Mental Health Assistance for Suicide Survivors
When survivors do seek mental health assistance, they often do so on their own or through encouragement of friends or family. When they come to counseling, they might have a feeling that they "should be doing better by now." The belief that grief ought to be over after a certain period is popular in Western society, and suicide survivors might be getting messages from their social network that something is abnormal about them and their grieving process. As we discussed earlier, the grieving process for suicide survivors is "abnormal" in comparison with other kinds of grief, but the process is "normal" for suicide survivors. For suicide survivors, it appears that certain grief symptoms (e.g., guilt, rejection, shame, stigma) that occur after a suicide death for survivors complicate the bereavement process (Harwood, Hawton, Hope, &Jacoby, 2002). Clinicians need to realize when working with bereaved suicide survivors that they might not recover as quickly as other types of survivors and might have some special issues that complicate therapy. Above all, the experience of these clients will most certainly not fall nicely into the discrete stages of a "normal" grief process.
The most salient aspects of suicide survivor bereavement that have been identified in the literature relate to extreme feelings of guilt and shame. A second theme that emerges is the need to make sense out of the death, to answer questions of "why?". Third is to cope with social stigma and resulting isolation. In addressing these issues, suicide survivors must avoid denial, social withdrawal, self-destructive behavior, failures to communicate, and developing enduring mental and physical health problems. Dunne (1992) stated these issues somewhat differently and listed the following as the dominant psychological themes for suicide survivors in counseling:
- Obsessive search for the why of suicide
- Sense of stigmatizations
- Incomplete or unusual grieving pattern
- An invasion of conscious thought by the idea of suicide
- Sense of helplessness and low self-esteem
- Reduction in size or complexity of social relationships
- Erosion in basic trust of others
Even after identifying useful themes for directing therapy from the literature, clinicians still must remember that clients have many individual differences. Age, gender, cultural background, and life experiences all affect the grieving process in general and suicide survivor grieving in particular. However, how these many identities and experiences interact to produce the grieving process is poorly understood. For example, some individuals might not exhibit any grief and, contrary to myth, might not have a delayed grief reaction. At present, there is no long-term study on outcomes of these cases. Others find comfort and meaning in suicide notes left behind, while some find these notes heart-wrenching and more complicating to the process. The relationship of the survivor to the victim and the characteristics of that relationship are important individual modifiers. The perceived closeness by the survivor to the victim might be more important than the actual genetic relationship.
Given the complexity of survivor grief, clinicians might become impatient or discouraged with treating these clients. Fortunately, there are some very real things that mental health professionals can do to help. Farberow (1992) offered the following list of activities that survivors have reported as helpful:
- Talking with friends and family (most helpful)
- Reviewing pictures and mementoes
- Visiting the grave
- Rearranging and storing the belongings
- Individual psychotherapy (50% thought it helpful)
- Group psychotherapy (22% thought it helpful)
© ______ 2007, Merrill, an imprint of Pearson Education Inc. Used by permission. All rights reserved. The reproduction, duplication, or distribution of this material by any means including but not limited to email and blogs is strictly prohibited without the explicit permission of the publisher.
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