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Teen Suicide: Helping Survivors Make Sense of Sudden Loss
Teen Suicide continuing education social worker CEUs

Section 7
Track #7 - Surviving Siblings:  Structured Sleeping Technique

CEU Question 7 | CEU Answer Booklet | Table of Contents | Grief
Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs

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On the last track, we discussed the Letter to Grief technique and the Family Trigger Chart Technique.

On this track, we will discuss four types of reactions the siblings of a teenager who commits suicide may exhibit.  These reactions are, feeling like secondary mourners, feeling like a substitute, rebellion, and parenting the parents.

4 Reactions a Sibling may Exhibit
Share on Facebook 1. Secondary Mourner
A first type of reaction the siblings of a teenager who commits suicide may exhibit is feeling like a secondary mourner.  When Carrie’s sister Bridget, 17, was found dead after slitting her wrist, Carrie, age 14, felt that she had lost more than her older sister. 

Carrie stated, “I feel like I’ve lost my whole family.  Sure, our family and friends are being supportive, but they only pay attention to Mom and Dad.  Mom’s completely out of control.  She spends all her time screaming and crying, and if I try to talk to her she just gets more upset.  Dad acts like I don’t even exist.  He can be looking right in my direction and it’s just like he’s seeing right through me. All my whole life it’s been ‘Bridget, Bridget, Bridget.’  I miss my sister, but even now that she’s dead she still getting all the attention!  No one cares that I’m hurting too!  I can’t sleep, I can’t concentrate… and no one cares!” 

Share on Facebook 2. Substitute
A second type of reaction the siblings of a teenager who commits suicide may exhibit is feeling like a substitute.  Some sibling survivors may feel that they are being ‘used’ to fill the emotional void left by their sibling’s suicide.  Additionally, becoming overprotective of surviving children is a natural reaction.  A young teenager who may have begun taking age-appropriate steps prior to the suicide may feel his or her parents are suddenly being intrusive or judging his or her capabilities unfairly.

Share on Facebook 3. Rebellion
In addition to feeling like a secondary mourner and feeling like a substitute, a third type of reaction the siblings of a teenager who commits suicide may exhibit is rebellion.  As you a well aware, a surviving sibling may make use of the parent’s apparent failure as an excuse to reject parental direction. 

I have found that grieving parents may be afraid to confront surviving siblings about rebellious or dangerous behavior out of fear that the surviving sibling may blame them for their brother or sister’s suicide.  In my experience, a constructive strategy for helping grieving parents address the fears involved with reestablishing active parenting is for me to help these parents find a support group in which they can hear other brothers and sisters discuss what they went through after suicides in their families.  

Share on Facebook 4. Parenting the Parents
A fourth type of reaction the siblings of a teenager who commits suicide may exhibit is parenting the parents.  Carrie felt that she was being required to be the adult in her house. 

Carrie stated, “No one has cooked a meal in my house other than me since Bridget died.  No one cleans the house unless I do.  I have to remind my dad to pay the bills.  I started going over to my friend Tricia’s house every day for dinner, but then Tricia’s mom started asking why I never wanted to eat at home.  So I just started going grocery shopping and cooking for everyone.”  Of course, other surviving siblings may put aside their own needs in a number of other ways as well. 

Since Carrie had mentioned insomnia as a primary symptom, I included the Structured Sleeping Technique in my intervention with Carrie.  Since Carrie felt that her life was very chaotic without the parental support she was used to having, I found that the Structured Sleeping Technique helped Carrie feel more in control, in addition to addressing her difficulty sleeping.

Share on Facebook Structured Sleeping Technique
The first step in the Structured Sleeping Technique is to create an hour-by-hour daily calendar.  I stated to Carrie, “I’d like you to make a plan for what you are going to do during each 24-hour period.  Each day will be divided into four parts.”
1. Morning.  List what you will do from the time you get up until the time you have lunch.  Schedule your lunch at a specific hour, and eat at that time whether you feel like eating or not.
2. Afternoon.  List what you will do after lunch until time for dinner.  Schedule dinner at a specific time, and eat whether or not you feel like eating.
3. Evening.  List the hours of the evening from dinner until bedtime.  Fill in what you will do each hour of the evening.  Try to follow through with each evening’s plan.  Schedule relaxing activities that focus on your own needs. 
4.  Night time.  List the time that you are waking most frequently during the night.  Carrie found that she usually awakened around 2 am.  I then asked Carrie to list each half hour from three am to her normal waking time at 6am. 

I stated to Carrie, “Each evening, write down what you will do in 30-minute increments from the time you wake up until your normal rising time.  Give yourself tasks to do that are unpleasant.  Clean your room or bathroom, fold laundry, or anything you don’t like to do.  Do not snack or lie in bed staring at the ceiling.”

To complement the Structured Sleeping Technique, I instructed Carrie in a variety of relaxation breathing, progressive muscle relaxation, and visualization exercises.  I stated to Carrie, “If you do find yourself going back to bed during your early morning waking, use one of these relaxation techniques to help you go back to sleep.”   I explained to Carrie that most people find that after a few nights of using the structured sleeping technique, they are sleeping until their normal rising time without further problems.

During our next session, Carrie stated, “I’m sleeping a lot better now.  Things at home are still pretty bad, but I think I’m able to handle it a little better.  Not losing so much sleep made a big difference in my mood.” 

Carrie found that once she was taking care of her body better, she was better able to work on addressing the process of mourning her sister Bridget.  In addition to helping improve Carrie’s coping strategies, I of course also engaged Carrie’s parents in family therapy to help them identify and address the needs of their surviving daughter. 

Think of your Carrie.  Would the structured sleeping technique be helpful to him or her?

On this track, we have discussed four types of reactions the siblings of a teenager who commits suicide may exhibit.  These reactions are, feeling like secondary mourners, feeling like a substitute, rebellion, and parenting the parents.

Online Continuing Education QUESTION 7
What are four types of reactions the siblings of a teenager who commits suicide may exhibit? To select and enter your answer go to CEU Answer Booklet.

 
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