Mental health social workers provide a significant proportion of services to emotionally fragile clients, many of whom are at risk of suicide. Studies indicate that between 28 percent to 33 percent of mental health social workers have experienced fatal client suicidal behavior, whereas over 50 percent have experienced nonfatal client suicidal behavior (Jacobson, Ting, Sanders, & Harrington, 2004; Sanders, Jacobson, & Ting, 2005). Research supports that social workers have varied personal and professional reactions following client suicidal behavior (Jacobson et al., 2004; Sanders et al., 2005); however, research on social workers' coping behaviors, strategies, and sources of support following client suicidal behavior could not be located at the time of this study. Thus, the purpose of the current study is to address the lack of knowledge on the coping behaviors and supports available to social work clinician-survivors, a term used to describe professionals surviving the fatal or nonfatal suicidal behaviors of clients (Farberow, 2005).
Theoretically, coping is defined as conscious and intentional responses to an unexpected trauma or series of stressful events, as opposed to defense mechanisms, which are defined as unconscious and unintentional responses (Cramer, 2000). There has been debate over whether coping behaviors are stable, similar to personality styles, or prone to change depending on the specific stressful situation and an individual's cognitive assessment of the stressor, past experiences, and beliefs (Folkman & Lazarus, 1984) .Typically, coping behaviors, styles, or strategies have been dichotomized as positive and negative, repressive/avoidant and sensitization/approach, or problem focused and emotion focused (Byrne, 1961, Endler & Parker, 1990; Folkman & Lazarus, 1984; Roth & Cohen, 1986; Ruzek, 2005). However, most would agree that coping strategies are not always mutually exclusive; instead, different types of coping strategies are often used simultaneously (Roth & Cohen, 1986). For example, an individual might seek emotional support while trying to repress painful thoughts. In this exploratory study, both positive and negative coping reported by social workers were examined under the theoretical orientation that coping behaviors, though distinct, could be used concurrently after the traumatic event of fatal and nonfatal client suicidal behavior.
Traditionally, research on client suicidality examined reactions from samples of psychiatrists and psychologists (Chemtob, Bauer, Hamada, Pelowski, & Muraoka, 1989; Chemtob, Hamada, Bauer, Torigoe, & Kinney, 1988; Ellis & Dickey, 1998; Kleespies, Penk, & Forsyth, 1993) despite the fact that social workers are just as likely to work with suicidal clients. Prior research has also focused on suicide assessment and prevention and predictive characteristics and behaviors of suicidal individuals (Appleby, 1992; Callahan, 1996; Norlev, Davidsen, Sundaram, & Kjoller, 2005; Weyrauch, Roy-Byrne, Katon, & Wilson, 2001). Recently, several large national studies assessed the prevalence of suicidal behavior among clients of mental health social workers (Jacobson et al., 2004; Sanders et al., 2005). Using both qualitative and quantitative methods, researchers have also examined social workers' reactions, education or training needs, and perceptions toward suicide assessment and clinical tools, such as no-suicide contracts (Freedenthal & Feldman, 2004; Sanders et al., 2005). The following section briefly summarizes available research from the social work field.
Reactions to Fatal and Nonfatal Client Suicidal Behavior
Jacobson and colleagues (2004),in a national random sample of mental health social workers (N = 697), found that 52.5 percent experienced fatal and nonfatal client suicidal behaviors, rates that are comparable to those experienced by psychiatrists and psychologists. …