Understanding a Suicidal Identity and Creating an Aspirational Identity
Clinical trials of youth who are suicidal provide insights about identity.
Posted November 24, 2025 | Reviewed by Abigail Fagan
In my lab, we watch dozens of videos of clinicians participating in five randomized controlled trials (RCTs) investigating the effectiveness of the "Collaborative Assessment and Management of Suicidality " (CAMS) developed in the SPL (Jobes, 2023). Among the ongoing RCTs, I have some observations to share from two particular multisite RCTs that are funded by the National Institute of Mental Health (NIMH).
The first one is a study of college students who are suicidal and seeking counseling center care at the University of Oregon, the University of Nevada-Reno, Duke University, and Rutgers University (Blalock et al., 2025). The second is a “CAMS-4Teens” RCT investigating adolescents who are suicidal in Seattle, Washington and Columbus, Ohio (Adrian et al., 2023). Our deep immersion in these trials, providing adherence coding and feedback to clinicians, along with holding weekly case consultation calls with study providers, offers some interesting observations about contemporary teenagers and college students today.
While there are always exceptions, I am aware of a distinct subgroup of youth who are clearly attached to the concept of suicide . They think about it, they fantasize about it, they interact with other like-minded youth on social media about it, and within their treatment, they talk about it a lot. But here is the thing—based on 43+ years of clinical and research experience, I often do not detect a genuine desire to actually die by their own hand in these youth. Among the patients I am describing, there is no suicide attempt history, plans for suicide are unformed and vague, and they are generally ambivalent about actually dying. And yet, these patient remain steadfast in their attachment to suicide and seem reluctant to give it up.
From a purely descriptive perspective, it seems to varying degrees that such patients have a “suicidal identity ” that is both captivating and can make them feel powerful. To my way of thinking, such patients have learned that verbal threats of suicide or suicide-related behaviors can mobilize adults around them and strike fear in the hearts of loved ones. In other words, they have learned that “being suicidal” is a way of knowing and even defining themselves. Moreover, among like-minded peers there can be inclusion within a shared identity. From an outsider’s perspective it is easy to be judgmental and pejorative about such youth; many adults in these patients’ lives tell them to “snap out of it” or assert that the youth is “crying wolf” or simply “seeking attention .” Such comments frankly never help and often may add fuel to the fire of youthful defiance leading to an even deeper embrace of a suicidal identity. From an insider’s (expert) perspective, my take is this: of course this young person is attached to suicide. They have learned and been reinforced to take on this identity because it can make them feel heard, seen, and even powerful when they may otherwise feel ignored, unseen, weak, and vulnerable. The “instrumental” nature of suicide is well known to suicidologists in that suicidal threats and behaviors can be extraordinarily powerful and impactful interpersonally. Given these considerations, what is a well-intended clinical provider to do about patient’s who are organized around a suicidal identity?
Within CAMS, we always endeavor to fully understand—and validate—a suicidal identity. We carefully respect this identity, while never endorsing it or prematurely challenging it. Within CAMS, we work to ensure that the patient and their struggle are always fully seen, honored, and heard, such that they feel understood and validated in the eyes of their provider. We routinely develop a CAMS Stabilization Plan and then further formulate a suicide-focused treatment plan targeting patient-identified “drivers” of their suicidality (i.e., various issues or problems that compel them to consider suicide). While understanding and validation are crucial to success, these do not ultimately carry the day of effective care. We know that to effectively treat anyone who is suicidal requires helping them manage their suicidal thoughts and feelings, while also achieving reliable behavioral stability. Within CAMS interim care, we use whatever makes sense to treat and/or address a patient’s suicidal drivers (e.g., cognitive therapy , trauma -focused care, insight-oriented therapy, family therapy, medications, interventions in the school, etc.). In turn, impacting a patient’s suicidal drivers usually leads to a fairly rapid resolution of their suicidal risk within six to eight sessions (Jobes, 2023).
But in terms of the suicidal identity that we are seeing in young people, we are careful not to “take it away” from the patient (as if we could). Instead, we endeavor to plant seeds for creating a rival aspirational identity . To this end, we often use values clarification as done in Acceptance and Commitment Therapy (Hayes & Lillis, 2012), and we explore distinctly existential topics with an explicit focus on increasing purpose and meaning in a young person’s life. Increasingly, we are also being transparent and overt about creating a rival aspirational identity for the youth’s consideration.
For example, there is a recent case of a 16-year-old teenager who was hospitalized and described a profoundly impactful discussion with a Psych-Tech on the inpatient unit. This staff member candidly disclosed to the teen that he had been depressed , suicidal, and hospitalized in his youth. In the course of this conversation, the Tech challenged the patient to consider "flipping the script" from being a “ psychiatric screw up” to someone who could help others just like he did. With this new aspirational identity firmly implanted in the teen's mind, his work in CAMS resolved quickly and basically focused on getting him involved in his church, a youth peer-support group, and exploring what it would take for him to become a psychologist someday.
Bottom line: For those who aspire to clinically treat—or raise—youth, we must endeavor to truly hear and see them while offering an alternative aspirational identity to help a troubled young person navigate away and/or detach from a suicidal identity to discover and fully embrace an aspirational identity that enables them to find a path to a life worth living.
If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the 988 Suicide & Crisis Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.
Adrian, M., McCauley, E., Gallop, R. , Stevens, J., Jobes, D., Crumlish, J., Stanley, B. Brown, G., Green, K. L., Hughes, J. L., & Bridge J. A. (2023). Advancing Suicide Intervention Strategies for Teens (ASSIST): Study protocol for a multisite randomized controlled trial. BMJ Open Access. https://doi.org/10.1136/bmjopen-2023-074116
Blalock, K., Pistorello, J., Rizvi, S. L., Seeley, J. R., Kassing, F., Sinclair, J., Oshin, L. A., Gallop, R. J., Fry, C. M., Snyderman, T., Jobes, D. A., Crumlish, J., Krall, H. R., Stadelman, S., Gözenman-Sapin, F., Davies, K., Steele, D., Goldston, D. B., & Compton, S. N. (2025). The Comprehensive Adaptive Multisite Prevention of University Student Suicide Trial: Protocol for a Randomized Controlled Trial. JMIR Research Protocols. https://www.researchprotocols.org/2025/1/e68441
Hayes, S. C., & Lillis, J. (2012). Acceptance and commitment therapy. American Psychological Association. https://doi.org/10.1037/17335-000
Jobes, D. A. (2023). Managing Suicidal Risk: A Collaborative Approach 3rd edition. Guilford Press.
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David A. Jobes, Ph.D., ABPP, is a Professor of Psychology, Director of the Suicide Prevention Laboratory, and Associate Director of Clinical Training at The Catholic University of America.
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