Degree In Sight
Last year, Laura Sobik, PhD, was finishing her internship at Texas Women's University when she received the news: A client she had worked with for two months had killed herself.
"I didn't realize just how painful it would be," says Sobik, now a psychologist at James Madison University's counseling and student development center.
Sobik's client had struggled with severe depression and attempted to kill herself before. Still, Sobik wasn't ready for her intense reaction to the woman's suicide.
"I was unprepared for how shattered I felt, both personally and professionally," she says. "As a young therapist, it forced me to grow up really quickly."
Sobik's experience is rare, at least in graduate school. A 2003 survey of 238 predoctoral psychology interns in Suicide and Life-Threatening Behavior (Vol. 33, No. 2) found that 5 percent experienced a client suicide, although 99 percent said they had treated at least one suicidal client during training. Over time the number rises, so that one in four psychologists loses a client to suicide at some point in his or her career. About half of psychiatrists, who tend to see more severely troubled patients, experience such a loss, research finds.
Client suicide often strikes trainees more deeply than seasoned clinicians, because students tend to be more idealistic about therapy's benefits and less experienced in dealing with very troubled clients, says Gregory Eells, PhD, director of counseling and psychological services at Cornell University. "The more experience you get, the more you realize that while therapy can be helpful and useful, it is not always a panacea," Eells says.
Unfortunately, some graduate programs don't adequately train students in suicide and suicide prevention. Only half of trainees in the 2003 survey said they attended programs with formal training, for example. Others feel existing training isn't enough to prepare students for working with these clients, who often have complex and deep-seated problems.
"There are a few evidence-based treatments that work for suicidal behavior, and graduate students should be routinely trained in them," says University of Washington suicide expert Marsha Linehan, PhD.
That said, there are many resources available to help students cope and even grow in the face of this trauma. If it happens under your watch, experts urge you to:
Talk to someone who can help. Finding good supervisors, mentors and others to help you is by far the most important thing you can do following a client's suicide, experts agree. "The most healing part for me was talking to others who had been through a similar situation, and were now on the other side," says Sobik.
One especially helpful resource, she says, was the Clinician Survivor Task Force of the American Association of Suicidology (AAS), an organization dedicated to understanding and preventing suicide. Task force members who had lost clients to suicide provided "a lot of warmth and validation," Sobik says.
She also talked to supervisors, friends and colleagues and eventually sought therapy to come to terms with the situation. "The more we talk about these events, the more helpful it is for us as clinicians and as humans going through such a sad and difficult thing," she says.
Avoid extreme reactions. In the wake of a client taking his or her life, it can be tempting either to isolate yourself or to overcompensate by trying to be a "supertherapist" with other clients, Eells says. Steer clear of either path, he advises. Instead, discuss your feelings with a trusted supervisor, who can help you address issues of perceived professional inadequacy, and explore feelings of guilt and second-guessing about past clinical decisions. A key part of the process: accepting that you cannot control everything, he says.
Take time to grieve. Grieving has its own trajectory, so allow yourself to work through those feelings, advises Vanessa McGann, PhD, co-chair of the AAS Clinician Survivor Task Force.
"Sometimes people expect that a week or two after a client's death, they'll be over it," she says. "But you might be working with clients without any trouble for six months, and suddenly the impact of the suicide will surface."
Again, getting therapy can help you process those feelings, she says.
Know the research. Data can help to put things into perspective, whether it is the fact that many clinicians experience client suicide, that suicide is often an impulsive act, or that your client falls into a high-risk category such as having a history of suicide attempts, mental disorders or a history of trauma or abuse.
Combing the literature helped Sobik cope with the force of her own grief, she says. "At first I felt like I was going crazy—why couldn't I put it aside? Why couldn't I hold it together?" she recalls. When she read that a client's suicide can elicit as strong a grief reaction as the death of a family member, it helped to normalize the experience for her, she says.
Learn from the experience. Such professional challenges can deepen your therapeutic understanding of other clients who express suicidal thoughts, Sobik says.
The support she received and her own work processing the event and learning more about suicide "increased my tolerance and understanding of suicidal ideation," she says.
Working through her feelings also helped her address what kind of therapist she wants to be.
"Did I want to become jaded and closed off or to be the kind of therapist who feels this deeply, takes lessons from it and moves on?" she says. "While I haven't figured out all the lessons or healed completely, I know for certain I'd rather be the second kind."
By Tori DeAngelis
Tori DeAngelis is a writer in Syracuse, N.Y.
American Association of Suicidology: www.suicidology.org. Access the organization's Clinician Survivor Task Force at http://mypage.iusb.edu/~jmcintos/basicinfo.htm. It includes a listserv and personal accounts by students and others who have lost clients to suicide.
The American Foundation for Suicide Prevention: www.afp.org.
The Jed Foundation: www.jedfoundation.org.
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