It is not uncommon for patients with histories of neglect and abuse to express profound doubts about whether their therapist “really” cares about them:
“Of course you act like you care; you’re trained to do that and that’s what you’re paid for.”
And there’s actually a grain of truth to this generalization. Indeed, therapists do care for patients in a different way than they care for their spouses or children. Only then is a healthy, effective therapeutic relationship able to develop.
On the other hand, those who doubt the reality of a therapist’s caring should know more about the impact of a patient’s suicide on the therapist. Indeed, the impact of such a jarring loss is often a revelation to the therapist as well.
Research on impact of a patient’s suicide
The research on this topic is consistent and clear: When therapists who have lost a patient to suicide (somewhere between 20 and 50 percent) are studied as a group, most are found to have been profoundly affected. One study using an instrument called the Impact of Events Scale found that, on average, the sense of shock and loss was on a par with the death of a family member. Some therapists were found to have such profound self-doubts stemming from the experience that they contemplated leaving the field.
“What’s up with this?” you might be thinking, “Surgeons and nursing home workers lose patients all the time; they understand that it goes with the territory.”
The loss of a psychotherapy patient to suicide differs in some important ways. First, when death is self-inflicted, myriad thoughts about preventability inexorably arise: What did I miss? What might I have done differently to prevent this?
Second, in contrast to the surgeon, the primary tool of the psychotherapist is the person himself or herself. And, to the extent that the therapy has failed, it can be argued that it is the self of the therapist that has failed.
Finally, it is practically impossible for one human being to have deep knowledge of another person’s suffering without to some extent sharing that suffering and, by extension, suffering in response to that person’s death. It is simply how we are wired. Ever notice how uneasy you feel when you witness another person being seriously embarrassed? Or emotionally or physically injured? Imagine experiencing the death of someone who has shared with you his or her deepest insecurities, fears and traumatic memories, and someone in whom you have seen great promise and potential for future happiness. The extent of the tragedy of a self-inflicted death is never more apparent than in this context.
It is well-known that one of the leading reasons for malpractice lawsuits against mental health professionals is for wrongful death in cases of a family member’s suicide. What is less well-known is that, even more often, families understand the difficulties the clinician faced and the limitations of the power of psychotherapy in challenging cases. Some even appreciate that freedom, even when constrained by illness, can result in a choice to end life. Indeed, stories of family members, even in the throes of grief, reaching out to therapists to ask, “Are you OK?” are surprisingly common.
When a clinician loses a patient to suicide, the memory of the person, and the experiences shared, remain. Mourning the loss often entails a memorial service, as well as ongoing discussion with colleagues and private reflection. Like other losses, expressions of compassion and shared suffering are perhaps the surest route to coping and eventual recovery.