People left bereaved by suicide now face losing their trusted counsellors
Published 11/07/2016 | 02:30
'Why, oh why"? These are the words heard repeatedly from those who have lost a loved one to suicide, which is frequently inexplicable in its cause and always devastating for those left behind.
The counsellors in Console know this, of course and it is a deep disappointment that the HSE has decided to shut down the organisation and transfer its bereavement services to some other sector, presumably related to suicide.
For those presently availing of the services of Console, it will be upsetting, since counselling for any set of problems involves forming a trusting, confiding and respectful relationship with the counsellor.
As trust grows, the revelations become more personal. Alternatively, if such a relationship does not develop, then the person is unlikely to benefit from the intervention.
Once the therapist-client relationship is established, healing may begin.
Continuity in the therapeutic process is essential and rupturing the bond that has developed with the therapist can be devastating for a client.
This is particularly pertinent to a person bereaved by suicide, who will already have experienced a sudden and often inexplicable loss.
The changeover to another therapist can resemble a further bereavement.
To speak of the grief following suicide as "traumatic" is not hyperbole. The public and many in the medical profession are unaware that the grief following suicide, accidents or homicides is variously called complicated grief (CG) or traumatic grief to distinguish it from integrated grief, which is seen after death from natural causes.
This is because there are qualitative differences in the symptoms, their intensity and duration, all of which are greater.
It is now accepted by grief therapists, even for those suffering the raw grief that is associated with suicide, that routine therapy should not be offered. Instead, time should be allowed to pass, so that the natural processing of the event and the emotions associated with suicide can be expressed.
In a 'therapy-infused' culture, there is a danger that the counsellor's office will be the first port of call once the funeral has taken place.
This risks worsening the grief, rather than allowing it to ebb and flow and eventually stabilise.
Thus, counselling should be at the behest of the person bereaved, rather than being prescribed by well-meaning friends and family.
The question 'why' is the most prominent for those left behind after suicide. And sometimes no simple answer is forthcoming, since the reasons are complex.
Take two people with similar constellations of problems - one may take their life, while the other emerges enriched by their suffering. Factors such as mental illness, social supports, overwhelming stressful events, social attitudes to suicide and personality are just a few of the variables that influence one person towards, and the other away from, suicide.
Suicide bereavement is filled with guilt, blame directed to others and to oneself, anger and shame.
Those left behind sometimes feel rejected or abandoned because they feel that the deceased has chosen to leave them behind.
At times when a person discloses suicidal intentions, their relative will request a promise not to carry it out. When death then happens, there is a sense of having been deceived and misled.
There is then the legal process of the will to be executed and the inquest, which relatives say is the most difficult aspect after the death.
The person finding the remains of their loved one needs particular attention as memories of this may haunt them for years to come. Intense feelings of being utterly bereft are common.
The grief that suicide engenders is profound, complex and often enduring. It is very different from the emotions after other losses.
The counselling of those bereaved by suicide is also more specialised. Those charged with moving the services provided by Console need to be well informed about the particular needs of these people.
It is not enough to be well- meaning. Professionalism, evidence-based best practice, clarity of purpose and sensitivity are the key ingredients to appropriately fill the huge lacuna left by the closure of Console.
Patricia Casey is Professor of Psychiatry at UCD and Consultant Psychiatrist at the Mater Hospital, Dublin