Since the quality and quantity of resources available to families contribute to mental and physical health, effective intervention must begin with a comprehensive understanding of the social environment of survivors. Counselors are challenged not only to understand the individual context of grieving, but also various family issues, including the synchronicity of grieving within the family. There is no standard timetable for healing and adjustment. Children do not usually move into their grief reactions until after their surviving caretakers have stabilized (Dalke, 1994).
For the bereaved, community support is also important in managing daily living and interpreting the meaning of the loss. Funerals are an important ritual to help a family regain emotional balance (Baldwin, 1989), and most survivors recall receiving considerable emotional support at the funeral (Van Dongen, 1993). Unfortunately, after a suicide, the cultural rituals for interpreting the meaning of death and prescribing roles for survivors are not well scripted, and survivors often report the support they received to be unhelpful (Allen, Calhoun, Cann & Tedeschi, 1993; Smith, Mitchell, Bruno, & Constantino, 1995).
The helper role in assisting families is complex and multidimensional (Trolley, 1993). The helper must serve as a resource person, information disseminator, and sometimes the "quiet voice of reason." Because survivors are often in shock, experiencing a blurred reality, the quiet voice of reason can encourage viewing of the body, if appropriate; assist in communication with medical personnel; and respond empathetically to the intense display of emotions. Survivors need to hear that "it won't be like this forever."
The helper may also be required to educate survivors about coping styles, the impact of grief, and children's responses. Serving as a family counselor or group facilitator is an additional aspect of the helping role. Talking with other suicide survivors can provide affirmation, validation, and a reduced sense of isolation (Moor, Freeman, & Stephen, 1995). Questions such as "What will it be like for you when you finally get through the mixed-up feelings about suicide?" may also be useful (Dalke, 1994). All feelings are legitimate. The role of the counsellor is to acknowledge the family's difficulty and affirm the feelings of all its members (Dalke, 1994).
Self-reflection is also critical to effective helping. Questions for self-reflection include, "Do I see suicide as taboo and shameful?" "If so, am I colluding with the family to develop a conspiracy of silence around the suicide?" "Do I see suicide as a mental illness, and if so, through a process of contagion, are survivors being viewed as mentally ill?" The intense emotions of survivors are often difficult to confront, and they challenge helpers to face the fragility and unpredictability of life. This may lead to collusion with the survivors not to discuss the death.
The social stigma of suicide erects barriers to seeking help and can leave survivors with a sense of blame by helping professionals. Therefore, they tend to resist intervention (Barlow & Morrison, 2002). Resistance toward the helping community is also related to perceptions of non-support prior to or immediately following the suicide. Moreover, survivors may not perceive a need for assistance, and others may not know about the resources available.
It is imperative for survivors to understand that "figuring it out" is an individual process that consumes considerable intellectual and emotional energy. As the survivors move in and out of coming to terms with their individual interpretations of "why," the counselor can help families refocus on beliefs about themselves and their futures (Dalke, 1994). Ultimately, survivors need to assign the responsibility for the suicide to the deceased and acknowledge the impossible task of defining causation (Trolley, 1993). These messages, applied sensitively and at the right time, can help the family move on.
Counselors may find guidance in the writings of Iris Bolton (1998), who wrote a personal and moving account about her grief after the suicide of her son. She documents four tasks of grieving:
- Tell the story. "Talking about what happened magically helps it become real" (p. 356).
- Express your emotions. "Talk them out, scream, write, draw, punch a punching bag, tell an empathic friend, take a walk, do something to express what you feel" (p. 356).
- Make meaning from your loss. "You can determine that something positive will come out of the horror of this tragedy" (p. 356).
- Make a transition from the physical presence of the person to a new relationship. This connection may be spiritual or it may develop through memories of the past.
The suicide of a family member is one of the most difficult life events an individual may face. The adjustment becomes exponentially difficult because survivors must not only take care of themselves, but must also consider other family members. Because personal responses to the death depend on a complex set of variables, such as emotional attachment to the deceased, role in the family, and personal coping styles, grieving family members may be out of step with one another. Helpers working with families bereaved by suicide face a complex task, requiring them to assume both educational and counseling roles to help families effectively cope with their loss.
- Barlow, Constance, & Heather Coleman; Suicide and families: considerations for therapy; Guidance & Counseling; Winter 2003; Vol. 18; Issue 2.
Reflection Exercise #2
The preceding section contained information regarding counseling guidelines for treating families grieving suicide. Write three case study examples
regarding how you might use the content of this section in your practice.
Online Continuing Education
According to Barlow, what are three benefits in talking with other suicide survivors? Record the letter of the correct answer the