privacy cannot be observed.

Research shows that most
suicides are preceded by the victim reaching out for help in various ways.
Communications of any kind, including texts, social media, or conversation, need
to be taken seriously by those who receive them, even if they are youth themselves.
The first action to take is to ensure that this young woman gets the professional
help she needs. The mistake the stepmother made was to try to “fix it” herself
by reaching out to her daughter’s friends’ parents, rather than following the
guidance of an experienced clinician.

Once your patient is
connected with appropriate clinical care, her stepmother needs to reach out and
repair their relationship. There is no more potent healer of emotional and
relationship wounds than apology and forgiveness. The stepmother must apologize
to her daughter, admitting that she was scared and did not know how to handle this
situation. She must acknowledge that she made a mistake in communicating with
her daughter’s friends’ parents and that she recognizes that this error in
judgment resulted in her daughter being further isolated. The community as a
whole would be helped by some focused education about the realities of teen
suicide, particularly to discount the notion that suicidal thoughts are contagious
and that, to protect one’s children, one must isolate them from friends who are
struggling.

You can offer to “broker” the
beginnings of this reconciliation by meeting with both stepmother and daughter.
Your presence and moderation can help
the apology and discussion stay on track.

1. Help the daughter understand that her
   stepmother was scared, responding to her own
   emotions, and made a mistake.
2. Help the stepmother understand that her daughter
   may not be able to hear what she has to say.
3. Encourage them both to use “I” rather than
   “you” statements – “I did this and felt that
   way” rather than “You did this to me.”
4. Encourage them both to listen, letting each other finish their thoughts
   rather than interrupting.
5. Help them each to be direct, rather than hedging, both about how they feel
   and about explicit apologies. The stepmother should acknowledge and respect her
   daughter’s feelings of betrayal.
6. Encourage explanation, not excuses. The stepmother can explain that her choices
   were wrong, but she was scared.
7. Discuss what each wish they had done instead. Acknowledge that with 20/20 hindsight, the stepmother
   should have connected her daughter to a doctor or professional counselor in a
   respectful and confidential way to help her work through her struggle and come
   up with coping strategies.
8. Acknowledge the courage it took for the daughter to reach out to friends
   and thank her for sharing her suffering so that those who love her could help
   her find ways to cope.
9. Offer to speak with the daughter’s friends, to remind them how important they are to the
   daughter, demonstrated by the fact that she trusted them with her cry for help,
   and her friends’ parents, to
   reassure them that communication of powerful feelings among friends is normal
   and beneficial, suicidality is not contagious, and that relationships among
   their children are healthy, even when one of them is struggling.

Cries for help by adolescents
in crisis are not new, the digital environment in which these cries occurred is.
Unfortunately, many parents feel incompetent in and often, like this stepmother,
afraid of the digital domain – and they have defaulted it to their children. As
a result, kids (and many parents) have come to believe that the digital domain
is their private space, impenetrable by parents. But since youth spend so much
of their time online, parents need to parent them there, too. They need to be
present for their children when they are in distress, but also when they are
bullying, sexting, or neglecting more important activities online. Whether by
“friending” their children on social media or having access to their accounts,
parents can parent their children in the digital domain, guiding, teaching, and
intervening on problematic situations just as they do IRL (in real life).

Enjoy your media and use them wisely,
The Mediatrician®