Daisy, a 16 year old high school student, was referred to me by her school. According to her school counselor, Daisy was hospitalized recently for suicidal ideation and needed to be seen for her depression. When Daisy walked into my office, the first thing I noticed was all of her piercing. She had a few piercing in her arms, a few on her cheek, and two on her chest. I also noticed the cuts on her wrists and shoulders. I put my observations to the side and decided to come back to them later. I had to build rapport with Daisy first. I asked her about her hobbies, her friends, her boyfriend, etc. Daisy and I were able to build a positive therapeutic relationship fairly quickly. In the middle of our first session, I assessed Daisy for current suicidal ideation. Daisy shared with me that she does not currently want to die, but a few weeks ago was really contemplating killing herself. Daisy stated that she was happy that she was hospitalized because she is getting support and is now taking anti-depressants. She also stated that she is looking forward to continuing therapy with me, feeling like I can really help her. Therapy with Daisy really focused initially on stabilizing and creating safety for her. Daisy’s triggers of depression were discussed, along with her triggers for cutting and self-harming behaviors. A safety plan was put together for Daisy, in which she could utilize a list of alternate coping skills instead of cutting. Daisy and I put together a “Feel Good Menu,” which lists the things that make her feel good. We used her 5 senses to put this list together. For example, things that she sees that makes her feel good (such as seeing her boyfriend), or things she can hear (such as her favorite music), or things she can taste (such as her favorite ice cream flavor), etc. Daisy carries her “Feel Good Menu” with her wherever she goes, as a reminder that she has alternative ways to take care of her emotions.

Every session I assess Daisy for suicidal ideation. We also go over her coping skills as a means to reinforce them. Currently, Daisy is keeping herself safe and putting to use other coping skills to deal with her emotions. We have started to talk about her depression and where it stems from. Daisy has been raised by a single mother who has verbally/emotionally abused her. I am also assessing Daisy for possible sexual abuse, which up to this point she has denied. (The reason for me assessing her for sexual abuse is because one of her siblings was abused by a family member and Daisy whole-heartedly protects this family member from anything negative spoken about them).

A big part of my treatment has also included Daisy’s mother. I have met with her to discuss parenting skills and deal with mother’s own abuse history. Daisy’s mother is starting to see how her unresolved abuse is getting in the way of her parenting. Daisy’s mother is now receiving her own therapeutic services with another therapist in efforts to work on her abuse history. Family sessions have been held to work on communication skills. Initially, Daisy and her mother would talk over each other, interrupting one another, and not listen to what the other is expressing. Now, Daisy and her mother are learning how to listen to each other and wait for their turn to speak. They are finally able to talk and build a strong relationship with each other. Daisy even showed her mother her “Feel Good Menu,” as a way to share her coping skills with her mother. This also allows for Daisy’s mother to know how to help soothe her daughter. Therapy with Daisy and her mother is a work in progress!

Signs of Cutting Behaviors

-Scars, from cuts or burns, found on different parts of the body (for example, on the stomach, arms, or thighs).

-Having sharp objects in possession

-Covering up the body with long pants or long sleeves, even if it’s hot

-Having fresh scratches or burns

-Having a lot of “accidents”

-A lot of isolation

For more information on cutting, please visit http://helpguide.org/mental/self_injury.htm.

Suicide warning signs:

* Risk taking behaviors such as reckless driving
* Becoming suddenly cheerful after a period of depression
* Saying things like, “I’d be better off dead” or “I wish I could die.”
* Looking for a means to kill themselves, such as weapons or pills
* Writing stories, notes, or poems about death, dying, or suicide.
* Giving away favorite belongings or promising items to friends/family
* Saying goodbye to friends and family as if for good.

24-hour suicide prevention & support: 1-800-273-TALK.

Helpful Websites:




Author's Bio: 

I am a Marriage and Family Therapist in Pasadena, CA. I work with children, teens, and adults to help improve interpersonal relationships. I do individual, family, and group therapy. Please visit my website for more info. www.cristinamardirossiantherapy.com