Suicide: Impact on student therapists

I applaud the recent interest in trauma. There are articles and trainings everywhere on how to help our clients with trauma. My concern is that so little is done to prepare student therapists for trauma. If you are in the psychotherapy business for any length of time, you are going to have losses, failures and deaths. Yet, our students appear unprepared. I have supervised students from most of the mental health disciplines. Not once have I met a student who had received any training on how to handle a successful suicide.

I believe it is our duty to prepare students for tragic eventualities. Let me suggest the following interventions:

First, we need to warn our students that they will lose clients. The awareness of this helps prepare them. We need to tell them before it happens.

Second, our clients are important to us. We care about them and offer communicative intimacy to them. They have shared their lives with us, so losing them is traumatic. Students should be encouraged to treat these losses as a trauma. Therefore, trauma interventions are appropriate. Students frequently tell me that they are discouraged from talking about treatment losses. When I was an intern and a client died, there were meetings to discuss the death, but interns were not allowed to attend. Our students should be encouraged to talk about their losses. Treatment teams need to provide time to debrief and students should not be excluded.

Third, after a successful suicide, clinicians need to distinguish between who is responsible for the suicide versus what were the contributing factors. To this end, I encourage reminiscing after a loss. I encourage therapists to review all their interactions. What did the therapist say? What did the client say? Did they miss anything? What could they have done differently that might have made a difference? What could have been done to avoid the suicide? Upon completion of this review, students are usually able to make a determination that the client is solely responsible for the death. Did the student contribute, miss something important not say the right thing? Maybe but that does not make them responsible for the suicide. Having completed a review of the case, including time to process all the interactions, most students will accept that they provided support, attention, guidance and caring interventions. They can accept that their actions were those of a reasonable clinician and that short of following the client home, they could not have prevented the suicide.

Finally, I want my students to feel more prepared for potential suicides. I ask them to provide a report on the characteristics of clients before suicide. By reviewing the characteristics of these clients, they lern how impossible it is to correctly predict which clients will be successful with suicide attempts. This knowledge helps students understand what is known about suicide and represents their only defense for this clinical situation.

I suspect that one of the major reasons that therapists have a short career span, burn out and leave the field, is because they are never trained on how to handle trauma. It is our duty as supervisors and clinicians to help prepare students for one of the most difficult professional problems they will face.