Therapists' reactions to patients' suicides

Objective: The authors wished to obtain information from therapists about their reactions to the suicides of patients in their care. Method: Therapists for 26 patients who committed suicide completed a semistructured questionnaire about their reactions, wrote case narratives, and participated in a workshop to discuss their cases. The therapists discussed what they would do differently, the impact of the death on their treatment of suicidal patients, their interaction with patients' relatives after the suicides, and the reactions of their colleagues and supervisors. Results: Shock, grief, guilt, fear of blame, self-doubt, shame, anger, and betrayal were the major emotional reactions. In 21 out of 26 cases, therapists identified at least one major change they would have made in their patients' treatments; most frequently mentioned were changes in medication, hospitalization of the patients, and consultation with the patients' previous therapists. Nineteen of the therapists saw the patients' relatives after the suicides; in almost all cases the relatives were not critical of them. Some of the therapists were reluctant to accept subsequent suicidal patients into their practices, Although colleagues were supportive, institutional responses and case reviews were rarely helpful, offering either blame or false reassurance that the suicide was inevitable. Conclusions: Clinicians felt they learned from participating in the project and that it was therapeutic for them. Review of such cases by a disinterested independent group with no institutional ties to the therapists seems desirable.