CLINICIANS AS SURVIVORS OF SUICIDE: PERSONAL ACCOUNTS BY CLINICIAN SURVIVORS

Note: The personal accounts that follow have been selected by the task force as highly useful descriptions by therapists who have lost a client to suicide. The personal accounts have been provided by various task force members and other interested therapists. The task force thanks those who have taken the time to provide their personal accounts and experiences for the benefit of others.

Personal Accounts
Losing a Client to Suicide: The Experience of a New Clinician When I was just 2 months away from completing a Master's degree in Clinical Psychology, I had the unfortunate experience of losing a client to suicide. It was something that had been discussed, albeit peripherally, in my classes, but it had always felt like something that would happen to other clinicians. It was never something I considered might happen to me. I was young. I was invincible. I was going to be the next Carl Rogers, or Albert Ellis, or Freud, or whoever -- I was going to be the next great therapist. Right? Well, maybe, but I deluded myself into thinking that my clients would never deteriorate, would be dedicated to our work together, and would never betray me or the counseling process by committing suicide. I found out the hard way that I was wrong. Upon returning from my doctoral interviews in Northeast Ohio, I walked into my clinic eager to get my messages, break out my clients' charts, and get back to work. And then the rains came. No sooner had I walked into the lobby when the receptionist told me "You have two messages, one of your clients cancelled today, and, by the way, one of your clients committed suicide over the weekend." I thought she was kidding, but I was immediately sick to my stomach. "What kind of sick joke is this," I wondered to myself. It was no joke. One of my very troubled clients, who had struggled with chronic suicidality for the better part of his life, had finally done it. His dramatic musings about killing himself had turned to reality, and I was never to see him again. I'll spare you, the reader, the details about the client, because those are really not important for the purpose of this story. My purpose here is to shed some light on how the experience went after I found out about it. I regret that I can not provide a story that paints a more positive image of what it was like to lose a client to suicide. While mental health workers certainly recognize that a client suicide represents one of the worst possible outcomes, we must also take a moment to acknowledge that given the reality of client suicide, clinicians must utilize the event to the greatest extent possible so that they can learn from it, move on, and allow it to inform future clinical work. When I lost my client to suicide, the growth/educational potential was completely destroyed because I was forced to defend myself, my clinical work, and my case conceptualization. If there was a single facet of the event that I could cite as being the most "helpful," I suppose I would say that it was the personal support that I received from my colleagues in my academic setting. The faculty at both my academic and clinical settings were, for the most part, unsupportive, unavailable, and unwilling to rally behind me. Now much of the research into the effects of client suicide on the therapist has differentiated between two types of responses, personal and professional. Given this convention, I will briefly address both. On the personal level, I think that I delayed having a truly personal, emotional response to the event for several months. I was near the end of my degree program, terrified that the suicide of a client would delay receipt of my Master's degree, and consumed with the rigors of my academics. That, along with the fact that I was placed in a defensive position by the administrators at the clinic where I was working, served to stifle my own personal reaction. Professionally, I tried very hard to reflect on the work that I had done with my client. I reviewed my case notes (to the extent that I was permitted access to them), I considered consultations in which I had engaged with other members of the client's treatment team, and I reviewed the literature that had informed my case conceptualization. Ultimately I came to the decision that my own clinical work had been both professional and appropriate, but there is a lingering doubt that will always remain. I frequently wonder if I would ever again counsel a client such as the one I lost. Now clearly I have painted a rather grim picture of what it was like in the aftermath of my client's suicide, and to be sure it was pretty miserable. There was one bright spot, however, and that was the support I received from my colleagues (the other students in my Masters program). Those who I felt especially close to allowed me a willing ear to talk about the events, the responses, and my own feelings of fear and doubt. Being given a chance to "unload" those feelings made them manageable. I often wonder what I might have done differently. Certainly it didn't have to go the way it went, and despite the fact that most of the responses to the event were beyond my control (e.g., supervisors, administrators, etc.), there were a few things that I could have done to seek out more support. As I have progressed to a doctoral program, I have discovered that I have a very strong interest in researching different areas of suicide. By throwing myself into that endeavor with both feet, I have discovered a body of literature that comforts me. It lets me know that I am only one of many clinicians who have struggled with the loss of a client. If I had known about the AAS when I was experiencing the loss, I would have joined in a second. The support that is given to survivors of suicide (including clinicians) at AAS is marvelous, and would have been much appreciated, had I known about it at the time. Additionally, in retrospect it seems a rather major mistake on my part to have foregone the chance to engage in my own counseling following the suicide. I should have given myself the opportunity to be a client -- to experience my feelings, to face my doubts, to confront my guilt, to address my anger at the way I was being treated. Instead, I secluded myself under the umbrella of my studies. I really have no wonderful way to close this story, except to make two requests of the reader. First, if you are a clinical supervisor, please be aware that inexperienced therapists need to feel that they have your unwavering support during your time together. Should you ever supervise a therapist who has lost a client, be aware that the therapist needs to be reassured that we, as a profession, recognize that sometimes suicide happens, and sometimes we can do nothing to prevent it. Do all you can to prevent the assigning of blame and the arousal of defensive positions. Second, if you are a therapist, either in training or experienced, please remember what the literature consistently suggests -- that approximately one-in-five therapists will lose a client to suicide during the course of a career. Don't believe the myth that says it is a "rare" event. Don't be afraid to seek out the support you need during a time of personal and professional turmoil. Remember that you are not, in fact, alone, and that there are many of us around who will be happy to provide you with the support you need should you have difficulty finding it elsewhere. Thank you, reader, for taking the time to consider my story. Jason S. Spiegelman, M.A. Doctoral Candidate, The University of Akron Office: (216) 687-2277 speegs@aol.com A revised version of this personal account appears in: Spiegelman, J. S. (2001, January/February). Losing a client to suicide: The experience of a new clinician. The Los Angeles Psychologist, 12-13. | Top of Personal Accounts | Go to Story: [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ] [ 6 ] >3/29/00< contact rev. 9/26/00	1
Suicide and the Restimulation of Other Losses Each subsequent loss like an ever tightening vine creeping up the edges of a life; darkening shadows threaten to obscure all light, weighing heavy on inner and outer structure. Although I am tired from a five-hour drive starting at 4:30 a.m. and stressed from no pay for two months (having just started a private group practice), early morning energy is holding me up. I am pleasantly pleased to greet my psychiatrist colleague as he approaches our office. He says he has bad news and I think O.K. I am ready. "It is really bad" Mmmm, I wonder what it could be -- a further financial delay? His words begin to sound confusing, then garbled. Wind like air is rushing through my ears as I struggle to hear him and make sense of what he is saying. A whitish fog of light seems to make him fade further away. Then the words cut through, violently, screaming at me "SHE KILLED herself." I start to picture her in my mind's eye, sometimes childlike, sometimes aloof, vibrant, full of talent and love for everyone but herself, hugging her anger and disappointments close in her loneliness. Some said she was a "difficult" client. I have always worked well with said labeled clients, and she seemed to be slowly working in therapy, expressing both pain and hope, denying suicidal ideation and planning for the future. Was this to be a lesson in humbleness, is that what is called for? Through shock little vibrations trickle through my body, a sinking feeling comes into my heart, then my stomach. I can not move. My mouth goes dry. Thoughts start tumbling through the air-landing on my body -- how, when, what does this mean, what will happen, will I be blamed, what is going on, how will I get through the day, don't scream must act professional, get concrete, O.K. I will call the minister, I have a client waiting, stop the tears, act AS IF. The day goes on as any normal day, details are filled in, I am asked how I am doing and I answer, "I am alright now but I do not want to go home alone." They nod and walk away. I AM alone. I go to my car and drive home. How did I get here? There are no smells, no light, only a fog around me and then Hell Bursts forth like white hot lightning, wrenching sobs for her, for me, for the multitude of unexpected confusing losses, where is someone to hold me like a mother? Another loss, can I move or will it suck me dry? What will this mean? How will it impact me? My clients? My spirit? I do not want to be alone....... POSTCRIPT: I attended the funeral with the psychiatrist that referred her to me. Her son fell sobbing into my arms and then stood up and said the healing words, "please do not ever think you let her down. She loved you and said you were the best therapist she ever had." Her minister and Primary Care Provider thanked us for coming. "Usually the mental health professionals are distant." One of my best friends and fellow colleague tells me how brave I was to attend the funeral, facing possible blame from the family. Some things you just know you need to do. The healing has started. I will never forget. - Submitted Anonymously | Top of Personal Accounts | Go to Story: [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ] [ 6 ] >3/29/00<	2
Excerpts from a Psychotherapist's Log Day 0: 1:15 a.m. I finally heard back, a police officer called and said my client, Mary, had killed herself. I was in shock. 2 a.m., I took a sleeping pill in the hopes of a little bit of sleep. Day 1: I was feeling numb and obsessing at the same time. I went through uncountable "what If" scenarios. I wrote my notes for the past weekend. I spoke with a colleague, who was a lifeline. I made calls for resources. I talked with Mary's psychiatrist. I somehow got through the day. I was scared; scared I hadn't done enough, scared I hadn't done the right thing, scared I would get sued, scared I wasn't a good therapist, scared… Day 2-4: I felt guilty, despondent, sad, scared, unsure and more. I talked to friends and colleagues. Having the support of 3 colleagues who also lost a client to suicide was especially helpful. Oddly enough by day 4, I began to have moments when I didn't feel completely awful. And then I would feel guilty when I didn't feel awful. Day 5, The Funeral: The service was very personal. I had colleagues on either side. I so appreciated their support. I cried, lots. I learned about a part of Mary's life that I hadn't seen before. This was somehow helpful. I felt drained. Day 7-8: I began to have an image of Mary that was other than traumatic. Day 8: I'd had a week to recover and I tried to get back in the swing of things. It was overwhelming. I got some things done and other things just had to wait. Day 25: I somehow expect Mary to leave me a message telling me she is OK. I miss her. Even though I know other colleagues have lost clients to suicide, I feel so alone. Day 30: Mary's sister is in town and leaves me a message. Feelings of panic emerge. What does she want? What can I say? My own grief comes back to the surface. Day 31: I talk with Mary's sister. I express my condolences and tell her that I miss her sister. She said another family member will probably contact me. Feelings of terror erupt. I am scared of being sued. I am scared of not saying the right thing. I am in a gray area and am afraid I will somehow misstep. Day 46: I didn't sleep well last night. I had talked yesterday with a colleague who was just going to trial after losing a client to suicide 5 years ago. I feel the weight hanging there ready to drop at any time and the weight could be there for another 5 years. I feel angry that Mary put me in this situation. The feeling of loss has been very strong lately. I lost Mary. I lost being a member of the elite who has never lost a client to suicide. Already, I lost many hours of my time -- planning, fretting, and talking. I lost sleep. I lost confidence. I may have lost part of my joy in being a therapist. 7 months later: I still think of Mary. The waves of loss are farther between and much less overwhelming but the undercurrent is still there. Her suicide has touched me on many levels. During these past months, one professional implied that clinicians are not affected by a client's suicide and brushed me aside. I felt very invalidated and angry. Another colleague insisted that anti-suicide contracts really work. I felt defensive. I had taken this step and others, but it was not enough to save Mary's life. Fortunately, others have been supportive. They have listened and just sat with me. They have put me in touch with other psychotherapists who have been through this. Most people do not know of my difficult journey and I feel safer that way. - Submitted Anonymously | Top of Personal Accounts | Go to Story: [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ] [ 6 ] >3/30/00<	3
Clinician Survivor Professionally speaking, my life changed 180 degrees in the Spring of 1999. It started as a typical Monday, hectic and short-staffed. Of two therapists in an outpatient counseling setting, I was the only one available that day. In fact, I was the only one available for the next three weeks while my cohort vacationed out-of-state. Initially, it didn't seem like a big deal to me, but little did I know what my future held. On that same Monday, I learned that one of my clients, one I had recently seen, shot and killed himself. Tragically so, he was only 17 years old. His death made absolutely no sense to me. After all, I had carefully assessed his suicidality during our last session and there was nothing there to alarm me. Yet, he was dead, and with his death, a part of me died as well. This experience has been a life-changing event for me. What started out for me as a professional tragedy, soon gained momentum into my personal life. That is, I immediately began to experience numerous emotions, fears and thoughts, many of which were quite foreign to me. After the total shock and disbelief began to diminish, I started to sob, sobbing uncontrollably at times. I experienced extreme anxiety, gross sleep disturbances, and profound sadness. I was spiraling downward quickly, and I was emotionally paralyzed. Unfortunately, I did not find much emotional comfort from my employer nor was I able to take adequate time away from work, which only exacerbated my struggle. The peer response I received was truly that of a "mixed bag" and that too compounded my situation. That is, some seemed genuinely concerned, while others were perplexed by my reaction-----"he's' just a client, it's not like he's family." My family, especially my dear husband, didn't know how to respond to me. After all, none of them had ever seen me like this. In their respective eyes, I was the "healthiest one, the one who could handle anything." Fortunately, my mother eventually nudged me enough to seek professional help and I will be forever grateful to her for this. Yet, I must say, seeking help was an extremely difficult thing for me to do, and I think my resistance to it speaks to the "norm" and not the "exception." With the relentless love and support from my family and my very, very dear friend, Margie, coupled with the professional help I received, I have slowly but surely begun the healing process. I believe it's a wound that will eventually heal, but I am certain that a scar will always be left behind. While I initially strongly considered leaving the social work profession, I have not done so nor do I plan to do so. I am, however, acutely aware that I will likely work again with a client who is suicidal, and while that immediately heightens my anxiety, it no longer makes me feel incompetent or incapable. As for a profession of "helpers," I believe we have a long way to go to really understand the dynamics of "clinician survivor." I also believe that we must develop a myriad of resources for the clinician survivor in an effort to acknowledge and understand their pain and suffering. With such great extension of technology, I believe we can avail many resources to one another which are far-reaching, but we must first enter into honest dialogue with one another about the pain and reality of clinician survivor, rather than pretend it does not exist. And because of our individual uniqueness, our emotional needs will vary, and rather than place judgment on this, I believe we must prepare ourselves to "start where the client is." In this instance, we must further recognize that the "client" may be our employee, our colleague, or our dear friend. My decision to make my story known to the American Association of Suicidology rests solely upon the fact that if it helps only one clinician, it will have served its purpose well. Please know that you need not suffer alone; clinician survivor is a journey and please allow others to travel with you in your journey. - Submitted Anonymously | Top of Personal Accounts | Go to Story: [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ] [ 6 ] >4/30/00<	4
A Clinician's Journey of Loss, Grief, Healing and a Search for Meaning The requirement to have your story posted on this web site is simple. Sometime during your career you have experienced the death of a client/patient to suicide. I hope you never have a story to share. Losing a client to death by suicide was my biggest fear and three years after being licensed my biggest fear became my reality. I shall always remember that night when the phone rang around 9:30 p.m. and after a long pause on the other end the words "he killed himself" bellowed through loud and clear. My heart skipped a beat and in an instant a kaleidoscope of emotions and thoughts bombarded me. What? When? What did I miss? Are you sure? How is the family? It can't be so; there must be some mistake? In the mist of feeling numb, shock, denial, guilt, fear, shame, and anxiety, I managed to continue the conversation with the family member. I put on my running shoes and hit the pavement. It was a warm evening and the darkness of the night seemed endless. My body contorted with tears and painful emotions. I began reliving the last phone call, our last session, and the past few weeks, over and over the questions continued. Why? What had I missed? If only….. Had I not heard him? The next few days were filled with educating myself on all the necessary tasks. The consultant with my liability insurance company guided me through a conversation with the police, legal issues, as well as the practical decisions. Do I go to the funeral, talk with the family, send a card, and what about confidentiality? On Monday after going to the funeral home on Sunday, I was sitting opposite Lanny Berman, Ph.D. and the Executive Director of the American Association of Suicidology. I would like to say we did a psychological autopsy, processed the suicide, shared my emotions with other colleagues, and returned to life as usual. I did the above mentioned things and lost 12 pounds in 12 days, lived with free - floating anxiety, began to question my competency and whether to continue to stay in the field. I knew it was necessary to give myself one year before making any major decisions. Even though my husband, colleagues, and friends were very supportive, I felt so alone. Their support and my spiritual beliefs kept me going during the next few months. That summer I attended several workshops on suicide. I read everything I could about "survivors" and I could relate to the emotions they described. I was told I was not a survivor, only the clinician. On 1/1/95 I decided by the end of '95 I would either continue in the field or choose a different career path. This was a time of spiritual searching and a lonely year for me. I spoke with Helen Fitzgerald who leads a survivors group and she recognized the need for a support system for clinicians. She was filled with suggestions and encouraged me to pursue this issue. As I digested her ideas, I left feeling energized and excited (which had been missing in my life) as I fantasized of all the possibilities. I rushed back to the office and called David Jobes, Ph.D., past President of the American Association of Suicidology. I relayed my meeting and quickly began calling the three AAS members he recommended that were experts in the field of clinicians as survivors. The next three months my path crossed (by way of long distance phone calls) with several AAS members. They were supportive and encouraging for which I am eternally grateful. Can you imagine what a relief it was to have my feelings and thoughts validated in print by Frank Jones, a psychiatrist, when I read his chapter on clinicians as survivors in the "Aftermath of Suicide" by Dunne, McIntosh, and Dunne-Maxim? For the first time I did not feel so alone. I later read in a national study 97% of clinicians were afraid of losing a patient to suicide. It was suggested I attend the AAS conference in St. Louis. The result was a Task Force was formed to develop a national support system for clinicians. The Task Force recognizes the need and desires to develop and provide available mechanisms to insulate clinicians against and support them through the stressful impact of a client/patient's suicide. This would include establishing methods to educate the clinicians about patient suicide and to assist them in the aftermath of a suicide. I have learned as long as I am a helper; I will not be free from the vulnerabilities to the suicide of a client/patient. The aftermath of a suicide will continue to bring feelings of guilt and or incompetence and leaving unanswered and unanswerable questions. Suicide is powerful and poignant as it taps into our very core and shines a light on our humanness and powerlessness. When we lose a client/patient to death by suicide, we are forever reminded of how little control we truly have over the lives and choices of others. We recognize the false sense of confidence that the world is a safe place has been shattered, predictability is lost and leaving the fear of other attacks. I am reminded of Iris Bolton, therapist and author of "My Son, My Son," talking about the "hidden treasures" to be found in the loss. As I reflect upon my experience of losing a client to death by suicide, one thing is clear; the people who make up AAS have been one of my "hidden treasures." As I speak to groups of clinicians I am in awe of your courage to share your experiences and the depth of your pain. Frank Jones quotes the Kingston Trio song, "You got to walk that lonesome valley, you got to walk it by yourself, nobody else can walk it for you. You got to walk it by yourself." Although we are never prepared to walk that valley, there is another song, which speaks to the purpose of the Task Force and our need for each other: "I'll get by with a little help from my friends." The Task Force invites you to share your experience and let us know how we can be of help to you. - Judith F. Meade, LPC, LMFT Therapy Professionals at Tysons 2110 A Gallows Road Vienna, Virginia 22182 (703) 827-9700 E-mail: meadjf@erols.com | Top of Personal Accounts | Go to Story: [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ] [ 6 ] >6/20/00<	5
University Grand Rounds: June 8, 1987 I must say at the start that this is a very difficult case to discuss. In 25 years I have not publicly talked about it. This is a case where it is important to tell you all about my credentials as an analyst, as a senior university faculty member, etc. Notice that I included the word "Senior ." Can you believe that? After 25 years I still need to armor myself? Now why talk about this? Because I think it will help others to talk, so we can support and help each other to handle of these situations better. There were no antidepressants in the days when I saw this patient but all the antidepressants in the world will not stop suicide attempts. We need able, alert, intelligent psychotherapists who know how to use drugs and administer psychotherapy. (Notice how I snuck in that there were no drugs for depression. In other words, "Don't blame me."). Frank was 21 when I first met him during my second year of residency here at the university. He informed me that I was fortunate to have met such a patient, since he was Jesus Christ returned to earth, a brain surgeon, and a very talented artist. The last was true. I was his psychiatrist for six weeks on the inpatient service, and when I was transferred to the outpatient department I encouraged him to leave the hospital so I could follow him. He was no longer delusional, so I thought. I saw him two times a week during the next month, during which time his depression deepened and his psychosis remained in abeyance. I failed to recognize the depression. His best friend called me to say that he was a very worried, and an attendant who knew him on the ward "Dropped into" my office one day to tell me that Frank had called him and seemed, not delusional but, very depressed. This gentleman was worried about him. I found Frank to be depressed and obsessional about the side effects of his medication. I must say that I omnipotently avoided thinking that anyone I was caring for could commit suicide. It was not the first time in my life I had faced a suicidal person. The first time was when I was a small boy and the "Patient" was my mother. This experience with Frank was before my personal Analysis and I had no idea how deeply the early events in my life could color my capacities as a therapist. I didn't see it and so I did not clearly transmit the information to my Supervisor, so he was unable to help. Needless to say I was shocked by the phone call from the emergency room telling me that my patient had shot himself in the head and died immediately. I was so upset that I could not talk to the family for a day or so. My attempts to talk this over with fellow colleagues and staff members were met with various responses. My supervisor told me immediately that he had never had a patient commit suicide so that made me feel I was really an incompetent fool. My peers listened to me, but were thinking, I'm sure, "There but for the grace of God go I." the message was "Let's not talk about it," or "Let's see how our fellow resident's patient is different from mine," or "How I am more competent than he." At least that is what I felt they felt. Most people told me, in a their attempts to be helpful, that "This is always going to happen if you work with disturbed patients," or that I was being a bit omnipotent to think I could help someone so sick, or I could've helped him more if he would have come in more often which he wouldn't do, or "If someone really wants to do it there is no way to stop them." I must say all this "support" left me rather flat. Finally I came to another faculty member. After listening a while he said gently, "Well I guess you made some big mistakes, join the group." I can't tell you how helpful this was. He was really willing to listen and did not have to pacify me when I said I felt it was a mistake to discharge him so early just so I could continue to be his psychiatrist. I had also told the Supervisor that I felt I had not listened carefully enough to him when he told me how alone and helpless he felt. I also confessed that I had missed the significance of is beginning to give his artwork away. I had missed that significance because I was glad to receive his art as a gift. I told all this to the Supervisor who listened emphatically, understood, and did not reassure me. In the months that followed I experienced depression, a strong sense of inadequacy as a psychiatric resident, a reluctance to see any new patients with suicidal potential, and a great fear that any one of my current patients might commit suicide. Each time the phone rang my heart skipped many beats. There is more to tell but I have explained this to you in order to make some points, not just to use this as a confessional, although that's not a bad idea either. The issues I have intended to underline are these: (1) When dealing with death or potential death it pays to know one's self. One's own experiences shade and color the material so strongly that we often cannot see the forest for the trees. (2) It pays to talk to colleagues and supervisors when you become uncomfortable. (3) Don't be afraid to ask more people if the help is not adequate. (4) There is no way for a good therapist to avoid the feelings of failure sooner or later. More open talk would've helped me a lot. Discussions like the ones we're having today are a good start in opening up the subject so we can all better help our patients and ourselves. - Submitted Anonymously | Top of Personal Accounts | Go to Story: [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ] [ 6 ] >7/10/01<	6