Written by: Howard Fradkin, Ph.D., Chairperson, OPA Colleague Assistance Program
Think about who are your most challenging clients. My guess is for many of us, suicidal clients rank right up there as some of the most challenging.
At the end of October, OPA sponsored its Fall Assembly, and the topic was suicide prevention. While we talked a lot about what resources are out there for suicidal clients, and what evidence-based methods are effective, what struck me from a colleague support perspective is the dearth of help for any of us struggling with the personal emotional challenges of working with suicidal clients. Some folks on the call talked about how they faced stigma reactions from colleagues when a relative died by suicide. Others shared how in their agency, if a colleague has a client commit suicide, they were instructed not to talk to them or to anyone about it.
We talked about how important it is for clients to know they can talk to us about anything, especially feelings of wanting to end their lives. And we talked about how important it isto encourage clients to reach out for support so they know they are not alone.
But who do we talk to about the feelings that may surface as we gently and compassionately help them with these struggles? Do you feel alone with these struggles because you have not given yourself permission to reach out for the help you need and deserve? What if our agency takes the position we can’t talk with other colleagues? Where do we turn?
It feels very important, just as we give clients permission to talk about any feelings, that we need to give ourselves and our colleagues the same permission. It is normal when working with a suicidal client to experience mirror feelings of hopelessness, helplessness and powerlessness. Even though we know there is always a way to find hope, when a client is so down that they cannot feel any hope, and when we offer them hope and they rebuff us, that can be very painful and frustrating for us. When a client tells us, “don’t worry about me, I am fine,” but inside you have the felt sense they are far from fine, how do you cope with that anxiety? Maybe they even make another appointment, and you say to yourself, well,
that is a relief, at least I know they will be back. But will they? When they walk out of your office, and you are left with uncertainty, how much does it bog you down? It can be very difficult to figure out how much responsibility do we have. Do you spend time going over and over the session, wondering, did I ask enough questions and do a thorough enough assessment? Did I somehow unconsciously communicate my anxiety to them, somehow leading them to believe they are responsible for me? Did I offer them enough reassurance, or did I get manipulated into believing their internal lie because I’d rather believe they will be okay, and then I won’t have to worry. It is very complicated, and I believe we all at times need support to sort through the many complex feelings this work evokes.
A number of us have had one or more clients also commit suicide while under our care. This usually creates much more intense feelings –feelings of incompetence and failure, shame, feelings of fear about being sued, losing our license or career, or fears of others losing faith in us or judging us. We may face colleagues avoiding us, not knowing what to say. Perhaps we work in one of those agencies where we are not allowed to talk about it, and yet our insides are screaming for support.
As a professional organization, we talked at the Assembly about how important it is for OPA to figure out ways we can provide this needed support. Your Colleague Assistance Program will be exploring ways we can help you if you are facing these struggles. We are all valuable and do very important, honorable work. I encourage you to know you are worthy of all the support you need, whatever the source of your struggles may be.
Maybe we can organize a gathering/video discussion/conference call for folks willing to talk about these issues and do some brainstorming? OPA recognizes that our struggle is real and as an organization, it is opening a door for all of us. Let's walk through it. Together we can come up with some options for supporting one another as human beings and as psychologists...options that acknowledge the complexities that we face in doing this work...options that don't feed the fear or shame. We are not super-human. As people and as professionals, we need this.
I'm in. Anyone else?
Howard: Thank u so much for participating in the Assembly. Your contributions were powerful! I'm also grateful to u for writing this article. I'm saddened (but not surprised) by the lack of response to it. Psychologists are human. We have feelings. We struggle. We're no different than those who sit across from us in therapy. Yet even with all of our experience & knowledge about health & healing, we struggle to speak openly about how we are impacted by suicide. And that is unfortunate. The work we do is hard! We need to support one another, but we can't without acknowledging feelings & voicing our needs to one another. Without change, we'll work in isolation, hide our internal struggles & continue to (hypocritically) advise clients to do what we don't/won't/can't. At some point, it'll become too much, we'll burn out & leave the field or even worse, stay & be ineffective or do harm. What are we going to do about the fears and ongoing stigma that silence us? See also next comment.