Suicide is the client crisis most frequently encountered by mental health clinicians (Bongar, 1993; Juhnke, 1994). It has been deemed an "occupational hazard" for students and practitioners in the disciplines of psychiatry and psychology (Chemtob, Bauer, Hamada, Pelowski, & Muraoka, 1989, p.294). Despite the apparent universality of this crisis, no information appears to exist regarding the frequency of suicides among the clients of student and professional counselors. Nor does there appear to be any information available regarding the impact of clients' suicides on counselors professionally and personally. The few studies that have been conducted on the frequency and impact of client suicides have focused almost exclusively on student and professional psychiatrists and psychologists.
Statistics suggest that as many as one third to one half of students in psychiatry have experienced the death of a client by suicide during their psychiatric residency programs (Henn, 1978; Rosen, 1974). In a study by Brown (1987a), 37% of the 55 residents at the Department of Psychiatry at Cambridge Hospital reported experiencing the suicide of a client during their clinical training. The frequency of client suicides was substantially higher in Chemtob's survey of 269 practicing psychiatrists, in which a rate of 51% was reported (Chemtob, Hamada, Bauer, Kinney, & Torigoe, 1988a). By comparison, rates of client suicide among students and practitioners in psychology are lower than those reported by their counterparts in psychiatry. Kleespies' (1993) statewide survey of nearly 300 pre-doctoral interns in psychology found that one in nine or 11.3% had experienced a client suicide during the internship experience. That rate is nearly doubled for practicing psychologists. Of the 365 respondents to a national survey of Registered Practicing Psychologists conducted by Chemtob, 22% reported having had a client who committed suicide (Chemtob, Hamada, Bauer, Torigoe, & Kinney, 1988b).The disproportionately high number of client suicides experienced by psychiatrists may, according to Brown (1987b) and Chemtob et al. (1988a), be due to their longer period of clinical training and their increased likelihood of working in settings (psychiatric hospitals and psychiatric wards of general hospitals) associated with higher rates of suicide. Brown added, however, that other health professionals are not immune to or spared this problem, and current statistics indicate that client suicide is more than a rare event in psychology training and practice.
Therapists uniformly have experienced the suicide of a client as stressful, and for a substantial number the event has had a significant lasting impact on their personal and professional lives. In his study of psychiatrists, Brown (1987a) found that every individual he interviewed remembered the name of his or her deceased client, and details of the incident remained vivid even after 20 or 30 years. Forty-nine percent of the psychologists surveyed by Chemtob et al. (1988b) reported symptoms of stress in the weeks after a client suicide that were comparable to those of people for whom the impact of parental loss was severe enough to necessitate treatment. More serious pathologic grief reactions to client suicide, including melancholia, atonement, and narcissistic avoidance, have been reported by Maltsberger (1992).
Therapists in training may experience a reaction to their client's suicide that is as strong if not stronger than that of their professional counterparts (Brown, 1987b; Kirchberg, & Neimeyer, 1991; Kleespies, Penk, & Forsyth, 1993; Rodolfa, Kraft, & Reilley, 1988). Following the suicide of a client, predoctoral interns in psychology have reported feelings of shock, disbelief, failure, sadness, self-blame, guilt, and shame that were significantly higher than those found in comparable studies of professional psychologists (Kleespies et al., 1993). Two studies involving psychiatric trainees reported responses including frequent feelings of guilt, sadness, anger, and increased fear in dealing with suicidal patients as well as various anniversary reactions to the event (Sacks, Kibel, Cohen, Keats, & Turnquist, 1987; Schnur, & Levin, 1985;). Brown (1987b) reasoned that when a client commits suicide, student therapists are more likely to feel that they have failed as persons than experienced professionals who are better able to separate personal failure from limitations of the therapeutic process. Consequently, the loss of a client to suicide may pose a greater threat to the self-concept of the student therapist than it does to the experienced professional who has a broader base of experience from which to process the event.
- McAdams III, Charles & Victoria Foster; Client suicide: its frequency and impact on counselors; Journal of Mental Health Counseling; April 2000; Vol. 22; Issue 2.
Suicide Bereavement and Complicated Grief
- Young, I. T., Iglewicz, A., Glorioso, D., Lanouette, N., Seay, K., Ilapakurti, M., and Zisook, S. (2012). Suicide Bereavement and Complicated Grief. Dialogues in Clinical Neuroscience, 14(2). p. 177-186.
Reflection Exercise #5
The preceding section contained information regarding client suicide frequency and impact on counselors. Write three case study examples
regarding how you might use the content of this section in your practice.
Peer-Reviewed Journal Article References:
Lewis, K. C. (2019). Review of Teenage suicide notes: An ethnography of self-harm [Review of the book Teenage suicide notes: An ethnography of self-Harm, by T. Williams]. Psychoanalytic Psychology, 36(1), 108–111.
Love, H. A., & Durtschi, J. A. (2020). Suicidal ideation and behaviors in young adults: A latent profile analysis. Journal of Family Psychology. Advance online publication.
Zisk, A., Abbott, C. H., Bounoua, N., Diamond, G. S., & Kobak, R. (2019). Parent–teen communication predicts treatment benefit for depressed and suicidal adolescents. Journal of Consulting and Clinical Psychology, 87(12), 1137–1148.
What were three pathologic grief reactions experienced by therapists related to client suicide? To select and enter your answer go to Test.