The more you try to be persuasive,
the more implausible you are.

Humberto Maturana

Psychotherapy of depression with suicidality in childhood and puberty

“The one who takes notice of a crisis – differentiates.
The one who differentiates – gains the prerequisite to decide.
The one who decides, solves crises by taking a stance.”
(Dieter Lotz)

Whether consciously or not, everyone asks for meaning. Imparting of values starts in the experience sphere.

Warning signs of suicide risk for children and adolescents

(according to Kerns 1997)

  • change of behaviour (a sociable child withdraws into himself)
  • negligence of one's own appearance
  • social withdrawal, isolation
  • giving away one's personal valuable belongings
  • increased attention to the issue of death
  • open or hidden suicidal intentions
  • previous suicide attempts
  • contemplation on suicide methods
  • excessive consumption of alcohol or drugs
  • lagging behind at school
  • sudden high spirits
  • frequent accidents
  • running away, escaping


There are fundamental differences in the psychotherapeutic work with children under and over 12:

Children under 12:

To the front comes cognitive immatureness and impulsiveness. Suicidal thoughts are accompanied by feelings of despair and guilt, the children show a picture of aggressiveness and irritability. At that, family and school conflicts are the main risk factor, e.g. problems with discipline and mobbing at school or confrontations within the peer group.
In case of suicidal tendency, hospitalization is always advisable when the child must be taken out of the conflict situation.

Suicides are very rare in Austria among children under 14, (0,3/100.000) – similar data are obtained in Switzerland. In the case of adolescents and young adults (aged 15 to 24), overall suicidal tendency is 13,0/100.000. Girls attempt to commit suicide three times as often as boys. On the other hand, suicide attempts among boys lead three times as often to death as those among girls. Male adolescents resort to “hard” means as, e.g. death by handing, shooting or throwing themselves in front of the train. They want to “carry suicide through”, mere attempts are rare. On the contrary, suicide attempts among girls and women are often of a vividly appealing nature and do not aim inevitably at death (para-suicide).

“Actually I'm quite different. But I so rarely have time to show it."
(Ödön von Horvath)

16-year-old Josephina cut her wrists open but timely phoned her parents. She had many physical complaints, fears and a strong need for control. She had “everything” but still could not be happy. Massive feelings of guilt seized her because “others had less”. She felt the best in the nearby farm, but her parents were reluctant to this, as “she stank of stable” - and she'd rather practice her fourth foreign language, Russian was important for the expansion to the East – this knew her successful father – till Josephina's suicide attempt. He understood his daughter's appeal and was deeply shocked. As the nearby farm sheltered Ukrainian refugees, Josephina's Russian language skills improved significantly – she insisted on the young family's talking to her only in Russian and replied in German. Spontaneous healing – by no means a surprise! Keen interest, enthusiasm, elevated mood at work produce such side-effects as joy and first of all quick wits, flexibility and creativity. We reach our maximum efficiency much easier, we take our tasks as challenges, we live up to them. A bit of pressure (stage fright) enhances concentration and motivation.

In emotionally loaded situations, people have three reaction possibilities: attack, escape and stupor. The suicide trigger is clearly distinguished from the reason to take this decision. Failure at school, work or in a love relationship are triggers for turning the suicidal fantasies into reality, whereas the cause lies deeper, is linked to the life story of the young person and reveals e.g. his dependence, his pyramidal values arrangement (a core values becomes a sore value), his feelings of inferiority.

Neither shall cultural discrepancies be overlooked. Also, those between North America and Europe. Time and again American and Canadian young women raped by young men during their stay in Europe as exchange students have been coming to my practice for many years. Luckily, there is a study published by Paul Watzlawick which affirms that mating behaviour in North America and Europe differs and is therefore misunderstood. In both cultures, there are about 30 stages up to an intimate, metaphysical relationship. But: kisses come in North America at stage 5 and in Europe at stage 25!

Anne, 17, exchange student from Los Angeles, after passionate kissing followed her neighbour, 23, into his flat. The attractive ski instructor found her wild resistance “classy” - he did not understand her clear signs. Anne perceived it as sexual abuse. He was her first man. Inwardly, she has not been ready for this last step yet.