One day two taut and haggard parents arrived at my office with their 16-year-old daughter, Amanda, who had been discharged the day before from the hospital following her third suicide attempt.  Amanda had been in treatment for several years, and had been hospitalized on two previous occasions, with little resultant success. This most recent suicide attempt had also been her most lethal one—after swallowing dozens of pills, some prescribed, some over-the-counter, she had washed them all down with half a bottle of vodka.

Fortunately, one of her close friends knew something was up when she tried to IM Amanda and encountered a morbid Away Message, and had then alertly called Amanda’s mother when Amanda didn’t answer her cellphone.  Her mother discovered Amanda lying, unconscious, on the floor of her bedroom, called 911, and she was transported by ambulance to the ER.  Once medically stabilized, she was transferred to an inpatient psychiatric unit for three days, and then released with the expectation that she participate in therapy.  A colleague of mine who worked at the hospital provided the family with my name, and they called the next day to schedule their initial consultation.

Amanda, of course, like most of the adolescents I see, was coming under protest.  Not only was it not her wish to be treated, but, according to the previous therapists’ notes, she seemed to assiduously resist every effort on anyone’s part to promote change.  Meanwhile, she had already been diagnosed with and treated for a wide-range of mental illnesses—Bipolar Disorder, Borderline Personality Disorder, Dysthymic Disorder, Major Depressive Disorder, Schizoaffective Disorder, Adjustment Disorder, Attention Deficit Disorder, and Dissociative Disorder.