Playing With Fire: Crisis Intervention With A Suicidal Adolescent, by John M. Dyckman, Ph.D. 1

Perhaps the most useful of Erickson’s remarkable techniques is the concept of utilization. Utilization relies on the language and experience of the client. . It allows them to use their own knowledge, strengths and skills to explore useful solutions to their own problems. As such it is well suited to working with clients like the adolescent described below, who may not be particularly interested in “therapy” or in “self-examination”.

J. is a 17-year-old male high school senior. He is on track to graduate in June and has enlisted in the service, promised that he will be trained as a damage control officer. He already has a year of experience as a volunteer fire fighter. His mother brings him to the clinic after they have spent an unpleasant night in the emergency room having his stomach pumped after an impulsive suicide attempt. His girlfriend of about a year dumped him for one of his friends. J. got furious, got drunk and overdosed on pills. He is a handsome and athletic young man, but not particularly verbal nor very happy to be in my office. He still had not ruled out suicide as a response to the rejection.

After eliciting his history, and a few false starts into “curiosity” about his life, we struck up a conversation about fire fighting. This is something that he knows and cares about, so we conducted the entire rest of the session discussing some principles of “Fire Science”: First I asked him what he knew about “accelerants”. He named a few of the common ones. I nodded and then offered, “How about alcohol?” He grinned, and we were off to the fire.

I acknowledged his expertise, then said that I had some friends who were firefighters and they had shown me that explosions were just very fast fires, were more damaging when they were contained in a small space and lost much of their power when they happened in a larger space. I told him that to qualify for the California Dept of Forestry’s fire-fighting program, one has to do 50 sit-ups in 60 seconds while holding a 30# weight on the chest. I wondered if doing sit-ups, or even taking a run, would be a good way to dissipate potentially explosive energies?

I also asked him to tell me something about the different types of fires he had seen, and the different techniques used to fight them. What would happen if you mis-diagnosed and used water on an oil fire? What could he remember about how he felt at the moment he discovered his girlfriend’s cruel betrayal? He remembered a flash of sadness before he became furious. I asked what was the best way to extinguish the sadness? I invited him to ask his mom how she dealt with that. They had a nice conversation about expressing sadness in the form of tears, and the likelihood that the sadness once expressed would soon “burn out”.

I then asked him about “search and rescue”. We determined that when in a burning or damaged building it was advisable to keep one hand on the wall, and one on the person ahead of or behind you. I said it sounded to me like his plans for his future were a kind of solid “wall” that he could lean on, but that when “visibility is low” it was crucial for him to keep to his plan, to “keep your hand on the wall”. I suggested he ask himself whether a particular action would help or hinder his plan.

His other hand needed to be on the person in front or behind him. I asked him who would be his “buddy”. He chose his mother, a few named friends, and me. I agreed that it was important to have several different people to trust, so that it was likely that someone would be available in time of need. His mother expressed her relief and gratitude to her son, who received it with more graciousness than I usually expect from 17-year-old males. They left saying that they felt a lot better, and that they didn’t think that they needed to come back. I followed-up a week later by phone, and J. was back at school and apparently back on course.

Impulsive suicide is a real risk in adolescents. J. had the advantage of some previous experience of the importance of calm but decisive action in the face of real danger, and so was able to mobilize resources that he had not realized he had. Most everyone has resources of which they are not aware. Our job as therapists is to help them access these in the most natural way possible.

1. This article appeared in the Case Studies column of the Newsletter of the Milton H. Erickson Foundation, vol. 28, #3, Winter 2008.