Initiating talk about suicide and self-harm in psychotherapy with adolescents with depression in China: A conversation analysis approach

Talking about suicide and self-harm with depressed adolescents is a delicate aspect of psychotherapeutic interaction. While conversation analytic studies on suicide risk assessment have concentrated on adult populations in western settings, little is known about how suicide and self-harm are initiated in Mandarin-language psychotherapy for depressed adolescents. Drawing on conversation analysis and employing 24 audio recordings as the data, this study examined how talk about suicide and self-harm was initiated and responded to in psychotherapeutic interactions with depressed adolescents in China. We identified two primary initiation patterns: therapist-initiated inquiries and client-initiated disclosures. Specifically, therapists initiated inquiries by grounding inquiries in clients’ prior accounts, softening inquiries, and progressing incrementally from general mood inquiries to specific questions about suicide and self-harm. Clients initiated disclosures by embedding disclosures in their narratives, managing delicacy through mitigations, and exercising agency in shaping the therapeutic agenda. Both patterns were accomplished through calibrated interactional practices that balanced therapeutic obligations with the sensitivity of the topic, presenting the initiation as collaborative achievements shaped by mutual orientation to delicacy. This study contributed to the understanding of the complexities in the psychotherapeutic interactions with adolescents with depression and provides implications for offering evidence-based insights into recognizing and responding to the openings of suicidal talk.