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Section 6
Family Interventions following a Suicide
Question 6 | Test
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In the last section, we 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.
In this section, we will discuss the Letter to Grief technique and the Family Trigger Chart Technique.
Frank, 53, came in to therapy on the suggestion of his wife, Deborah. Three weeks after their son David’s suicide, Frank resumed his day to day routines. Deborah stated, "I’m just so worried! I know Frank cries, but he hides it from me, and most of the day he just goes around, doing his routine like some kind of robot!"
When I spoke with Frank, he stated, "I feel like I’m about to lose it. I have to take care of my wife and our other son, so I can’t afford to fall apart. I just try to push it all down, but lately I bounce back and forth between feeling like I’ll never stop hurting and being completely numb. I can hardly sleep, and I can’t seem to make even a simple decision like whether or not Jim can use the car to go to his friend’s house."
I stated to Frank, "I understand that sometimes it feel like grief gets in the way of what we have to do. But sometimes, grief can be an important teacher. Taking the time to listen to what your grief is telling you can help you recognize important steps you can take towards rebuilding your life."
♦ "Letter to Grief" Technique
-- 1. I invited Frank to try the "Letter to Grief" technique. I stated to Frank, "For this exercise, you are going to write two letters. If you have a regular stationary that you use for family letters, I suggest you use that. The first letter is from you to your grief. Before you write, ask yourself, if you could tell your grief what you are thinking or feeling, what would you say? What do you want your grief to know about its impact on your life? Be as frank as you can. Write the letter, then sign it and seal it in an envelope."
Frank’s letter to his grief began, "Dear grief, You are a pain. You have stolen my energy, my decision making skills, and my drive. I was prepared for the immediate grief when David killed himself. I wasn’t prepared for this low energy level, numbness, and feeling dumb all the time. I am impatient with you. You take so much out of me when I need to be able to support the rest of my family, and I don’t understand why."
-- 2. In our next session, I asked Frank to write a second letter. I stated, "This time, I’d like you to write a letter from your grief to you. Before you start to write, think about what you think your grief is trying to tell you. What does your grief want from you? Then, as frankly as possible, write to yourself on behalf of your grief."
Frank’s letter on behalf of his grief stated, "Dear Frank, I am sorry that I’ve caused you so much pain. But grief is the last gift of love you can give David. Try to experience it in a normal way, and let your own time frame happen. I know you are working hard to get through this phase of your life. You should be proud of that, and of how you’ve been able to keep taking care of Deborah and Jim. But I want you to take care of yourself too. Get extra sleep once or twice a week, even if you have to let something slide. You’ll be all right. If you take the time to take a little extra care of yourself now, soon your energy levels will be back. I am a part of life. there is a purpose for me."
-- 3. I asked Frank to take both letters home, and put them aside for at least two days. I stated, "After a couple of days, reread both letters. What do the letters together reveal about your attitude towards grief? What new things can you learn about yourself from the letters?"
In one of our later sessions, Frank stated, "I used to spend a lot of time asking myself why David would kill himself when he had such a bright future ahead of him, and when we loved him so much. But recently, I spend a lot more time asking myself how I can fill the void that David’s death left in our lives."
Clearly, this progression from asking ‘why’ questions to asking ‘how’ often indicates that a client is ready to face the reality of his or her loss. Asking ‘how’ questions may also express a client’s search for ways to put his or her life back together after the loss of a teenager to suicide.
♦ "Family Trigger Chart" Technique
One technique I recommended to Frank is the ‘Family Trigger Chart’ technique, to help Frank, Deborah, and Jim discuss how to rebuild their life as a family.
I stated to Frank, "As you recover as individuals and as a family, you will each probably continue to find that there are some situations which trigger emotions or responses connected to David’s suicide. The Family Trigger chart can help you let each other know what reminders are the hardest for you, and how you can work together to either minimize your exposure to these triggers. The Family Trigger chart can also help you agree ahead of time on strategies for conveying love, understanding, and support when one of you has been triggered."
3 Steps in the "Family Trigger Chart" Technique
-- Step 1. I stated to Frank, "The first step in the family trigger chart technique is for you, Deborah, and Jim to each take a sheet of paper and make four columns. Head the first column ‘trigger,’ the second ‘my reactions,’ the third ‘memory,’ and the fourth, ‘how others can help.’
-- Step 2. Next, in the first column, each of you lists situations on which you feel overwhelmed by David’s suicide, when you feel the adrenaline rush to flee or fight, or where you shut down and feel numb emotionally, physically, or both. These triggers may be sights, sounds, objects, or situations that you closely associate with David or the events surrounding his suicide. In the second, indicate your specific reactions to each situation. In the third, write which specific memory each trigger is associated with."
-- Step 3. The final step in the Family Trigger Chart technique is for each family member to fill in suggestions for what others might do for them to help in a trigger situation. The family can then discuss their charts together, and the rest of the family can add suggestions of how they could help each other.
Think of your Frank. Would the Family trigger chart help him or her understand and anticipate when he or she might be susceptible to triggers? Would the family trigger chart help the family work together to address triggers that stem from a teenager’s suicide?
In this section, we have discussed the Letter to Grief technique and the Family Trigger Chart Technique.
In the next section, we will discuss four types of reactions the siblings of a teenager who commits suicide may exhibit. These reactions are, feeling like secondary mourners, feeling like a substitute, rebellion, and parenting the parents.
Reviewed 2023
Peer-Reviewed Journal Article References:
Asarnow, J. R., Berk, M. S., & Baraff, L. J. (2009). Family Intervention for Suicide Prevention: A specialized emergency department intervention for suicidal youths. Professional Psychology: Research and Practice, 40(2), 118–125.
Bartik, W. J., Maple, M., & McKay, K. (2020). Youth suicide bereavement and the continuum of risk. Crisis: The Journal of Crisis Intervention and Suicide Prevention. Advance online publication.
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.
Diamond, G., Creed, T., Gillham, J., Gallop, R., & Hamilton, J. L. (2012). Sexual trauma history does not moderate treatment outcome in attachment-based family therapy (ABFT) for adolescents with suicide ideation. Journal of Family Psychology, 26(4), 595–605.
Kaslow, N. J., & Gilman Aronson, S. (2004). Recommendations for Family Interventions Following a Suicide. Professional Psychology: Research and Practice, 35(3), 240–247.
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.
QUESTION 6
What two concepts may be implied by a client’s move from asking ‘why’ questions about a teenager’s suicide to asking ‘how’ questions? To select and enter your answer go to Test.