Responding to childhood suicidal ideation through understanding and curiosity
Amanda Kemperman, Emerging Minds, Australia, May 2025
Resource Summary
What is this resource about?
This practice paper builds on the content in the Emerging Minds online course Understanding and responding to childhood suicidal ideation.
Children, even at a very young age, can experience significant distress and despair that may lead them to think about suicide. Adults and practitioners in children’s lives have invaluable opportunities to create safe spaces where children feel comfortable sharing their experiences, which can reduce their sense of isolation and burden.
This paper highlights the importance of listening to children and striving to understand their thoughts, ideas and perspectives on the challenges they face, which can provide them with immense relief. By practising intentional curiosity, practitioners can identify how children are responding to their circumstances and recognise how these responses are connected to what matters most to them. Through this work, practitioners can help to unearth children’s skills and expertise.
Who is this resource for?
This practice paper is designed for practitioners directly working with children who may be experiencing distress and their families. It acknowledges that children may endure prolonged distress, which can lead to despair and suicidal ideation. Practitioners can use key practice strategies to help children and families explore and develop their strengths and enhance their mental health and wellbeing responses.
Contents
Introduction
In times of high distress or during crisis, well-meaning adults often adopt rescuing or fixing strategies that may unintentionally disempower children. These approaches can disqualify children’s perspectives on the problems they are facing and their attempts to overcome these problems.
By adopting a curious approach and using double listening skills, practitioners gain deeper insight into the difficulties children face. They can explore experiences that reveal children’s important relationships, desires and abilities in coping and responding. Through active listening and curiosity, practitioners can foster agency and choice, empowering children to recognise their own strengths and solutions.
Increasing children’s choice and agency in therapy
When children experience distress, isolation, trauma or disadvantage, they may appear quiet, withdrawn or hopeless. In these moments, practitioners might feel compelled to take on a convincing role by reassuring children of their worth, listing their strengths or telling them what they have to live for. However, children may struggle to see their own resilience, strengths and knowledge, often feeling like they have little to contribute. This can lead them to rely on the practitioner to shape their story, agree out of obligation or accept solutions that don’t fully reflect their experiences, further distancing them from their own perspectives and agency (Vermeire, 2017).
Increasing children’s choice and agency in therapeutic sessions might involve taking a step back from immediate solutions. When children can describe the history of distress, isolation or trauma in their lives, they can name and talk about the problems they are facing in their own way. In doing so, they can also describe what the problem is getting in the way of, and their hopes and preferences for different experiences (Yuen, 2019). They may even mention strategies they have used in response to the problem.
When children can recognise and begin to generate meaning from these responses themselves, this is potentially more helpful than having a practitioner interpret their story (Emerging Minds, 2022). These kinds of conversations might be unfamiliar to children, and their answers of ‘I dunno’ in response to practitioners’ questions do not necessarily mean they are unwilling to share. It remains the practitioner’s responsibility to approach conversations with curiosity, attentively listen and ask about the details in a child’s story, including their actions, feelings and meanings. By doing so, children can ‘know’ more about their life and practitioners can gain a deeper understanding of the child’s experiences. This approach respects and honours children’s abilities and agency (Yuen, 2019).
Practice example
Clary, a social worker at a local health service, has been working with mother Semmy after her recent divorce and struggles with depression. In their first meeting, Semmy mentioned how she has been really worried about her son, Max. She said that he is always ‘getting in trouble’ at school and has been aggressive towards the teachers. Semmy shared plans to bring Max into the next session with Clary.
A week later, Clary is meeting with Semmy and Max. Semmy shares her frustration about Max’s behaviour at school, saying: ‘Why can’t you just listen to your teachers and stay out of trouble? I just can’t deal with this right now!’ In response, Max storms out of the room while yelling that nobody loves him, that he doesn’t belong and that he should ‘just die’. While Max is out of the room, Semmy says this is a common reaction from Max and she is scared he might hurt himself one day.
After checking on Max, Clary spends some time talking with Semmy about her hopes for helping and supporting him. Semmy says that ‘with everything going on at the moment’ – dealing with work, moving house and Max’s father – she has been struggling and doesn’t know what to do about Max. Clary asks Semmy if it would be okay to seek to understand what might be going on for Max, including his behaviour at school. Semmy agrees this would be helpful.
Inviting Max back into the room, Semmy apologises and reassures him that she wants to help and support him. Clary asks Max’s permission to talk about some of the tough things he might be going through. She enquires what it might be like for Max to talk about those things, what they can do if it gets uncomfortable, and how he wants to speak about the suicidal thoughts, including any particular language he would prefer to use.
In response, Max expresses his frustration and voices his feeling that he can’t get anything right, no matter how hard he tries. He says that everyone is being unfair, they are too hard on him and his parents treat him like a baby. He admits ‘it all feels overwhelming sometimes’ and that thoughts of being dead cross his mind as a ‘way to escape’. Max refers to these as ‘die thoughts’, so Clary also uses this language.
As their conversation continues, Clary explores the impact of Max’s ‘die thoughts’, helping him to recognise and explore the patterns of when they increase and decrease. Max shares that these thoughts intensify when multiple people are telling him what to do or criticising him and he feels like a failure. He says these thoughts shrink when he is left alone to focus and can gain momentum with being good at what he’s doing. Clary summarises these effects, emphasising the environmental impact on Max’s suicidal thoughts. This helps highlight how Max can influence his thoughts and feelings of overwhelm, while also encouraging Semmy to reflect on how she can support him. Clary continues to learn from Max about the various strategies he uses daily to cope with frustration, overwhelm and the ‘die thoughts’.
By exploring and considering the varying characteristics and impacts of their distress or despair, children can begin to see what is happening as something that is separate to their identity and that they can have influence over. They might begin to talk about distress being worse at night or during school, or less present when they draw or play computer games (Vliegen et al., 2022).
When children richly describe these contexts, it makes it more possible for them to identify strategies they have used in the past to minimise distress and that they could adopt in the future. Importantly, being curious about the child’s thoughts, feelings, hopes and needs is different to a practitioner or parent generating quick fix solutions that may not resonate with them (Johnson, 2010).
What is hiding within the distress?
When children meet with practitioners, they often view themselves solely through the lens of their withdrawal, anxiety or distress. In the practice example, for instance, Max sees himself as the ‘problem child’ at school and the ‘depressed child’ at home, where his parents are worried that he will hurt himself. Children may come to believe that this distress is an inherent part of who they are. Parents may also describe a sense of overwhelm, perceiving their child as inherently depressed or distressed (Bernardi, 2023).
Practitioners can engage children and their families to uncover what is hiding within the distress and what else is present besides the distress. This can lead to conversations that identify the motivations shaping a child’s behaviour and highlight their agency and resilience. This approach offers families alternative perspectives and options for support.
Double listening
Building on foundational active listening skills (e.g. paraphrasing, reflecting, summarising and confirming understanding), double listening enhances practitioners’ awareness by recognising multiple perspectives a child may hold (Meyer, 2015). It acknowledges that identities are shaped by diverse narratives and experiences, allowing practitioners to create space for a fuller, more contextual understanding of a child’s challenges (Guilfoyle, 2015). When responding to childhood distress, double listening makes room for both the trauma and the child’s responses, reinforcing their agency. Beyond simply validating their experiences, double listening helps identify children’s strengths, their values and the skills they use to navigate difficulties (Vermeire, 2023).
Clary explores how Max’s behaviour at school and home reflects what is important to him and what he needs. Using a double listening approach, she asks Max about his experiences with ‘getting in trouble’. Max expresses frustration and explains that it feels unfair. He says he isn’t trying to misbehave and simply wants to join in class activities, yet he always ends up being reprimanded and sent out of class.
Clary continues to explore Max’s actions with curiosity. Instead of focusing solely on the label of ‘bad behaviour’, Clary seeks to understand Max’s experiences. She stays attuned to what he might be advocating for through his actions and remains curious about what is important to him.
By paying attention to children’s behaviours, practitioners can notice subtle clues about what matters to them. Practitioners might observe these clues through children’s creative expressions, such as drawing, or by noticing their imagination or problem-solving approaches (Emerging Minds, 2022). These clues can foster a practitioner’s curiosity about children’s interactions, their behaviours and the strategies they use, especially during moments of distress or difficulty.
Clary invites Max to tell her about some of the times when he has been able to ‘join in’ class activities but ended up being reprimanded and sent out. Max shares with Clary that he tells funny stories in the classroom, which gets him in trouble. Clary is curious about what Max’s hope is when he is doing this. Max’s response helps Clary to understand that he is hoping to make his classmates laugh and think he is cool. Clary asks why this might be important to him. Max shares that he often feels anxious around groups of people; when people are laughing and being nice to him, he feels more at ease.
By remaining curious about the purpose behind Max’s behaviour, Clary recognises it as a strategy Max uses to manage stress. Practitioners who engage in double listening and actively seek to notice a child’s sense of agency are more likely to uncover these valuable insights. Contextualising problems to highlight their complexity can create space for a fuller understanding and expand the range of possible ways forward. The stories practitioners hear and the meanings they assign to shared experiences can shape children’s lives and relationships (Chauvin et al., 2019).
Max’s mother is witnessing this conversation and Clary asks her what it is like hearing Max give context for his words and actions. Semmy says she had not known Max was struggling in class. Through this discussion, she now recognises that humour is Max’s way of coping. Clary then asks what difference this new understanding might make in how she sees and supports Max. Semmy responds that knowing he is just trying to ‘get through’ helps her be more understanding and not be so harsh on him. She speculates that perhaps she could let the teacher know what might be happening for Max and ask her to be more flexible.
Problems as pathways to what matters
Double- or multi-storied conversations recognise the duality in all experiences, acknowledging both the challenges a person faces and their hopes for how things could be. These conversations highlight how problems obstruct what individuals want and value, while also supporting them to reconnect with and strengthen what they are striving for. A child’s description of a problem is inherently relational, shaped by what is cherished, valued and hoped for in their daily life (Beaudoin, 2020).
Being curious about why something is a problem can help practitioners to collaboratively uncover what might be important to a child – something that can sometimes get hidden by a problem. Drawing on the child’s own language and descriptions supports practitioners to explore children’s experiences more fully and without imposing their own ideas, assessments or judgements (Marlowe, 2010).
Continuing her work with Max, Clary stays curious and asks him about the times he uses humour to manage feelings of overwhelm and anxiety. Max explains that sometimes the humour helps, but the pressure on him can build if it fails to change an uncomfortable situation. He says this can lead him to yell or swear at someone to get them to leave him alone. When that doesn’t work, he says that ‘everything feels hopeless and the die thoughts come’.
Noticing Max’s comment about feeling hopeless, Clary’s use of double listening leads her to wonder what this might reveal about the things that are important to Max. She recognises that, for something to feel hopeless, there must also be something hoped for that is under threat.
Clary asks Max what he wishes were different and what he is trying to focus on each day that the surrounding pressure makes it hard for him to do. Max talks about how he really hopes his parents get back together ‘like before, when everything was good’. He says he loves reading and learning new things, but the pressure means he finds it hard to concentrate. He shares how he hopes to have a good job and help his mother buy a house one day.
Clary remains curious about what Max values. She summarises Max’s key hopes and skills, highlighting his strong desire to help his mother and how important his family is to him. She then asks how he has worked toward these things previously, and how he might continue to do so into the future.
After understanding the child’s distress, practitioners can deepen the conversation by exploring and identifying the values and hopes connected to the child’s experiences. Asking questions like those in the following table can help practitioners move beyond discussing problems to uncover what truly matters to the child.
Children’s and families’ descriptions of their struggles are significant and valuable. However, a fuller picture emerges when practitioners explore what the distress is contrasted against or shaped by. This approach helps uncover the hopes, values and needs hidden beneath the desperation (Carey et al., 2009). This creates movement in children’s minds and experiences, reconnecting them with what matters most and offering possibilities that counteract feelings of being trapped, powerless or without a way forward (Marlowe, 2010).
Responses demonstrate agency
Children are always responding to their environment. When practitioners approach children’s responses with curiosity, they can uncover and highlight children’s efforts to advocate for themselves and navigate their experiences (Emerging Minds, 2024). By helping children recognise the special skills they employ and the values underpinning their actions, practitioners reinforce their sense of agency and ability to stand up for what’s important. This active approach counters feelings of hopelessness and reminds children of their influence in shaping their lives. It can also help to prevent their responses from being overlooked, dismissed or diminished (Carey, 2017; White, 2004).
Even in the face of overwhelming trauma, people take steps to modify its impact, protect what they value or preserve what is precious to them (Brown, 2018; Moss, 2022). Every response carries meaning – even silence or a smile. Practitioners using double listening can ask curious questions (e.g. ‘If that action could speak, what would it say?’ or ‘What hopes did this action have?’) to foster agency-based conversations that strengthen a child’s sense of self. By exploring these insights, practitioners can help children identify what their responses to the trauma reflect about the things that are important to them and their aspirations for the future (Guy, 2020; Sweeney et al., 2018).
Recognising ‘pain as testimony and distress as a tribute’ (White, 2005, p. 16) encourages practitioners to explore children’s experiences of suffering as meaningful expressions rather than symptoms of powerlessness. This perspective allows for conversations that honour a child’s emotions while also uncovering the values, relationships and commitments that may be related to their distress.
Clary recalls Max’s words that he feels he is ‘treated like a baby’ by his parents, and she asks him to share an example. Max explains that when he doesn’t follow instructions, he is sent to his room, which makes him angry and leads him to yell.
Clary refers to a particular occasion and asks, ‘If the anger had words, what would it be saying to your parents?’ Max replies, ‘That they are wrong, and they don’t know anything.’ Clary continues to explore by asking, ‘What does this anger hope for? Does it have a purpose?’ He responds, ‘To be listened to. Sometimes I have better ideas than them and I know what I need to do.’ Clary reflects, ‘So, the anger is a way of saying that you know things and want to share them, but that you don’t always get the chance.’ Max agrees. Clary then wonders how things might shift for both Max and his mother if they saw his anger as a sign that he has valuable insights to contribute.
By shifting the focus from helplessness to agency, practitioners can support children in seeing their responses as reflections of what matters to them. This can help children to foster resilience and feel a sense of influence over their own lives.
In the following video (2 minutes, 6 seconds), social worker and narrative therapist David Newman shares practice examples of what it can look like to recognise a child’s agency, explore what is important to them and help them to identify the skills they used.
Protective connections
Our values shape our sense of purpose and meaning, often influenced by the relationships that matter most to us. For children, strong connections with trusted adults provide essential support and guidance. However, children experiencing mental health challenges may face isolation, which can heighten distress and increase suicide risk (Emerging Minds, 2024).
Practitioners play a vital role in strengthening these connections by fostering safe, supportive environments where children feel heard and encouraged to seek help. By reinforcing supportive relationships with family, friends and communities, practitioners can promote wellbeing and reduce suicide risk (Suicide Prevention Australia, n.d.). When children feel safe and supported in expressing themselves without fear of judgement, they are better able to process their experiences and access the help they want (Cochran et al., 2023; Holt-Lunstad, 2022).
Through connecting them with trusted others, children can also reconnect with themselves. Practitioners can facilitate reflections with children by bringing others’ perspectives into the conversations. Seeing themselves through the eyes of others can help to reacquaint children with what is important and valuable to them. Children more easily reconnect with those positive aspects of themselves when they are recognised and appreciated by others. As these connections are grounded in the child’s own experiences and perspective, they can be deeply meaningful and empowering (Beaudoin et al., 2016).
‘Bringing others’ perspectives into conversations with children can not only increase children’s options but also their agency and sense of belonging. Reinforcing connections centring the child offers alternatives to social isolation and creates a safe landing pad for children’s distress and problems to be navigated.’
Watch the following video (48 seconds) to hear social worker Zoe Walter share her observations on the connection between despair and isolation.
Clary continues to explore Max’s skill of ‘knowing what to do’, which stands in contrast to his feelings of overwhelm and thoughts of wanting to die. She asks Max if anyone else has noticed this ability, particularly in situations where problem-solving was needed. Max shares that the other children at school know he is good at maths, so they sometimes copy his answers. Clary then explores why ‘knowing what to do’ is important to Max. She wonders about what kind of person someone is if they take charge themselves instead of waiting for others to solve problems. Max replies, ‘A strong person.’ Clary recognises that many qualities help to form this skill. To help explore these qualities further, she asks Semmy to respond to the same questions.
Clary then enquires if ‘knowing what to do’ has helped Max support others. Max responds that he helps his friends, who often come to him for advice. He shares that they see him as a good listener and someone who helps them feel better with his humour. Clary asks if others also notice this about him. Max says his Aunty Anne does. This is a further opportunity to expand and strengthen the attributes of this skill.
Strengthening connections
Strengthening family relationships can be a strong protective factor for children.
Watch the following video (44 seconds) to hear Arianne, a child and family partner, speak about a strategy that a practitioner used to encourage and strengthen the connection between her and her child.
Practitioners can help to support children to recognise and strengthen peer connections. During a consultation for an Emerging Minds online course on suicidal ideation, one practitioner suggested that finding ways to share children’s skills with others can be a valuable tool for fostering relationships with peers (C. Markey, research interview, 2024). Visual tools, like the image of a large tree on a wall where children can write their skills as they are uncovered during sessions, can be used to inspire and support others. This approach not only encourages children but also helps them feel less alone by connecting with the stories of their peers.
Social worker and narrative therapist David Newman has created a series of resources detailing ways to connect young people. Making these connections can help to amplify their voices and encourage them to empower one another. Some of the tools Newman has co-created with young people to share with other young people include:
- Dictionary of Obscure Experiences: This is a dictionary for experiences that are hard to find words for; experiences that are unique, complex or obscure. It is a deliberately playful project, carefully avoiding expert or psychiatric language.
- How we deal with ‘way out’ thoughts: Life-saving stories from young people: The stories in this collective document offer some glimpses into the ways young people are finding life-saving know-how in the face of ‘way out’ or suicidal thoughts.
- The things we do to survive that can get missed by others: This document is full of stories about small steps of survival in the face of mental health turmoil; stories that can go unnoticed.
These resources and others can be found at the following link:
Re-membering lost or distant relationships
When the supportive relationships of children’s lives become lost or distant, practitioners can explore ways to reconnect and strengthen these bonds, reducing the isolation often present in childhood despair (Carey & Russell, 2003). These connections don’t have to be people – they can include characters from books or movies, toys or pets that help children reconnect with valued aspects of their world. Vermeire (2023) illustrates how meaningful objects, like a favourite toy, can anchor experiences that contrast with distress, failure and loneliness. These reflections challenge negative narratives and recognise children’s strengths, skills and values, which reinforces a more empowered sense of self (Carey & Russell, 2003).
Practitioners can initiate conversations that strengthen a child’s connection with a supportive person or other figure from their past, reintroducing them into the child’s life and positioning them as a supportive ally. Enquiring about what the re-membered figure contributed to the child’s life; how they influenced the child’s sense of who they are and what their life is about; and what the child might have contributed to the figure’s life can enrich the child’s connection to this relationship. This can help the child feel less alone and more connected with others (Hayward, n.d.; Tilsen, 2013).
Summary
This paper highlights strategies for practitioners working with children in distress, including ways to support to them to feel heard and to enable them to navigate their experiences. Providing children and families with opportunities to discuss their challenges can help bring clarity and offer a platform to explore and address what is happening in their lives.
By centring the strengths, values and relational connections of children and their families, practitioners can recognise and develop contexts where children are supported to share their problems without being judged, dismissed or ‘fixed.’ Highlighting children’s responses and values encourages their agency and confidence in navigating the challenges in their lives.
References
Beaudoin, M. (2020). Affective double listening: 16 dimensions to facilitate the exploration of affect, emotions, and embodiment in narrative therapy. Journal of Systemic Therapies, 39(1), 1–18. DOI: 10.1521/jsyt.2020.39.1.1.
Beaudoin, M.-N., Moersch, M. & Evare, B. S. (2016). The effectiveness of narrative therapy with children’s social and emotional skill development: An empirical study of 813 problem-solving stories. Journal of Systemic Therapies, 35(3), 42–59. DOI: 10.1521/jsyt.2016.35.3.42.
Bernardi, F. (2023). Postponing humanity: Pathologising autism, childhood and motherhood. In D. Milton & S. Ryan (Eds.), The Routledge International Handbook of Critical Autism Studies (1st ed., vol. 1, pp. 106–121). Routledge.
Brown, C. (2018). The dangers of trauma talk: Counterstorying co-occurring strategies for coping with trauma. Journal of Systemic Therapies, 37(3), 42–60. DOI: 10.1521/jsyt.2018.37.3.42.
Carey, M. (2017). From implicit experience to explicit stories. In M. Beaudoin & J. Duvall (Eds.), Collaborative therapy and neurobiology: Evolving practices in action (pp. 40–49). Routledge.
Carey, M., & Russell, S. (2003) Re-authoring: Some answers to commonly asked questions. International Journal of Narrative Therapy and Community Work, 2003(3), 19–43.
Carey, M., Walther, S., & Russell, S. (2009). The absent but implicit: A map to support therapeutic enquiry. Family Process, 48, 319–331. DOI: 10.1111/j.1545-5300.2009.01285.x.
Chauvin, I. A., Pierce, L. A., & McDaniel, J. R. (2019). Narrative reframing of stories and fables: Implications for counseling. International Journal of Humanities and Social Science, 9(6), 10–17. DOI: 10.30845/ijhss.v9n6p2.
Cochran, N. H., Nordling, W. J., & Cochran, J. L. (2023). Child-centered play therapy: A practical guide to therapeutic relationships with children. Routledge.
Emerging Minds. (2022). Engaging children: Rich pictures [Online course]. Emerging Minds Learning.
Emerging Minds. (2024). Understanding and responding to childhood suicidal ideation [Online course]. Emerging Minds Learning.
Guilfoyle, M. (2015). Listening in narrative therapy: Double listening and empathic positioning. South African Journal of Psychology, 45(1), 36–49.
Guy, S. (2020). Making use of practitioners’ skills to support a child who has been sexually abused. Emerging Minds.
Hayward, M. (n.d.). Re-membering map [Online course content]. In Maps of narrative practice. Dulwich Centre.
Holt-Lunstad, J. (2022). Social connection as a public health issue: The evidence and a systemic framework for prioritizing the ‘social’ in social determinants of health. Annual Review of Public Health, 43, 193–213. DOI: 10.1146/annurev-publhealth-052020-110732.
Johnson, L. (2010). A child’s voice: Narrative family therapy. International Journal of Narrative Therapy and Community Work, 2010(4), 3–14.
Marlowe, J. (2010). Using a narrative approach of double-listening in research contexts. International Journal of Narrative Therapy and Community Work, 2010(3), 41–51.
Moss, D. (Host). (2022, June 24). Supporting children who disclose trauma – part one [Audio podcast episode]. In Emerging Minds Podcast. Emerging Minds.
Meyer, S. A. B. (2015). Double listening and the danger of a single story. Wisdom in Education, 5(2).
Suicide Prevention Australia. (n.d.) Stats and facts [Web page]. Accessed 17 September 2024.
Sweeney, A., Filson, B., Kennedy, A., Collinson, L., & Gillard, S. (2018). A paradigm shift: Relationships in trauma-informed mental health services. BJ Psych Advances, 24(5), 319–333. DOI: 10.1192/bja.2018.29.
Tilsen, J. (2013). Friendly ghosts: Re-membering conversations with children. In J. Chang (Ed.), Creative interventions with children: A transtheoretical approach. Family Psychology Press.
Vermeire, S. (2017). What if … I were a king? Playing with roles and positions in narrative conversations with children who have experienced trauma. International Journal of Narrative Therapy and Community Work, 43, 50–62.
Vermeire, S. (2023). Unravelling trauma and weaving resilience with systemic and narrative therapy: Playful collaborations with children, families and networks. Routledge.
Vliegen, N., Tang, E., & Meurs, P. (2022). Children recovering from complex trauma: From wound to scar (1st ed.). Routledge.
White, M. (2004). Working with people who are suffering the consequences of multiple trauma: A narrative perspective. International Journal of Narrative Therapy and Community Work, 2004(1), 45–76.
White, M. (2005). Children, trauma and subordinate storyline development. International Journal of Narrative Therapy and Community Work, 2005(3 & 4), 11–21.
Yuen, A. (2019). Pathways beyond despair: Re-authoring lives of young people through narrative therapy. Dulwich Centre Publications.
