January 22, 2025
A preteen overcomes anxiety and suicidal thoughts
A young Kaiser Permanente member speaks up to gain the mental health support she needs with the help of a model called feedback informed care.
Zoe Berger is enjoying life and feeling much more positive after working with her therapist.
Zoe Berger was 11 years old when she began to have stomach pain and headaches each morning before school.
Jamie Berger, Zoe’s mother, received frequent calls from the school nurse that Zoe wasn’t feeling well.
She was picking at her skin, worrying, and having difficulty sleeping. These symptoms of anxiety started after Zoe’s father died when she was young. As she grew older, the symptoms grew worse.
Zoe began seeing Kate Westerfield, a Kaiser Permanente child and family therapist in Portland, Oregon.
Eventually, Zoe revealed that she was considering suicide. Westerfield and Berger were shocked.
Helping Zoe express her feelings
During the beginning of her therapy sessions with Westerfield, Zoe struggled to open up.
“Zoe found it difficult to talk about her feelings because she didn’t want anyone to think something was wrong with her,” Berger said. “She was afraid of being judged, and it took time for her to feel comfortable.”
Fortunately, Westerfield, like many Kaiser Permanente therapists, used an approach called feedback informed care, which helps therapists gather regular patient feedback and use it to guide their treatment.
The goal is to put every patient’s voice at the center of their care. Research shows that this strategy improves outcomes for members receiving care for mental health and addiction.
Westerfield gave Zoe and her mom each a short survey to fill out before every therapy session. The questions asked about how they were feeling and how helpful treatment was for Zoe. This helped her compare their different perspectives during therapy sessions, when Westerfield either spoke with both of them or with Zoe alone.
“Filling out the survey gave Zoe the opportunity to share, ‘I’m thinking about suicide, and I have a way I’m thinking about doing this,’” Westerfield said. “She’d never mentioned anything about suicide to anyone, so we may have never known about her plans without this survey.”
The importance of feeling heard
Zoe’s revelation allowed Westerfield to work with her and her mom to create a suicide safety plan. A safety plan is a written plan that helps you or someone you love stay safe when having suicidal thoughts.
Zoe has been able to speak more openly about her feelings and the challenges she’s facing. And when Zoe shared more about her daily life, Westerfield and Berger could provide better support through her mental health journey.
“Every session, I share something new with Kate. Our relationship is growing because she’s really understanding,” Zoe said. “It feels good to be around her and have someone to talk to that I can trust.”
Zoe just began 6th grade and is enjoying life more. She also recently met one of her treatment goals: She hasn’t thought about suicide or hurting herself for more than 60 days.
Zoe (left) and Jamie Berger enjoy a walk along the Oregon coastline.
“I’ve been feeling a lot happier. I love and feel more positive about myself and I’m not thinking as many negative thoughts,” Zoe said.
Zoe participates in activities she wouldn’t have before her treatment due to her anxiety. For example, she attended an overnight camp with her school and spent time exploring nature with classmates.
“I believe Zoe’s treatment is working because she plays a key role in her own treatment plan,” Westerfield said. “With her feedback, I can adjust her treatment based on what’s working well and what isn’t.”
