Ep. 193- Youth in Crisis: What To Do When a Teen or Adolescent Wants To Hurt Themselves
This episode describes how to respond when a teen, adolescent or young adult says they want to hurt themselves or kill themselves.
It's horrifying when someone as young as 12-20 years old says they want to take their own life. When a teen or young adult confesses thoughts of hurting themselves or even hints at a plan, panic often kicks in...but what you do next can mean the difference between life and tragedy. In this episode, Dr. Kibby describes how you can transform fear into effective, life-saving support. If you're a parent, clinician, educator, or anyone caring for at-risk youth, this episode will change your perspective on how to handle these terrifying moments with compassion, clarity, and confidence. In this honest conversation, you'll discover why traditional reactions often do more harm than good and how shifting from control to understanding can unlock trust and safety.
Dr. Kibby shares insights from her nearly lifelong work with mental health crises as well as adolescent and family Dialectical Behavior Therapy expert Dr. Marcus Rodriguez. Drawing from what she learned from Dr. Rodriguez, she emphasizes the importance of treating the whole family and system instead of isolated individuals. You'll learn why vague answers from teens are actually a sign of trust-building, not apathy or indifference, and how impulsivity heightens the risk of dangerous behaviors that require immediate, delicate intervention. We break down practical, step-by-step frameworks for assessing suicidality, from asking direct questions about plans and access to means, to understanding the importance of safety measures like environment restriction and involving the support system. You’ll hear specific scripts designed to validate pain without validating harmful coping strategies, and how to balance genuine empathy with concrete safety protocols.
The core message: you’re not just stopping a moment of crisis- you're working with the teen, their family, and their community, to understand their pain and help them find hope. Interpersonal triggers like breakups, bullying, and social rejection are particularly devastating for teens, and how they differ from adult experiences. Dr. Kibby describes how you can meet teens where they are, by respecting their vague answers, impulsive actions, and emotional intensity, and why working systemically is essential for lasting safety.
Remember: Asking directly about suicide does not plant the idea; it saves lives. Whether you’re facing an immediate crisis or working to prevent one, this episode is your essential guide to understanding and intervening with care, respect, and hope.
Trigger warning: Sensitive topics discussed include self-harm, suicidal ideation, and family trauma.If you’re involved with teens or young adults, or if you simply want to learn how to support someone in their darkest hour, this episode is a must-listen.
Resources:
Parents, partners and other loved ones of people struggling with self harm and suicide, check out KulaMind. Book a free call with Dr. Kibby to learn how she can help.
Adolescents, teens and families in California in crisis should learn about Dr. Rodriguez's Dialectical Behavior Therapy program at Youth and Family Institute
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Dr. Kibby McMahon (00:09.154)
Welcome back, little helpers. Today I'm going to be talking about a truly scary topic, which is how do you respond to self-harm or suicidal crises in teens and young adults? So today, my good friend and colleague, Dr. Marcus Rodriguez, who is an adolescent and family dialectical behavior therapy therapist,
Marcus and I did a webinar for clinicians about responding to different kinds of self-harm crises in kids ages, you know, generally 10 up till 20. And it was such a good webinar. I learned so much from from Marcus and also just talking about the topic, it definitely resonated with a lot of people who were struggling knowing what to do.
When it comes to this this particular situation where someone as young as 10, 11, 12 comes to you, maybe you're a clinician, a parent, educator, or someone who just cares for youth, and that that kid tells you, I'm thinking about hurting myself, I'm thinking about killing myself. I I can't imagine anything scarier. And
So we we went deep into the belly of the beast, which is what do you do? What do you actually say? What is the right way to respond to something so scary like that? I'll say up front that I'm basically gonna give you a lot of the webinar right now. I'm gonna talk through the different elements that we covered, which is why this is such a problem, how to assess suicide or self-harm urges, and
principles to actually respond in healthy ways and really helpful ways and what families can do bringing in the family system so those are the different parts of the webinar and i will say up front that a lot of this material was I got from Marcus. So if you have a if you're in California
Dr. Kibby McMahon (02:29.13)
And if you have an adolescent or young adult or even your family who is struggling with someone who is suicidal or hurts themselves, you can reach out to Dr. Marcus Rigas and his clinic is called the Youth and Family Institute. So if you're in California, talk to him. I'll leave the the website in the show notes. and if you are like a parent or family member,
partner, another loved one of someone who is suicidal or self-harms. that's that's my area. So you can learn more about KulaMind, K-U-L-A-M-I-N-D. that's my program where I coach family members on how to actually respond to really intense mental health crises like this. So for the family, I'll do the coaching and Marcus could do the the therapy with with the with the youth. So
hold on. Pineapple.
Dr. Kibby McMahon (03:38.936)
So I'm jumping back in. Pineapple.
So why even bring up this topic? full disclosure, I'm an adult therapist. I most I work with adults, and that's my main main experience. But I am talking to a lot of adults who have teens, adolescents, youth in their life that are struggling. I'll just say teens. I'll just say I'll, you know, I was go back and forth between youth and young adults. I'll I'll just say
I'll just say teens. and when I mean teens, I also include people up until their early twenties because I feel like now we, you know, adolescence has extended to a lot longer than we had before. So the reason why we did this we talked about this topic is working with young adults and teens. It's not scarier than it used to be. before the pandemic.
I think that it, you know, you might have a few, a few kids who are going through something really difficult who suicidal, or self harm. I know that when I look back on on my childhood, and I look at my adolescent years, I had a I had a number of friends who I I mean myself, I actually I actually myself cut a little bit when I was in high school and I was dealing with a lot of stressful situations with my mom, but
I did know several of my really good friends who either hurt themselves in some way, like cutting or hitting themselves really common, burning or scratching. I don't know anyone who did that, but burning or scratching is one form of self harm. And there were a few of my really good friends who you know, tried to take their own life, took a bottle of pills and took, you know, a bottle of alcohol and ended up in the emergency room. I didn't
Dr. Kibby McMahon (05:42.679)
realized just how high pressured my my background was now that I'm taking my son to a different looking at different schools and hearing about my schools and how intense and pressure cookery they were. I was like, I I just really I was in a really intense, stressful environment. So there were a lot of a lot of kids that I I knew, a lot of good friends who struggled with these kind of things. But talking to
administrators, educators, clinicians, I mean it it it just seems like the youth, the teens, adolescents, like kids who are too young to be even thinking about this. They should be having fun, but instead they are thinking about hurting themselves. It's awful. It feels like high crisis right now. It feels like young people aren't able to cope with a lot of the stress stressors of the world.
even going to school terrifies them, right? So there's just like so much pain that they don't know how to deal with. Even just the stats that we listed out, it's like one in five US high school students seriously considered suicide in the past year. Nearly one in ten reported a suicide attempt.
And suicide remains one of the leading causes of death in adolescents and young adults. So it just feels scarier. And if you are, if part of your life, daily life or work involves young people, you will come across this. It almost seems pretty likely that you have dealt with this already if you're listening to this. I've talked in those podcasts about what I think it could be contributors. I mean
Everyone wants to blame social media. Everyone wants to go, well, you know, the kids are struggling because of social media. Not no, but I think that is one symptom of the problem. we forget that a lot of kids a lot of these kids now who are teens had a significant part of their childhood in COVID, right? And yeah, we might look back on it like we stayed inside for a while, but if you don't remember the terror in the beginning, this the
Dr. Kibby McMahon (08:00.386)
The fear that if you go outside or stand too close to someone, you can kill them. And I I think existentially it's scary for a kid to see the world shut down. Right. There's so much of teen and y young adult life with that is about experimenting and doing stupid things and acting out, rebelling, finding yourself. And that all makes sense when the overarching structure is solid.
There's a foundation of safety. You have a family who will be there to help you and love you and walk you through the hard times. There will be a world with rules and expectations. And if you go to school and go to work, you know, everything will be fine. And then all those assumptions were gone, right? Like suddenly the world can stop and you're doing, you know, school on online and we didn't know what was gonna what was gonna happen. So I do think that COVID had a major
major effect on youth mental health and really pull them away from being able to cope with a lot of painful things. So this is just something that is more of a problem now than ever. So if you f if you are in contact with teens and you're like, why is this so hard? I I I think they're the I think there's a real reason for that and validating that for you. So pineapple and Jan, I'll be switching
I'll be switching through the slides when I do get cut that part out.
Dr. Kibby McMahon (09:38.723)
I will say that thinking about helping and supporting teens who are struggling with suicidal thoughts or self-harm, full disclosure, my training as an adult clinical psychologist, I assume that teens are just young, small adults, that they probably have less regulation, so they're
They don't have as many coping skills, they don't have wisdom, and that's the difference. So that couldn't be further from the truth. Teens and adolescents are not just small adults. They have their own needs. They have their own considerations. Yes, all the things that I said, they don't have a fully formed prefrontal cortex, so they don't have the same kind of regulation skills that we do, getting through hard times and trying to figure a way out. But we can't just think, it's like helping an adult.
except smaller or easier definitely not i'll point out four major differences four things to really think about if you're a clinician or you know a a teacher or you have teens here are four things to wrap your head around about how it's different than working with adults how teen suicide and self-harm can be very different
One is that when you help an adult with suicidal so suicidal thoughts of self-harm, you might be talking about helping an individual, right? You work with one person, you ask them what kind of coping skills they have, you help one one person. I actually argue that even when you're an adult, it there's still not it's not just one person, but it really is a critical part of treating
And supporting teens. It's like thinking about I'm treating a family system. I'm treating a community. I'm treating a support network around this teen. Maybe the teen isn't even the biggest problem. Maybe it's their parents' marriage. Maybe it's the school environment that's just really not supportive, right? So because they're so housed and so interconnected with their social environment, it's
Dr. Kibby McMahon (12:01.802)
you have to think about how do I treat a family system, not just how do I treat a an individual. And I say treat a lot with this with this talk, but I will, you know, you may not be a c clinician. You may not be a therapist, but I'm saying if you are in a position of helping a teen. So we'll say helping or or treating. So the first one is treating the family system. The second is that
It is more normal to hear shutdown, ambivalence, or they might not give you much. So, and I was talking to Marcus about this, it's so interesting that teens and adolescents are just they don't really have a lot of control of their lives. Right? They're sent to a school, they are told when to go where. they
you know, we limit how much screen time they have, right? So they're they're a lot of their lives are not their own. And the a lot of c the control they have is withdraw, right? So the if they want to make sure they could trust you before sharing or control how they're being treated or their relationship to you and what you do, they might say,
I don't know. Or yeah, I don't really care. Or maybe. Like they give you non-answers. So that that's their way of just, you know, protecting themselves is to be kind of vague. But you should expect that. And you should expect that resistance or not openly sharing is the norm. They're trying to figure out who they can trust and how. And they're just not gonna be as clear about.
Yes, I've had thoughts of hurting myself. I I'm really scared. I really need help. I'm I'm at risk of harming myself. Adults might be able to because they have a little bit more coping skills and communication, but it is more normal for kids not to say that outright. So if you see a kid who is not doing well, you're worried about their well-being, they've they've hit some hard times, and there's a risk.
Dr. Kibby McMahon (14:28.078)
I would not take the I don't know as a sign that there is no risk. I would take that as a point to start assessing more, to be open and to listen more. That's the start of the conversation. So I wouldn't confuse the I don't know or I don't care with I'm fine. They might even say I'm fine. They might not be fine. So expect ambivalence and vague answers from teens. The third consideration is.
the research shows that adolescents and teens are very high at risk for self-harm and suicide, but especially because they have higher impulsivity, meaning that they will without much forethought or planning, they'll jump to doing something. They'll jump to a coping skill, which could be hitting themselves, hurting themselves, right? They might do things that are
you know, dangerous. So knowing that research, knowing that kids are my teens are a lot more impulsive.
Keeping the environment safe is super critical. And what I mean by that is making sure that someone is physically there with them, making sure that what's called method restriction, which is getting like locking up those guns, locking getting rid of any weapons or sharp things and medications, pills, anything that could be dangerous if you are.
you know, unsure or scared for their safety, I would make sure the environment is safe first. not first, but one of the one of the major things to think about. And then four, it's interesting that this was this was cited as a as a d major difference between teens and adults who are suicidal, but I really don't agree. But most
Dr. Kibby McMahon (16:32.974)
Cris are interpersonal in nature. So breakups, being bullied, being cyberbullied. If you've seen adolescence on Netflix, you'll know exactly what I'm talking about. Friendship conflict, friendship drama, feeling lonely, feeling like you don't fit in, not getting into a group or some kind of social community that you wanted. those are all major triggers of intense pain in teens. And
It's easy to, you know, as an adult to think, you know, I have so many problems. I, you know, I gotta make a living and I gotta support everyone and, you know, they they haven't paid taxes. Like my teen is, you know, obsessed over their breakup. That might be really missing the point because it is a major trigger of a lot of pain. It's a big deal.
For teens to go through interpersonal rupture or pain or drama. It might seem like a trivial small problem to us adults, which I actually don't think is true. I think that a lot of our triggers are interpersonal in nature, but with teens, they are developing their identity. They are individuating, they're breaking away from their family life and they're making new attachments. They're defining themselves with their social.
circle, right? We all know that we all have heard like teens care about being popular and belonging fitting in. So not doing that is not just, no big deal. It's a big deal for them. It's earth shattering. It could be like an existential crisis if you have a bad breakup. So when when teens go through that, don't minimize it. Really don't
you know, invalidate and say, like, this is not that big of a deal. It's just a dumb boy. Who cares? You'll date so many other other ones. but take it seriously and know that this is a trigger. This is up like those interpersonal ruptures are a trigger of a lot of serious and dangerous behavior. So those are the four major differences. I'm sure there's many more, but you know, treating a family system, expecting ambivalence or vague answers,
Dr. Kibby McMahon (18:48.942)
keeping in mind that they're impulsive, so keeping the environment safe and knowing that interpersonal problems are a big trigger. And so when you put all of these together, you get we gotta think about helping the support system be part of the safety plan instead of, there's one team with a problem. Right? There is a system. There is a family with a problem. So we gotta we gotta
loop in all of that. pineapple.
Dr. Kibby McMahon (19:29.624)
So
Dr. Kibby McMahon (19:33.047)
It's it I'm I'm gonna talk about assessment, how to assess, and how to actually find out if your teen, young adult are is actually thinking of hurting themselves. I'll say up front that it is saves lives to ask someone if they're thinking of killing themselves. Asking directly about self-harm and suicide saves lives. There are so many myths about that.
There's so it's such a scary topic to bring up that even me who's had a lot of training, who is very comfortable with talking about this, if I get a sense of, no, my patient or someone is maybe they're suicidal, like I I get scared to bring up that topic. Part of it is I don't want to hear it because it's so painful and scary. And then it might mean you have to do certain things, you have to call someone, you have to, right? you're scared of how it might, you know, interfere with your
relationship.
But not asking is more dangerous than asking. It does not plant the the idea in their head. They, if they're thinking about it, they will tell you. And it's not something that you just created. So ask. If you are a loved one, you know, if you are a sibling or a family member, you could say, hey. Actually, I'm j jumping right into it, but I'll I'll list out that the three major things to assess.
Maybe four. I'll say four. Are one, are they thinking of hurting or killing themselves? Two, do they have a plan, like an idea of how they would do it? Three, do they have access to the means right now about that are that would be dangerous and put them at risk? And four would be intend. Do you do they actually think about doing this and plan to do it and not just, you know, passive thoughts?
Dr. Kibby McMahon (21:36.797)
those are the those are the top things to really parse apart, right? And I'm not saying you have to you have to, you know, list these out, but and ask them one by one. But these are the things to think about the to look out for. You could ask questions like, for one, are they thinking of hurting or killing themselves? The questions I like to ask are are, you know, this pain has been so big, like you sound so overwhelmed. I get it, things have been really hard.
I I just I just wanna be sure and I just wanna understand. Have has the pain been so bad that you've thought about death or her taking your own life?
Dr. Kibby McMahon (22:19.252)
Me more about those thoughts. When's the last time you had them? Right? so really asking directly about thoughts of death or hurting themselves. And then you could ask, okay, if someone says yes, you say, Okay, do you think about how you would do it? Do you think about do you ever plan? Do you ever take steps to plan or make moves towards making it happen? And then access to me. So it's like, okay, well, is there anything around you that
Can be dangerous. Like, how can we make you how can we keep you safe? Right. is there anything like, especially if they tell you the the method or plan? Like if they're saying, I'm thinking of taking pills, then you say, Okay, are there pills in the house? Like, you know, let's talk through, let's walk through together how to get that away from you so we can just really understand and cope with your pain first. other things to pay attention to is if they have
self-harm a history of self-harm or suicide attempts, that really increases the risk a lot. So if you know you get asked them, have you ever done actually done this before? Have you have you ever hurt yourself? And then you can, especially if it's more recent, that that brings up the risk too. And understanding protective factors, which is like what are your reasons to live? What actually helps you get these through these moments?
When you've had these thoughts, what helps you feel better? What is something that you look forward to? So I'm not gonna give a whole rundown of like how to assess for suicidality, but those are the major parts. At least you you could ask those questions just as I as I said it, or you could weave that into a conversation, right? You could you could talk about like when this is the pain is so big. Like, do you do you think about, you know, do you think about how you feel better or
if they say they talk about death or they think about death, you'd be like, what does that mean to you? What do you think that that would solve? Like, so just have these kind of open conversations to really understand if if they were having these thoughts and feelings. pineapple.
Dr. Kibby McMahon (24:34.72)
And the pineapple. So then once you assess and they say yes, you know, I'm thinking about it. if they are an immediate crisis, like they're like, I I've thought about killing myself, I thought about how, and I'm gonna do it. That is high risk. I'll just say that, like if there's intent, a plan, and thoughts, that is high risk.
Call someone. Call 988 the crisis line in the US. 911. I know that's that's that's tricky. There is a lot of controversy about calling the police because it could be even more traumatic. It could be very traumatic to go in the hospital. so I d I definitely always recommend 988 the crisis line. If they have a therapist, you alert the therapist or you take them to the emergency room. Yes, I know that's gonna be tough. That's that's no one's gonna like that.
They're gonna be angry. It's unpleasant to be in the hospital. But if that if if there is like a a risk, like someone is at is at high risk like this, that is that is a way to go to keep them safe. You would prefer for them to be angry and bummed out eating the gross hospital food than seriously injured, right? So I I'll say that, especially if you're
you know, listening to this and you're like, I have had absolutely no training in handling suicidality, better safe than sorry. If it's not imminent risk, if it's not like if it's like thoughts of death or hurting yourself, also self-harm doesn't necessarily have to be suicidal. Some people hurt themselves and don't have any plan to kill themselves and take their own life. I would make that distinction really clear.
non-suicidal self-injury is a thing and it's more common than you think. a lot of time is to express how much pain they're in or to cope with the pain in some way. Like some people will do will create physical pain to themselves because it distracts them or takes their or externalizes the pain, right? It's a way of coping. But they don't think I'm gonna I wanna I wanna die. So being really clear and really asking for that. So if you if the there's no
Dr. Kibby McMahon (26:58.676)
immediate high risk of suicide and this or suicidal behavior or sorry. or if it's I won't say just self harm, but if there's no immediate risk of of death, then
Dr. Kibby McMahon (27:19.676)
Sorry, yeah, there's a lot of commotion outside.
Dr. Kibby McMahon (27:35.967)
I hope they're not too bad. then I would move to really I mean, do this anyway, i regardless. But Mark has really taught me this. It's really understand where they're coming from, really understand their pain. Talk to them. There's so much top down. Even as I'm thinking about if my son, who's, you know, if he turns thirteen and he tells me that he's thinking of jumping off the building, I would be
I would be in such terror that I would just be like, don't, don't do it. I would I try I would try to squash their feelings, you know, try to make them feel better and you know, to try to make them safe. Like I would try to get hands-on and stop the problem, right? I would be so scared. However, there is so much of that done to kids. There's so much top-down controlling doing.
forcing them, making them do this, making them do that, right? We, you know, we want to keep them safe so we know better. And there's a lot of a lot of doing things to them instead of with them. So but it goes a long way. I mean Marcus was saying this and I I know from my own experience that it goes a long way to try to understand their experience and not just telling them what to do. Right? Actually I did we we did a a podcast episode with Dr. Cam.
The teen translator a couple of episodes ago, and she said the same thing under not crisis situations. But we often try to make teens do stuff. Like we tell them go to school, we tell them to this and tell them that, give them advice, give them solutions. But what they're really looking for is someone to understand them and help them feel heard and get to know them as a person. So this approach, this
You could take the approach of really understanding what this teen is struggling with. What pain is so great, so big, that hurting themselves or taking their own life seems like the only solution. They might not even be able to articulate that, but no one just jumps right to that, right? There's there's usually so much pain. and
Dr. Kibby McMahon (30:00.375)
A lack of feeling there's a lack of feeling like that anything can help. And so it's a desperate measure, right? Killing yourself is a is a sign of desperation. So understanding how they got there, how they got so desperate, that would be the key. That's a key principle. And I love Marcus's script. I'll just read it out loud. He he he says to think about this.
Think about transmitting this message to this teen, this adolescent that's struggling. I'm not here to keep you alive just to prolong your pain. I want to understand the problem so we can solve it together.
Everything else, you know, locking up the the weapons, practicing skills, you know, getting people to help, it's all in service of that. It's all in service of I want to be able to understand the problem so we could work on it together. Think about it as as I said before, promoting and keeping keeping a teen safe is about dealing with the family system. How do you make the family safe? So instead of thinking,
You're a kid and you are thinking of killing yourself and you have this problem and you need to do something about it. It's like, how can we put our heads together and shoulder this burden together? You feel like this pain, this problem is so overwhelming. You can't think of anything else that can help. Well, let let me in and help you. Let let let's let's talk about it. Let's figure it out together. You're not alone.
Pineapple.
Dr. Kibby McMahon (31:47.243)
So in service of that, the first step is understanding the problem and validating. Again, this is all Marcus's what Marcus taught me today. And I've talked about this on this podcast over and over again, but it was just such a good reminder. Instead of thinking the fur if I'm picturing like if my 13-year-old son, he's three right now, but if his 13-year-old son said, I'm gonna hurt myself, I immediately will go to no, don't do that.
How do you make it how how how can we make you feel better? What do you want to do? What can I right? Like I'll I'm even getting anxious just talking about it, but I would rush to try to fix it. But that gives a message that we gotta get rid of this pain right away. We gotta solve this, get rid of this, but go bye-bye. I don't want this, right? No, no, no. It's actually a lot of suppression. Instead, slow down and take a moment to try to understand.
How did they get here? What is the most painful? I yeah, I'm gonna read out Marcus's script that he that he gave me. I want to understand what's causing you so much pain so that I can maybe help you find some way through it, some relief. I don't want to keep you alive and leave you stuck in the same level of pain. Right? So it's like, I want to understand this pain. When did the questions you could ask are?
Wow. So you're thinking of hurting yourself? What is going on right now? What brought what brought this up? When did you first start feeling this? What felt so overwhelming that you just can't handle it? You felt like you just can't handle it. What was that like?
Tell me more when you know what else are you feeling? What else made you made this so hard for you, right? What what have you tried? What have you done to try to fix it? Right? And just talk, talk to them, ask questions, ask clarifying questions. This is the place where I see loved ones as struggle because they are scared of the potential trauma of
Dr. Kibby McMahon (34:05.026)
Someone you love hurting themselves. So you you jump in with solutions. you don't don't worry about this. Go to your therapist. Like, that's not a big deal. you can handle it, don't worry about it. you've been graded tests before. Why should this be a problem? Right. You go, you you go into jumping to two solutions and not saying it could be especially because we as an adult,
We are adults think that we know better, especially if it's your kid or someone that you're you feel like you know and you're like, they were going through a breakup. I've been through breakups. I know how to handle it. I can tell them how to handle it. No. It's not your job to impose your wisdom onto them, right? If they ask for it, of course, and you might know that, okay, they could get through this, they have the skills, they're the capable, you know, they could get through this, but they don't know that.
Right. All they want they would love to have someone actually listen and listen fully. So ask questions. If you don't know, ask. Try to slow down. And I like to do this. I like as a therapist, I like to when I'm trying to understand a problem and trying to like really get into someone's world and understand what the pain is. I like to picture it. I'm more of a a visual person. So I like to you know almost picture like a movie, like what happened and
where is the pain and why is it so big and what's what else is really painful about it and why you what do they what does that mean for their future right I I just like to picture it. So if you feel like you're you know you're a visual person and you're trying to picture it or at least like analyze this problem in its full, there's any holes or gaps, fill it with a question. If you're like, wait a minute, okay, you broke up with your boyfriend.
And then you know a couple days go by and then you're thinking of hurting yourself. Walk me through that. How did you go from breakup to this feeling? What happened in those days? What the what was that like? What did that feel like? Wait, wait, wait. Okay, how long was that? Two hours? Where were you? Right. Just to flesh it out in your mind, really understand the problem. And then validate. Validation doesn't mean you're agreeing or just cheerleading. It's not like
Dr. Kibby McMahon (36:25.964)
I feel like especially online, validation is kind of this used as saying like confirm or approve, like I want to be validated. Validate here just means making sense of their feelings, telling them that it's legitimate to feel the way they're feeling, and then expressing that to them. okay.
This this relationship felt like you're everything. It felt like you finally had a home. It finally understood who you were. You finally felt cool. You finally felt like you had a group, and now it's all gone in a second. that would be so overwhelming. I totally get this is the validation part. I totally get why you'd be in so much pain. You don't have to validate the suicide or self-harm as a coping mechanism, right? You don't have to be like, Yeah, it makes sense that you would hurt yourself, or you know, yeah, you should take your own life.
Obviously don't do that, but don't be afraid of validating the feelings, even if you're afraid of it leads to this kind of deep dangerous behavior. Be like, that makes sense that you're feeling so much pain. Not don't worry about it, don't feel that pain. You know, but like, and you don't have to say, Okay, it makes sense why you're drinking and hurting yourself. Be like, I get that you feel this much pain.
And I get why this would feel like so overwhelming and you feel so alone in it that you didn't don't know how else to cope. You don't know how else to get through this moment. Right? Validate. Pineapple.
Dr. Kibby McMahon (38:14.54)
And then Marcus, and I think I've also coached my cool and clients in a similar way. You want to balance two things about your role. Your role as whatever clinician, you know, loved one, is that you want to share the load. You want to stand next to them and see the problem and work through the problem together. At the same time, you're trying to keep you're going to keep them safe, right? You want to help them stay safe.
so there's the dealing with the problem that led to the pain, sharing and validating that emotion. And also, hey, let's prevent coping with it in a way that is gonna be dangerous. So it's a tricky balance there, of course, because I think that a lot of people, especially with teens, it's so hard to get their trust that I would be afraid of like, hey, like how let me help you, let's talk about the suicidality. But then
Then doing all these things to keep them safe or you know, taking them somewhere, calling someone would make me seem like I'm not on their side, right? So having to balance, like I gotta I gotta get them to trust me and also I keep them safe. And then sometimes those feel like two different things. But if you can balance them both. So instead of thinking I'm here to stop you.
From hurting yourself. I'm here to stop your suicidality, which you are. But instead of fighting against something that they're doing, work with them to be like, okay, I'm here as an ally and as your support against your problem, the thing that is making you feel so upset. Right. I'm trying to figure, I'm I'll
I'll sit with you and think about and be with you in dealing with this breakup that is so painful that you're thinking about hurting yourself, right? So not like, hey, I'm trying to get you to stop hurting yourself. It's, hey, I'm here to sit next to you and really understand the problem with you and to work together to think of another solution, another way to get through this.
Dr. Kibby McMahon (40:38.7)
I love that pineapple, sorry, I just heard the I love that Marcus framed it this way.
You could say, I know that hitting yourself or thinking about suicide is not the problem. It is your solution to the overwhelming pain you're going through. Right? So, or feeling helpless or feeling angry or feeling lonely or ashamed. and you know, as I'm saying this, this goes with all different kinds of
coping mechanisms, people who are doing drugs, alcohol, you know, risky, all the all the things that you're like, that's a problem. Stop doing that. The more you fight against it, the more the other person is going to protect it, right? Because they're like the because of polarizing, it's putting you two together. It's like, I'm gonna stop this thing that you have felt like it is your way out or your solution. They feel like drugs, suicide, self harm.
Whatever is a solution to the problem. Not a great one, but it it is the one that they've feel like will be helpful. And then you're like, no, no, no, I'm gonna stop this and leave you with all that pain. Instead, be like, no, okay, I understand that this is a coping mechanism. This is a way to cope, but this pain is the problem. Right. So say, you know, I'm, I'm, I wanna understand. I want to, I wanna, I wanna help you with this.
At least I I want to share the load with you if if possible.
Dr. Kibby McMahon (42:21.004)
You could even say like I'm scared. I don't know what I'm doing, or I'm I'm not sure exactly how to help yet, but I can guarantee that I can try.
So
Dr. Kibby McMahon (42:40.574)
And so then how do you pineapple, sorry. So then how do you balance that? Like I'm on your side with I'm gonna stop you from hurting yourself. the way Marcus described it is a similar way that I tell coal of mine clients, which is or you know, how I do it myself, which is being genuine about the way you're feeling, right? If you're like, I I think that some people misunder like
assume that they have to be tough and be yeah, it's okay. I got this. I could fix this. and then hide or suppress what they're feeling, which is probably terror, probably even anger. You know, how could this kid be doing this dangerous thing? That's so stupid and it was so painful and so destructive. Why did they do this? So they might think, I have to shut down all my feelings and just but you could be genuine and say, hey, I'm here. I'm trying to understand this with you. I want to work work on this problem with you. But
If you're saying that you are gonna take a bottle of pills and you say that it's in the bathroom, I I'm t I'm too scared. I that's too scary. I I I can't even think. I can't that is really I can't even work focus on this problem because I'm so scared of what of what might happen about your safety. So can we figure out how to right now get through this moment?
What can make us a little bit safer? Can we I love that Marcus says, can we put some distance between you and it while saying on the phone or being with me? be and just be really direct, like, okay, please step off the ledge. You gotta step off the ledge. You got to, we got we gotta take these pills and we gotta get, you know, lock them up or give it to someone else who could keep them safe. you
You you have to pull over in the car. I can't I can't talk to you about this breakup when I'm too scared that you're gonna crash this car. Please pull over right now so we could talk about it. Right.
Dr. Kibby McMahon (44:52.052)
It's a way to say and and you know, I I'm actually what I've been telling people lately is is interestingly not just about them being harmful to themselves, but being abusive to you or being harmful to you, right? Like if we're not dealing with like the self-harm and suicide, it's it's someone who's screaming, someone's calling names like you're the worst mother and hate you and you blah blah blah.
And then, but they're also asking for, you know, to be heard and to have like their loved one recognize their pain and they're being mean, like you should be ashamed, you're an asshole, blah blah blah. I say it this way, like it's almost you could think of it as drawing boundaries where you could be genuine and say, like, I really want to hear you. I really want to understand, I want to help you through this. I don't I don't want you to feel alone. And I I get that you feel really unheard right now. So I'm I really want to hear.
About your experience. I'm having a hard time doing that when you're yelling at me like this, when you're calling me an asshole. Because I just get upset, I get defensive, and then I'm not even there with you. So it's not really working. Can we pause that? Like I get that you're I get that you're angry. And if the name calling keeps happening, I'm gonna walk away for a second and we we could, you know, just kind of.
take a walk or you know chill out for a second and then we could try talking again because I cannot focus if I feel attacked like this. Right. So you could frame you could frame the boundary, the saying no to the danger, the, you know, the the problem behavior as a way to really focus on the problem at hand. All right. pineapple.
And then in dialectical behavior therapy, which is what Marcus and I both studied, we there's all sorts of skills that help people get through the moment. These are all often called distress-tolerant skills, which is in a moment of crisis, what is a way to get through that moment without making it worse? You might not feel better, you might it might not fix the problem, but can it get you through 10 more minutes? Can it
Dr. Kibby McMahon (47:22.006)
let you ride out the worst burst of fear and anger. so you get a little bit of relief. You can breathe a little bit and get a little clarity. Like, can you, can it buy you some time? Right. I also like that a lot of DBT skills like these change your body chemistry. It's it's more about working on your body and soothing your body. Because when people feel,
you know, I I was in so much pain, I thought hurting myself was the only way to my make myself feel better. But I could stick my face in ice and I also feel better. Whoa, I have more control over my inner life. I have I can actually do something about this. It it gives a sense of agency. So, I mean, you I've talked about distress tolerance skills on this podcast before. You could look this up, but there are some very simple skills. Like one is intense exercise.
Jumping jacks, right? Rev up the body, and then it'll kick in the parasympathetic nervous system. One of my favorites is ice in the face, taking a bowl of water, filling it up with ice and water, and then sticking your face in it, holding your breath, sticking your face in it for as long as you can, as long as it's safe. or an ice pack over your forehead. I'm not gonna go deep into this, and like there's other breathing skills and meditation. It could be just walking or journaling or any kind of.
Coping skills, which is just something to do to get through the moment. I like going to see, I like watching horror movies when I'm really you know, like my distress knowledge is watching horror movies. I know it's weird, but it's works. It distracts me and makes me feel like I'm delving into the darkness without like well still allowing time to go by and then I can actually like channel it into something other than, you know, a dumb move that what I regret later.
So thinking of a way to cope in those moments. And you could walk through it with the teen together with your teen. You could both put your face in a bowl of ice. You can both do jumping jacks. You could all go for a run, sprint for 10 for you know five minutes. do it with them. And, you know, if that does and that's on magic bullet, right? You run once, it's not going to get rid of everything, but maybe you run and then you put your face in ice water.
Dr. Kibby McMahon (49:48.355)
Maybe you do some journaling after that. Maybe put on a movie after that. and do something soothing for your body, wrap up in a blanket and watch something stupid on the TV. And maybe all those coping skills could get you through the moment, right? And also it's implicitly showing that the teen that you're there with them, right? Not just like, hey, go run, right? You could do that too, but
It is let's run together. Let's do this together. You're not alone. I will do this with you.
Even if just very silly stuff, like you end up laughing, you end up feeling dumb, you end up racing or something like that. It's just it's physically moving with them to get through the moment.
Dr. Kibby McMahon (50:39.925)
Apple.
Dr. Kibby McMahon (51:02.306)
And then another piece of this is you don't do this alone, right? If you are the only one alone, okay. But if you can loop someone in, loop in a best friend, loop in your partner, loop in a neighbor, someone who can just be there, be a body double, be present, especially if you're not physically there, right? Figure out who can help. It might be awkward, but you know, you don't even have to tell them everything. You just be like, Hey, you know.
My my teen is like really just bummed out. Can you just like sit in the living room with them, watch some TV with them, right? Just so sharing the burden here. And then and then if they're feeling better, you don't have to don't just clock off and be like, okay, good, you know, not worried about that. They might feel pain again. They might think about this again, right? So check in and think of a plan moving forward. Get a commitment.
Like say, okay. You know, not telling them, but just saying, hey, okay, so let's make a plan for how to actually get through the night until we could talk to your therapist, or we can, you know, figure this out together, or we can figure out other solutions. But what can we do to actually get through this moment again for the rest of the night? Right. if we get through this, we could really address the problem together. So
what can keep you safe for the night, what can keep us safe for the night. and then checking in, troubleshoot, say what is gonna be, what is gonna get in the way of that plan? Right? Like it it is so tempting to be like, okay, got it, you know, like they're they're all good. We figured it out. but you know really plan for what can go wrong. Like
Okay, are you gonna forget? Let's write it down. you feel embarrassed? Okay, let's let's talk about how you wanna talk about this with other people. All right. So even if it's like it might be up to the level of, you know, can you check in with me every, every few minutes or every hour or something like that? And, you know, just can we actually, you know, figure out a way to not just say,
Dr. Kibby McMahon (53:28.478)
not just set the plan and leave it, but set the plan and really make sure that we're, you know, executing. We're actually doing it. So
And then and then an another piece of that is then assess and follow up, right? Like, okay, how are you feeling now? What are your urges to hurt yourself? let's let's figure out like just the next steps, how to get through the next moment. Okay. So it's like an ongoing process for for dealing with feeling that intense pain. It's not like they're gonna feel better and it's done. Now, this is where this is the part I love is
making sure that we have a family system, treating the family system. So I was just talking as though it was just one person, you and and the teen. But then we got to think about how can I help the family create safety, right? I hear about I hear this in KulaMind a lot where people are like, my relationship with my son, my relationship with my daughter, I'm the only one who could help them. I'm usually running in and fixing them. Right. And then there's other people. There's a dad, there's a brother, there's like all these other people in the mix.
That are worried and scared or angry, or you know, there's a whole thing going on. And that feels overwhelming for everyone involved. And maybe that's even the problem, right? That they're so fractured. So the the principle I like to think about is how can we get all on the same page with a plan together? And what do I do in that plan? What does the brother do in that plan? What does the father do? Like what
What situation are we gonna call emergency services? Or how are we gonna contact the clinician? Right. It's like you think about this, it's like a treatment team, a crisis management team. Everyone's involved. it could just be like, there's a their best friend is around and they could just like play games until they're feeling better. Okay, that's that's that person's role. So developing a plan.
Dr. Kibby McMahon (55:33.433)
Being all on the same page, if possible, I know that's not easy. and figuring out what role does everyone have. And if you are a caregiver, you're a parent, you are another loved one. I I've been saying this a lot more lately. It is traumatic to have your kid hurt themselves, have a history of hurting themselves, taking their own life. That's a trauma for you. Don't underestimate that.
So you might be in fight or flight mode. You might run away. You might, you know, try to pretend this is not happening. You, you know, they're feeling better. Okay, I'm not gonna talk about it, right? Pretend, you know, go back to normal. Or you might get angry. if you can, try to avoid acting on that, on those impulses, right? especially don't berate them.
Or scold them or shame them. Like, how could you do this to me? don't you know what this is doing to me? you know, yeah, all those always just shaming and judgment. Like, if you do this, I will, you know, if you hurt yourself, I will, you know, take away the cart, right? Don't, don't add, I know this is scary. So I know that a lot of what people say in these moments are just like.
in that heat of the moment and that fear. But if you can, don't shame them. You just say, thank you for telling me. I really appreciate it. This is really scary, but I'm here for you. parents and other family members can really do a lot by staying physically nearby in high risk periods or making sure that someone is around physically, right? And is able to restrict the means, make the environment safe, take away weapons, take away dangerous things.
get them away from windows. and validating the pain, but not suicide and self-harm as the way to cope with that. As you don't have to validate that as a solution, right? This I f like parents are fine have a really hard time, right? Cause they 'cause I would you know, I've heard I've heard this a lot and I totally get it. They're like, I don't wanna say
Dr. Kibby McMahon (57:54.829)
It makes sense that you're feeling this terrible from your breakup because what if they, you know, what if the validation makes them feel justified in like feeling it and then they go and do something about it, you know? people worry that validating the emotion makes it more likely that they're gonna act on that emotion in ways that are scary. but no, you could just, you don't have to say,
I agree with everything you're doing or agree with everything you're saying. Be like, I get that you're in pain. I under I see that this is so hurtful for you. Point blank. That's all you need to say, right? Understand the problem and say, I get it. And then following that safety plan. Now, most families, especially parents, do not want to talk about a safety plan when everything's great. Right? It is a bummer. It is.
It it it's you know, it's a weird thing to be like, something something happens to you or if you're at risk or you know, what should we do when there isn't a problem? But you're not gonna want to think about that in the moment. You're not gonna want to try to think on the spot and be a first responder and be like, Okay, you know, like they s they said this, but then they said th you know, then they also had a breakup and they didn't sleep and they had a lot of adderall like a
what do I do now? Make a plan in advance. Even if it's like, hey, you know, like you know, this is a caregiver. Like, I know I'm a worrywart. I know I'm anxious. I can't help but think about the worst case scenario. I know that, you know, you struggled with mental health or hurting yourself. And the thought of that happening is paralyzing.
It would really help me and my anxiety if we can figure out what steps that we should take together to make sure that you're safe. can we talk to your therapist about that? Can can can I speak to your therapist about that? What do you think, you know, we should do? What would be the most helpful? So even starting the conversation, just saying, Hey, it's just for me. I'm a worry war, just humor me, that might be enough to even just get a few steps of this is what I can do.
Dr. Kibby McMahon (01:00:10.702)
And I this is a script that I like. You say, I'm I'm not mad at you. I'm really glad you told me that you're thinking of hurting yourself. I'm really glad you came to me to talk about this. So we're gonna make tonight safer and we're gonna help with this pain and we're gonna figure it out together and figure out how it got s got this overwhelming. So let's figure this out together, okay?
So I I really, I mean, I've learned so much from this conversation. it's taken a lot of things that I've already known, but really just, you know, making it an actual plan and f framing the understanding the problem, getting on their side, validating their experience as parts of the strategy for how to keep someone safe. Not like, you know, casual chit chat, but then
when you know there's they're gonna cut themselves and we gotta get them, you know, we gotta call 911, right? It's there's so many different things that you can do to make them feel heard, make them feel seen, make them feel not alone, make them feel understood about why they got to the point where they were so desperate that hurting themselves or taking their own life felt like the only option.
I hope this was helpful. I I know this is a really tough thing to talk about. And I know that not everything I said today said here is gonna apply to you. I there's every I know that every situation's different. I highly encourage conversations among everyone involved. Again, the family system. Talk to the teachers, talk to their friends, talk to their
They're doctors, right? And you can be really upfront about that. You could you instead of saying, like I'm gonna keep this a secret, I'm not gonna tell dad a lot. You'd be like, listen, I I really wanna understand how we can talk about this in a way that, you know, you feel like your privacy is protected. I'll say that privacy is protected. But I wanna I wanna be able to have open conversations so that you trust me. but let's
Dr. Kibby McMahon (01:02:38.796)
This is a big problem. This pain from this breakup is a big problem. And I wanna I wanna think through this together. You're not alone. and let's let's figure out how we can all all help with this problem together.
So, again, I hope this is helpful. if you again, if you are in California and are looking for a therapist for an adolescent or teen or even family with suicidality, self-harm, or just extreme emotion regulation, definitely check out Dr. Marcus Rodriguez at the Youth and Family Institute. but if you are a loved one of someone who is struggling with
suicidality and big emotions and you feel helpless and you want more of this like hands-on how do I how do I help them? That's where I come in. KulaMind , K-U-L-A-M-I-N-D.com. it's where I just teach like this, but I teach, you know, how to apply what I just talked about, these skills to your situation. So thank you all. And if this was helpful, please send this
to anyone who needs to hear it. the more you spread this information, the more, the more we could get on the same page with helping helping the person in need. And leave us a five star rating on Apple Podcasts and Spotify. If you have questions, leave it in the comments. Especially if you're watching this on YouTube or Spotify. I love I love talking to all of you. So I'll see you next week. Thank you.