Reactions to Patient Suicide Deep, Long Lasting
The suicide of a patient can affect a clinician long after the event (see article above). At the annual meeting last month of the American Association of Directors of Psychiatric Residency Training, Jane Tillman, Ph.D., described an empirical study of 12 psychoanalytic clinicians who had a patient commit suicide.
Her study, “When a Patient Commits Suicide: An Empirical Study of Psychoanalytic Clinicians,” was published in the February 2006 International Journal of Psychoanalysis. At a workshop on dealing with the suicide of patients treated in residency programs, she reported the devastating effects a suicide can have on even seasoned clinicians.
“I underestimated the power of the emotional responses I would receive going into the study,” said Tillman, a clinical psychologist at Austen Riggs Center in Stockbridge, Mass. “All of the clinicians were deeply affected even years after the event.”
Tillman told training directors at the workshop that one respondent compared his feelings, years after the suicide of a patient, to a PTSD response. “When I am home and the phone rings, my heart starts pounding,” the clinician told her. “Four years after the event I still feel a rush of adrenaline every time the phone rings.”
In the study, she interviewed six psychologists, five psychiatrists, and one social worker who had been in practice from one to 25 years. She identified eight themes in the responses of the clinicians:
Traumatic responses—initial reaction, dissociation, avoidance, and somatic symptoms | |||||
Affective responses—crying, sadness, anger, grief | |||||
Responses regarding treatment-specific relationships—review and reconstruction of work with the patient, sense of responsibility to the patient's family | |||||
Responses to relationships with colleagues—personal analyst, supervisor, or peers | |||||
Responses related to risk management concerns—fear of a lawsuit | |||||
Responses of grandiosity, shame, humiliation, guilt, judgment, blame | |||||
Sense of crisis—loss of faith in psychodynamic treatment, concerns about competence | |||||
Concerns about effect on work with other patients | |||||
The study “confirms the narcissistic injury to clinicians who have a patient commit suicide,” Tillman wrote. “But more importantly, I think these clinicians are telling those who have not had a patient commit suicide about the risks that may be inherent in the choice of profession.”
An abstract of her study can be accessed at<www.ijpa.org> by clicking on “Past Issues” and then “February 2006.”
