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Teen Suicide: Helping Survivors Make Sense of Sudden Loss
Teen Suicide continuing education addiction counselor CEUs

Section 5
Suicide Intervention Skills

CEU Question 5 | CEU Test | Table of Contents | Grief
Psychologist CEs, Social Worker CEUs, Counselor CEUs, MFT CEUs

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On the last track, we discussed three types of bargaining survivors of a teenager’s suicide may use to cope with the trauma.  These three types of bargaining are the long goodbye, scapegoating, and cutting off.  We also discussed the Rescripting technique.

On this track, we will discuss explaining four concepts regarding responding or (moving on) to a teenaged loved one’s suicide to clients.  These four concept are responding is not the same as forgetting, responding takes time, painful feelings are normal, and mourning is essential.  We will also discuss the programmed cry technique.

Larry and Melinda, both 48, had prided themselves on being the perfect parents.  They spent almost every free moment with their daughters, Becky, 18, and Stacy, 16.  Larry and Melinda were well aware that Stacy was a slow learner, and so the couple spent time each evening helping Stacy with her homework and trying to help her feel better about herself.  When Stacy turned 17, she took her own life. 

Larry and Melinda reacted with anger.  Larry stated, "I feel cheated!  We devoted our whole lives to Stacy and Becky, and now Stacy has taken our lives along with hers!"  Becky, the couple’s oldest daughter, found it difficult to deal with her parents’ pain, and stayed away from home as much as possible.  By the time Larry and Melinda entered therapy, she had moved into her own apartment.

Although Larry and Melinda’s ability to express their anger towards Stacy was of course a positive sign, but the couple was clearly not making progress in responding to Stacy’s suicide.  In our first session, I explained the process of responding to a loved one’s suicide to Larry and Melinda.

4 Step Process of Responding (Moving On) to a Loved One's Suicide
-- 1. Responding is not the Same as Forgetting
I stated to Larry, "A first concept regarding responding is to recognize that responding is not the same as forgetting about what happened. This does not mean that you can expect to get over Stacy’s suicide completely, or that you have to completely let go of the anger you feel.  But responding does involve letting yourselves think good thoughts about Stacy, and learning to feel good about yourselves again.  For many people, responding also means learning not to feel guilty."

-- 2. Responding takes Time
A second concept regarding responding to a teenager’s suicide involves recognizing that responding takes time.  I reminded Larry and Melinda that their feelings of anger, grief, depression, guilt, and despair may continue as they work through the responding process.

-- 3. Painful Feelings are Normal
In addition to responding is not the same as forgetting, and responding takes time, a third concept regarding responding to a teenager’s suicide is that painful feelings are normal. 

I stated to Larry and Melinda, "The anger you are feeling is natural, and it is healthy to acknowledge and express this anger.  However, it is important to allow yourself to feel other emotions as well.  Many survivors of a loved one’s suicide feel guilt, fear, relief, loss, or depression, and may even have suicidal thoughts themselves.  Sometimes I have found that when a survivor begins to feel and acknowledge this range of emotions, he or she may feel like he or she is ‘losing it,’ but that is not the case.  Feeling a wide range of strong emotions is a normal part of the responding process."

-- 4. Mourning is Essential
A fourth concept regarding responding to a teenager’s suicide is that mourning is essential. 

I stated to Larry and Melinda, "What I mean by mourning is taking time out from the real world, even briefly, to think about Stacy and your relationship with her.  After this period of focusing on Stacy, the goal is to return to your normal life, having made an adjustment to her death, able to respond to the world around you.  Mourning is very necessary, but many survivors don’t get an opportunity to mourn because they get stuck.  Their guilt or anger is so intense, they stay in their grief not moving ahead."

Programmed Cry Technique
To help Larry and Melinda acknowledge and express other emotions in response to Stacy’s suicide, I encouraged both clients to try the "Programmed Cry" technique.  Clearly, anger had felt like a safe emotion for Larry and Melinda, since expressing anger diverted them from feeling and expressing sorrow, grief, and guilt.

I stated, "This is an exercise you should each do individually.  Each of you should choose an evening that you can set aside to take time to cry and express grief."  To prepare for the programmed cry, I asked Larry and Melinda to each identify a supportive friend who could ‘be their caretaker.’ 

I stated, "Your caretaker should be someone who is familiar with the circumstances of Stacy’s death.  During your programmed cry, keep his or her number by the phone in case you need assistance."

The 11 steps in the programmed cry are as follows:
1. Choose a room in the house that has special importance to you.  You may want to consider choosing Stacy’s bedroom.  Bring a full box of tissues, a radio or cd player, a pillow, and a picture of Stacy with you.  Choose a time in the evening for your programmed cry.
2.  Turn the lights in the room low, and turn on soft music.  Select a station with few interruptions, or a tape or CD of sentimental music.  Turn the volume as loud as is comfortable.
3. Feel the impact of the mood you have created.  Allow it to touch your sadness.  Think about Stacy and look at your photographs.  Remember your most special times, and think about your loss.  Turn your feelings loose.  Say what you are feeling aloud to yourself.
4.  Put two chairs back to back.  Sit in one, and imagine Stacy sitting in the other.  Talk directly to Stacy.  Tell her what you are feeling out loud.
5.  If you have a religious orientation or a concept of a divinity, you may wish to picture God or another spiritual focus sitting in the other chair.  Tell God, or your chosen focus, your feelings about your loss without restraint.
6.  Hold your pillow in your arms and cry into it.  Rock back and forth.  Yell if you want to.  Call out your loss.  Let your feelings go for as long as they want to come out.  Know that you are bveing healed by the release of all the pain and sadness.  Do not try to hide any feelings.
7.  When you begin to feel better, allow that new feeling to emerge.  Concentrate your attention on ther positive thoughts that you are having.  Say those positive thoughts out loud.
8.  When you are ready, turn up the lights and turn the music down low.  Change the mood of the music to something happy and bright.  Put away the symbols of your cry- the tissues, pillow, and chairs.
9.  Do breathing exercises; stretch your muscles.  Do simple calisthenics or run in place.
10. Drink a large glass or two of water.  Make some herbal tea, or have some juice.  Snack on something healthy like fruits or vegetables.
11.  Take a warm bath or shower, read a humorous book, and then go to sleep.  The next morning, journal about your experience.

Think of your Larry or Melinda.  Would the programmed cry technique help him or her start to accept and express a broader range of feelings as he or she begins to respond to the suicide of his or her loved one.

On this track, we have discussed explaining four concepts regarding responding to a teenaged loved one’s suicide to clients.  These four concepts are responding is not the same as forgetting, responding takes time, painful feelings are normal, and mourning is essential.  We also discussed the programmed cry technique.

On the next track, we will discuss the Letter to Grief technique and the Family Trigger Chart Technique.

Peer-Reviewed Journal Article References:
Braun, M., Till, B., Pirkis, J., & Niederkrotenthaler, T. (2020). Suicide prevention videos developed by and for adolescents: A qualitative study. Crisis: The Journal of Crisis Intervention and Suicide Prevention. Advance online publication. 

Lee, E., won Kim, S., & Enright, R. D. (2015). Case study of a survivor of suicide who lost all family members through parent–child collective suicide. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 36(1), 71–75. 

Love, H. A., & Durtschi, J. A. (2020). Suicidal ideation and behaviors in young adults: A latent profile analysis. Journal of Family Psychology. Advance online publication. 

Mackelprang, J. L., Karle, J., Reihl, K. M., & Cash, R. E. (G.). (2014). Suicide intervention skills: Graduate training and exposure to suicide among psychology trainees. Training and Education in Professional Psychology, 8(2), 136–142. 

Zisk, A., Abbott, C. H., Bounoua, N., Diamond, G. S., & Kobak, R. (2019). Parent–teen communication predicts treatment benefit for depressed and suicidal adolescents. Journal of Consulting and Clinical Psychology, 87(12), 1137–1148.

Online Continuing Education QUESTION 5
What are four concepts regarding responding to a loved one’s suicide which you may want to explain to a grieving client? To select and enter your answer go to CEU Test.

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