When clients kill themselves contd ...
The family
Contact the family as soon as possible after learning of the suicide. Preferably, do it in person in a quiet and private setting. Expressing how sorry you are does not constitute an admission of liability or a suggestion that your actions may have been negligent. It may also be a healthily cathartic action for you.
Allow the family members to react in a way that they choose, offering help in referral to other professionals if this feels appropriate. But be careful of becoming the family therapist if there was a complicated relationship between them and the deceased. Engaging in family therapy with the survivors may be construed as unethical behaviour if it is seen as an attempt to swing their opinions about your potential negligence.9 Make yourself reasonably available to them at least until the funeral has been conducted.
Also, be careful about disclosing information about the deceased or their treatment. The ethical constraints of confidentiality continue beyond death and a practitioner may be liable for harm caused by disclosures about deceased patients. Take, for example, a client who suffered abuse by another family member and requested that the therapist not let the family know that she was in therapy.
In hospital
You may be the person who has to tell the rest of the patients and other staff of the hospital. Approach it in much the same way as you would the family of the deceased. Other patients may be seeking reassurance that you, as the psychiatric staff, are able to help them. Research suggests patients in hospitals feel more vulnerable when a fellow patient commits suicide, possibly raising the risk of other suicidal behaviour in the following days.
Staff may be encouraged to attend the funeral to round out their understanding of the client. This may also assist them to process their musings about what they may have done to prompt the suicide.
Some recommend a psychological autopsy with the staff, presided over by a therapist unfamiliar with the client or the staff and aimed at allowing feelings to be aired and to address concerns about how patient care may be improved.
The physical autopsy
Suicides will often be the subject of autopsies. Odd as it may sound, attending them may be of use to the practitioner both as a way of understanding the person's death more fully and, in the event that the cause of death is equivocal, psychiatrists or trained physicians may be able to assist the pathologist. But they can also be more upsetting, so use your own discretion.
Further reading
Freud, S. (1960) The Psychopathology of Everyday Life. London: Hogarth.
Kleespies, P. M. (1993) The stress of patient suicidal behaviour: Implications for interns and training programmes in psychology. Professional Psychology: Research and Practice, 24, 477 - 482.
Resnick, H. L. P. (1969) Psychological resynthesis: A clinical approach to the the survivors of a death by suicide. In E. S.
Schneidman and M. Ortega (Eds) Aspects of Depression (213 - 224) Boston: Little, Brown.
Horn, P. J. (1994) Therapist's psychological adaptation to client suicide. Psychotherapy, 31, 190 - 195.
Litman, R. (1965) When patients commit suicide. American Journal of Psychotherapy, 19, 570 - 576.
Chemtob, C. M., Hamada, R. S., Bauer, G. & Torigoe, R. Y. (1988) Patient suicide: Frequency and impact on psychologists. Professional Psychology: Research and Practice, 19, 416 - 420.
Kaye, N. S. and Soreff, M. (1991) The psychiatrist's role, responses and responsibilities when a patient commits suicide. American Journal of Psychiatry, 148, 739 - 743.
Ness, D. E. and Pfeffer, C. R. (1990) Sequelae of bereavement resulting from suicide. American Journal of Psychiatry, 147, 279 - 285.
Pearlman, T. (1992) Letter: American Journal of Psychiatry, 149, 282 - 3.
Schacht, T. E. (1992) Letter. American Journal of Psychiatry, 149, 282.
Fox, R. and Cooper, M. (1998) The effects of suicide on the private practitioner: A professional and personal perspective. Clinical Social Work Journal, 26, 143 - 157.
New Therapist
Indispensable survival guide for the thinking therapist