When a psychiatry resident's patient commits suicide: transference trials and tribulations

It is an unfortunate reality that a substantial proportion of psychiatry residents will experience the suicide death of one or more of their patients during the course of their training. The psychological impact of such deaths may result in marked repercussions on the treating resident; but, in addition, many other individuals and entities--resident peers, supervisors, other mental health professionals and staff, training directors, training programs, psychiatry departments--may be affected as well to a greater or lesser extent. This paper explores one manifestation of the impact on a psychiatry resident of a patient's suicide death: the activation of transference reactions and transference enactments on the part of both a resident and a residency training director. The author argues that the very breadth and depth of such transference responses offer invaluable opportunities for self-observation, psychological introspection, and personal growth if involved individuals have sufficient courage and supportive mechanisms for processing of the patient suicide and its aftermath. The failure of many current psychiatric trainees to undergo personal intensive psychotherapy is identified as a major obstacle to turning such potentially destructive experiences into learning and growth opportunities.