Workplace Responses and Psychologists’ Needs Following Client Suicide

Abstract

This research aimed to explore the role of workplace responses in psychologists’ adaptation to client suicides. Participants were 178 psychologists who completed an online self-report questionnaire which included both open and closed questions yielding qualitative and quantitative data. Fifty-six (31.5%) participants reported one or more client suicides. Mixed results were found in terms of perceived support from the workplace following a client suicide. Psychologists reported a need for more open communication in the workplace, peer supports, space to grieve, as well as opportunities to engage in a learning process. The findings have important implications for research and for understanding the role of the workplace postvention. It also raises the need for external support to be accessible for psychologists working in private practice.

Keywords

workplace client suicide psychologists bereavement postvention

Most of the research on the impact of suicide is concerned with the experiences of family members or friends of the deceased. An aspect of suicide bereavement which has not received much research attention is the experiences of psychologists who have lost clients to suicide (Farberow, 2005). The existing research has indicated that client suicides are an “occupational hazard” in that they have serious personal and professional impacts on psychologists (Chemtob, Hamada, Bauer, Kinney, & Torigoe, 1988). Few studies, however, have reported on the frequency of client suicide among psychologists. A landmark study undertaken in the United States by Chemtob et al. (1988) reported that approximately 22% of psychologists had experienced a client suicide. Of these psychologists, 39% had experienced more than one suicide. Trimble, Jackson, and Harvey’s (2000) Australian study, by comparison, found that over one third (38.9%; n = 170) of psychologists had experienced one or more client suicides. A more recent study by Finlayson and Simmonds (2016) found somewhat lower frequency rates with 31.5% (n = 56) of participants reported a client suicide. Both the studies of Trimble et al. (2000) and Chemtob et al. (1988a) reported no differences in gender, age, and years of service between psychologists who had experienced a client suicide and those who had not. Results from Finlayson and Simmonds (2016), in contrast, indicated that psychologists with more years of service were more likely to have experienced a client suicide than those with less years of service.

Emphasis in Trimble et al.’s (2000) study was however on the utility of talking to work colleagues or supervisors, with little exploration of the overall organizational response and how this may contribute to psychologists’ coping and adjustment following client suicide. Eyetsemitan (1998) argued that where organizations lacked sensitivity to the bereaved role of an employee, this tended to create “stifled grief” which is where the bereaved person is denied the opportunity to process grief in its full course. Findings from a study by Gaffney et al. (2009) indicated that mental health workers who struggled most with adapting to or coming to terms with a client’s suicide were those who experienced pressure to resume work or undertake organizational and legal duties. Such findings highlight the need for organizations to be aware of the grief-related needs of the helping professional and to be flexible in enabling adjustments to work loads and time off so that space is given to mourn or adapt to the loss. Organizations can also be instrumental in providing adequate support resources, such as individual or group supervision, as well as opportunities for professional development which are likely to help psychologists to better process and adapt to the loss of a client by suicide (Strom-Gottfried & Mowbray, 2006).

The way in which organizations approach a case review or psychological autopsy of a client suicide also needs to be considered in light of psychologists’ adaption. Research carried out by Hendin, Lipschitz, Maltsberger, Haas, and Wynecoop (2000) studied 26 therapists who completed a questionnaire and attended a workshop where their cases and reactions to a client suicide were discussed. Hendin et al. (2000) argued on the basis of their findings that case reviews or psychological autopsies which explored the client’s treatment and circumstances surrounding the suicide tended to shift blame onto the therapist and that this blame tended to increase self-doubt and distress for therapists. These authors asserted that investigations or reviews of a client suicide need to shift from a blaming perspective to a learning perspective denoted by learning as much as one can about the suicide.

A potential problem for psychologists who work in private practice is that there may not be managers or peers in their workplace setting who they can turn to for support in the event of a client suicide. Hawgood and De Leo (2015) recommended that such psychologists have structured plans regarding who to contact for support in the event of a client suicide. Faberow (2005) also recommended that setting up independent institutions which have clinicians who are well informed about suicide and do not express negative judgments could also be helpful for psychologists in private practice.

Taken together, the research has indicated that organizational responses to a client suicide can either support or hinder psychologists’ processing and adaption to loss of their client by suicide. In other settings, such as private practice, there may not be any organizational structures in place which can lend support to psychologists following a client suicide. Consequently, this raises the need for research to consider psychologists’ experiences of organizational support in the aftermath of client suicide. The research reported here formed a part of a larger study which explored psychologists’ experiences of a client suicide. This research extended Trimble et al.’s (2000) study on the impact of client suicide and is also one of the first studies to have explored the role of workplace responses regarding psychologists’ adaptation to a client suicide. The aim here was to explore the extent to which psychologists felt their workplace was supportive following a client suicide and the support the psychologists identified they would have liked.

Method

Participants

Participants were 178 psychologists from across Australia. Of these 178 participants, 56 psychologists had experienced a client suicide. Forty-three of these psychologists were female (76.8%), 12 were male (24.4%), and 1 did not disclose gender. Nearly 39.3% were between 30 and 39 years of age (n = 22). This was followed by 19.7% of participants (n = 11) who were between 40 and 49 years of age, 14.3% who were between 60 and 69 years (n = 8) of age, 14.3% who were between 20 and 29 years of age (n = 8), and 12.5% were between 50 and 59 years of age (n = 7). Table 1 provides a summary of professional experience and demographics of the client whose suicide impacted on the participant the most. Participants responded to an invitation to participate in the study which was advertised on the Australian Psychological Society research page and also sent to approximately 500 different organizations employing psychologists for dissemination.

Table 1.

Participants’ Professional Experience and Characteristics of the Client Whose Suicide Impacted Participants the Most.

Professional experience	n	%
Professional group
Clinical psychologist	29	51.8
General psychologist	24	42.9
Counselling psychologist	4	7.1
Educational or school psychologist	1	1.8
Forensic psychologist	2	3.6
Organizational psychologist	2	3.6
Workplace setting
Private practice	34	60.7
Community mental health	17	30.4
Hospital	16	28.6
Academic	4	7.1
Other	13	23.2
Years of service
<1 Year	2	3.6
1–5 Years	11	19.6
6–10 Years	11	19.6
11–15 Years	11	19.6
16–20 Years	8	14.3
>20 Years	13	23.2
Gender of client^a
Male	35	63.6
Female	20	36.4
Age
<14 Years	1	1.8
15–24 Years	13	23.2
25–34 Years	16	28.6
35–44 Years	10	17.9
45–54 Years	9	16.1
>55 Years	7	12.5
History of previous attempts
Yes	31	55.4
No	20	35.7
I don't know	5	8.9
Was risk being attended to
Yes	44	78.6
No	12	21.4
Length of time since suicide
<1 year	23	41.8
1–2 years	12	21.8
3–5 years	9	16.4
6–10 years	5	9.1
>10 years	6	10.8

Missing data for one client on gender.

Questionnaire

A self-administered online survey was used to investigate the frequency and impact of client suicides on Australian psychologists who chose to participate in the research. The online survey used a mixed methods design with both quantitative and qualitative questions in the form of fixed choice and open-ended questions, respectively. The survey took approximately 5 min to complete for participants who had not experienced a client suicide and approximately 30 min to complete for participants who had experienced a suicide. The survey was composed of five sections, with the first-four sections designed for all participants. The first section gathered sociodemographic data on age and gender. The second section collected information about professional experience such as type of psychologist, years of practice, and workplace setting. The third section was concerned with the amount of suicide and professional training the participant received (reported in a separate article). The fourth section assessed the participant’s contact with a client suicide in their professional career and is subject to another study (Finlayson & Simmonds, 2016). Participants who reported that they had experienced a client suicide went onto complete the rest of the survey.

Fifth section asked the participant how many of their clients had died by suicide and then asked about the characteristics of a client whose suicide had the most impact on the participant and is reported in another article (Finlayson & Simmonds, 2016). Information was also gathered on the extent to which the participant considered the suicide to have been predictable, preventable, and whether they felt responsible for their client’s suicide (reported in Finlayson & Simmonds, 2016).

Information on professional changes, emotional experiences, and coping responses following a client suicide were also gathered and reported in a separate article (Finlayson & Simmonds, 2016).

In relation to workplace or organizational responses, participants were asked to rate the level of support that they received from their workplace at the time of the client’s suicide using an ordinal scale of “very poor, poor, fair, good, very good, and not applicable.” Two open-ended questions explored workplace support. The first asked “what sort of support did you receive from colleagues or the organization you worked for?” and the second asked “if you rated the support you received from the workplace as very poor or poor, what sort of support would you have liked to have received?

Procedure

Ethics approval was gained from the researchers’ university committee. It was considered that some distress or trauma could be experienced by participants in answering some of the questions about a client suicide. Participants who decided to participate in the research used a link to respond anonymously to an online Qualtrics software survey.

Participation was voluntary and participants were assured of confidentiality and anonymity. The survey program on Qualtrics was set up so that responses were anonymized which meant IP addresses, e-mails, or names were not recorded. In the event that participants experienced emotional distress while completing the survey, all participants were provided with telephone numbers for psychological support from two relevant services.

Data Analysis

Descriptive statistics were used to analyze quantitative data ratings of workplace support. All statistical analyses were implemented using the Statistical Package of Social Sciences (SPSS) software (version 20).

The qualitative component of the survey was analyzed using thematic analysis. Thematic analysis was selected for its accessibility and flexibility in enabling patterns in the qualitative data to be identified and analyzed (Clark & Braun, 2013). As recommended by Braun and Clark (2006), six phases of thematic analysis were used for the current study. Of the six phases, the first and second phases comprised familiarization with the data and the generation of initial codes for different features of the data, respectively. The third phase involved searching for themes in the data set by grouping different codes into themes. The fourth phase involved reviewing the themes identified in which themes were double checked to make sure the data set formed a coherent pattern. The fifth phase comprised defining the themes in the data set and naming the themes. Finally, the sixth phase involved producing an analysis for the current research, including a display of data extracts to support the themes identified.

Results

Workplace Support in the Aftermath of a Client Suicide

Participants who had experienced a client suicide were asked to rate the extent to which they had felt supported by their workplace on an ordinal scale of very poor, poor, fair, good, very good, and not applicable. A summary of the ratings on workplace support is provided in Table 2. Of the 56 participants who had experienced a client suicide, one in five (n = 12, 21.4%) participants reported that the support they received from their workplace had been poor or very poor. In contrast, approximately half of the participants (n = 29, 51.8%) reported good or very good support from their workplace in the aftermath of a client suicide.

Table 2.

Participants’ Ratings of Support From Their Workplace Following a Client Suicide.

Extent felt supported by workplace	n	%
Very poor	6	10.7
Poor	6	10.7
Fair	10	17.9
Good	13	23.2
Very Good	16	28.6
Not applicable	5	8.9

Participants who had experienced a client suicide were invited to describe the type of workplace support that they had received. Of the 56 psychologists who experienced a client suicide, 47 described the support they received from their organization or institution. Summarized in Table 3 are the key themes which highlight the varied types of support received from the workplace following a client suicide.

Table 3.

Frequency and Summary of Key Themes of Workplace Support Reported by Participants Following a Client Suicide.

Themes	n	%
Private practice—an isolating experience	4	8.5
Struggling silently in a workplace where grief is not openly acknowledged or attended to by managers or team leaders	11	23.4
Resorting to work colleague or peer support in face of poor management or team leader support	9	19.1
Stifled grief and adjustment in face of investigatory action	1	2.1
Disturbed relationships with colleagues or within team	2	4.3
Open communication and ongoing support within a supportive workplace	29	61.7

Note. For some of the 47 participants more than one theme was generated as such they total 56 in number.

Private Practice—An Isolating Experience

Some participants who had been working in private practice reflected on their experience as having been isolating, with one participant having decided to leave private practice as a sole practitioner, describing it as both “very isolated” and “horrible.”

Struggling Silently in a Workplace Where Grief Is Not Openly Acknowledged and Attended to by Management or Team Leaders

A recurrent theme among the psychologists who had rated their workplace support as very poor or poor was the organization’s failure from management to openly talk about client’s suicide.

The workplace did not really address the issue at all; it was not spoken about in an open way. It felt like things just had to go back to normal immediately.

For one particular participant, they described feeling “punished for taking time off and not wanting to pick up high risk clients soon afterwards.”

Resorting to Work Colleague or Peer Support in Face of Poor Management or Team Leader Support

For those participants who experienced poor support from management or team leaders, there was a marked tendency to rely on peer or colleague support.

I received most support from my colleagues who allowed me to talk about how I was feeling and coping at the time, and later helped me to review the case and ask for assistance if I was having doubts regarding any other at-risk clients.

Stifled Grief and Adjustment in Face of Investigatory Action

For one psychologist, the capacity to grieve and adjust to a client suicide was hindered by an investigatory inquiry which alienated them and erroneously shifted blame onto them.

This suicide triggered an investigation into my professional performance, and I was unable (and too ashamed) to discuss this with anyone. Allegations of poor professional performance were not substantiated.

Disturbed Relationships With Colleagues or Within the Team

For some participants, a lack of support in the workplace stemmed from relationship issues within the team.

There were significant issues within the team I worked for prior to the client's death, and therefore there was not a lot of support available from internal supervisor or colleagues.

My manger was great. The rest were pretty atrocious.

Open Communication and Ongoing Support Within a Supportive Workplace

Characteristics which defined a supportive workplace included open discussions about the client’s suicide within the team or from management which were handled empathically and respectfully. Follow-up and ensuring the psychologist had the support of colleagues they could talk to were also considered a feature of a supportive workplace. A workplace was also considered supportive when space was provided for psychologists to grieve as demonstrated through encouragement to have time off, to attend the funeral or other mourning rituals, such as a commemorative run. The following two extracts highlight these characteristics of supportive workplace.

My boss discussed how I was feeling, told me to take a break, discussed who I'd talk to for support, made clear they were available to ring at any time and followed up a couple of times to see how I was doing.

Formal debrief, plus informal discussions. Discussed both what happened while also talking about the nice things about the client. Encouraged and given time to attend the funeral. Attended funeral together with the team. Discussed with supervisor (external). More recently, having space to bring up in peer supervision the lingering effects of client's suicide. Constant validation and not being judged.

Type of Support Psychologists Would Have Liked to Have Received From Their Workplace or Employer

Where participants rated the support they received from their workplace as having been poor or very poor, they were invited to reflect on what type of support they would have liked to have received. Seventeen participants answered this question, and this included participants whose rating of workplace support had been fair (n = 3), good (n = 4), and very good (n = 1). Table 4 provides a summary of the four key themes identified in regard to the type of workplace support psychologists would have like to have received following a client suicide.

Table 4.

Frequency and Summary of Key Themes on Type of Workplace Support Participants Wanted Following a Client Suicide.

Theme	n	%
Open communication and acknowledgment
More communication	4	23.5
Appreciation or acknowledgment	2	11.8
Support
Opportunity to debrief or gain supervision	7	41.2
Peer support	1	5.9
Referral to support services	2	11.8
Space to grieve
Support to attend funeral	2	11.8
Time off	2	11.8
Opportunities to engage in a learning process
Team review	3	17.6
Better review of practices or case	3	17.6
More suicide risk training	1	5.9

Open Communication and Acknowledgment

For four of the participants, open communication and debriefing in the team would have been helpful and “Information on what occurred and on what would be occurring.”

An appreciation and acknowledgment of the experience or work was important for two others; “Just an awareness of the difficult work I was doing and appreciation.”

Space to Grieve

The opportunity for space to grieve was denoted by having permission from management to take leave or attend the client’s funeral.

I would have liked the opportunity to attend the funeral and express my sorrow to the client's mother (who I had significant dealings with)

Formal Support

For seven of the participants, the opportunity to debrief or gain supervision would have been most helpful.

I have found there to be a culture in mental health hospitals of just “getting on”. No one said that they needed any support or counselling, and denied the need for this when asked, so there was no follow up. I think the need to have structured and compulsory debriefing meetings would be of value. Compulsory, so people attending aren't seen to be “unstable/weak/emotional” etc. if they attend or speak up in wanting support.

Whereas gaining peer support and referrals for support would have been useful for some.

Opportunity to Engage in a Learning Process

Six of the participants described how reviewing of the case or practice would have been helpful as a learning process.

Better managerial support regarding review of case and finding where things could have been improved.

For one other participant, the provision of suicide risk training would have useful: “more training to help identify suicidal ideation and intent.”

Discussion

The current research was concerned with understanding psychologists’ experiences of workplace support following a client suicide. Quantitative data indicated mixed findings in that half of the psychologists rated the support they received as good or very good, yet one in five psychologists rated the support they received as poor or very poor, with the remainder rating it as fair. The qualitative data on the type of workplace support received provided better understanding of such mixed experiences, including the poor and very poor ratings of workplace support.

Where “private practice—an isolating experience” emerged as a theme, this reflected the acute isolation that some psychologists working in private practice experienced following a client suicide. This finding raises the need for external support resources such as clinical supervisors and colleagues to be readily available for psychologists in private practice. As recommended by Hawgood and De Leo (2015), psychologists in private practice need to have structured plans in terms of who they can contact for support in the event of a crisis such as a client suicide. Alternatively, Faberow (2005) suggested psychologists in private practice would benefit from having access to clinicians from an independent institution that have special training in suicide support and could help them work through a psychological autopsy.

A major finding from the qualitative data on workplace support was the importance of open communication. Here, the way in which service managers or team leaders communicated to the participants and their peers about a client suicide had important implications for adaptation. Where psychologists in the current study perceived their workplace to have been supportive, this was marked by the presence of open communication, as is conveyed in the theme which emerged of open communication and ongoing support within a supportive workplace. In contrast, where support from the workplace had been rated poor or very poor, this was denoted by an absence of open communication, as depicted by the theme struggling silently in workplace where grief is not openly acknowledged or attended to by managers/team leaders. This theme highlighted feelings of isolation that were experienced when there was a lack of open communication or acknowledgment of the psychologists’ grief and loss. Such findings of isolation in the face of poor communication or acknowledgment were similarly found in Ting, Sanders, Jacobson, and Power’s (2006) study.

The emergence of open communication as an important workplace need was also found when participants were given an opportunity to voice what they would have liked in terms of workplace support. Here, participants who were unsatisfied by the responses of their work place voiced the need for open communication and acknowledgment of a client’s suicide. Openness in communication about a client suicide has been thought to help destigmatize suicide and enable psychologists to feel less isolated and more able to voice their grief-related needs (Grad, Clark, Dyregrov, & Andriessen, 2004; Ting et al., 2006).

Another major finding was the importance of receiving both informal and formal support from colleagues and management, respectively. Such support is thought to be critical in the prevention of burnout and for enabling psychologists to better process and adapt to the traumatic loss of their client (Strom-Gottfried & Mowbray, 2006). The theme of open communication and ongoing support within a supportive workplace was denoted by ongoing support from management, supervision, and peers. Complementary to this, psychologists who reported the support by their workplace as being poor and very poor voiced the need for support in the form of debriefing and supervision and peer support as well as referrals to professional supports.

In some instances, participants expressed mixed views about their experiences of workplace support. For some, their experiences were denoted by adequate formal support from management yet poor support from peers, as was depicted in the theme disturbed relationships with colleagues or within team. Experiences of relationship disturbances among team members of colleagues is thought to contribute to a sense of isolation, fear about judgments, and general avoidance of work colleagues (McAdams & Foster, 2000; Ting et al., 2006). This raises the need for organizations to pay attention to the workplace culture and how relationship dynamics between staff may hinder an employee’s ability to cope with a client suicide.

In other instances, workplace support was characterized by excellent collegial or peers support which tended to compensate for a lack of support from management. This was reflected in the theme work colleague/peer support in face of poor management support. The importance of informal support from colleagues confirms the previous findings of Trimble et al. (2000) that reaching out and talking to colleagues is a helpful coping resource following a client suicide.

Where participants considered their workplace response to have been poor or very poor, there was also the emergence of the theme stifled grief in face of investigatory action. This theme highlighted how the capacity to process the grief and loss of a client can be hindered by workplace investigations into performance. Here, increased distress and self-doubt is thought to occur when investigatory processes shift blame onto the psychologist and prevents them from accessing social support (Hendin et al., 2000). Such findings raise the need for organizations to review the way in which investigatory processes are handled and to take care that their responses do not involve the scapegoating or blaming of a staff member who may be blameless. It also highlights how organizational fears about potential law suits and other adverse outcomes may hinder an organization’s capacity to play a supportive role toward psychologists who have experienced a client suicide.

The theme of space to grieve, take time off, or attend funeral also emerged as a workplace need. Enabling the space to grieve and not pressuring psychologists to resume work can help these psychologists to better process and adapt to their loss (Eyestemitan, 1998; Gaffney et al., 2009; Strom-Gottfield & Mowbray, 2006).

Finally, emerging from the data was the need for opportunities to engage in learning process through case reviews with team or managers, suicide risk training. Such learning opportunities can help alleviate self-doubt and enable psychologists to move forward (Hendin et al., 2000).

The research has important implications for workplace practices in terms of how organizations respond to psychologists who have experienced a client suicide. The results suggest a need for organizations to facilitate more open discussions about client suicides, to be aware of the impact that client suicides have on psychologists, to provide support resources such as individual and team debriefing or supervision, as well as flexibility in enabling leave or workload adjustments. Through addressing the workplace needs of psychologists, organizations can play an important role in preventing burnout and promote staff retention and positive workplace culture.

A major limitation of this research study was that recruitment of participants relied on self-selection sampling. Atypical participation was found across psychologist types in the data of this research and was likely to be caused by a bias in self-selection. For example, a large majority of the sample in this research comprised clinical psychologists despite general psychologists being a populous category. Consequently, the frequency rate of client suicides among psychologists in Australia may not be entirely representative. It is recommended that future studies recruit more broadly to enable a more representative sample.

It is possible that characteristics of the participants such as gender, age, or years of professional experience may have contributed to the extent to which some participants were treated poorly by management or their work colleagues. However, such an exploration was beyond the scope of this research. Future research could explore whether differences in these variables contribute to some psychologists being discriminated against or treated more unfairly than others.

Another limitation is that the number of participants in this research study was low. An online survey which was advertised on the APS research page and e-newsletter was used in this research. Invitations to participate in the online survey were also sent to over 500 different workplace settings which employed psychologists, yet it was unclear how many followed up in disseminating the information. The use of an online survey is likely to have excluded participants who did not have ready Internet access (Bethlehem, 2010). It is also possible that the length of the online survey could have deterred participation, as the survey required at least 30 min of participants’ time if they had experienced a client suicide. However, Trimble et al.’s (2000) survey was just as time consuming.

Finally use of open questions in survey to gather qualitative data meant follow-up questions could not be asked to clarify key issues or ambiguous responses as is possible in interview research (Creswell & Clark, 2011). Despite this constraint, qualitative data from the survey were valuable in that it helped to identify themes over a larger number of participants.

Further investigations into the experiences and potential support mechanisms for psychologists in private practice would also be beneficial, particularly given the finding that psychologists’ experiences of private practice were isolating in the aftermath of a client suicide. Inclusion of semistructured interviews to gather qualitative data could also further help enrich understanding of psychologists’ experience of workplace responses following a client suicide.

Conclusion

In conclusion, this research contributes to understanding psychologists’ experiences of work place responses following client suicide. In doing so, it is likely to increase awareness in contemporary psychology as to the potential role that workplaces have in psychologists’ adjustment to a client suicide. This study has the potential to open up a number of avenues for future research in relation to workplace support and private practice.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Melissa Finlayson is a general psychologist who has previously completed a Master of Psychology (Counselling) at Monash University, Melbourne, Australia. Melissa currently works in the community services sector and is passionate about suicide prevention.

Janette Simmonds is a counselling and clinical psychologist and senior lecturer in psychology at Monash University, Melbourne, Australia.

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