Therapists-in-training who experience a client suicide: Implications for supervision.

Abstract

Client suicide is often an extraordinarily painful process for clinicians, especially those still in training. Given their training status, supervisees may look to their graduate programs and supervisors for guidance and support when such an event occurs. This study qualitatively examined the experiences of 13 prelicensure doctoral supervisees regarding their client's suicide. Findings suggest that these supervisees received minimal graduate training about suicide and that support from others, including supervisors, helped them cope with their client's death. Supervisors are advised to normalize and process supervisees' experiences of client suicide. Implications for training and practice are discussed.According to the National Institute of Mental Health (2004), more than 30,600 people committed suicide in 2001, making suicide the 11th leading cause of death in the United States. Suicide is thus a significant mental health concern, one that affects individuals of various ages, socioeconomic statuses, and ethnicities (Dixon, Heppner, & Rudd, 1994). The prevalence of suicide and its emotional impact have implications not only for surviving loved ones but also for faculty and students involved in mental health training (Laux, 2002). Unsurprisingly, then, suicide has been identified as the emergency situation most frequently encountered by mental health clinicians (Schein, 1976) and is thus also likely an experience that therapists-intraining may face (Chemtob, Bauer, Hamada, Pelowski, & Muraoka, 1989).The majority of research about client suicide and therapists-intraining has investigated the experiences of student interns and residents in psychology and psychiatry and has specifically focused on the frequency of such suicides (Foster & McAdams, 1999). In the first of two studies, Kleespies, Smith, and Becker (1990) found that 19% of the former psychology interns they surveyed had a patient who attempted suicide and 17% had a patient who completed suicide during their training years. Three years later, Kleespies, Penk, and Forsyth (1993) reported that 29% of psychology interns surveyed had a patient attempt suicide and 11% had experienced the completed suicide of a client.More recently, McAdams and Foster (2000) conducted a national survey of professional counselors regarding the frequency of client suicide. Of their 376 respondents, almost one quarter (i.e., 23%) had experienced the suicide of a client they were treating; within this NOT THE PUBLISHED VERSION; this is the author's final, peer-reviewed manuscript. The published version may be accessed by following the link in the citation at the bottom of the page.Professional Psychology: Research and Practice, Vol. 37, No. 5 (October 2006): pg. 547-555. DOI. This article is © American Psychological Association and permission has been granted for this version to appear in ePublications@Marquette. American Psychological Association does not grant permission for this article to be further copied/distributed or hosted elsewhere without the express permission...

Evaluation of the Recognizing and Responding to Suicide Risk Training

“…The lack of a formal, systematic, and evidence‐based skills training in the assessment and formulation of suicide risk and treatment of clients at risk of suicide is one contributing factor to the low‐level skills evidenced among health and mental health clinicians (Bongar & Harmatz, 1989; Jacobson, Ting, Sanders, & Harrington, 2004; Knox, Burkard, Jackson, Schaack, & Hess, 2006; Schmitz et al., 2012). At least three associated steps lead to a goal of improving clinicians’ abilities to work with clients at risk of suicide.…”

Engaging in ritual after client suicide: the critical importance of linking objects for therapists

“…This 'code enforcement' (O'Connor, 2001), has also been noted by researchers in relation to supervision. While not disputing the fact that speaking with supervisors and work colleagues after the death of a client is the most commonly sourced means of support, followed by family and friends (Knox et and Etkin, 2003), the quality of the supervision offered has been found to be highly variable (see Campbell & Fahy, 2002;Carroll, 2008;Knox et al, 2006;Pilkinton & Etkin, 2003) leading to, 'varying degrees of therapist satisfaction in relation to the supervisory process' (Clark, 2009b).…”

Facing up: psychotherapists writing about dealing with the idea of one’s own death

“…Other studies do turn to a focus on the therapist rather than the patient, but still in relation to the patient rather than a therapist oneself or a therapist's loved one (e.g. Atkins & Loewenthal, 2004;Becvar, 2004;Bram, 1995;Knox, Burkard, Jackson, Schaack, & Hess, 2006;Michel, 1997). While these studies address crucial issues, they do not yet turn to therapists themselves writing about their own dealings with mortality: first, regarding mortality in general and, second, regarding their own mortality.…”