Archive for the ‘crisis management’ Category


Wednesday, November 19th, 2014

(part 1; part 2; part 3)

Many parents fear asking their child about suicide thinking that by asking they might give their teenager some ideas or perhaps plant a thought in their head that may be acted upon later. As result they never ask and end up surprised! Don’t be that kind of parent, ask your teenagers about suicide. Questions never killed anyone, if anything the question will let your teenager know you care. However, don’t forget that relationship is always the key to getting good information. So if you want to get the truth from your child you will need to approach them with great care and loads of respect. Chances are you will have earned the right to ask them about suicide because you have been working hard to connect with them over the past few weeks and months by meeting them right where they are and taking the time to really listen (without judgment and without pressure) to what has been going on in their life.

First, take a deep breath and try to stay calm. Of course there is a chance that when you ask them if they have ever thought about suicide that they will say yes. This “yes” may be one of the scariest “yes’s” you have ever heard and you will need to be prepared for the emotional impact this has on you. No parent ever wants to hear about their child having considered suicide, but don’t forget that you are not alone; many other parents have gone before you and survived.

Second, once you have calmed down you will need to try your best to ask about the following 4 things (White, 1999): (Remember, you are not a mental health professional and no one expects you to be, however, having more information is going to be really helpful when trying to help your teenager cope with this stuff both now and in the future).

IDEATION: Thinking about suicide and planning your death are two different things. Studies have found that 20-30% of teenagers will report experiencing thoughts of suicide at some point during their teenage years (Brener, Krug, Simon, 2000; Kandel, Raveies, & Davies, 1991). While these numbers are alarmingly high, it would seem that thoughts about suicide are fairly common during the teenage years, so you will need to be ready to deal with them.

INTENT: As stated above thinking about suicide and wanting to die are two different things, however they always need to be assessed together. When your teenager tells you that they have thought about suicide your next question needs to be about motivation; do they want to die?

MOTIVATION: By asking about their intentions you are attempting to figure out if they really want to die, are attempting to manipulate, are crying out for help, or have some other reason for wanting to die (White, 1999). Remember, that just because they maybe attention seeking or manipulating does not mean that they are not a serious risk! In most cases they will say “no” when asked about motivation, however its fairly common for someone who has experienced thoughts of suicide to be somewhat ambivalent about their desire to die; a part of them wants to die, yet another part of them doesn’t. Helping them resolve this conflict may be the key to keeping them safe.

Here are some questions you could ask to assess INTENT (White, 1999):

“Why do you want to die?
“What are the contents of your thoughts?”
“What does death mean to you?”
“How long have you been thinking about hurting yourself?”
“How frequent and persistent are the thoughts?”
“Are you pre-occupied or obsessed with the idea of killing yourself?”
“Can you control your thoughts?”

Having a plan is often the most important part of determining what is going on with your teen. Suicide can occur without a well thought out plan, however most individuals experiencing thoughts and intentions will often very quickly arrive at a plan. Some will spend days, even weeks, planning their attempt without telling a soul.

Questions to ask yourself in addressing your teenager’s plan (White, 1999):

How far has the adolescent developed the plan?
When is the proposed plan going to occur?
How specific is the plan? (place, time, method)
Is the plan effective and feasible?
Is the adolescent’s chosen method lethal?
Will he/she have access to the chosen means when he/she needs it?
Does he/she know how to use the means?
Has he/she rehearsed his plan?
Has he/she taken precautions to avoid rescue?

When asking about your teen’s plan you will want to try and figure out just how plausible their plan appears to be. While every suicidal thought, intent, and plan should be taken very seriously and properly addressed by a competent mental health professional, some plans need to be taken much more seriously than others. The more lethal the means the more dangerous your teenager might be.

The 4 most common means of teenage suicide are:

Guns: Firearms typically account for about 60% of all completed suicides in the United States and any suicidal thought or plan that incorporates their use needs to be taken very seriously!
Cars: While there does not appear to be any statistics regarding teenager’s use of cars as a means of suicide, it is safe to say that not every death by auto accident is an “accident.”
Drugs: Drug overdose is very common in western culture and many, if not most, of the suicide attempt victims I have worked with decided to kill themselves by taking a handful of pills, or combine pills with alcohol.
Combination of all three

When asking about METHODS and MEANS you need to ask about two things:

ACCESS: Does your teen have access to the tools they are planning to use? Consider guns, knives, explosives, belts, ropes, sheets, medications (prescription and over the counter), drugs and of course alcohol.
KNOWLEDGE: You will need to find out how much your teen knows about the means they have mentioned. Do they even know how to use a gun? Do they know how to hang themselves? Etc.

PLEASE REMEMBER…Any person who is experiencing thoughts of suicide needs to be assessed by a mental health professional as soon as possible!

***Any advice given on this website is offered in generic form. In other words, all of our site visitors have unique qualities that play a role in their personal mental health. We do not know you personally and can therefore not take into consideration these qualities when offering advice, and do not claim to do so. All information provided on this site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing psychologist, mental health professional, teacher, or professor.***

Brener, N. D., Krug, E. G., Simon, T. R. (2000). Trends in suicide ideation and suicide behavior among high school students in the United States, 1991-1997. Suicide & Life-Threatening Behavior, 30, 304-312.
Kandel, D. B., Raveis, V. H., & Davies, M. (1991). Suicidal ideation in adolescence: Depression, substance use, and other risk factors. Journal of Youth and Adolescence, 20, 289-309.
White, T. W. (1999). How to identify suicidal people: A systemic approach to risk assessment. The Charles Press Publishers, Inc., PA.

by Joe James, Psy.D.
other articles on teens


Wednesday, November 5th, 2014

(part 1; part 2)

While there are occasions when someone may significantly hurt him or herself “out of the blue”, most cases involve warning signs. The problem is that most of us don’t notice them! There are a few things you can be looking for. First, and foremost is a significant change in behavior, such as increased drug use, moodiness that appears to be over and above “normal”, withdrawal from either friends or family, and an increase in impulsive high-risk behaviors (Debski et al., 2007).

Perhaps most common is the proverbial “change in friends.” Rather than spending time with the friends your teenager has had since the 5th grade, he or she may begin to bring some “new” kids over to the house. While it is good for your teenager to branch out, meet new people and make new friends, most often this group of friends is the one your parents told you about when you were a teenager. They look and act in a manner inconsistent with your values and will often result in you making statements like “I just don’t like his friends” and “things really started to change when ‘so and so’ started coming around.” While a significant change in friends does not mean your teenager is thinking about suicide, this change often comes with many of the other warning signs such as doing drugs, the onset of a depressed mood, a drop in school performance, and run-in’s with the police.

Second, making statements about suicide or expressing some type of preoccupation with death should be taken seriously. For some these types of behaviors can become so common that you may begin to ignore them. If you find this to be the case, please consult a mental health specialist immediately. Suicidal statements, even those that are passive in nature (ie. “you guys would be better off without me”), need to be taken seriously and addressed directly. Some studies have found that as many as 83% of teenagers who successfully killed themselves made a verbal threat to do so during the week prior to completion (Brent, 1995, as cited by Rubin, Wainrib, & Bloch, 1998).

Because depression is so closely related to suicide, the symptoms of depression and teenage suicide should be closely monitored. Symptoms include (Debski et al., 2007):

Major changes in eating or sleeping habits (too much or too little of either)
Expressions of hopelessness, guilt, shame, or worthlessness
Intense anger toward self and/or others
Drop in school performance
Loss of interest in usual activities (ie. quiting the football team)

Studies have shown that teenagers who deliberately hurt themselves (i.e. cutting) are 4 to 10 times more likely to die (Goldachre, & Hawton, 1985; Hawton & Harris, 2007, both as cited by Hargus, Hawton, & Rodham, 2009) and as many as 70% of teenagers who reported an act of self-harm also reported at least one suicide attempt (55% reported multiple attempts) (Nock, Joiner, Gordon, Lloyd-Richardson, & Prinstein, 2006, as cited by Hargus, Hawton, & Rodham, 2009). That is pretty alarming! You should take self-harming behaviors very seriously.

Significant changes in behavior, making suicidal statements, symptoms of depression, and cutting/self-harm are all behaviors that can very easily get “lost” in the day to day busyness of life. That is why it is so important for you to do what you can to connect with your teenager on a regular basis. Your teenager doesn’t need you to breath down their neck (and most likely will let you know this on regular basis) but they most definitely need and want the adults in their life to show them that they care.

***Any advice given on this website is offered in generic form. In other words, all of our site visitors have unique qualities that play a role in their personal mental health. We do not know you personally and can therefore not take into consideration these qualities when offering advice, and do not claim to do so. All information provided on this site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing psychologist, mental health professional, teacher, or professor.***


Debski, J., Spadafore, C. D., Jacob, S., Poole, D., & Hixon, M. D. (2007). Suicide intervention: Training, roles, and knowledge of school psychologists. Psychology in the Schools, 44(2), 157-170.

Hargus, E., Hawton, K., Rodham, K. (2009). Distinguishing between subgroups of adolescents who self-harm. Suicide & Life-Threatening Behaviors, 39(5), 518-537.

Rubin Wanrib, B., Bloch, E. L. (1998). Crisis intervention and trauma response: Theory and response. Springer Pub, NY.

White, T. W. (1999). How to identify suicidal people: A systemic approach to risk assessment. The Charles Press Publishers, Inc., PA.

by  Joe James, Psy.D.

(more articles on teenagers)


Wednesday, September 17th, 2014

(part 1 can be found here)

Chronic health problems or long-term personal issues often trigger adult suicide attempts. Teenage suicide attempts are often triggered by problems in relationships; especially significant “break ups” or major disruptions in relationships with close friends or family members. When relationships end it can be very difficult, even under the best of circumstances, so when your teenager looses their boyfriend or girlfriend it can be very traumatic, especially if they have emotionally invested a lot of themselves in the relationship. For many teenagers their relationship with their significant other is viewed as the “best thing that ever happened” to them. Consequently, when this relationship is lost you may need to treat it as such. This may be really hard to understand as an adult because so often we are tempted to see these relationships as “childish” or “just a phase.”

Parents of suicidal teenagers often overlook the loss of this kind of relationship. For some it is because the teenager has kept the relationship a secret. For others it is simply because parents often underestimate the power of these young relationships over their child. The answer to this problem is awareness. Parent getting and staying connected with their kids; parents earning the right to talk with their teenagers about their “love life” by meeting and loving their child as they are, listening well, and communicating a genuine sense of love and care that transcends the felt need to lecture and coerce.

Problems in school seem to be a pretty common theme with teenagers and suicide attempts; problems with grades and performance, of course, but perhaps more are their relationships with friends (White, 1999). As a parent you send your kids to school to get an education, but an education is only half of what they receive. Peer relationships are vital to your child’s development, however; as you may already know, teenage peer relationships can be very complicated. Social blunders often overlooked in the adult world are exploited by teenagers and used as a means of singling out certain individuals and targeting them for social punishment. Time and again I have worked with teenagers who made a mistake, made someone else angry, or hurt a specific person’s feelings and subsequently were socially destroyed; targeted, attacked and essentially “kicked out” of their group of friends. As a result many teenagers will begin to feel rejected, lonely, hopeless, and worthless.

A significant breach in the relationship between a parent and a child can be devastating at any age. Family fights are often the trigger of suicide attempts and need to be handled with care (White, 1999). May of the parents of suicidal teenagers I work with often appear surprised when I inform them that abuse (physical, emotional, and sexual) is often associated with suicide attempts. Perhaps this is due to the dramatic nature of abuse as a very “messy subject” and inability to cope with their child being abused. However, abuse, in all its forms, is often a trigger of suicidal thoughts and cannot be overlooked. Also the loss of a significant family member, especially a parent, through death, divorce, or abandonment can be a major trigger. Many times teenagers (and children) will begin to think that they were the reason their parent is gone, blaming themselves for their situation in a manner in which they will begin to struggle with feelings of self-hatred and self-destruction.


  • Use and/or abuse of drugs and alcohol (some drugs can trigger this kind of stuff)
  • Feeling hopeless, alone, or alienated
  • Recent suicide of a friend, family, or role model
  • Legal problems
  • Moving
  • Failure
  • Access to a weapon (White, 1999)

***Any advice given on this website is offered in generic form. In other words, all of our site visitors have unique qualities that play a role in their personal mental health. We do not know you personally and can therefore not take into consideration these qualities when offering advice, and do not claim to do so. All information provided on this site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing psychologist, mental health professional, teacher, or professor.***


White, T. W. (1999). How to identify suicidal people: A systemic approach to risk assessment. The Charles Press Publishers, Inc., PA.

by Joe James, Psy.D.
other articles on teens

Disaster Mental Health Response in Moore, Oklahoma

Tuesday, May 28th, 2013

CFI’s Dr. Tim Doty volunteered last week with the American Red Cross in Moore as a Disaster Mental Health responder. This blog post is reposted from www.DrTimDoty.com

As you have all seen from the pictures, videos, news reports, etc., the devastation is immense and fierce…but so is the spirit to rebuild.  I had two different assignments while on the scene.  The first was to accompany an Emergency Response Vehicle (ERV)into the field to give out hot meals and cold water to people who haven’t had power or access for days.  I was assigned to a team of two nurses and two disaster mental health volunteers to help triage wounds, both emotional and physical. We talked to people who had lost everything…in fact some people had lost everything more than once.  They also survived the May 3, 1999 tornado.

Photo May 22, 10 10 38 AMPhoto May 22, 10 10 33 AM

In Disaster Mental Health, our role is to encourage, support, promote healthy coping strategies and to help identify those who need help immediately (like psychosis or suicidal/homicidal). There has been media coverage about who was let into the disaster areas and who was not (as in some residents) during the search and rescue and search and recovery phases of the disaster response.  Red Cross was given access on Wednesday, so we were among the first to be delivering food and water since Monday.  People were gracious.  They have been through incredible events.

Yesterday (Thursday) I had the honor of assisting with the reunion of the Briarwood elementary school that took place at Bonds elementary in Moore, just down the road from the destroyed Briarwood.  Again, as a Disaster Mental Health volunteer for the Red Cross, 8 psychologists were sent (4 each) to Briarwood and Plaza Towers reunions. It was a touching and powerful event.  Students and teachers reconnected.  Parents and family members were able to hug one another and actually close out their school year, which they were otherwise unable to do since the school was destroyed Monday. Some of the students were telling one another “I saw you on TV, so I knew you were ok.”  In fact, one father did not know that his son was alright until he viewed his son on TV as well.

The work through the Red Cross is emotionally challenging, but very rewarding when you can help encourage healthy coping strategies and help families predict the kinds of emotions and responses they are likely to encounter in the days and weeks ahead.

Our prayers continue to be with the survivors as they rebuild.

Dr. Tim headshot

Tim Doty, Psy.D.

twitter: @DrTimDoty


How to Talk to Your Kids About News and Tragic Events

Monday, April 15th, 2013

The following is reposted from our CFI Facebook page:

man listening to childIn light of the tragedy at the #bostonmarathon today, please be cautious how much of the news you take in around your children. We advise that children who are not of age to understand violence and tragedy (and really, who among us does understand it), can be insulated from the news as long as parents and caretakers shield them from the information. Obviously, at the speed of communication, many of our teens, pre-teens, and adult family members will have seen/heard about the violence and we should take care to console one another in the face of tragic events. For younger kids, there is no need to watch/listen to reports of violence in front of them. If they hear about the tragedy, take time to explain with child-appropriate wording. We will post resources ASAP.

Here are the resources we linked to on Facebook:

If you, a family member, a loved one, or a child are experiencing difficulty in response to tragedy in the news, we have staff available to help you manage traumatic stress reactions.  Give CFI a call to set up a time to meet with one of our professional therapists. 


Holiday Family Challenges

Monday, November 12th, 2012

The holidays are stressful in many ways.  The increase in activities, shopping, travel, and extra costs are only the beginning of the list of stressors.   Holidays are also filled with increased family stressors, such as:

–       Increased family expectations to spend time together

–       Pressure to conform to family traditions

–       Seeing family members who may be kept at arms-length during the rest of the year

–       Reminders of family members who have died

–       Exposure to increased alcohol consumption among some family members

–       Children spending time out of school and at home

–       Reminders of family hurts and disappointments

–       Increased dealings with extended family and in-laws

Even the healthiest of families contain personalities and family members whose personal values clash, or where some family members’ behavior is difficult to be near. These pressures contribute to breakdowns in communication and increased conflict.

We strive to establish comfortable levels of distance and boundaries during the year.  This often collapses around the holidays when we change our routines and increase contact with our extended family.  Intrusions and offenses increase.  Occasionally, these gatherings result in conflict that includes unpleasant escalations and hurtful words.

Though it is probably impossible for most of us to eliminate family stresses and conflicts altogether, there are some ways to reduce stress.  Consider some of the following options:

–       Parents, prior to making holiday plans, can reconsider and re-negotiate what is best for their family, rather than simply doing the same things that have been expected in the past.

  • When visiting conflict-prone family members, make visits shorter
  • When traveling out of town, consider motels rather than cramming large numbers of people into small spaces.  This also allows for some private times to de-stress.
  • Some family confrontations are predictable.  It’s okay to intentionally plan to avoid unproductive and vulnerable situations.
  • When stressors and conflicts are building during a visit, go for a walk or a drive with safe people to decompress.

–        When unresolved conflicts with family members can be identified in advance, be pro-active.  Consider your best conflict-resolution skills and plan to use them in advance of holiday get-togethers.  When you have made your best effort to seek peace with problem family members and it hasn’t worked, consider consulting an expert on family conflict.  They may be able to suggest tools you may not have considered, or they may be able to mediate civil conversations (at CFI we frequently mediate conflicts over the holidays and any time during the year.)

–       If you have lost a significant family member recently, make time to celebrate and honor that person.  Do it in a way that is most meaningful to you.

–       Make the reason for the season central to your family get-togethers.  Christmas is about Christ and His great gift of His life to us through his birth on earth.  Even when surrounded by others who may not share your faith, renew your own celebration of Christ with those who do share your faith.  Pick out verses from scripture that speak to your situation and that assist you to have a fresh perspective and renewed mind, such as:

  • Regarding Christmas:
    • The Christmas Story from Matthew 1
  • The importance of married people setting limits with family:
    • Genesis 2:24 (NIV)  For this reason a man will leave his father and mother and be united to his wife, and they will become one flesh.
  • Dealing With Anger and Conflict:
    • Proverbs 15:1  (NLTSE)  A gentle response defuses anger, but a sharp tongue kindles a temper-fire.
    • Proverbs 18:13 (MSG)  Answering before listening is both stupid and rude.
    • Romans 12:18 (NIV)  If it is possible, as far as it depends on you, live at peace with everyone.
    • Proverbs 22:24 (NIV)  Do not make friends with a hot-tempered man, do not associate with one easily angered,
  • The Goal To Love:
    • Ephesians 4:15 (NLTSE) Instead, we will speak the truth in love, growing in every way more and more like Christ, who is the head of his body, the church.
    • I Tim. 1:5 The goal of this command is love, which comes from a pure heart and a good conscience and a sincere faith.
    • I Cor. 13:4-8 (NIV) [4] Love is patient, love is kind. It does not envy, it does not boast, it is not proud. [5] It is not rude, it is not self-seeking, it is not easily angered, it keeps no record of wrongs. [6] Love does not delight in evil but rejoices with the truth. [7] It always protects, always trusts, always hopes, always perseveres.[8] Love never fails.
  • We, like Jesus, need time to reflect, refresh, and pray:
    • Mark 1:35 (NIV)  Very early in the morning, while it was still dark, Jesus got up, left the house and went off to a solitary place, where he prayed.
  • Finding Peace in Even the Most Stressful  Circumstances:
    • Phil. 4:4-8 [4] Rejoice in the Lord always. I will say it again: Rejoice! [5] Let your gentleness be evident to all. The Lord is near. [6] Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God. [7] And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus.[8] Finally, brothers, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable—if anything is excellent or praiseworthy—think about such things. [9] Whatever you have learned or received or heard from me, or seen in me—put it into practice. And the God of peace will be with you.

Merry Christ-mas!

Dale R. Doty, Ph.D.

FAQ Why Does my Kid Cut (him/herself)?

Tuesday, May 22nd, 2012

Cutting often signifies intense emotional pain. Teens sometimes cut to distract themselves from it.  A list of negative feelings may be associated with cutting and includes feelings of hopelessness, abandonment, threat, fear, isolation, guilt, abnormality, overwhelmed, self-hatred, trapped, ignored and confused.

Cutting represents more than just trying to deal with negative feelings, it may signify a need for greater help.

Inagural Video Podcast- What Every Youth Minister Needs to Know About Crisis Management

Tuesday, August 10th, 2010

Mr. Bowden McElroy and Dr. Tim Doty discuss what “we wish every youth minister knew about crisis management in twenty minutes or less.” We cover issues of confidentiality and legal/moral/ethical obligations to be wary of secret-keeping. We also discuss linking to referral sources and we encourage youth ministers and helpers in general to prioritize self-care. We hope you enjoy this podcast and we look forward to posting additional teaching-related material.

What Every Youth Minister Needs to Know About Handling Mental Health Crises from Dr. Timothy Doty on Vimeo.

Helping a Loved One Who Self-Injures

Monday, April 12th, 2010

Self injury tends to be a misunderstood behavior. The most common assumptions of self injury are that it is a suicide attempt or an attempt to seek attention. In reality the most common reasons for self harm are: attempts to relieve and express overwhelming emotional pain; attempts to control what feels like an out of control life; and in some instances, self injury is used to relieve feelings of numbness.

When someone you love harms themselves through cutting, burning and other ways, it is difficult to understand why that person would do something that seems so extreme and painful. It is important to realize that even if you do not understand it, self-harm is an outlet for some to cope with intense emotional issues.

The way in which you react can have an enormous impact on your loved one. Here are a few suggestions:

1)     Do not overreact. Be calm and understanding.

2)     Do not judge her or make her feel stupid. Be compassionate.

3)     Listen to the feelings and the struggle, but do not problem solve.

4)     Do not expect him to stop immediately. He needs to develop other means of coping and this may take time.

5)     Help her find a professional to talk to. A trained therapist can help your loved one develop alternative coping skills and sort through issues with which she struggles.

Self injury is a growing method of coping with emotional pain in our society. As a friend or family member your response to and understanding of this growing problem is vital. This is an opportunity to show love and compassion to someone who may desperately need it.

Jill Butler, MS, LMFT


A Compassionate Reponse to the Haitian Earthquake

Tuesday, January 19th, 2010

The recent news of the January 12 earthquake in Haiti leaves many of us feeling great sadness and compassion for the people affected by the tragedy.  Many of us, with good intentions, want to respond and help in any way we can.  In fact, some whose resources allow may feel a desire to board a plane and add to the ongoing relief efforts in person.  However, our initial desire to act may not be the most sustainable and helpful responses.

Because of the need to respond to primary needs and rescue efforts urgently, philanthropy experts recommend giving monetarily to relief-aid groups who have an established presence in Haiti.  It is more effective during the early stages of disaster relief and during ongoing rebuilding efforts to work with organizations that have leadership in place to respond to a needs-based assessment on the ground.  New organizations to the area or individuals who join in aid efforts without connection to an organization may add to the chaos.

It is okay to wait on your giving.  Reconstruction efforts will take time and monetary giving will be needed on an ongoing basis.

It can be anxiety-provoking to sit “idly by” when so much is needed in response to the Haitian earthquake.  However, this is an instance in which relying on experts in the area (i.e. the Haitian people and established relief-aid workers) is perhaps a more compassionate response than rushing in with our “expertise.”  I would encourage you to donate monetarily and prayerfully to organizations that you already trust to do compassionate work for the needs of our world.

Tim D. Doty, Psy.D.

The following is a list (not exhaustive) of organization who have a presence in Haiti:

Action Against Hunger

American Red Cross

Beyond Borders


Direct Relief International

Doctors Without Borders


International Medical Corps

International Relief Teams

Meds and Food for Kids

Mercy Corps

Operation USA

Oxfam America

Partners in Health

Save the Children

Stop Hunger Now


World Concern

World Vision

Yele Haiti