are struggling with chronic pain; who have command hallucinations; and
Family dynamics and genetics also contribute to suicide risk (Bilsen et for suicide (Sheftall et al., 2020). All individuals who die by suicide are not depressed. Some have an impulsive thought and act on suicide within higher risk following precipitating events, such as an argument with a Access to lethal means with suicidal ideations places a child at higher risk include impulsivity,
isolating behaviors, rehearsal or preoccupation
with dying, a plan of suicide, making suicidal statements, anxiety, sleeplessness, withdrawal
from friends or activities, or giving away
personal possessions. There is not one cause of suicide, and more than one factor may play a role in an individual dying by suicide.
Collaborative Safety Planning Treatment for suicide in a play therapy setting initially includes individualized and collaborative safety
planning with the client,
caregivers, and providers. According to Stanley et al. (2012), the plan needs to include: • reducing imminent risk and the client’s access to lethal means; • stabilizing and securing environments; • treating suicidal ideations, thoughts, feelings, and behaviors directly; and
• creating a tangible plan or reminders that clients can access during crisis to increase the likelihood of using the safety plan.
Therapists should help caregivers and clients identify the client’s unique warning signs that led to the crisis, their unique internal coping strategies, the people and settings that provide distraction from suicidal thoughts, the people who are available to them and from whom they can ask for help in personal and professional spheres, and steps to make their environment safe (Stanley et al., 2012).
Following the detection of a client’s elevated risk for suicide, The National “reassess risk and review and/or update the patient’s safety plan at every should help families revisit, role play, and revise the safety plan (Stanley ability to implement the plan.
Why Use Play Therapy Play allows the play therapist a window into the child’s world to collaborate with the child using the child’s words (toys) and language (play; Landreth, 2012) to assess and address suicidality. In play therapy, repetition, rhythm, and attuned relationships create a safe environment in play therapy to allow children to feel safe enough to process new information (Gaskill, 2019). Play processes information in a variety of parts of the brain using
CLINICAL EDITOR’S COMMENTS: All play therapists should actively assess and address client suicidality.
senses, emotions, and cognitions to make lasting changes (Gaskill, 2019). Practicing therapeutic skills with the child in a new, stimulating way each session can build new healthier synapses. Play therapy techniques are useful in building resiliency skills in children. Building resilience increases protective factors to prevent suicide (Hurley, 2020; Prater, 2020).
solving strategies and coping skills diminish during crisis (Stanley et al., 2012), even if previously internalized and mastered (Gaskill & Perry, recommended to address suicidality, children are often dysregulated cognitive behavioral play therapies used to improve cognitive regulatory control are likely to fail when lower brain networks are disorganized or impaired. Regulation techniques are used in play therapy to build internal coping skills to help decrease risk for suicidality in youth.
Bottom-up somatosensory play therapy techniques, such as movement, yoga, or breathing techniques in play therapy are used to practice shifting from an alarm state to a regulated state (Pliske & Balboa, 2019). Practicing these techniques in play therapy can help the child learn to bodies and minds (Pliske & Balboa, 2019). Regulation can lead to the flexibility and capability to manage suicidal ideations and the pain that led them to the place of such discomfort (Luoma & Villatte, 2012). Mindful play therapy tools can help children become attuned to their bodies and recognize their triggers to understand the warning signs felt internally that led up to the crisis (Pliske & Balboa, 2019). Mindfulness play therapy emotions to increase tolerance and acceptance of emotions and body relaxation, and grounding techniques can help the child go to a safe place in their mind and body or learn to contain their feelings (Maiberger, 2009). Because emotional regulation, emotional tolerance, and impulse control are associated with suicide risk (Hatkevichet al. 2019), targeting these skills with play therapy techniques may reduce the risk for suicide by building resiliency.
External Regulation, Support Systems, and
Reinforcement Establishing collaboration between child, family, teachers, and other professionals, such as psychiatrists, school counselors and pediatricians,
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