square bulletPostvention is Prevention

September 23, 2017

From A. Del Quest, PhD, LCSW, Assistant Professor, Pacific University Oregon

CAUTION: Content may be upsetting to some readers.

Those of us who work in the suicide field know the importance of effective aftercare (postvention) for family members and friends of someone who died by suicide. Postvention refers to those activities that provide support and grief services in the aftermath of a suicide death. As providers, we know how critical that care is for long term recovery. Research has shown that those who lose a loved one to suicide are at increased risk themselves. So as therapists, we suggest rest, eating well, exercise, time with loved ones, and any other tactics the clients use to care for themselves. But all that seems to go out the window when the loss is close to home. If we lose a client or loved one to suicide, somehow all the things we would normally encourage in a client seem impossible to do ourselves.

We know our clients may feel hopeless or done with their pain at some point. We try to hold that pain for them but it isn’t always enough. Hard as we try, providers cannot always show the light ahead. We are not always able to help them have a vision of life other than the one they live on a daily basis. And, sometimes we have a client who cannot see beyond what they feel in the moment nor can they envision feeling differently in the future. For some of us, that client will find a way out that was nothing we ever anticipated. Those clients stick with us forever.

I remember how she described her pain and I understand she saw no other way out. She explained clearly that she did not want to remain in a home where she had felt only abuse. She trusted very few people for good reasons. One of the few she did trust, told her how she could make the pain go away forever and she believed him. So on a sunny summer day, she followed the steps he described and ended her life. I know it was the only way she saw to end the unending pain. I know she felt she was taking control of her life, in a way she had never been able to before. I know these things and I still will never think of her without the deepest sadness. There is not much of that day I don’t remember in the most vivid detail—the sounds, the smells, the terror on the faces around me. While I have done a lot of my own therapy work since then, I still have moments when I am overwhelmed and certain things still trigger the images that resurface.

I sat down to write this blog thinking I would talk about suicide postvention and the importance of understanding how to help clients face this type of loss. I thought I might say a bit about the gap in training for mental health providers when it comes to suicide-related topics. I wanted to ask you to think about your values and biases about suicide and those who take their lives and how that might get in the way of being able to understand what your client means when she tells you she will not go home. But my message turned more personal. Perhaps it is OK to just tell you that you will survive the crushing blow of losing someone you care about to suicide. You will find the way to get up day after day and go through the motions of living. And you will be forever changed. It is loss and trauma unlike most of us have ever imagined. At first you will not understand why they died. Later you may come to the realization that they saw no other way through. But you will always feel regret and maybe some anger and even possibly despair. Sometimes your feelings will surprise you and yet, those feelings are normal. In those moments, remember what advice you’d give a client about caring for themselves . . . and do it for yourself.