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Therapists' reactions to patients' suicides
H Hendin1, A Lipschitz, J T Maltsberger
1American Foundation for Suicide Prevention, New York, NY 10005, USA. hhendin@afsp.org
The American Journal of Psychiatry
|December 1, 2000
Summary
Therapists experienced significant emotional distress, including guilt and grief, following patient suicides. Many identified treatment changes, but institutional reviews offered little support, highlighting a need for independent case reviews.
Area of Science:
- Psychiatry
- Psychology
- Mental Health
Background:
- Patient suicide is a critical event in therapy.
- Therapists' emotional and professional responses significantly impact patient care and clinical practice.
Purpose of the Study:
- To explore therapists' emotional and professional reactions to patient suicides.
- To identify potential changes in clinical practice following patient suicide.
Main Methods:
- Semistructured questionnaires administered to therapists of 26 deceased patients.
- Therapists wrote case narratives and participated in workshops to discuss reactions and potential treatment modifications.
- Exploration of post-suicide interactions with patient relatives, colleagues, and supervisors.
Main Results:
- Therapists reported intense emotional reactions: shock, grief, guilt, fear, self-doubt, shame, anger, and betrayal.
- In 21 cases, therapists identified specific treatment changes (e.g., medication, hospitalization, consultation).
- Therapists were reluctant to treat subsequent suicidal patients; institutional reviews were often unhelpful, offering blame or false reassurance.
Conclusions:
- Therapists found participation in the project to be a valuable learning and therapeutic experience.
- There is a need for independent, disinterested review of suicide cases to support clinicians and improve patient safety.