[00:00:02] Speaker A: Welcome to the Emerging Minds podcast.
[00:00:07] Speaker B: Hi everyone, my name is Amanda Kempferman. Welcome to this Emerging Minds podcast for practitioners supporting children who might be experiencing suicidal ideation.
I join you today from the lands of the Kaurna people of the Adelaide Plains and invite you to take a moment to reflect on and acknowledge the lands on which you're listening to this podcast. I pay my deepest respects to the traditional custodians of these lands, honouring the centuries of knowledge and wisdom they hold in working in harmony with the land and fostering strong, resilient communities and healing practices.
I also extend my respect to all Aboriginal and Torres Strait Islander people, their ancestors and elders past, present and emerging from the many diverse first nations across Australia and as well as those listening today.
Recently we developed an online course named Understanding and Responding to Childhood Suicidal Ideation. I had some great conversations with parents and practitioners about how they support children experiencing suicidal thoughts and behaviours.
One of the practitioners I was meeting with was social worker and narrative therapist David Newman. David lives and works on Gadigal Country, Sydney, Australia. He's a faculty member of the Dulwich Centre and an honorary clinical fellow at the University of Melbourne's School of Social Work. He has extensive experience teaching in Australia and other countries and in individual, couple and family therapy, primarily through his independent therapy practice, Sydney Narrative Therapy. He also currently works part time as a family therapist in an alcohol and other drug service.
In today's podcast, David shares with me some of the key principles that guide him in his work with children and young people, as well as some of the ways he approaches the nuances that arise. I started by asking him some broad brush questions about his approach in therapy and he started by sharing some of his basic premises with me.
[00:02:09] Speaker C: I think the idea that people suicide and that it is a lonely, secretive and often immensely frightening act is one thing I really want to do my best to minimize in the world that I'm in so to do whatever I can so that taboo, secrecy and fear of coercion is minimized in these conversations is a really important principle that I bring to this work.
Knowing people want a sense of understanding, knowing people want a conversational partner or someone else that they've shared such intricate, often tender, often incredibly complex experience with, knowing that they, they may want someone to kind of be there for them and respond with know, softness and really leave judgment out of it, you know, and I'm trying to join with someone, I'm trying to bring some warmth, I'm trying to do what I can to have a sense that I will try and understand them rather than try and act and perhaps bring in coercive aspects of the mental health system.
[00:03:31] Speaker B: We then got onto where to start and what to focus on in those early stages of the session. I asked David how he negotiates the conversation and asks permission and maintains accountability to the child based on what they.
[00:03:45] Speaker C: Determine is important, the importance of negotiating the conversation, permission, asking if there's some. Some big things that are happening, or we've heard that a child has been considering dying or want or flirting with dying or what might be called suicidal experience, we might say, look, how would it be if we talk about some of the bigger things in life? How would it be if we talk a little bit about some big topics? How would that be for you, and would that be okay by you or not? If we did start speaking about those big things? What's your guess about what it would be like for you? What's your guess about what we can do if it gets uncomfortable? And how do you want to speak about it? Like, what's the language that you might want to use about it? So we really want to pay a lot of attention to the negotiation of the topic and seeking permission. Another thing that I think can be really helpful is this notion that we aren't sort of owed a response. We don't have an entitlement to know. You know, we can ask children and young people questions, but, you know, sometimes those questions can be very, very hard to answer for all sorts of reasons. It could be a cultural reason, it could be a class reason, could be a gender reason that someone might find difficult to speak to us as practitioners. So I never hold an entitlement to know. And one way I enact that principle is I say, look, we can go to all sorts of different places in this conversation. We can put our focus in all sorts of different directions. So if you don't like a question or a theme that we're speaking about, let me know and we'll go elsewhere. So that's another thing that I will tend to do. I'll also be really on the lookout for people's responses and children and young people's responses to what I'm doing and the questions I'm asking, if there is some hesitation or they're looking a little bit uncomfortable. I orient my practice around accountability. Always be checking in. Like, is that question, okay, what do you think about what I just said or did? What was that like for you? So I'll always check in with people. If we're checking in about the effects of our practices, our questions, even our theories and our ideas. We're much less likely to misuse power. And there's always going to be power, not just power as a result of a worker and someone who's consulting a worker or a therapist or a community worker. There's power relations of age too. So we're much less likely to misuse power. But we're also, I think, really centering the preferences and, and the experience of the child or the young person. We ask those kind of questions.
[00:06:43] Speaker B: There's also some key approaches and ideas that David shares that he follows in his work. He shares with me what children have told him that they want, how he joins with them, how he's led by them whilst he's seeking to understand them. I asked him what children have told him that they want from adults. And here's what he shared with me.
[00:07:04] Speaker C: Don't try and fix us, don't try and prevent us. I said, really? What do you mean? She says, well, you've got to try and understand us. Try and understand us. Then when you understand us together, maybe then you can prevent. Maybe then you can talk about suicidal experience and stop us from ending our lives. I think the key thing I would say, or at least first step, is to just get clearer about what matters to them. That's what we're after. Rather than us impose what we think should matter to them. We want to know what matters to them.
[00:07:41] Speaker B: David also adds the importance of seeking context for their distress, that people have.
[00:07:47] Speaker C: A sense of the context through which their distress, through which their despair has been cultivated, know what's the context of their life that's opened the door to this despair, to these really horrid times, be it homophobia, be it transphobia, be it abuse, be it racism, poverty, et cetera, these things aren't obscured in the discussions. They're not obscured by diagnostic talk and diagnostic orientation, but they set a stage. You know, what's been happening in people's lives are a really center stage in the conversations because once the context gets named and people know what they've been being put through and how that shapes despair, they're much less likely to get involved in some kind of self recriminations, feel like they're culpable for where they find themselves in.
[00:08:44] Speaker B: I really wanted to know about the usefulness of risk assessments too. David continued to share with me what, what he's learned from working with young people and what he prioritises in his conversations.
[00:08:58] Speaker C: Now, risk assessments can be a little bit cooler. They can be A bit removed. They can be a bit more professionally distant and oriented around sort of certainty or an assessment. I think this young person was making a plea for joining in their experience to really get a sense of just what's going on. And I think we don't want to bring a coolness, a distance to these conversations when so much is at stake, when there's such sorrow, thick sorrow around. I'm also knowing that there's more than one story. I do try and keep hold of that idea. There's more than one story. Even with the most thick, heavy, horrid experiences, I know that there's more going on than what we might be hearing. So that's one way I can stick with it. But you know, like, I'm also conscious that if we make room for people's experience in the ways that they want to speak about, we hold off on acting too soon or doing risk assessment. We are actually, I think in the service of making the conversation safer.
The more we might be orienting ourselves around mental health response round kind of risk assessment, the harder it is for people to speak. So we really want to make room for people to speak.
[00:10:24] Speaker B: We know that in most cases a child's parents and family can be their best support and the most effective protective strategy. Practitioners direct attention to working with children's parents. David shares with me how he approaches parents worries to strengthen the child's support.
[00:10:43] Speaker C: Caregivers can express worries in heavy handed ways, but the worries can speak to the care that they have. And the care is what we might want to build on. That's the story we might want to build here. So there are a couple of options. There are a couple of things that I keep in mind when there's something like dismissal. But look, let's say we do both of those things and caregivers are saying things that are dismissive, they that are hurtful, that are creating harm. I'll interrupt it, I'll interrupt it, I will change the topic, I'll find another thing to talk about because we never want these conversations to be creating more harm for a child, more complexity, more turmoil for a child or a young person. We really never want to be implicated in that. So I'll, yeah, I'll interrupt that. Not in a way that will have a, hopefully that will have a caregiver, not, not have a caregiver feeling ashamed or shut down. But I'll interrupt it nonetheless. You know, when children and young people are in a place of great despair, when they're flirting with wanting to die, often there's you know, what's happening around them and people's response to them can be acutely sensitized to what's happening. So we really have to take some responsibility and take great care with conversations around these matters. What I've learned in terms of some of the skills that can assist in this work with families, one would be families have taught me time and again that keeping relationships in good shape, in the best possible shape when turmoil is visiting, when dire thoughts are visiting, is a key thing. So whatever it might take for relationships to be in good shape, sometimes young people have said, look, my parents can freak out when I speak to them about just how desperate I feel.
But if they could take their freak out somewhere other than me, you know, they could settle some of those very unsettled feelings that they have. If they could find some steadiness outside of their relationship with me, that can be very, very helpful.
So that's one way that many families have told me that they can keep relationships in good shape.
[00:13:11] Speaker B: David continued by sharing with me some powerful ways. He privileges children's voices and helps them to have a voice when talking with them.
[00:13:20] Speaker C: One of the things I'm trying to do is really listen intently to young people's and children's language, like how they might speak about what's going on for them. So for instance, when I've spoken with children, sometimes they've used language that's a little bit surprising or a bit catches my attention. I remember speaking with someone who spoke of way out thoughts rather than suicidal thoughts. And that was the language we used, way out thoughts. So that's, that's one thing we can do is we don't impose professional language. You don't rework the language that children are using so that it's from the professional world and professional language. So that's one thing we might want to do. We also might want to think about how children can find it hard to maybe just speak on their own behalf. So one thing that I've done over the years is I've collected a whole lot of documents, know how that children and young people have around all sorts of matters. I've mostly collected these when working in a psychiatric unit for young people, but one of them is around way out thoughts or suicidal experience. So we can like, you know, introduce children to the stories of other children or young people to the stories of other young people so that children or young people in a sense don't have to start the conversation. They don't have to be burdened with starting the conversation. They can join a conversation that's already started via the written word from other young people or children. Or maybe images could be an image of the problem story or even an image of the strong story.
[00:15:08] Speaker B: We then spoke about the aims of his conversations with young people and, and what David pays special attention to. He was clear about the importance of enabling a child to share their grievance. Not rushing to fixes and what there is to live for and what they're good at, but also noticing these strengths based conversations.
[00:15:29] Speaker C: I'm not interested in just hearing what is possible, what works well, what skills people hold and use. I'm interested in hearing, you know, about the hardship. And I think quite often children, young people, most people are interested in having their hardship, the extreme turmoil, the, the great suffering, the great sorrows. They're, they're interested in having that witnessed and heard and not kind of glossed over or kind of feeling like they're being jollied along.
So really wanting to hear just how hard things can be and the experience of turmoil. So that's one reason why one way I wouldn't be just rushing to a solution. The other thing is the more we kind of slow things down in a conversational way, the more that the know how is just being presented.
The preferences, the principles, the values are being presented. I might hear someone say, look, I feel like I am just a burden. I'm way too much work for all the people in my life and that's just another reason why I really should leave this world. Now that's a sad sentiment. That's a sad sentiment and I want to acknowledge that. I want to hear a bit about that, that sense of what it's like to be a burden. But what's on the other side of that is someone who's very interested in the other person's experience with them. They're interested in the effect that they're having on other people and that can be honored. You know, like that can be, that can be part of a story that really can be life saving, you know, the importance of attending to the other and perhaps the implicit kindness that might be part of that story. Say someone says, you know, I've got nothing left. This is just way too hard. You know, I'm climbing a mountain that just doesn't have a peak.
So I might ask them something like, well, if you're climbing a mountain that doesn't have a peak, if this is an endless kind of work that you're doing just to kind of get on with life, just to get through Every day. My guess is you're working very, very hard. You're working very, very hard. Would you mind just sharing with me how hard you're working at this? Tell me how hard you're working. Is it a, Is it like a minute by minute thing? Is it, Is it more like an hour by hour kind of thing? Just, just. Would you mind letting me know just how hard you're working in this or who is it in your life who knows how hard you're working at this, how hard you're fighting at this to kind of keep at it, to keep it something that seems just so difficult. Some might ask questions that directly get onto the absent, but implicit, like that.
[00:18:28] Speaker B: Our conversations then shifted towards the vital role that practitioners can play in supporting children and families. David shares, drawing on narrative therapy to focus on the skills and abilities of both the children and their families, helping to challenge and counteract the persistent, often overwhelming notion that children are helpless or unable to respond in their experiences.
[00:18:53] Speaker C: The first hope I would have is that young people, children, their families, their networks, caregivers, parents, are able to know more. Their know how, you know, there's. There's more of a spotlight shone on what they know about life, what they know about keeping relationships in reasonable shape despite the turmoil, what they know about just getting to the end of the week and staying alive. The other thing that I would be hoping for is that whatever it is that young people, children and those in their networks are able to articulate what's important to them. So I would hope we can get onto what their hopes are and orient the work and orient their lives for the paths to be lit up by those hopes. I guess another thing that I would be really hoping for is that there's less isolation in people's lives. Often it's isolation that just makes difficult times way more difficult, makes trauma more traumatic. It makes despair amplified.
So whatever ways people can feel joined with others, whatever ways people can feel less isolated, the way I orient the work is a fairly well worn principle, or at least a well expressed principle of narrative practice, which is a double storied conversation. We might be with a child or a young person and join them in some sorrow, but we also want to listen out for the openings to territory that's outside of sorrow or outside of despair. And I'd also say there might be a distinction between despair and sorrow, and joining someone in despair is really where you can get pulled down a rabbit hole. That might not be very helpful, but I'd say we want to join people in sorrow. For a few different reasons. I mean, one of them is that there's a lot to be sorrowful about. There's a lot of sadness that can circle people's lives and can be very, very difficult for children and young people. And, and we just might, we just really want to make room for it. I think that's if we're going to try and understand someone, if we're going to try and make room, as much room as possible for someone's experience, we really want to join them in sorrow.
[00:21:25] Speaker B: David articulates and offers us insight into how he gets onto the young person's skills that are present within the distress and despair and what he's learned from young people.
[00:21:37] Speaker C: One thing that I rarely do in the practice is say a question or ask a question that's something like what do you do that makes the problem smaller? How do you deal with way out thoughts? I rarely ask that question. And more what I'm doing is I'm just on the lookout for any glimpses of life, anything that shines that's outside of despairs territory. It's outside of the territory of the way out thoughts. So it might be meeting with a family and child or a young person walks over the table and grabs the tissues and takes over their mother when their mother's weeping or something. And I might say, what do you think I appreciate about what you just did? Does that say something about, about you as a, as a person that you just did that for your mother? Or I might say I get a picture of you as someone who's quite aware of where other people are at and wanting to assist if someone's sad. Would other people say that about you? Now that's to get onto a story that's other than despair story.
It might not be directly related to despair, but it's another story. Or I might notice that someone's really funny in the way they're telling the story and, and I'll pick up on that and say, you know, do other people think that you're, you're a humorous person. I get the sense you are. So these are, these are things that I'm on the lookout for, always on the lookout for. Kind of know how that's inside the conversation, that's inside what's happening. What we can do when we ask people to go outside the conversation potentially is we can set them up for failure because they may not have a, they may not have a, an answer. What do you do to deal with way out thoughts if they don't have an answer? They can feel perhaps even less equipped to deal with the ups and downs of life. But the more we trained ourselves, the more we build on skills to pick out what we've been hearing or what we've been noticing, what's been happening in a conversation, around the conversation, the less likely we are for people to experience a sense of failure and the more likely it is for people to know and to have something to say that can build a strong story. Also, always on the lookout for any kind of playfulness, any kind of humor. Because what you could say about despair is that whenever you're in the realm of playfulness or lightness, despair can't exist there. You know, if you're, if you're having a joke or having. Or there's some smiles or something, it's really, you've really kind of stepped into outside of spare territory.
[00:24:23] Speaker B: I also asked David about how he uses the concept of the absent and implicit. It's based on the idea that when a person expresses a worry or a concern, that there's also something that's important to them that remains hidden.
[00:24:38] Speaker C: Well, look, the absent of implicit is something I really kind of rely on and get drawn to a lot.
Very broad brushstrokes. I would say the absence of implicit in very thick, powerful sorrow and despair is that something is very, very precious to someone that is being stamped on, that is being ridiculed, that is being not able to be expressed. Okay, so in fact, what we could say is the more someone experiences distress, the more someone has a sense that this is so distressing that they don't want even to live. The more precious something is present, the more it really desperately matters to that person. But I would say what can be helpful about the absolutely implicit is the more there is distress, the more we know something is very precious. Very precious.
[00:25:38] Speaker B: David then spoke about how he notices children's responses and resistances as opportunities to notice and explore what sits behind these actions and intentions underpinned by thoughts, ideas, hopes and values.
[00:25:53] Speaker C: We're always on the lookout for the smallest of resistances. I can give you an example. Young people have told me that there might be something like a hierarchy of self harm. Okay? Some harms harm you more than other harms. And often when a young person, or maybe a child chooses a self harm that's less harmful, all that's a small resistance, you know, that's a small resistance to self hatred. And I think what we can do is we can recognize that the self harm might not be in burning yourself or cutting yourself or some heavy or serious things like that. It might be in really restricting your eating or something. But these are deliberate. These can be deliberate actions that have agency and we can honor them even when they seem very small. I would say if we're looking for triumphant, you know, significant turning points as these resistances, we're really going to be setting everybody up for failure. So we really want to work with the small resistances.
[00:27:01] Speaker B: If you're interested in learning more about recognizing and cultivating the skills children, young people and families use to respond to distress, including understanding how children's resistance can reveal pathways to their skills, values and hopes, visit our website. There you'll find other resources, including our online course for practitioners understanding and responding to childhood suicidal ideation. Thanks for tuning into this podcast where David shared with us how he approaches his conversations with children, young people and their families, where distress and despair are taking precedence in their lives. Thanks for listening and thank you for all you do in supporting children and families health and wellbeing.
[00:27:49] Speaker A: Visit our
[email protected] au to access a range of resources to assist your practice. Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds, the Centre is funded by the Australia Australian Government Department of Health and Aged Care under the National Support for Child and Youth Mental Health Program.
