Self-harm and suicidality in young people is one of the most distressing and threatening presentations for practitioners. Not only are parents frightened and disempowered but the system around them becomes equally focused on the risk and potentially disastrous trajectory. A vicious cycle emerges of increasing attention to the young person and attempts to understand, manage, and change their thinking with a concomitant loss of the resources and wisdom available to the whole system. Everyone; young person, parents, practitioners, and teachers are immobilized and risk increases.
How Can we Conceptualize this?
One lens through which to understand this is that of Bowen family systems therapy using the concept of emotional triangles within the family and helper system. Wright et. al. (2024) writing in the Australian and New Zealand Journal of Family Therapy explains Bowen’s concept of triangulation; ‘unresolved tension, conflict or emotional discomfort (overt or covert) builds in a twosome, a third will become involved, relieving the tension in the twosome by shifting the focus of the discomfort …by spreading out the relational and emotional intensity between the members of the system.’ When a young person is suicidal the whole relationship network finds itself similarly triangulated and anxious, which ‘shifts the focus from self-directed thinking towards the emotional state of others and the relationship tensions between them.’ All parties find themselves limited in their cognitive and behavioural flexibility and capacity to access effective parenting, teaching or management strategies. The practitioners’ task is to refocus attention from changing the young person to re-invigorating effective parenting strategies and allowing others in the system to reengage with their appropriate roles.
The Bower Place Approach
Bowen’s theory of triangulation is one that fits comfortably within bower(method) an integrated model that is inclusive of other theoretical and conceptual frameworks.
bower(method) pays particular attention to the question of ownership of the problem, within the politics meta-frame, the question of who in the system has the power to effect change and who is properly taking responsibility to ensure this change is made manifest. Directly addressing this question has two positive benefits. It allows everyone in the system to be clear about actions that should and must be taken if a young person is deemed to be at risk. There is no debate. In doing this anxiety is reduced and space created for the important tasks of adolescence to be addressed which have often been sidelined by fear and danger. Questions that fit in the development meta-frame, those of attachment, peer relationships, sexuality and productivity can be addressed by parents, educators and other practitioners, with less fear of consequences. Once the anxiety of self-harm is less pervasive these questions can be more fully and openly explored.
Of equal importance is the opening of cognitive and emotional space for parents to address individual and couple relationship issues that have been put aside while attending to their child. These are equally important if the family is to be protected from a rise in anxiety and a recurrence of suicidal or self-harming behaviour.
In Conclusion
Working with adolescents who threaten or act to end their lives is both distressing and stressful. Clear and coherent guidelines that reduce anxiety, manage inequality and allow for important and expansive conversations is most protective for all members of the system.
Wright, J., Milligan, R., & Varcoe, M. (2024). Reducing risk: navigating emotional triangles in clinical work with youth suicidality and self-harm. Australian and New Zealand Journal of Family Therapy, 45, 209–217. https://doi.org/10.1002/anzf.1598
