Coping with client death: Using a case study to discuss the effects of accidental, undetermined, and suicidal deaths on therapists.

Abstract

Over one-quarter of psychologists and psychiatrists will lose a client to suicide, and the impact of suicide on therapists is profound. Therapists report both personal (e.g., emotional) and professional (e.g., fears of litigation, doubts about competency) reactions to client suicide, and these reactions are thought to be pronounced for therapists-in-training. However, little is known about the effect of nonsuicidal client deaths on therapists, especially how the experience of a client suicide might compare with other forms of unanticipated client death, such as accidental injuries (e.g., car accidents) or deaths of undetermined intent. The current article reviews family members' bereavement responses based on differential death classification, as well as therapist reactions to suicidal deaths. A case study of undetermined death will be described in light of the extant literature on therapists' coping responses to suicide, including reflections on emotional and professional implications to a nonsuicidal death. A recent social psychological model of adaptation to emotional experiences (Wilson & Gilbert, 2008) will be used as a theoretical framework to discuss how death by suicide may be construed in comparison to undifferentiated and/or accidental deaths, with a focus on informing sorely needed future research in this area.

Impact of Client Death on Clinical Geropsychologists: A Qualitative Analysis

“…This challenge often spurred personal and professional growth for geropsychologists as they adapted and developed strategies to cope with their experiences. Thus, the present results supported prior findings that client death led to growth and professional development for clinicians (Veilleux, 2011;O'Brien, 2011;Lardaro, 1988). Further, specific coping strategies identified by this study such as cognitive reframing of client death and using rituals to gain a sense of closure demonstrate specific ways that professionals cope with this phenomenon.…”

“…Existing research has relied on case studies and clinical case reflections based largely on the experiences of generalist practitioners who experienced client death as a rare and unexpected event. Results of these studies identified some common issues therapists experience when a client dies: countertransference effects in which experiences from their personal histories complicated their reactions, struggle with the ambiguity of the therapeutic relationship, and feelings of guilt, denial, and avoidance (O'Brien, 2011;Veilleux, 2011;Rubel, 2004;Schwartz, 2004;Lardaro, 1988).…”

Distinctive emotional responses of clinicians to suicide-attempting patients - a comparative study

“…Differences between such responses to patients’ suicide deaths, attempts of different severity, and unexpected non-suicide deaths have not been studied and are poorly understood [33]. It is possible that the differences in recalled reaction to patients in the encounters preceding such events are attributable to their recollection being colored differently by those very events.…”

Preventing Suicide through Improved Training in Suicide Risk Assessment and Care: An American Association of Suicidology Task Force Report Addressing Serious Gaps in U.S. Mental Health Training

“…When a mental health professional sees a patient who is at risk for suicide, he or she is faced with the need to make decisions about patient care that can have serious life‐or‐death consequences. If a patient dies by suicide, there is a significant emotional impact on the patient’s family, his or her social network, and the clinician or clinician‐in‐training treating the patient (Calhoun, Selby, & Faulstich, 1980; Cerel, Roberts, & Nilsen, 2005; Chemtob, Hamada, Bauer, Torigoe, & Kinney, 1988b; Kleespies, Penk, & Forsyth, 1993; Veilleux, 2011). When a patient of a mental health professional dies by suicide, clinical, ethical, and legal questions may arise about the adequacy of the clinician’s evaluation and about the sufficiency of his or her training to perform such evaluations.…”