Until recently suicide in children under the age of fifteen was relatively rare, but that is sadly no longer the case. Depression, anxiety and tragically suicides in this age group are on the rise (WSJ: Loneliness, Anxiety and Loss: the Covid Pandemic’s Terrible Toll on Kids).

Many factors have contributed to this including social isolation from peers, fears and anxiety around Covid-19 about becoming infected, ill or having a parent become ill, increased parental conflicts and tensions and many more conditions.

That said, why is it that some children survive through these stressors, and even thrive while, while others don’t?

It is often helpful to approach such matters thinking of the biopsychosocial elements that may contribute.

Regarding biology, there are those fortunate children who are blessed with genetics that lead to resilience, perseverance and “half-filled cup” optimism. 

For the purpose of this discussion we will not focus on the social factors because nearly all children are experiencing undue stress because of the isolation, lack of peer contact, lack of physical and social activities and living in a masked world where physical touch (beyond your family) is forbidden.

Instead, let’s delve into psychological factors to see if there might be something there to ameliorate the situation.

Object Constancy is a term in psychology that is defined as “the ability to believe that a relationship is stable and intact, despite the presence of setbacks, conflict, or disagreements. People who lack object constancy might experience extreme anxiety in relationships of all types-not just romantic ones-and may live in constant fear of abandonment (Source: Better Health).”

Although not usually discussed beyond this, it can also mean the ability to hold onto positivity, optimism and hope through and past the experiences of disappointment, rejection, criticism and other negative experiences. It is what underlies the adage, “This too shall pass.”

That translates to knowing you will somehow survive a relationship breakup, a school failure, being bullied, the divorce of your parents, abuse, abandonment, etc.

I know that may sound impossible or highly unlikely and I am not implying that people who don’t make it through are weak or less than those who do, other to say they are less fortunate.

Rare as it may sound, there are people who do survive through all of those obstacles and even some who in spite of them, go on to prosper.

What separates them from the majority of children who don’t survive as well?

Is it possible that they have object constancy and know that whatever happens to them, they will somehow make it through?

And the relevance of this to childhood suicide, especially in children under the age of 15?

Is it possible that the more object constancy, i.e. a belief that they’ll survive and make it through adversity, the greater a buffer against depression, anxiety, hopelessness (not seeing a future) and suicidal thinking?

If you agree with this hypothesis, might there be a way to increase object constancy, optimism and resilience in children? And if possible, could it be something that could occur within families and without the need to see therapists? (Please note that I am not against therapy as a resource to families and children in deep psychological distress. To the contrary, I am a great supporter of it. However, given the shortage and expense and complexities of finding, seeing and paying for therapists especially in disadvantaged communities, anything that parents might do with their children to help the situation would all be to the good).

With that in mind, we have been recommending to parents who are worried about their children that they utilize a BFUDLT exercise as a nightly family routine in which all family members share the following:

BFUDLT stands for:

  1. Best – “What is the best thing that happened today and what made it so?” – This clearly doesn’t apply with regard to creating object constancy, but may help begin the discussion.
  2. Frustrated – “What most frustrated you today?” – Frustration is something that is easy for most people to talk about, and begins surfacing the negative experiences that when suppressed and repressed can become an obstacle in developing object constancy. This begins the process of everyone being able to express what they would normally try to push down and away, which will often cause psychological symptoms later.
  3. Upset – “What upset you most today and what about it caused you to feel that way?” – This is used to enable angry feelings to be safely expressed vs. acted out.
  4. Disappointed – “What were you most disappointed about today and what made it disappointing?” – Disappointment is a much quieter emotion and offers people the chance to express disappointment in others, in a situation or in themselves and is actually calming when expressed.
  5. Lesson – “What is a single lesson you can learn from that to be able to handle it better the next time it happens?” – Turning the events into lessons plants the seeds for judgment and future decision making.
  6. Tomorrow – “ What is it that you’re most excited and nervous or worried about tomorrow?” – This helps build perspective and object constancy, that good and bad things happen every day, but we generally make it through them.

We advise parents that when they share, to not select overly frightening matters such as fears of losing a job, or coming down with a severe illness, or going to lose all their money that would overwhelm their children. Rather this approach is meant to model how talking out and through frustration, upset and disappointment are helpful.

As awkward and artificial as this may initially seem, we find that families that practice this feel closer, more optimistic and are better able to psychologically get through and learn from crises and creates a very sound foundation for emotional wellbeing not only in children, but the parents as well.

It would not surprise us if the times spent as families doing these exercises will become among the fondest memories all family members have later on in life.

In the near future, we are looking to do this with parent groups who will use the BFUDLT as a nightly family routine for one month with their children who are under the age of 15 and report back the results. They of course can choose to continue indefinitely even into the times after children grow up and leave home.



  • Mark Goulston, M.D.

    Author, speaker, podcast host, psychiatrist

    Dr. Mark Goulston is the inventor and developer of Surgical Empathy an approach that helps people to break their attachments to counterproductive modes of functioning and frees them to connect with more productive and healthier alternatives. He is the host of the “My Wakeup Call” podcast where he interviews people on the wakeup calls that changed who they are and made them better human beings and at being human and the host of the LinkedIn Live show, "No Strings Attached." He is a Founding Member of the Newsweek Expert Forum. He is one of the world’s foremost experts on deep listening, radical empathy and real influence with his book, “Just Listen,” becoming the top book on listening in the world, translated into twenty languages and a topic he speaks and teaches globally. He is an advisor, coach, mentor and confidante to CEO’s, founders and entrepreneurs helping them to unlock all their internal blocks to achieving success, fulfillment and happiness. Originally a UCLA professor of psychiatry and crisis psychiatrist for over 25 years, and former FBI and police hostage negotiation trainer, Dr. Goulston's expertise has been forged and proven in the crucible of real-life, high stakes situations including being a boots on the ground suicide prevention specialist and serving as an advisor in the OJ Simpson criminal trial. Including, “Just Listen,” he is the author or co-author of nine books with multiple best sellers. He writes or contributes to Harvard Business Review, Business Insider, Biz Journals, Fast Company, Huffington Post, Psychology Today and has appeared as an psychological expert in the media including: CNN, Headline News, msNBC, Fox News, Wall Street Journal, New York Times, Forbes, Fortune, Psychology Today and was the subject of a PBS special. He lives with his wife in Los Angeles, California.