Lessons Learned: Forty Years of Clinical Work With Suicide Loss Survivors

Abstract

The author has been a grief therapist in private practice for almost 40 years. The largest percentage of his clients have been suicide loss survivors, and in this article, the author reflects on the "lessons learned" about how grief therapy with survivors is both the same as, and very different from, work with clients bereaved after other types of losses. After briefly reviewing some of the empirical literature about differences between suicide bereavement and grief after other modes of death, the author argues that perhaps the most distinguishing and difficult aspect of a suicide loss is the "perceived intentionality" of the death, and the related "perceived responsibility" for the death. The author goes on to identify a number of tasks of psychological reintegration after a suicide loss that can serve as a template for treatment goals for clinicians and clients alike. These include the cultivation of a very specific type of secure and nurturing therapeutic alliance; extensive psychoeducation about suicide, trauma, and grief; the need to help the client repair the psychological continuing bond with the deceased; and providing gentle support for the survivor in rebuilding an assumptive world that has been shattered by the suicide of a loved one. Finally, the article concludes with a discussion of the clinical implications of these differences for work with suicide loss survivors.

How best to provide help to bereaved adolescents: a Delphi consensus study

“…Panellists endorsed many statements about support specifically in the context of bereavement by suicide, showing the importance for aspects of bereavement support to be tailored for suicide bereavement. This concurs with the literature stating that although grief processes after any cause of death are similar, people bereaved by suicide, as well as helping professionals working with them, tend to emphasise that there are important differences from other forms of bereavement [10,43]. Further, research shows that some grief experiences (e.g., feelings of guilt, rejection, struggles with "why" questions, and diminished social support) can be more pronounced in adolescent grief after suicide [17].…”

“It Changes Your Orbit”: The Impact of Suicide and Traumatic Death on Adolescents as Experienced by Adolescents and Parents

“…Some young participants who had experienced different losses reported that in their experience a death by suicide was more impactful than other losses, which taps into a much-debated topic in the literature regarding the “uniqueness” of loss by suicide [ 15 , 62 ]. Based on findings from controlled quantitative studies, there is growing evidence that there are more commonalities than differences between different groups of bereaved people, based on cause of death, regarding major grief themes, grief processes and grief outcomes [ 8 , 9 , 63 ]. However, there is also evidence of increased risk of mental health complications and suicidal behaviour in adolescents bereaved by suicide or other external causes compared to natural deaths (e.g., [ 50 , 59 , 60 ]), a concern that was also strongly voiced in this study.…”

“…However, quantitative studies cannot grasp nuances of personal experiences, and personal accounts of individuals bereaved by suicide and narratives of clinicians seem to stress features that are experienced as unique or central to the loss by suicide in adults (e.g., [ 9 , 64 ]. Similarly, qualitative studies with adolescents have reported that they experience feelings such as guilt, shame, anger, rejection, and struggles with “why” questions, features that may be more pronounced, though not unique to suicide bereavement [ 10 , 22 , 45 , 65 ].…”

“…Common grief reactions in adolescents include crying and feelings of sadness, guilt and longing [ 7 ]. Although the grief processes after any type of death may be similar, some grief features may be more pronounced depending on the cause of death [ 8 , 9 ]. Adolescents bereaved by suicide may experience more feelings of shock, anxiety, anger, and self-blame than adolescents bereaved by natural causes.…”

Caregivers’ Grief in Acquired Non-death Interpersonal Loss (NoDIL): A Process Based Model With Implications for Theory, Research, and Intervention

“…Such term derives from Bowlby's attachment theory, which stresses the importance of these relationships for physical and psychological survival and well-being (Bowlby, 1969(Bowlby, , 1973Cassidy and Shaver, 2016;Lahousen et al, 2019). Accordingly, grief and mourning are framed as responses to broken attachment bonds (Bowlby, 1980;Jordan, 2020).…”