Child and Adolescent Social Work Journal

, Volume 34, Issue 2, pp 95–106 | Cite as

Three Psychotherapies for Suicidal Adolescents: Overview of Conceptual Frameworks and Intervention Techniques

  • Jonathan B. Singer
  • Kimberly H. McManama O’Brien
  • Mary LeCloux


Suicide is the second leading cause of death among youth, and as many as one in five youth report having had at least one serious thought of suicide in the past year. Despite the enormous emotional pain and suffering associated with suicidal thoughts and behaviors, up to 40 % of suicidal youth never receive treatment. Given that social workers are employed in multiple settings where suicidal children and adolescents are encountered (e.g. schools, homeless shelters, emergency departments, outpatient mental health agencies, private practice), they play a critical role in the identification and treatment of suicidal youth. In the past decade, evidence has emerged that attachment-based family therapy, integrated cognitive behavioral therapy, and dialectical behavior therapy can reduce suicidal ideation and/or suicide attempt in youth. The purpose of this article is to review the theoretical assumptions, conceptual frameworks and key intervention techniques for these three interventions so that clinicians can integrate these approaches into their practice with suicidal youth and families. Implications for practice are integrated throughout the review.


Youth suicide Empirically-supported interventions Attachment-based family therapy Integrated-cognitive behavioral therapy Dialectical behavior therapy 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. Ainsworth, M. S., & Bowlby, J. (1991). An ethological approach to personality development. American Psychologist, 46, 333–341. doi: 10.1037/0003-066X.46.4.333.CrossRefGoogle Scholar
  2. Almeida, J., O’Brien, K., Gross, E., & Gironda, C. (in press). Development, implementation, and evaluation of a comprehensive course on suicide in a Masters of Social Work program. Journal of Social Work Education.Google Scholar
  3. Asarnow, J. R., Porta, G., Spirito, A., Emslie, G., Clarke, G., Wagner, K. D., … Brent, D. A. (2011). Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents: Findings from the TORDIA study. Journal of the American Academy of Child & Adolescent Psychiatry, 50, 772–781. doi:  10.1016/j.jaac.2011.04.003
  4. Bagge, C., & Sher, K. J. (2008). Adolescent alcohol involvement and suicide attempts: Toward the development of a conceptual framework. Clinical Psychology Review, 28, 1283–1296.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Saddle River, NJ: Prentice-Hall.Google Scholar
  6. Barrio, C. A. (2007). Assessing suicide risk in children: Guidelines for developmentally appropriate interviewing. Journal of Mental Health Counseling, 29, 50–66.CrossRefGoogle Scholar
  7. Brent, D. A., McMakin, D. L., Kennard, B. D., Goldstein, T. R., Mayes, T. L., & Douaihy, A. B. (2013). Protecting adolescents from self-harm: A critical review of intervention studies. Journal of the American Academy of Child and Adolescent Psychiatry, 52, 1260–1271.CrossRefPubMedGoogle Scholar
  8. Brown, R. A., Strong, D. R., Abrantes, A. M., Myers, M. G., Ramsey, S. E., & Kahler, C. W. (2009). Effects on substance use outcomes in adolescents receiving motivational interviewing for smoking cessation during psychiatric hospitalization. Addictive Behaviors, 34, 887–891.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Calear, A. L., Christensen, H., Freeman, A., Fenton, K., Busby Grant, J., van Spijker, B., & Donker, T. (2016). A systematic review of psychosocial suicide prevention interventions for youth. European Child & Adolescent Psychiatry, 25, 467–482. doi: 10.1007/s00787-015-0783-4.CrossRefGoogle Scholar
  10. Centers for Disease Control and Prevention. (2014). National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. Retrieved March 6, 2016 from
  11. Corcoran, J., Dattalo, P., Crowley, M., Brown, E., & Grindle, L. (2011). A systematic review of psychosocial interventions for suicidal adolescents. Children and Youth Services Review, 33, 2112–2118. doi: 10.1016/j.childyouth.2011.06.017.CrossRefGoogle Scholar
  12. Council on Social Work Education. (2015). Educational Policy and Accreditation Standards. Alexandria, VA: Council on Social Work Education.Google Scholar
  13. Daniel, S. S., & Goldston, D. B. (2009). Interventions for suicidal youth: A review of the literature developmental considerations. Suicide and Life Threatening Behavior, 39, 252–268.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Diamond, G. M. (2014). Attachment-based family therapy interventions. Psychotherapy, 51, 15–19. doi: 10.1037/a0032689.CrossRefPubMedGoogle Scholar
  15. Diamond, G. S., Creed, T., Gillham, J., Gallop, R., & Hamilton, J. L. (2012a). Sexual trauma history does not moderate treatment outcome in attachment-based family therapy (ABFT) for adolescents with suicide ideation. Journal of Family Psychology, 26, 595–605. doi: 10.1037/a0028414.CrossRefPubMedGoogle Scholar
  16. Diamond, G. S., Diamond, G. M., & Levy, S. A. (2013). Attachment-Based Family Therapy (ABFT) [National Registry of Evidence-based Programs and Practices (NREPP)]. Retrieved September 22, 2015 from
  17. Diamond, G. S., Diamond, G. M., & Levy, S. A. (2014). Task I: Relational reframe. In G. S. Diamond, G. M. Diamond, & S. A. Levy (Eds.) Attachment-based family therapy for depressed adolescents (pp. 61–95). Washington: American Psychological Association. Retrieved from
  18. Diamond, G. M., Diamond, G. S., Levy, S., Closs, C., Ladipo, T., & Siqueland, L. (2012b). Attachment-based family therapy for suicidal lesbian, gay, and bisexual adolescents: A treatment development study and open trial with preliminary findings. Psychotherapy, 49, 62–71. doi: 10.1037/a0026247.CrossRefPubMedGoogle Scholar
  19. Diamond, G. S., Reis, B. F., Diamond, G. M., Siqueland, L., & Isaacs, L. (2002). Attachment-based family therapy for depressed adolescents: A treatment development study. Journal of the American Academy of Child and Adolescent Psychiatry, 41(10), 1190–1196. doi: 10.1097/00004583-200210000-00008.CrossRefPubMedGoogle Scholar
  20. Diamond, G. S., Wintersteen, M. B., Brown, G. K., Diamond, G. M., Gallop, R., Shelef, K., & Levy, S. (2010). Attachment-based family therapy for adolescents with suicidal ideation: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 122–131.PubMedGoogle Scholar
  21. Donaldson, D., Spirito, A., & Esposito-Smythers, C. (2005). Treatment for adolescents following a suicide attempt: Results of a pilot trial. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 113–120. doi: 10.1097/00004583-200502000-00003.CrossRefPubMedGoogle Scholar
  22. Donath, C., Graessel, E., Baier, D., Bleich, S., & Hillemacher, T. (2014). Is parenting style a predictor of suicide attempts in a representative sample of adolescents? BMC Pediatrics, 14, 1–13. doi: 10.1186/1471-2431-14-113.CrossRefGoogle Scholar
  23. Erbacher, T. A., Singer, J. B., & Poland, S. (2015). Suicide in schools: A practitioner’s guide to multi-level prevention, assessment, intervention, and postvention. New York: Routledge.Google Scholar
  24. Esposito-Smythers, C., & Goldston, D. B. (2008). Challenges and opportunities in the treatment of adolescents with substance use disorder and suicidal behavior. Substance Abuse, 29, 5–17.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Esposito-Smythers, C., Spirito, A., Kahler, C. W., Hunt, J., & Monti, P. (2011). Treatment of co-occurring substance abuse and suicidality among adolescents: A randomized trial. Journal of Consulting and Clinical Psychology, 79, 728–739.CrossRefPubMedPubMedCentralGoogle Scholar
  26. Esposito-Smythers, C., Walsh, A., Spirito, A., Rizzo, C., Goldston, D., & Kaminer, Y. (2012). Working with the suicidal client who also abuses substances. Cognitive and Behavioral Practice, 19, 244–255.CrossRefGoogle Scholar
  27. Feldman, B. N., & Freedenthal, S. (2006). Social work education in suicide intervention and prevention: An unmet need? Suicide and Life-Threatening Behavior, 36, 467–480.CrossRefPubMedGoogle Scholar
  28. Fleischhaker, C., Böhme, R., Sixt, B., Brück, C., Schneider, C., & Schulz, E. (2011). Dialectical Behavioral Therapy for adolescents (DBT-A): A clinical trial for patients with suicidal and self-injurious behavior and borderline symptoms with a one-year follow-up. Child and Adolescent Psychiatry and Mental Health, 5, 1–10. doi: 10.1186/1753-2000-5-3.CrossRefGoogle Scholar
  29. Galaif, E. R., Sussman, S., Newcomb, M. D., & Locke, T. F. (2007). Suicidality, depression, and alcohol use among adolescents: A review of empirical findings. International Journal of Adolescent Medical Health, 19, 27–35.CrossRefGoogle Scholar
  30. Garraza, L., Walrath, C., Goldston, D. B., Reid, H., & McKeon, R. (2015). Effect of the Garrett Lee Smith Memorial Suicide Prevention Program on Suicide Attempts Among Youths. JAMA Psychiatry, 72, 1143–1149. doi: 10.1001/jamapsychiatry.2015.1933.CrossRefGoogle Scholar
  31. Goldston, D. B. (2004). Conceptual issues in understanding the relationship between suicidal behavior and substance use in adolescence. Drug and Alcohol Dependence, 76(Suppl), 79–91.CrossRefGoogle Scholar
  32. Harrington, R., Kerfoot, M., Dyer, E., McNiven, F., Gill, J., Harrington, V., … Byford, S. (1998). Randomized trial of a home-based family intervention for children who have deliberately poisoned themselves. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 512–518Google Scholar
  33. Hawkins, E. H. (2009). A tale of two systems: Co-occurring mental health and substance abuse disorders treatment for adolescents. Annual Review of Psychology, 60, 197–227.CrossRefPubMedGoogle Scholar
  34. Huey, S. J., Jr., Henggeler, S. W., Rowland, M. D., Halliday-Boykins, C. A., Cunningham, P. B., Pickrel, S. G., & Edwards, J. (2004). Multisystemic therapy effects on attempted suicide by youths presenting psychiatric emergencies. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 183–190. doi: 10.1097/00004583-200402000-00014.CrossRefPubMedGoogle Scholar
  35. Joiner, T. E., & Ribeiro, J. D. (2011). Assessment and Management of Suicidal Behavior in Children and Adolescents. Pediatric Annals, 40, 319–324. doi: 10.3928/00904481-20110512-08.CrossRefPubMedGoogle Scholar
  36. Klonsky, E., May, A. M., & Glenn, C. R. (2013). The relationship between nonsuicidal self injury and attempted suicide: Converging evidence from four samples. Journal of Abnormal Psychology, 122, 231–237. doi: 10.1037/a0030278.CrossRefPubMedGoogle Scholar
  37. Kuntsche, E., Knibbe, R., Gmel, G., & Engels, R. (2005). Why do young people drink? A review of drinking motives. Clinical Psychology Review, 25, 841–861.CrossRefPubMedGoogle Scholar
  38. Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.Google Scholar
  39. MacPherson, H., Cheavens, J., & Fristad, M. (2013). Dialectical Behavior Therapy for Adolescents: Theory, treatment adaptations, and empirical outcomes. Clinical Child and Family Psychology Review, 16, 59–80. doi: 10.1007/s10567-012-0126-7.CrossRefPubMedGoogle Scholar
  40. Main, M., Hesse, E., & Kaplan, N. (2005). Predictability of attachment behavior and representational processes at 1, 6, and 19 years of age: The Berkeley Longitudinal Study. In K. E. Grossmann, K. Grossmann, & E. Waters (Eds.), Attachment from infancy to adulthood: The major longitudinal studies (pp. 245–304). New York: The Guilford Press.Google Scholar
  41. Mazza, J. J., Dexter-Mazza, E. T., Miller, A. L., Rathus, J. H., & Murphy, H. E. (2016). DBT skills in schools: Skills training for emotional problem solving for adolescents (DBT STEPS-A). New York: The Guilford Press.Google Scholar
  42. McConnell, M., & Moss, E. (2011). Attachment across the life span: Factors that contribute to stability and change. Australian Journal of Educational & Developmental Psychology, 11, 60–77.Google Scholar
  43. Mehlum, L., Ramberg, M., Tørmoen, A. J., Haga, E., Diep, L. M., Stanley, B. H., … Grøholt, B. (2016). Dialectical behavior therapy compared with enhanced usual care for adolescents with repeated suicidal and self-harming behavior: Outcomes over a one-year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 55, 295–300. doi:  10.1016/j.jaac.2016.01.005
  44. Mehlum, L., Tørmoen, A. J., Ramberg, M., Haga, E., Diep, L. M., Laberg, S., … Grøholt, B. (2014). Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: a randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53, 1082–1091. Scholar
  45. Miller, A. L., Rathus, J. H., & Linehan, M. (2007). Dialectical behavior therapy with suicidal adolescents. New York: Guilford Press.Google Scholar
  46. Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). New York: Guilford Press.Google Scholar
  47. National Association of Social Workers. (1996/2008). Code of Ethics of the National Association of Social Workers. Retrieved from
  48. Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: Results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry, 70, 300–310. doi: 10.1001/2013.jamapsychiatry.55.CrossRefPubMedGoogle Scholar
  49. O’Brien, K. H. M., Singer, J. B., LeCloux, M., Duarté-Vélez, Y., & Spirito, A. (2014). Acute behavioral interventions and outpatient treatment strategies with suicidal adolescents. International Journal of Behavioral and Consultation Therapy, 9(3), 19–25.PubMedPubMedCentralGoogle Scholar
  50. Ougrin, D., Tranah, T., Stahl, D., Moran, P., & Asarnow, J. R. (2015). Therapeutic interventions for suicide attempts and self-harm in adolescents: Systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 54, 97–107.CrossRefPubMedGoogle Scholar
  51. Pisani, A. R., Wyman, P. A., Petrova, M., Schmeelk-Cone, K., Goldston, D. B., Xia, Y., & Gould, M. S. (2013). Emotion regulation difficulties, youth-adult relationships, and suicide attempts among high school students in underserved communities. Journal of Youth and Adolescence, 42, 807–820. doi: 10.1007/s10964-012-9884-2.CrossRefPubMedGoogle Scholar
  52. Ribeiro, J. D., Bodell, L. P., Hames, J. L., Hagan, C. R., & Joiner, T. E. (2013). An empirically based approach to the assessment and management of suicidal behavior. Journal of Psychotherapy Integration, 23, 207–221. doi: 10.1037/a0031416.CrossRefGoogle Scholar
  53. Rizvi, S. L., & Ritschel, L. A. (2014). Mastering the art of chain analysis in dialectical behavior therapy. Cognitive and Behavioral Practice, 21, 335–349. doi: 10.1016/j.cbpra.2013.09.002.CrossRefGoogle Scholar
  54. Robinson, J., Cox, G., Malone, A., Williamson, M., Baldwin, G., Fletcher, K., & O’Brien, M. (2013). A systematic review of school-based interventions aimed at preventing, treating, and responding to suicide-related behavior in young people. Crisis, 34, 164–182. doi: 10.1027/0227-5910/a000168.CrossRefPubMedGoogle Scholar
  55. Rossouw, T. I., & Fonagy, P. (2012). Mentalization-based treatment for self-harm in adolescents: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 51(1304–1313), e3. doi: 10.1016/j.jaac.2012.09.018.Google Scholar
  56. Ruth, B. J., Gianino, M., Muroff, J., McLaughlin, D., & Feldman, B. N. (2012). You can’t recover from suicide: Perspectives on suicide education in MSW programs. Journal of Social Work Education, 48, 501–516.CrossRefGoogle Scholar
  57. Scheel, K. R. (2000). The empirical basis of dialectical behavior therapy: Summary, critique, and implications. Clinical Psychology: Science and Practice, 7, 68–86. doi: 10.1093/clipsy/7.1.68.Google Scholar
  58. Schilling, E. A., Aseltine, R. H., Glanovsky, J. L., James, A., & Jacobs, D. (2009). Adolescent alcohol use, suicidal ideation, and suicide attempts. Journal of Adolescent Health, 44, 335–341.CrossRefPubMedGoogle Scholar
  59. Scott, M. (2015). Teaching Note—Understanding of Suicide Prevention, Intervention, and Postvention: Curriculum for MSW Students. Journal of Social Work Education, 51, 177–185. doi: 10.1080/10437797.2015.979095.Google Scholar
  60. Sharma, T., Guski, L. S., Freund, N., & Gøtzsche, P. C. (2016). Suicidality and aggression during antidepressant treatment: Systematic review and meta-analyses based on clinical study reports. BMJ (Clinical Research Edition), 352, i65.Google Scholar
  61. Shea, S. C. (2002). The practical art of suicide assessment: A guide for mental health professionals and substance abuse counselors. Lexington, KY: Mental Health Presses.Google Scholar
  62. Sher, L. (2006). Alcohol consumption and suicide. QJM, 99, 57–61.CrossRefPubMedGoogle Scholar
  63. Sher, L., & Zalsman, G. (2005). Alcohol and adolescent suicide. International Journal of Adolescent Medical Health, 17, 197–203.Google Scholar
  64. Singer, J. B., & Greeno, C. M. (2013). When Bambi Meets Godzilla: A practitioner’s experience adopting and implementing a manualized treatment in a community mental health setting. Best Practices in Mental Health, 9, 99–115.Google Scholar
  65. Spirito, A., Esposito-Smythers, C., Wolff, J., & Uhl, K. (2011). Cognitive-behavioral therapy for adolescent depression and suicidality. Child and Adolescent Psychiatric Clinics of North America, 20, 191–204. doi: 10.1016/j.chc.2011.01.012.CrossRefPubMedPubMedCentralGoogle Scholar
  66. Stanley, B., Brown, G., Brent, D. A., Wells, K., Poling, K., Curry, J., … Hughes, J. (2009). Cognitive-behavioral therapy for suicide prevention (CBT-SP): Treatment model, feasibility, and acceptability. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 1005–1013Google Scholar
  67. Swales, M. A., Taylor, B., & Hibbs, R. A. B. (2012). Implementing Dialectical Behaviour Therapy: Programme survival in routine healthcare settings. Journal of Mental Health, 21, 548–555. doi: 10.3109/09638237.2012.689435.CrossRefPubMedGoogle Scholar
  68. Tanner-Smith, E. E., & Lipsey, M. W. (2015). Brief alcohol interventions for adolescents and young adults: A systematic review and meta-analysis. Journal of Substance Abuse Treatment, 51, 1–18.CrossRefPubMedGoogle Scholar
  69. Thyer, B. A. (2001). What is the Role of Theory in Research on Social Work Practice? Journal of Social Work Education, 37, 9–25. doi: 10.1080/10437797.2001.10779034.Google Scholar
  70. Ting, L., Jacobson, J. M., & Sanders, S. (2008). Available supports and coping behaviors of mental health social workers following fatal and nonfatal client suicidal behavior. Social Work, 53, 211–221.CrossRefPubMedGoogle Scholar
  71. Walrath, C., Garraza, L. G., Reid, H., Goldston, D. B., & McKeon, R. (2015). Impact of the Garrett Lee Smith youth suicide prevention program on suicide mortality. American Journal of Public Health, 105, 986–993. doi: 10.2105/AJPH.2014.302496.CrossRefPubMedGoogle Scholar
  72. Wells, E. A., Kristman-Valente, A. N., Peavy, K. M., & Jackson, T. R. (2013). Social workers and delivery of evidence-based psychosocial treatments for substance use disorders. Social Work in Public Health, 28, 279–301. doi: 10.1080/19371918.2013.759033.CrossRefPubMedPubMedCentralGoogle Scholar
  73. Wong, S., Zhou, B., Goebert, D., & Hishinuma, E. (2013). The risk of adolescent suicide across patterns of drug use: A nationally representative study of high school students in the United States from 1999 to 2009. Social Psychiatry and Psychiatric Epidemiology, 48, 1611–1620. doi: 10.1007/s00127-013-0721-z.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Jonathan B. Singer
    • 1
  • Kimberly H. McManama O’Brien
    • 2
  • Mary LeCloux
    • 3
  1. 1.Loyola University Chicago School of Social WorkChicagoUSA
  2. 2.Simmons School of Social Work, Boston Children’s HospitalHarvard Medical SchoolBostonUSA
  3. 3.West Virginia University School of Social WorkMorgantownUSA

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