An identity theory perspective on how trainee clinical psychologists experience the death of a client by suicide.

Abstract

The following report serves to explore how trainee clinical psychologists could experience the death of a client by suicide. Although a client suicide is a difficult event to process for clinical psychologists, it appears that trainees have additional factors that are detrimental to their healing process after a client suicide. The utilization of identity theory has not previously been used as a framework to understand trainees' reactions. Moreover, trainees' newly developing professional identity may complicate their grieving process. Implications for trainees, supervisors, training programs, and the clinical psychology profession are grounded in the context of identity theory. In light of the limited research, particularly regarding trainees' experiences after a client suicide, the following discussion has been extrapolated from several sources, and placed within the context of identity theory.

The COVID-19 era: How therapists can diminish burnout symptoms through self-care

“…Research indicates that, as far as patient suicide is concerned, more than 30% of psychologists will have had a client commit suicide at one point in their careers (McAdams III & Foster, 2000 ; Gill, 2012 ). Upon a client’s suicide, the psychotherapist who treated them will, most probably face significant negative effects their personal and professional lives, and up to 33% of them subsequently suffer from severe mental distress (Hendin, Haas, Maltsberger, Szanton, & Rabinowicz, 2004 ).…”

After a client death: Suicide postvention recommendations for training programs and clinics.

“…Ignoring the very clear possibility of a client death in training clinics is unwise, because if a client death occurs, the training programs and/or clinic will scramble to react to the event. Reactive rather than proactive responses increase the likelihood that even well-intentioned supervisors, training clinics and programs will err in how they manage trainee clinicians dealing with what might be one of the most difficult training experiences that a trainee can face (Gill, 2012). Adopting a postvention procedure does not mean a clinic or program is willing to see riskier clients, only acknowledging the very real possibility that sometimes working with distressed people means having to encounter client death.…”

“…Two additional issues are worth mentioning. The supervisor should plan to help the student clinician think through issues related to death and risk, and monitor negative effects on future client care (Gill, 2012). The supervisor may benefit from consultation around this if he or she wants assistance helping the clinician work through some of these questions (Kleespies et al, 1993).…”

“…According to existing surveys, many training programs and clinics lack policies for how to manage a client death if one occurs (Ellis & Dickey, 1998; Knox, Burkard, Jackson, Schaack, & Hess, 2006), perhaps because the occurrence is—thankfully—relatively rare in training clinics compared with independent practice or community mental health settings (Chemtob et al, 1989). Evidence suggests that the primary method for addressing trainee needs following the death of a client is via clinical supervision (Ellis & Dickey, 1998; Gill, 2012). Given considerable variability in the quality of clinical supervision (e.g., Veilleux, Sandeen, & Levensky, 2014), trainees may have no clear programmatic framework for managing the grief associated with the loss of a client.…”

“…The intention of this paper is to provide “best practices” in postvention procedures according to the existing literature, aimed at health service psychology training programs and training clinics, also likely applicable to social work and counseling programs. We pull from published reports of therapists and trainees who experienced client suicide (e.g., Hendin, Lipschitz, Maltsberger, Haas, & Wynecoop, 2000; Knox et al, 2006; Spiegelman & Werth, 2004) as well as related literature in psychiatry, where suicide is even more common (Kaye & Soreff, 1991; Little, 1992; Pieters, De Gucht, Joos, & De Heyn, 2003), as well as expert recommendations (Balon, 2007; Brown, 1987a; Ellis & Patel, 2012; Foster & McAdams, 1999; Gill, 2012; Schultz, 2004). We also note that although these procedures are geared more toward client death by suicide, they are likely applicable to other forms of client death, which may also be difficult for both clinicians and training programs (Dwyer et al, 2012; Veilleux, 2011).…”