Clinicians Who Lose Relatives to Suicide
By Vanessa L. McGann, Ph.D., a clinical psychologist in NYC and a survivor of her sister's suicide
For mental health professionals, the loss of a client to suicide is surprisingly common, if not an occupational hazard. In addition, many mental health professionals experience the loss of a family member or relative to suicide, either before, during or after their professional training. No matter what the timing and nature of the loss, clinicians are often left to cope with the consequences of the suicide on their own and under less than optimal conditions, though many prevail and become more competent and confident clinicians. Although there are common themes experienced by clinicians following the suicide of either clients or family members, each type of loss may carry distinct implications for coping in the aftermath. Presented here are some of the ways in which clinicians mourning personal losses are commonly affected.
On the most basic level, clinicians experiencing the loss of a loved one share the common reactions of other family survivors. Reactions typically include initial shock, denial and numbness, intense sadness, anxiety, anger and intense distress. They are also likely to experience PTSD symptoms such as intrusive thoughts, experiences of detachment, and dissociation. In addition, suicide loss is often accompanied by intense confusion and existential questioning, reflecting a blow to one’s core beliefs and assumptive world. Finally, they also commonly experience guilt and shame, and this may be socially reinforced by the general stigma around suicide as well as the actual blaming and avoidance responses of others.
However, for clinicians who lose a family member to suicide, the ripple effect of reactions are not limited to their personal life; the loss of a family member to suicide affects clinicians in the larger arena of their professional life as well. Thus, in addition to the personal grief reaction entailed in losing a family member, this loss is likely to impact the nature and extent of their self-blame, their clinical work, their relationships with colleagues, and their professional identities.
For mental health workers, assumptions around their clinical competence are often severely challenged when a family member kills him/herself. Even though the loss did not occur in the professional realm, a clinician’s sense of professional responsibility (“how can I try to help clients when I couldn’t even save my mother”), self-blame (“I am a trained clinician; I more than anyone else should have seen the signs in my brother months ago”) and fear of judgement from colleagues and family members (“I know that they are all looking at me and thinking, s/he’s a therapist, why didn’t s/he know to do more?”) may all greatly exacerbate their distress.
In general, the suicide loss of a family member commonly leads therapists to question their clinical abilities, and to experience a sharp loss of confidence in their work. PTSD symptoms may impair clinical response and therapeutic judgment, and since such symptoms and states may be triggered by exposure to potentially suicidal clients, they are more likely to impact clinical functioning when working with suicidal individuals. Research has often found that even the most experienced therapists expressed difficulty in trusting their own clinical judgment, or accurately assessing risk after a suicide loss, often tending towards hypervigilance in relation to potential suicidality or, conversely, the minimization or denial of suicide potential.
Many factors can affect the duration and intensity of a clinician’s response to a family loss, not the least of which are often supervisory and colleague support. Unlike those clinicians mourning the loss of a client, legal prohibitions around confidentiality, and the subsequent lack of access to grief rituals (funerals, etc.) are not factors inhibiting the clinician of family losses’s grief process. However, many clinicians who lose family members still experience reactions from colleagues, staff and supervisors which are quite unsupportive. Many clinicians report a pattern of isolation and interpersonal discomfort with their colleagues, who implicitly or explicitly express judgment about their competence. Such reactions may lead to a well-founded ambivalence about disclosure, and consequent resistance to seeking out optimal supervision/consultation or even personal therapy that could help clinicians gain clarity or support. Many professionals, after experiencing a personal or professional loss, have described how, after the distressing experience of losing a client to suicide, they feel completely abandoned by their colleagues.
Family loss to suicide can often lead to a crisis of faith about a clinician’s profession. Whereas before a loss a clinician might feel that therapy works, a suicide can often lead one to feel cynical or jaded about just how powerful clinical interventions can be. In addition, because of their personal mourning process, they may wish to avoid the intense day-to-day interactions with needy and pained clients. They may also wish to create more space between their personal and professional roles but find it very difficult to do (they can’t “leave their troubles at home” and compartmentalize in the way other survivors might be able to do); finally, their sense of isolation from their colleaugues may lead them to question their desire to stay in the field. All of these factors can strain, compromise and alter their sense of professional identity.
Despite these clinical and personal challenges and hurdles, traumatic experiences can paradoxically present a multitude of opportunities for new growth.Fuentes and Cruz (2009) found that post-traumatic growth was fostered by perceived social support, the willingness to discuss distressing issues with supportive others, and openness to change. Thus, despite their initial distress, many clinicians are able to identify retrospective benefits to their experience. These include becoming better educated about suicide and the likelihood of its occurrence, and an increased sensitivity towards suicidal clients and those bereaved by its loss. In addition, clinicians report more realistic appraisals and expectations in relation to their clinical competence, and more awareness around their own therapeutic limitations. They also become more aware of the issues involved in the aftermath of a suicide, including perceived gaps in the clinical and institutional systems that could optimally offer support to both families and clinicians. In addition to the changes related to knowledge and clinical skills, many clinicians also note deeper personal changes subsequent to their client’s suicide. Many clinicians, once they feel that they are more resolved with their own grief process, have expressed the desire to support others with similar experiences.
The Clinician-Survivors Task Force of the American Association of Suicidology provides consultation, education, support and resources to clinicians who have experienced the suicide loss of patients, family members, clinical colleagues or therapists. We recognize that all of these losses carry implications within personal, clinical and professional domains. The Task Force provides a listserve and a website, on which there are opportunities for clinicians to share experiences about suicide loss, a bibliography of relevant publications, and postvention protocols. In addition, the chairs of this task force conduct Clinician-Survivor support activities at annual AAS conferences, and in their respective geographic areas. Future goals for the task force include empowering current clinician survivors to advocate for the support of future clinician-survivors, to disseminate the information that is currently available on the sequelae of clinician suicide loss, and to increase the research that is conducted on this topic. To access the CSTF website, follow the links though the AAS website (www.suicidology.org). To request to join the listserve, please contact Dr. Vanessa McGann at firstname.lastname@example.org.
Fuentes, M. & Cruz, D. (2009). Posttraumatic growth: Positive psychological changes after trauma. Mental Health News, Winter 2009.