Navigating Survivor Guilt Following Suicide or Other Death Circumstances

Yesterday, I ran a process therapy group with adolescents in a hospital setting. Another therapist had run the group with them the day before. One girl apologized and told me that they had spent the whole session the day before talking about her issue that she felt guilty for not having done something to prevent her friend from committing suicide. Despite their discussion, the girl said she still felt guilty. I did a quick survey of the 12 individuals in the group. All but two had experienced the death of someone they knew within the past year. Half of those deaths were the result of suicide. A third of the deaths had happened just in the previous month.

The girl explained that her friend had made a joking comment that he would commit suicide. She didn’t recognize that he meant it. I validated her belief that if she had recognized his reality, she might have been able to do something to influence him and prevent the suicide. Someone in the group confronted me, “Why are you doing that; you are making her feel worse?!” So as to let them know I was not just cruel, I gave them some of my background. I have been a therapist for over 20 years. I had a close family member commit suicide. I spent time with that person a few weeks before they did the suicide. I was a therapist at the time. I did not recognize that they were suicidal and so did nothing to intervene. I let the group know that, looking back after-the-fact, there were several signs in the person’s behaviors that could have alerted me to their suicidality. I emphasized to the group that as a therapist, I was supposed to recognize the signs and I was supposed to do something to help. But even with my training, I did not see it in my family member. A new girl in the group who was sitting in the back spoke up, “You don’t want to see it in your own family.” I agreed and stated, “It did not register in my mind.” Now the group understood that I certainly had reason to feel guilty and here I was talking to them about death, suicide and guilt.

We then talked about what could be done if the person’s suicidality was recognized. I emphasized getting the person to a professional such as a doctor or therapist. I also pointed out that there are multiple people who likely could have had a part in identifying the suicidal person’s need. It was not solely the responsibility of the one who felt guilty. I also noted that it is unknown if the suicidal person would have gone along with the treatment that would likely be recommended: medication and therapy. Many of the adolescents in the group had their own reservations about taking medication and/or going to therapy. I observed that they could look back and there would be many ‘ifs’ that if someone had said or done something, the situation could have turned out differently. Another girl in the group said, “You can’t go back and change the past.”

I then moved the group into reviewing the stages of grief. When we talked about denial, we discussed shock and trauma and the adaptive process the brain engages in to protect one from experiencing too much pain too fast. I pointed out that denial can occur before the death takes place. That it contributes to our not recognizing the serious suicidal intent in another. Several people in the group reacted as this helped them to understand. We reviewed bargaining, anger, depression, and acceptance. Their thoughts, emotions, reactions were seen to be normal. Finally, the girl who had initiated the discussion stated, “Well, in some ways I feel worse but I also feel better. I would rather be honest and deal with reality. I think I am moving toward acceptance.” The entire group had worked through the concept that one can experience something very painful and can come to accept it and cope with the reality.