Losing a client to suicide can be devastating personally to a therapist, but professionally, there also can be many unforeseen consequences. The emotional toll is often compounded by systemic issues within the mental health field that can transform a tragic event into a potentially career-ending one.
In July, I had the pleasure of attending a talk given by Diego De Leo, PhD at the 2024 European Symposium on Suicide and Suicidal Behaviour, where he highlighted the intricate personal and professional dynamics therapists face after losing a client to suicide.
What are the systemic challenges?
In the aftermath of a client’s suicide, therapists frequently encounter systemic barriers that can exacerbate their distress. The fear of litigation and professional investigation is pervasive, often leading to a defensive practice style where open communication is stifled. The systemic response within healthcare settings can sometimes resemble a witch hunt, with an emphasis on finding fault rather than understanding the multifaceted nature of suicide.
This fear-driven culture often leads to a shutting down of communication, where therapists may feel pressured to remain silent about their experiences to avoid potential professional repercussions. As highlighted by a study in Clinical Psychology and Psychotherapy (Awenat, Y., et al. 2013), the intense scrutiny and judgment that therapists face after a client suicide can lead to a profound sense of professional insecurity and a fear of losing licensure or even one’s entire career.
This creates an environment where learning from these events is overshadowed by the fear of punishment, undermining opportunities for systemic improvement and support.
What are the most common experiences in this scenario? On a personal level, therapists often grapple with intense feelings of guilt and self-doubt. They may ask themselves, "Could I have done something differently? Did I miss a critical sign?" This type of existential questioning can lead to a deeper crisis of meaning, where therapists begin to doubt not only their professional competence but also the very nature of their work.
Research in the Journal of Affective Disorders found that therapists who experience a client suicide often undergo a period of profound self-reflection and existential questioning, which can shake their foundational beliefs about their purpose and the efficacy of their work (Hendin et al., 2004).
These feelings are further complicated by a sense of hypervigilance, where therapists may become overly cautious in their subsequent practice, fearing that another client might also be at risk. This heightened sense of vigilance can spill over into their personal lives, leading to anxiety about the wellbeing of loved ones and a pervasive fear of "Who will be next?"
Overcoming the barriers to open communication
This culture of fear and blame often leads to isolation, as therapists may feel they are not allowed to discuss their experiences openly. They might avoid interactions with colleagues or withdraw from professional networks, fearing judgment or blame. This isolation is compounded by the societal taboo that still persists around talking about mental health challenges and suicide.
Therapists are rarely acknowledged as fellow grievers
Creating a culture that encourages open communication and collective learning is vital. As Sue Murray discussed with me on my "Headspace for the Workplace" podcast, fostering a "just culture" in mental health settings—one that prioritizes learning from these tragic events over assigning blame—can help create a more supportive environment for therapists (Murray, 2024). This approach allows for a more constructive response to client suicides, where the focus is on systemic improvement and support rather than punitive measures.
Personal Reflections: Lessons from Losing Carson
Reflecting on my own experience of losing my brother Carson to suicide, I initially felt frustration with his mental health provider for what I perceived as over-medication and a lack of responsiveness to my concerns.
However, when she attended Carson's memorial service, just six days after his death, and expressed her profound grief and condolences, I saw her in a new light. I realized she was not just a provider but a human being deeply affected by Carson's death, doing her best with the tools she had. This encounter helped me understand the impact a client's suicide can have on their therapists and the importance of empathy and understanding in these situations.
Upon further introspection on Carson's death, I understand that I was grappling with the heavy weight of traumatic grief over the loss of my brother, while also trying to understand the complexity of his pain. We who loved him recognized he was struggling and did what we could—talking openly with him about his thoughts on suicide, connecting him to resources, and trying to understand his experience.
The net effect was that I questioned the mental health system, which often seems to operate from a place of fear rather than compassion. Now, decades later, I am determined to channel my deep sorrow for his loss into a force for transformational change, and create a more understanding and supportive environment for those in crisis.
What is the therapeutic community’s role in suicide aftermath?
