Academic journal article Perspectives in Psychiatric Care

Aftermath of a Patient's Suicide: A Case Study

Academic journal article Perspectives in Psychiatric Care

Aftermath of a Patient's Suicide: A Case Study

Article excerpt

TOPIC. Nurse psychotherapists often feel poorly prepared to cope with a patient's death by suicide. The psychotherapist may identify with the family, feel sad at the death, and be plagued by feelings of guilt and responsibility.

PURPOSE. A case study illustrates the meaning of the loss to the therapist and the influence on professional identity, self-confidence, and self-esteem.

SOURCES. Case study and review of the literature from Medline, psychinfo, and CINAHL.

CONCLUSIONS. Therapists experience their own grief as a lack of omnipotence over suicide, and the fear of their colleagues' responses. Understanding bereavement and factors influencing bereavement may help therapists facilitate and reduce negative consequences of their own grief.

Search terms: Bereavement, grief, professional bereavement

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For therapists, suicidal patients represent the most stressful and frequent emergency psychiatric situations. Higher rates of suicide occur among suicide attempters and people with a psychiatric diagnosis (e.g., mood disorders, schizophrenia, substance abuse, early dementia, borderline personality disorders) from 4 to 6 times more often than in the general population (12/100,000) (Bongar et al., 1998; Roy & Draper, 1995). A patient's death by suicide is a common occupational hazard in psychiatry, yet therapists often feel unprepared for their own, often intense, grief reactions (Midence, Gregory, & Stanley, 1996).

Although researchers describe studies of suicide incidence, risk, and interventions, little is written about the therapist's reactions to a patient's suicide (Rae, 1998). According to conventional wisdom, there are two types of therapists--those who have had a patient commit suicide and those who will. Suicide is a relatively rare event statistically, particularly in settings treating low-risk patients. However, most of the more than 30,000 people yearly who commit suicide in the United States have been receiving inpatient or clinic treatment. In addition, most of them have recently seen a primary care practitioner. Therapists have a pivotal role not only in detecting risk and symptoms of suicide, but in beginning to establish a therapeutic relationship, empathize with the patient's emotional pain, and begin education, treatments, and referrals.

Therapeutic interventions and social support can often reduce the risk of suicide and its precipitants (e.g., depression). However, therapists are not immune to the aftermath of a suicide or to the disruptive impact of a patient's suicide on their belief systems (Rae, 1998). A conflict between personal and professional responses may occur when therapists believe they are expected to behave in an objective manner when they have been bereaved. In the aftermath of a suicide, therapists believe they need to control their emotions, control situations, and provide leadership, but this may be complicated by personal responses to grief. Coping with a patient's suicide may be one of the most difficult challenges for clinicians (Midence et al., 1996). Although extensive literature emphasizes the family's bereavement, scant data depict the therapist's response to a patient's suicide. A patient's suicide can leave lasting impressions on the therapist even though the event may not be consciously remembered (Grad, Zavasnik, & Groleger, 1997).

One way the therapist may process the impact of the suicide is by relating a narrative to a supportive colleague or supervisor. As a form of inquiry, narratives are a dynamic process in which the self is constructed through language and telling the story to an empathic listener. In telling the story (e.g., what happened, how it happened, how I felt, what I thought how I responded), meaning is constructed.

The following case vignette presents the reactions of one nurse psychotherapist to a patient's suicide and a discussion of the relevant literature. …

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