Working with Suicide Loss Survivors

What makes suicide loss different?

A death by suicide is inherently sudden, often unexpected, and usually violent. These factors increase the degree of shock and trauma experienced by survivors. Survivors sometimes struggle for years to make sense of what happened.

Death by suicide also causes fundamental beliefs to be challenged. This is not a normal death where someone got sick and died. It can also be more complex if the person witnessed the death or found their loved one. They may suffer from flashbacks, nightmares, and posttraumatic stress symptoms. These can also happen even if the individual didn't find their loved one but can't stop thinking about the death.

Death by suicide is more uncomfortable for other people than any kind of bereavement. People are uncertain on how to react. It makes it more isolating for survivors because people feel uncomfortable around them.

There is still a huge amount of stigma associated with a loss by suicide that is rooted in centuries of history. This generates misplaced associations of weakness, blame, shame, and even sin. Stigma can prevent people from getting help when they need it, and it can make others tentative about offering support because they don't know what to do for the survivor.

There's a lot of unfinished business for survivors. They carry a lot of guilt and shame, often feeling somehow responsible for their loved one's death. There are a lot of loose ends, and all those “why” questions can last for a lifetime…

…because there's really no closure with a death by suicide.

Where do we start? We normalize their experiences. I take a strengths-based approach, so I'm always look at what's right with this client, not what's wrong. I want to be curious about their strengths and their potential for resiliency. I want them to feel that sense of safety with me in a therapeutic relationship.

These are some of the strategies I use as I begin to transition grieving clients who’ve lost loved ones to suicide from “why?” to “what’s next?”

Containment

Containment is about building a larger, more stable vessel to hold difficult emotions. I ask my clients to imagine a massive container, the kind you get when you are moving after you have lived in a house for 30 years. The client is going to imagine this container in their mind’s eye and visualize putting chains and a big lock on it. The only time they are going to unlock this container is when the nervous system is settled, and they are only going to pull out that which they can manage, because I want to keep teaching them how to stay within their window of tolerance.

They can even get an actual shoebox and do this. They can write on 3 x 5 cards their distressing thoughts and emotions, then place them in the box and put the lid on. They then only go to their box when their nervous system is settled and they feel equipped to manage these emotions.

This can be very empowering for clients because what I'm teaching them to do is master the skill of juxtaposition between strength and distress.

Grounding

For grounding work, I always recommend practicing yoga. The tree pose can be a useful grounding exercise. Have the client stand up and ground one foot into the earth. They then raise their other leg, placing it on their calf or thigh, and lift their arms into the sky. When they are practicing balance, the mind is focused and grounded to the foot that’s on the earth.

I also tell clients to stand up, pretend they have glue on their feet, and gently sway from side to side. They can do the same thing in a chair. Once they feel anchored, have them put their feet firmly on the floor and wiggle their toes, being aware of any sensation.

Mindfulness

Clients can imagine their negative feelings passing by on a cloud or as leaves floating on a gentle stream. They’re not denying their feelings, but instead noticing them and labeling them, because once they can put words to a feeling, the emotion loses some of its power.

Acceptance and commitment therapy can help clients learn not to fight against their emotions, instead accepting them without labeling them as good or bad. Grief is hard, agonizing work, but you have to go through it to get to the other side. That’s why I try to get rid of this language that tells me that an emotion is bad. What if we could feel these distressing emotions and move forward anyway?

Pendulation

Trauma constricts the mind and body. Pendulation is the body's natural restorative rhythm of contraction and expansion. You’ve experienced this if you’ve ever been driving down the highway and almost gotten into an accident. You slam on your brakes. Suddenly, all this adrenaline goes pulsing through your body, but what happens after a few minutes? You didn't hit the person in front of you, so you go on your merry way. Thirty minutes later, you don't even remember that it happened. Why? Because your body has swung back to balance.

This is what I want to instill in my clients: the knowledge that no matter how bad we feel, these feelings can and will eventually change, because suffering is time limited.

The perspective of your clients struggling with grief after suicide is only small way of looking at reality, though they don't see that yet. They can experience a different reality. It just takes time, and it will look different in each person's life.

What I want to leave my clients with is that our losses aren’t the end of the story. They are only the beginning. The story our clients are telling now is still unfolding. The real story is yet to come.

This is an adapted excerpt from Rita Schulte’s session at the PESI Grief Summit. Click here to access the self-study course.