Reducing risk: navigating emotional triangles in clinical work with youth suicidality and self-harm

In clinical work with families in which a young person is at real and significant risk of self-harm or even death by suicide, predictable emotional triangles both within the family and within the treating system intensify. As understandable fear and worry in parents and clinicians rises in response to potential risk, these emotionally driven relational processes become even more rigid. This typically results in a reduction in cognitive and behavioural flexibility, which can potentially and unwittingly increase the risk of self-harm by suicide. This article outlines some basic principles pertaining to the notion of emotional triangles, a central concept in Bowen family systems theory; its relevance for clinicians working with suicidal youth and their families; and its application to the context of a community child and youth mental health service. Practical application of theory to clinical work is demonstrated through clinical vignettes that describe the work of two clinicians and their clinical supervisor. The authors reflect on their understanding of the development of emotional triangles in the vignettes presented alongside their efforts to navigate these triangles through the regulation of their own anxiety and more objective thinking.