Suicide Loss crisis intervention strategies

Strategies for Crisis Intervention with Survivors after Suicide (those left behind)
From the work of Shoshana Alexander* – Volunteer for WinterSpring

“He was great because he just let me cry and carry on and didn’t try to ‘fix it,’ he didn’t try to make it better.  I told him that since he had no pat answer and no smooth solution—he just listened—it was marvelous!

~From Silent Grief: Living in the Wake of Suicide, by Christopher Lucas, 2007

Establish Empathic Connection

Do say:  “I’m so sad for your loss.”
Do listen, actively, with presence, without judgment
Don’t say: “I know how you feel.
Don’t give advice or try to cheer up client
Don’t say: “Things will get better; they always do.”

Assess Using ABCDE Model*

Affect:
  • Most common feelings are:
    • Shock and numbness
    • Hysteria (unable to stop crying)
    • Sadness and sorrow
    • Rage (This is unfair…why did God let this happen?)
    • Anger at self or at the deceased loved one (Why did I let this happen?  How could s/he do this to me?)
    • Guilt (I did something to cause the suicide.)
    • Shame (Suicide is a disenfranchised loss)
    • Denial (This can’t be true.)
    • Helplessness and feelings of abandonment
  • Assure client that intense emotions are normal
  • Ask gently:  What else are you feeling/experiencing?  And what else?
  • Reflect feelings back to them so they know you are listening.  “What I hear you saying is…”
Behavior Disorganization:
  • Confusion and disorientation
  • Withdrawal from friends and social interaction (No one wants to listen.  I’m not sure what to tell people about the death.)
  • Trouble sleeping and loss of appetite (nightmares, mental agitation)
  • Physical symptoms (nervous, jumpy, headaches, stomach aches, unusual sensations, weight loss, weight gain, etc.)
  • Difficulty concentrating
  • Self-medicating with alcohol, drugs; abuse of prescription drugs
  • Inability to work, go to school, attend to daily tasks
  • Overwhelm and inability to make decisions about logistics following the death
  • If there are suicidal impulses:
    • Ask directly and without judgment:
      • Have you thought about hurting yourself or ending your own life?
      • Do you have a plan?  The means to carry it out?  A time when you intend to do it?
    • Say: I care and don’t want to you die.  Explore options other than suicide.
    • Explore ambivalence, focusing on connections and purpose in life
    • Create together a “No Harm” contract
    • Be prepared to stay in touch often and on-going
    • Brainstorm and suggest supportive resources
    • On-going assessment and measures
    • In extreme cases, contact 911or call 1-800-273-TALK (8255)
Cognitive:
  • Encourage client to reveal and explore thoughts, beliefs, conclusions (e.g., I don’t deserve to live.  He must be suffering in hell.  I could have done something to stop her.)
  • Ask:  What are you thinking now?  What else is going through your mind?
  • In response to their sharing, ask:  How was that for you?
  • Assure client that the suicide was not his/her fault
Developmental:
  • Client may feel s/he doesn’t have the right to continue to live fully or embrace life again.
  • Assure client that their loved one would want them to live fully
  • Encourage returning to or moving forward with projects or dreams when they feel ready; gently explore and affirm the possibility; help them think of first steps
  • Acknowledge their strengths; e.g., say: “I noticed that you have reached out for help and this shows incredible courage.”
Environmental:
  • Explore all areas of support: family, friends, counselors, clergy, support groups, on-line chats and blogs from survivors; provide your own contact information, if appropriate
  • Recommend websites, emergency services numbers, books (e.g., Unfinished Conversation: Healing from Suicide and Loss, by Robert Lesoine, Marilynne Chöphel)
  • Recommend activities each day:  journaling, art, exercise, meditation, slow breathing

Ongoing Support:  Let client determine the pace; build on all positive steps.

Downloadable PDF Suicide Loss crisis intervention strategies

*This information was adapted by Shoshana Alexander from her Master’s program at Southern Oregon University and draws from the ABCDE model developed by Barbara G. Collins and Thomas M. Collins, Crisis and Trauma: Developmental-ecological Intervention, Brooks/Cole, 2005.