The CYC-Net Press CYC-Online

eJOURNAL OF THE INTERNATIONAL CHILD AND YOUTH CARE NETWORK (CYC-Net) – ISSN 1605-7406

ISSUE 107 DECEMBER 2007 •  CONTENTS •  HOME PAGE

adolescence

What makes the difference? Adolescent females’ stories about their suicide attempts

Lisa Crockwell and Gale Burford

Abstract: To learn about the “lived experience” of a suicide attempt, in-depth interviews were carried out with three young women who had previously attempted suicide by overdose. Excerpts from Darlene, Gina and Wendy’s “stories” are used to illustrate how normal developmental issues of adolescence provide a context for the turmoil and fallout resulting from abuse, thereby creating a combination that has become increasingly lethal in recent years. The findings are used to support the notion that the “phenomenology” of good practice with adolescents and qualitative research methods have much in common; that practitioners who work with teens who attempt suicide must be well-grounded in their understanding of adolescent development; have well-developed communication skills; and be willing to see past the young person’s behaviour to meet the “expert” within.

There’s a real stigma attached to trying to kill yourself. People think you’re screwed up! [Wendy]

Introduction
Intervention and research in the area of attempted suicide is characterized by an emphasis on diagnostic and quantitative measurement typically presented from the results of psychometric testing and behavioral ratings. Less is known about the “lived experiences” of the individuals who attempt suicide, how they view the interventions of others around the attempt, and what expertise they have developed as recipients of the interventions of others. The focus tends to be on behaviour and the content of “ruminations”; young peoples’ perceptions of their experiences are rarely recorded. Perhaps due to the fear that in-depth discussion of suicide might encourage the behaviour, professionals tend to minimize the time spent with young people discussing the process of suicide attempts.

Good practice is research
Research methods aimed at discovering the perspective of the subject are more consistent with the character of practice in the field of child and youth care than are methods aimed solely at behavioral specification and quantification. Practitioners who deal with the “messy” business of relationships, including attempting to capture teaching/ learning moments in the midst of crisis, are in a unique position to carry out qualitative research. This is especially so in the situation of sustained contact between the residential care worker and the young person, where both intensely experience the young person’s life-threatening behaviour. In these moments, practitioners know that discovering the young person’s and the involved staff member’s perception of events is the key to understanding and successful resolution. This is thought to be consistent with the expectations of both qualitative research (Bogdan & Taylor, 1975) and practice (Anderson & Goolishan, 1992).

The study reported in this article depicts the perceptions of young people who have attempted suicide as constituting valuable knowledge for researchers and practitioners. In so doing, the authors are committed to demystifying the research experience for child and youth care workers and promoting among them an “I can do that!” attitude.

Sample and methodology
The methods used in the study (Crockwell, 1991) were drawn from a phenomenological approach. The perceptions of persons who had attempted suicide were explored as much as possible “through their own eyes.” This methodology recognizes that while people may interpret their experience differently, the shared perspective of a similar situation offers valuable insights into that situation when the researcher attempts “to see things from the person’s point of view” (Bogdan & Taylor, 1975, p. 14).

Three young women between the ages of 16 and 23 years who engaged in multiple suicide attempts by overdose during adolescence were approached to be interviewed. Two of the young women were residents in a group care program at the time of the study and the other was engaged in counselling at a local community service agency. The young women were first invited by counsellors in these agencies to participate in the research. Once they had given their consent in writing for the researcher to contact them, they gave further written consent to participate in the study. As part of this consent, the staff who were actively working with the young women in their respective agencies made themselves available to help, if the research interviews unearthed feelings or memories with which these young women wanted help.

Open-ended questions were used to elicit the young women’s perceptions about their suicide attempts and their experiences with clinicians and significant others. Whenever possible the interviewer worked from general topics down through specific examples and incidents in order to minimize contamination from leading questions and to facilitate the exploration of values about general subject areas and their thinking and feelings about specific events in their own lives. Although the researcher was an experienced interviewer, care was taken beforehand to review and role play appropriate strategies and techniques for conducting in-depth interviews where, as Patton points out, “the purpose — is to allow us to enter the other person’s perspective” (Patton, 1987, p. 109).

The interviews were tape-recorded and transcribed for analysis. The grammar was standardized for presentation in this article while the syntax was left intact. This was done to reduce the risks associated with translating regional verbal expressions and dialects into writing. The transcripts were then analyzed from a phenomenological perspective utilizing the Constant Comparative Method (Glasser & Strauss, 1967; Lincoln & Guba, 1985). Additionally, an extensive review of the literature on youth suicide was conducted from which categories were derived as being universally important to the consideration of suicide and attempted suicide for persons in this age group. These headings included family structure and relationships, social isolation, physical ill health, psychiatric disorder, substance abuse, and physical and sexual abuse. Attention was drawn in the transcripts to any mention of these topics as an aid to reporting the material from the interviews in an organized manner.

This article is structured to present samples from the transcripts of the interviews in such a way as to illustrate how the interviews generally unfolded and how the researcher came to learn from the young women so that readers can judge for themselves how the researchers came to their conclusions.

The three participants in this study were given fictitious names to protect their identities and at the same time to lend clarity to the presentation. They are Wendy, Darlene and Gina.

Introduction to Wendy, Darlene and Gina
During the time the interviews took place, Wendy was a 23-year-old university student working towards a degree in one of the helping professions. Her parents divorced when she was a child. Wendy characterized her relationships with both parents as always having been “distant” and “unsupportive.” When she was in her early teens, Wendy was apprehended by Children’s Protective Services and placed in foster care. Her placement occurred in the aftermath of an unspecified number of suicide attempts by her mother. Wendy’s father was absent throughout most of her childhood. At the time of the interview, Wendy had no contact with her mother and was living with her father. She felt that she had no supportive relationships in her life and did not feel that she “fit in” with her peer group. Previous relationships with boyfriends were described as having been abusive and she recounted incidents of sexual abuse by males.
Wendy recalled two suicide attempts by overdose and several times when she had self-destructive thoughts. She had never been admitted to a psychiatric unit but was seen by a psychiatrist following her suicide attempts. She had also received follow-up by social workers and was involved in a group for survivors of sexual assault.

Wendy speaking about why young people attempt suicide:

You see the biggest thing for anyone who tries to kill themselves is usually, I don’t know, but I would suspect that they didn’t have the support and if they did have the support, it wasn’t the kind that they could talk to. I think the biggest problem and why I’ve gone through periods of being suicidal is because I have no ties. Other people have friends, relatives, etc. I just wanted someone to know how much I was frustrated — I just wanted someone to know how much I was hurting.

Darlene was 17 at the time she volunteered for the interviews. She had several previous suicide attempts by various methods including overdoses and had been admitted to psychiatric units.

Darlene had not lived with her family of origin for three years at which time her father had been charged with sexually assaulting her. Darlene’s mother left the family home at that time and had since refused contact with her daughter. During the ensuing period of time the father was convicted and incarcerated. Darlene described both parents as having been physically abusive and violent. When the sexual abuse charges were laid, Darlene was placed in a foster home and at the time of the interviews she was living at a residential treatment centre. She perceives minimal support in her life and believes that professionals have been the most significant sources of support.

Darlene was continuing to struggle with thoughts of suicide at the time of the interviews. She recalled her first thoughts of suicide as occurring at the age of eight or nine years and referred to suicide as “a way of ending the pain.” Darlene continues to wish that things would change:

I wish that I had a mother to go shopping with me — just someone to do something with or to go and talk when something is wrong.

and struggles with the role of her parents in her life:

I hate them for what they did to me but I still love them in a way — they’re my parents and they had me.
I need the support but I don’t have it — My family don’t give two hoots about me!
 

Gina was 16 and had been living with her adoptive parents a month before entering the residential program where the interviews with her took place. She had been in a number of foster homes before being adopted in her early adolescence.

Gina states that she was neglected and abused throughout most of her life. She became pregnant at the age of 12 following a rape. She intentionally miscarried the child when the perpetrator threatened to kill her.

Relationships within her adopted family changed throughout the last year when a member of the extended family was charged with sexually abusing her. A previously good relationship with her adopted father became distant. The interviewer notes still being able to recall the sound of Gina’s voice when she said:

I was Dad’s little girl. I was always his little girl. Then when he found out about the last time (sexual abuse) he said, “don’t you think you’re my little girl no more!” I just walked up over the stairs and screeched my eyes out the whole night. He found out and blamed me.

Gina shares the other participants’ feelings of isolation from a peer or support network: “I have no friends — not a soul”; “nobody cares.”

She views her previous suicide attempts as times of ambivalence. When discussing her reasons she states: “To die or get help.”

The participants’ responses
The participants responded to questions and comments that were aimed at eliciting the experiential component of their suicide attempts, their perceptions of the responses of others to those attempts and the expertise they have gained as recipients of professional intervention. While it is impossible to list all of the questions that would or could be asked in these types of interviews, the responses of the three young women are organized around some of the questions that were asked:


What was happening to you?

(Gina) I know it’s going to explode [a suicide attempt] because I can feel myself shaking and I can feel myself, I get a headache, that’s the first thing I usually do is reach for the pills, right. I get a headache and I start to shake and I get really frustrated and I start to pace back and forth, and back and forth and I’m really hyper and the whole works and I know then that something is going to happen. [Interviewer: And what’s that something that’s going to happen?] I’m going to take pills which I always do.(Darlene) It’s like sometimes things will go perfect and you have a little slip and you got to go back a few steps and you go a step ahead and then you got to go back again. That’s when you don’t care — Like everything is going good for you and you’re grounding yourself well with the flashbacks, let’s say, and you’ve had a good week and all of a sudden something happens and you can’t ground your flashbacks, that means you’ve got to go back a step. Then you say “Oh shag this, I can’t ground myself, what am I going to do? Take pills?” You know to get your mind off of it then it’s back another step. Then, when I attempt suicide, I go back another step.
(Gina) If I start drinking, then I know it’s going to be on the way. Like there’s certain different things that I know it’s coming around. Like if I start going out with a lot of fellas or, I start drinking or, I start doing all of these bad things, or getting in with the wrong crowd or anything like that, then I know it’s starting up.
(Darlene) It starts up.
(Wendy) It builds.
(Gina) It’s on the way.
(Gina) Being too far into it to stop.
(Darlene) It’s coming.

What did you want to happen?

(Gina) To die or to get help.
(Wendy) I thought I really wanted to die but I wanted help.
(Darlene) Every time I want to die.
(Darlene) I wanted someone to know how frustrated I was.
(Wendy) Does anybody really want to die?
(Wendy) I always felt like there was something wrong with me and I could never get through life but if I could find someone, someone to see how much I was hurting enough then maybe they would help me and make me feel better.

How did others react?

(Wendy) It was like in my family that suicide was a way of life so it wasn’t like a big shock right? “You took an overdose? I took six overdoses, tell me something else new.”
(Gina) Dad never showed not one feeling.
(Darlene) Nobody ever did believe me.
(Gina) Others say . . . “she’s doing it again, she’s only looking for attention, she doesn’t really want to die.”

What did you think of their reactions?

(Wendy) I don’t know why but I love her [mother] and I hate her.
(Gina) I don’t want nothing to do with him [father] but I don’t want nothing to happen to him — I love him.
(Darlene) I hate them — but I still love them — they’re my parents, they had me.

What do/did you need?

(Gina) Like if I wanted to kill myself now, you wouldn’t know, if I wanted to, unless I knew I was beyond the point and I couldn’t stop — Just before I was about to boil I’d probably tell you then — got me really down, I went straight down in the dumps, but then a little while after that when B started hugging me and I started coming back to myself and I didn’t try to kill myself. It was the first time I’ve ever been really down and I haven’t tried to kill myself. It was the first time I’ve ever been really down in the dumps that I never tried it.
(Gina) I’d like them [parents] to be sensitive instead of saying “Ah, here she goes again!”

Wendy discusses the impact that a positive response from her father would have had, even though she would not have acknowledged it at the time but that she now perceives:

He’s [father] not a nice person but he’s not awful either. So, if he had said “tell me everything that is the matter” I would have said “get out of my face” but, probably, it would have meant something to me — it would have been nice to know that I had someone who cared about me.

She also refers to her need for someone to take away the pain:

What I needed and what I think a lot of people need when they try to commit suicide is that they’re looking for, they are so frustrated, they want someone to give them something to make it better.

Gina discusses her need for help but has difficulty with that need:

I want the help but I can’t deal with it.
(Darlene) I’d rather that people went about their own business and didn’t bother me.
(Darlene) It’s like what I want to happen is be with somebody who is old, like say 25 or 26 that would always be there, like you know, never leave, never move away.

There were times when they all felt they needed to help themselves:

(Wendy) I know there is no magical power, professionals help, guide, etc., but the person has to do it themselves.
(Darlene) They can’t do nothing unless I’m willing and able to.
(Gina) The only one who could bring me up is myself.

What helped?

Sometimes Darlene wanted active intervention to ward off her fears and to take control:

Every time I had an hallucination, she’d [medical intern] run into my room and say “go tell your father to ‘F’ off” and when I wouldn’t do it, she’d do it for me!

At other times she just wanted someone to be there for her as is evidenced by her comments about the efforts of her medical intern who maintained a vigil by her bedside:

She’d put me to bed and give me a Zeddy and my quiltie and she’d tuck me in and say “go to sleep for a few hours, sweetie, and when you wake, up, I’ll be here” and all of the time when I woke up, she was there.

Still other times she wanted direction and advice:

[They should tell me] what I should do when I get suicidal tendencies, what I should do when I get flashbacks, how I’m supposed to get over the abuse.

Gina acknowledged the role played by the counsellors during one crisis:

Like, I, the other night I was really, really bad, I was going to kill myself, the whole works and they (counsellors) finally got through to me and that and I started to cry and that but after I felt like a hundred pounds was lifted off me — I felt bad — but they (counsellors) got me through it — ’Cause I wouldn’t have made it through only for the two of them that night. The best two that ever pulled me through yet!

She points to the importance of being kept “safe” and looked after:

The only time I ever felt safe was when I was in the hospital because nobody could get in or out without the nurses knowing — I knew I couldn’t hurt myself in the hospital. That’s the only time I ever do feel safe.

and the importance of feeling listened to:

When somebody will listen to me talking and know and hear what I’m saying and believe me when I say it. That makes me feel better.

What didn’t help?

Wendy hesitates in saying that attention to her feelings during her emergency room visit following an overdose would have been more helpful:

I — probably, but I don’t know if it’s just me or what, but I know that people were — I was, I was really upset and the only thing that people cared about was what I had taken. I know that was the priority at the time but it was humiliating but I suppose there was nothing — I mean — they could have done to not make it humiliating. Getting your stomach pumped is like there is no way you cannot make that humiliating because you’re having something stuck down your throat and you’re full of black stuff and it’s going all over you and like there’s no way you can console someone at that time or can realize what you’re going through.

But once she gets started, she identifies what might have helped:

Now, I mean, the psychiatrist and the intern were a...holes — It seemed like ages. I know I was begging them to pump my stomach for a long time — just two males and that made me feel uncomfortable because I would have preferred to have a female around — I think you should have the option to have someone stay even though they were psychiatrists.

Wendy discussed the manner in which she perceived the assessment interviews were conducted:

O.K. The first interview was just “so tell us what happened” and he wrote it up and said “um hm, um, hm” and wrote notes and he didn’t look at me but he was nodding and looking at the other guy. And they looked at each other and exchanged nods. It was very factual like “So what did you take?” and “What happened at the house?” Um, you know I felt like saying “I can understand English, doctor.” It was just very factual. They filled out their little form and that was it.

Wendy went to the psychiatrist’s private office for a follow-up:

I can’t believe I forgot his name but he — um — called me into the office. People were just bing, bing, bing, in and out of his office. I’ve gone to (psychiatrist’s name) and (psychiatrist’s name) and I complain because I have to wait so long but they give their patients time to talk and that’s why you have to wait because not everybody takes the same amount of time. But he was like ping, ping, ping. So anyway, I went into the office and — he might have said two words to me the whole time. He took notes. I don’t know, he must be a real advocate of Freud or something. I don’t know.

Wendy emphasized the importance of getting to know the young person. She identified her own reactions when she perceived that this was not happening during her interview with the psychiatrist:

Yea, but no input, nothing! He might have said something like, “um, how did that make you feel?” and then he’d start taking notes but nothing like “well, that must have been hard” or “boy, you’ve gone through a lot of shit” or you know or — or — or — nothing on just, like just getting to know me. Like me, maybe I put too much emphasis on it but I think there’s a lot of things like 'how’s your family life?That’s not to say that everything is the mother’s fault or something but I mean just to get to know me type of interview because he didn’t know me from Adam and all he had with me was the initial visit in the hospital which didn’t explain anything — He was the worst I’ve ever met and I’ve met a good few and he’s the absolute worst that I have ever met. Unfortunately, I had to meet him at a time when I was at my lowest. He did absolutely no good for me and unfortunately, if if hadn’t been for me trying to find somebody because for months and months after I just went straight down.

Darlene and Gina refer to “not helpful” statements:

What did you do this for? You’ve got lots to live for.

Oh, you’re a beautiful girl, there’s lots to live for.

The short office visit combined with the prescription for anti-depressant medication disappointed Wendy:

But now, back to the psychiatrist, when I left he gave me a prescription for antidepressants so we hadn’t talked, he didn’t once say “it’s O.K.” or give me any bit of feedback. He just wrote me out a prescription. I’d say I was only in there about 15 minutes, 20 at the most, and he wrote me out a prescription for anti-depressants and sent me on my way.

She speaks to the power of the professional:

Something about the psychiatrist coming in, you don’t know these people from Adam, and you’re pretty well made to say what’s the matter with you and he’s taking his notes. Like maybe you don’t want to talk to him but I probably would have been admitted if I hadn’t talked to him.

There’s a consequence?

Yeah, like “if you don’t talk to me then” — I feel like if you ever go to the hospital, you’re forced to have to tell people even though you might be seeing other people. You still have to tell these strangers you don’t know. Maybe if he could have said “If this is hard for you, is there someone else I could talk to, to get this information?” I find doctors really expect that because you’re there and they’re working there and they’re professionals that you have, they have the right to ask you anything and you’re a difficult patient if you don’t, and you’re looked at like oo, oo, as trouble if you don’t. And people that come in usually have the biggest problems, they have been abused or violated already. They don’t want to talk to a stranger. To me it’s like being violated again!

Wendy compares helpers:

Well for one, I could go in and cry my eyes out. The guy just wanted the facts but she was like I could howl and she would say “Don’t worry about being upset, just cry if you want to. You have every right to cry, you’ve been through hell” and just validation of your feelings and she got more into “where did I come from?,” “what kind of things have led up to it?” but so that was really nice but then I went to [social worker] and I could only see her a couple of times before I went. She always said “Whenever you want to cry, my shoulder is always there for you.” Every time I got upset, I’d go to her and she’d spend hours, talking to me. She’d say “It’s alright to cry” and all of this —

Darlene had expectations for follow-up:

Yea, I thought that was good because I didn’t like the way it was left. I wouldn’t like to think that other people are just left hanging. They just sent me off, “Are you fine?” “Yes, I’m fine, O.K.” and they let me go. I wouldn’t have wanted to be admitted because it wouldn’t have made things better but you’re kind of — left hanging — He was absolutely no good to me so — um — the only good thing I got out of that was the social worker so I wouldn’t say I minded that my name had been given to somebody because usually if you end up in the hospital like that you’re at the end of your rope so I’d think you’d be kind of grateful to get something back.

Gina believed that she must be “crazy” because she was seeing a psychiatrist:

I hated it. Couldn’t stand the psychiatrist — just thought “I must be crazy” that’s all that came into my head. That’s what I thought “if you see one of them, you’re crazy.” After hearing people say “Oh shrinks, they’re for ‘nuts people’ like that if you’re in hospital then definitely you’re wacky. So, I thought I was gone nuts totally when I was up there.

Discussion
Wendy, Gina and Darlene envisioned their suicide attempts as episodes having distinct beginnings and endings throughout which their feelings grew in intensity. As they discussed what they hoped would happen as a result of their suicide attempts, they expressed disappointment about the reactions of family members and friends and at the same time acknowledged ambivalent feelings about themselves and contradictory expectations about what they needed from others.

They were clearer about what helped and did not help following their suicide attempts and felt that some helping professionals played a significant role. These young women described their interactions with clinicians as generally more positive than their interactions with family members and friends.

The efficacy of the particular helping experience, however, often seemed to be clouded by their expectations of the helper and their struggles in other relationships which were carried into the relationship with the professional. These struggles are summarized as:

I need the helper/don’t need the helper
The first struggle is related to the young person’s expectations of treatment. These participants ascribed a tremendous power to the clinician and felt that the professional “could make it better.” The concept of being rescued predominated. The adolescent struggle of independence vs. dependence was evident as there were times when they felt dependent upon the helper to rescue them and others when they took a totally independent “don’t need the helper” attitude. This was manifested in an inconsistent attitude towards helpers which could change from one contact to another. An awareness of this as the larger independence/ dependence struggle would be of great benefit to any clinician during intervention.

Adolescents can be particularly vulnerable to giving too much power to a clinician to “fix” a problem. Intellectually, they may be aware of the limits but often do not accept these limits. They want to give responsibility to the clinician to solve the problem. They become disappointed when the problem is not solved as quickly as they would like. As clinicians, it is important to clarify the nature of the helping relationship with adolescents to avoid confusion about expectations and to facilitate a relationship which is built upon trust rather than false promises. The formation of professional relationships based upon this empathy and trust is difficult in busy settings such as emergency wards unless professionals are acutely aware of these struggles.

Throughout their discussions, these adolescents seemed to be searching for support, empathy and validation of their feelings. Rather than demanding that the system be changed, they requested that those who work in that system possess the ability and the will to offer support and empathy throughout the process. These are the basic skills of assessment and counselling which may all too quickly become lost in certain busy systems. Respect for the young person was identified as a major factor in their receptiveness to intervention. When they felt as if they were respected and their concerns were addressed, they were quite receptive to the intervention.

I need to disclose/need to be private
Even when the initial assessment period is successful and the young person agrees to continue counselling, the clinician must continue to be aware of ongoing struggles.

Disclosing information can be a major dilemma for anyone entering a counselling relationship and this was evident for this sample group of young people. These young women wrestled with their fear of what the helper may think if past experiences were disclosed. The fear of rejection by the helper was a powerful factor. The need to tell others their thoughts and feelings was equally powerful as they believed that if others could understand how they felt, then the pain may decrease. This struggle was observed in the participant’s experience of reaching out to the helper then retreating and testing the relationship. When disclosure of information was met with acceptance then this was viewed as significant by the adolescent.

Awareness of this struggle and the associated fear of rejection is helpful to the clinician when attempting to cope with testing in the counselling relationship with adolescents. Providing a forum through which disclosure is met with acceptance of the person, and handling the termination phase with sensitivity to it being reframed as a rejection, are practical methods of assisting clients with disclosure difficulties.

Relationships are “good” vs. relationships are “bad”
Understanding the young person’s perceptions of their previous relationships with family members, friends and other professionals can be a valuable assessment tool in working with young females who have attempted suicide by overdose. All of these participants had experienced strained or absent relationships with parents, disrupted peer relationships and physical/sexual/emotional abuse. These relationships had all been perceived as negative by the participants. Despite past experiences, they believed that relationships had the potential to be positive. These young people had difficulty understanding what a good relationship was and as a result transferred unrealistic expectations to their counsellors. They were at risk of attempting to place the helping professional in a role which compensated for other dysfunctional relationships in their lives. They perceived support as vital but had difficulty defining the boundaries. Therefore, clearly defining these boundaries is quite important when working with these young people.

Genuine caring by the helper vs. false caring by the helper
The participants of this study readily identified those helpers whom they perceived as genuine in their regard for them and those whom they believed were “false” in their caring. Genuineness was equated with trustworthiness and they distinguished between those statements which were said just to make them “feel better” and those which exemplified genuine caring. This distinction was quite important to each of the young people who were interviewed.

All of the participants in this study had been involved in a number of helping relationships. They readily identified those which reflected caring and trust and dismissed those where trust and caring were perceived as absent. Relationships that are built upon trust are important in any aspect of professional helping intervention. This study indicates that for these young women, trust is not associated with a professional position, rather it must be earned by the helper.

Summary
The stories of these young women reveal a picture of a suicide attempt as a distinct episode occurring within a context that includes both normal developmental issues related to adolescence and those circumstances and events which are particular to their individual lives. Like many other adolescents, Darlene, Gina and Wendy strive to live up to ideals about independence, relationships, authenticity and understanding in a world that frequently leaves them feeling that they are helpless, inadequate, misunderstood and surrounded by hypocrisy. Add to this the common experience of having been abandoned when they most needed protection, and the resulting feelings of rejection and betrayal, it is little wonder that they sometimes feel that the only thing they have absolute control over is whether they live or die.

These young women were valuable sources of expertise and knowledge as they related their straggles and recounted their experiences with helping professionals. They were able to highlight that their suicide attempts occurred solidly within the developmental context of adolescence.

Their struggles became those of any adolescent searching for identity, wanting to be heard and understood, seeing the world as black and white and often contradicting themselves. These adolescent struggles were magnified by the context of their lives, their relationships and their experiences.

These young women wanted some very basic qualities in their helper. They required honest and forthright answers so that false promises saying everything will “be O.K.” are not made, even when they seem to be demanding the opposite. They need to have the boundaries of professional relationships defined as their expectations may be greater than what can be realistically provided. They require the support, reassurance and recognition that it is often difficult to reveal the details of their lives. They want respect and autonomy and the opportunity to build trust over time. They need helpers to be genuine in their interventions and sensitive to issues around the termination phase as this is a time when feelings of rejection are common. These are the issues which make the difference.
The final word is Gina’s:

Listen to what they’re saying, believe in them and make them feel like you’re there for them. I know one thing. I really wanted people to be there for me; if they were, it would have made me feel a lot better. I’d say it would help other people too. And don’t take it lightly, that’s another thing. Some people just take it lightly and go “that’s another one of those ‘teenage phases’ they’re going through” or something like this but it’s not. It’s real!

References

Anderson, H., & Goolishan, H. (1992). The client is the expert: A not knowing approach to therapy. In S. McNamee & K. Gergen (Eds.), Therapy as social construction . pp. 25-39. Newbury Park, CA. Sage.

Bogdan, R., & Taylor, S.J. (1975). Introduction to qualitative research methods. New York. Wiley.

Crockwell, L. (1991). What made the difference? A study of the perceptions of females about their suicide attempts during adolescence.

Unpublished master’s research report. Memorial University of Newfoundland, St. John’s, NF.

Glasser, B.G., & Strauss, A.L. (1967). The discovery of grounded theory. Chicago. Aldine.

Lincoln, Y., & Guba, E. (1985). Naturalistic inquiry. Newbury Park, CA. Sage.

Patton, M.Q. (1987). How to use qualitative methods in evaluation. Newbury Park, CA. Sage.

This feature: Crockwell, L. and Burford, G. (1995). What makes the difference? Adolescent stories about their suicide attempts. Journal of Child and Youth Care, 10, 1. pp. 1-14.