Helping Someone in the Face of Suicidal Risk #218 (Part III) ⭕️

The myth of infallibility and the aftermath.

If you are a psychotherapist, you are bound to meet someone who is at risk of suicide.

If you stay in your profession long enough, especially in higher-risk settings, tragically, there is a chance you’d lose people by suicide.

When I first started out, even though I was working in a national psychiatric hospital, with about 2,000 inpatients spread across 50 wards (a large majority were long-term stayers), as well as an outpatient clinic, I somehow thought to myself that this is not going to happen under my watch.

.The hubris.

It’s hard to write about it. But I think it would do some good to address this.

I’ve known other clinicians who literally left the helping profession when one of their clients died by suicide.

I’ve been in practice as a psychologist for 21 years. I have lost two clients.

Both persons were once in an in-patient care facility.

I still keep the letter that I was about to send to one of them. I don’t normally write letters to clients, by partially inspired from David Epstein and Michael White’s work in narrative therapy and Irvin Yalom’s case studies, and also I felt compelled to for this particular person. Together with a colleague, I saw him in the wards for the first time just before discharge, making plans to work with him in the out-patient clinic.

Now that he was discharged, moments after I wrote the letter, thinking I would mail it out on my way home, I bumped into his treating psychiatrist. I said to him I got the referral, and was looking forward to working with the patient. I was too embarrassed to say that I wrote him a letter.

The psychiatrist said to me, “You mean you didn’t know?”

“Know what?”

“He completed suicide.”

I froze. Every single incident from my initial session with him flashed passed me. Did I miss anything? Was it pre-meditated? How was it that I didn’t pick it up?

I become infuriated with myself. How did I miss this? Was there anything I could have done to prevent this? I went through all his clinical notes again. I buried my head in books and articles, trying to re-think the whole fallacy about risk assessments. Maybe it wasn’t pre-meditated, and maybe he had an impulsive streak… But why didn’t I pick this up?

I later learned that a team of psychiatrist at our institution published a study on suicide prevalence. They found that the first four weeks post-discharge was classified as a “risk period.”

I wished I had known that earlier. Perhaps I would have tried to see him sooner…

As I write this, I’m reminded that this incident, though in greater detail, was meant to be the introductory piece for the book that I wrote about first sessions. After some editorial process, I was advised that it was not a good way to begin the book.

The point of the above is not to say that “oh well, it’s inevitable that we will lose clients by suicide anyway.” We are each other’s healthcare workers. There is always possible ways to reach, touch and tilt people towards a re-consideration of life, not death. There is a lot more we can be re-examining about how we engage with people, work on suicide prevention, and helping those at serious risk.

The point of this is to say, we too are affected when someone dies by suicide.

I was lucky. In both occasions, I was not working with both clients alone. Though I had not spoken about the other case here, I was working closely with the client and a medical worker social worker. I also had trusted supervisors. It made all the difference. I would have easily gotten swallowed by my own guilt.

I write about this with hesitation and care, as exposure to such content is in some way a risk exposure. But especially in the mental health profession, this has to be touched upon.

From Psychotherapy Networker

Maybe this already exists, but wouldn’t it be good if we have a professional repository, an archive of incidents that is updated in real-time by mental health professionals, that is indexed/tagged and categorised, so that it is searchable as a collective, “extended mind,” so that we can learn from others in the field?

Take for instance, school shootings. You would imagine that, given the gravity, there would have been a national database investigating all such tragic and violent acts in US, so as to better prevent such tragic incidents from happening.

There wasn’t.

Not until David Riedman came along.

He ran the database in his bedroom, recording every school shooting in the U.S. since 1966 — more than 2,600 incidents and 1,000 deaths And it wasn’t just the dates and a link.

Here’s Riedman:

Each incident is carefully set up with standardized, continuous, or categorical variables. There are more than 200 different variables about the who, what, where, when, and how. But also information about the location, about the situation, the shooter, the victims, the weapons used, and then lots of pieces that add extra context within the school day. You know, where in the school building did it occur? During what period of the school day, morning classes, lunch?

Thus, The K-12 School Shooting Database was born.

Riedman’s investigation ties in with Amy Edmondson’s research not just in mistakes and failures, but also the “chain of events” that leads to those failed outcomes.

What if we had something like this for mental health services, so that we can learn from the experiences of others as quickly as possible?

If you have experience a loss of a client, don’t suffer alone. Suffering is wasted when we suffer alone.

We are not meant to be isolated.

Don’t just reach out to ChatGPT. (see this).

Reach out to someone you trust.

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In case you missed it, here’s Part I and Part II on helping someone with suicidal risks.

Here’s this week’s recommendations:

1. The Myth of Infallibility:
   A therapist comes to terms with a client’s suicide.
   I’m not sure if this is free-to-access. I’m attaching the link to my saved version here just in case. Please support Psychotherapy Networker’s publications if you found this useful.
   

2. In the Aftermath of Suicide
   The long journey to healing. A story of a client who lost her husband to suicide. (link)
   

3. When Therapists Struggle with Suicidality
   From Stacey Freedenthal. You might recall her in Part I (link)

4. On the Death of My Friend
   A reflection on bipolar disorder and suicide. A tribute to the late editor of Psychotherapist Networker/Family Therapy Networker for 45 years.
   We miss you, Rich.

5. ⏸️ Word Worth Contemplating:

   Stay.

P/S: If this was hard to read, even if you are a helping professional, do reach out for support in your local area.

PP/S: Today’s the second anniversary of our edited book The Field Guide to Better Results. Thanks to all of the contributing authors.

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Daryl Chow Ph.D. is the author of The First Kiss, co-author of Better Results, The Write to Recovery, Creating Impact, and the latest book The Field Guide to Better Results. Plus, the new book, Crossing Between Worlds.

You might be interested in my other Substack, Full Circles: Meditations on the Inner and Outer Life.