SUICIDE BEREAVEMENT CLINICIAN TRAINING PROGRAM
Transcription
SUICIDE BEREAVEMENT CLINICIAN TRAINING PROGRAM
Morgan Forum Series Presents: SUICIDE BEREAVEMENT CLINICIAN TRAINING PROGRAM Wednesday, April 1, 2015 9:00 am—4:30 pm Developed in Collaboration with: The American Association of Suicidology The American Foundation for Suicide Prevention Northeast Ohio Medical University Education and Wellness Center 4209 State Route 44 Rootstown, OH The suicide of a loved one can have a profound and sometimes devastating impact on those left behind, called suicide survivors. Bereavement after suicide may entail high levels of disorientation, guilt, regret, anger, shame, and trauma. Survivors sometimes also find their relationships with other people changed, as they struggle with the social stigma often placed on suicide, and the altered family relationships that have been changed by the feelings of guilt, blame, and failure that suicide may engender. Survivors may also be at risk for elevated rates of complicated grief and future suicidality themselves. All of this makes surviving the suicide of a loved one a potentially life-transforming ordeal that requires a level of support that goes beyond traditional grief counseling. Yet very few mental health training programs devote any time to training clinicians about the challenging work of suicide postvention – helping survivors cope with the tragic loss. This workshop will provide a focused overview of the impact of suicide on survivors, and the clinical and support responses that are needed after a suicide occurs. The workshop will include didactic presentation, group discussion, case examples from the presenter’s practice, and video clips from grief therapy sessions. Topics to be covered will include: • the psychological impact of suicide on survivors and common themes in the bereavement of survivors • the impact of suicide on family functioning • what research with survivors tells us is needed • the tasks of loss integration and recovery for survivors • postvention options for survivors • principles of postvention after client suicide • principles of longer term clinical work with survivors • examples of specific clinical techniques that can be of use in grief therapy with survivors Register Online Now: www.mcmfdn.org John R. Jordan, Ph.D. - Instructor John (Jack) Jordan is a licensed psychologist in private practice in Wellesley, MA, and Pawtucket, RI, where he specializes in working with loss and bereavement. He was also the Founder and the Director of the Family Loss Project, a research and clinical practice providing services for bereaved families. He specialized in work with survivors of suicide and other losses for more than 35 years. As a Fellow in Thanatology from the Association for Death Education and Counseling (ADEC), Jack maintains an active practice in grief counseling for individuals and couples. He has run support groups for bereaved parents, young widows & widowers, and suicide survivors. For over 30 years, Jack has provided training nationally and internationally for therapists, healthcare professionals, and clergy through PESI Healthcare/CMI Education, the American Foundation for Suicide Prevention, and as an independent speaker. He has also helped to organize and lead dozens of healing workshops for suicide survivors. There is no cost to attend this event, but registration is required. Space is limited! AGENDA 8:15 am Arrive and sign-in 9:00 Introduction & Suicide Survivors: Who Are They? 10:45 Understanding the Impact of Suicide Loss 12:15 pm Lunch (provided) 1:00 What Can We Do to Help Survivors? 2:45 Grief Therapy with Survivors 4:30 Adjournment Objectives: 1. Offer a working definition of a suicide survivor 2. Identify at least five common themes in the impact of suicide on survivors 3. List tasks of psychological re-integration after suicide 4. Describe several options for intervention with survivors 5. Describe three categories of clinical technique with survivors. Continuing Education OhioMHAS Continuing Education Committee is an approved provider of Continuing Education for RNs and LPNs for the Ohio Board of Nursing and has awarded 6.25 CE contact hours per OBN003 92-1885CO. OhioMHAS has been approved as a provider of Continuing Professional Education credit by the Ohio Counselor, Social Work, Marriage and Family Therapist Board. 6.25 CEs have been awarded to Social Workers per RSX088902-2109CO and to Counselors per RCX068915-2093CO OhioMHAS is approved by OPA-MCE to offer continuing education for Psychologists. 6.25 MCEs are awarded per 311334820-1280CO. OhioMHAS is approved by the Ohio Chemical Dependency Professionals Board to offer recognized clock hours for chemical dependency counselors and prevention professionals. The provider approval number is 09-1315-64PVNR for 6.25 RCHs. To find out more about this workshop, contact: Victoria Romanda 330-655-1366 [email protected] The Margaret Clark Morgan Foundation Phone: 330-655-1366 www.mcmfdn.org Register Online Now: www.mcmfdn.org This event is planned in partnership with: John R. Jordan, Ph.D. - The Family Loss Project SUICIDE BEREAVEMENT CLINICIAN TRAINING PROGRAM 1 Presented By: 2 SUICIDE BEREAVEMENT CLINICIAN TRAINING American Association of Suicidology – www.suicidology.org American Foundation for Suicide Prevention – www.afsp.org Instructor: JOHN R. JORDAN, PH.D. Pawtucket, RI [email protected] 3 1 John R. Jordan, Ph.D. - The Family Loss Project WORKSHOP OVERVIEW Suicide Bereavement Clinician Training Introduction Suicide Survivors – Who are they? The Impact of Suicide What Can We Do to Help Survivors? Grief Therapy with Survivors Wrap-Up 4 Workshop Educational Goals At the end of this workshop, participants will be able to: Offer a working definition of a suicide survivor Identify at least five common themes in impact of suicide on survivors List tasks of psychological re-integration after suicide Describe several options for intervention with survivors Describe three categories of clinical technique with survivors. 5 FIVE QUESTIONS A Guided Reflection What is your own experience with suicide? Loss of a family member, friend, colleague? Loss of a client? Attempts? Work with suicidal clients? Your own suicidality? 6 2 John R. Jordan, Ph.D. - The Family Loss Project FIVE QUESTIONS (continued) Why do people take their life? Who is responsible when a suicide occurs? Can suicide be prevented? Should suicide be prevented? Rationale: Important to be aware of your own attitudes These are the issues with which survivors struggle 7 SURVIVORS – WHO ARE THEY? Who Is A Survivor? How Many Survivors Are There? Are Survivors at Risk for Suicide? Assessing Risk in Survivors 8 Definition of a Survivor Language Suicide attempters vs. suicide survivors Suicide survivor vs. bereaved by suicide Previous Definitions Exposure Kin Psychological proximity A Broader Definition “A suicide survivor is someone who experiences a high level of self-perceived psychological, physical, and/or social distress for a considerable length of time as a result of the suicide of another person” Jordan & McIntosh, 2011 9 3 John R. Jordan, Ph.D. - The Family Loss Project Cerel, McIntosh, Neimeyer, Maple, & Marshall (2014) – “A Continuum of Survivorship“ Bereaved, Long-term Bereaved, Short-term Affected by Suicide Exposed to Suicide 10 How Many Survivors Are There? – Exposure vs.Survivor Exposure - Crosby & Sacks (2002) 7% of U.S. population exposed in a year (21 million each year) 1.1% have lost a family member (3.3 million each year) Of those exposed: 3.2% lost immediate family 13.7% extended family 80.4% friend or acquaintance 11 How Many Survivors Are There? – Exposure vs.Survivor Cerel, et.al. (2014) 40 % had known someone who completed 64% had known someone who had attempted or completed 20% self-identified as a survivor – “affected by the suicide” Psychological proximity predicted selfidentified survivorhood 12 4 John R. Jordan, Ph.D. - The Family Loss Project Are Survivors at Risk for Suicide? Important Studies: Crosby & Sacks (2002); Qin, Agerbo, & Mortensen (2005); Hedstrom, Liu, & Nordvik (2008); Spiwak, et.al. (2011); Feigelman, Jordan, McIntosh, & Feigelman (2012) Summary Risk of completion increases 2-3 fold over all kinship categories Highest risk is a 46 fold increase for male spouses who lose a spouse to suicide Childhood loss of parent (particularly Mother) is a 3 - 5 fold increase Workplace (< 100) exposure involves a 3.5 fold increase Parent survivors report of ideation (Feigelman, et.al.): Almost 49% report ideation during first five years 18% still report ideation ten years or beyond Mothers bereaved 5 or more years reported ideation at a rate that was > 6 times the rate for a non-bereaved, demographically equivalent sample of women 13 Are Survivors at Risk for Suicide? Conclusions: Survivors can be at elevated risk for suicide Survivors should be more vigilant, but not terrified Survivor families need help in understanding and gaining perspective on their increased risk for suicide 14 Observations on Assessing Suicidality in Survivors Suicidality is not uncommon in survivors Particularly ideation Suicidality needs to always be assessed in survivors Distinction between: Passive vs. active ideation Tripartite Model (Sands, et.al. 2011; 2009) “Walking in the Shoes”/ Identification with the deceased vs. active suicidality Assessing suicide risk (AMSR Training) 15 5 John R. Jordan, Ph.D. - The Family Loss Project WHAT IS THE IMPACT OF SUICIDE ON SURVIVORS? What Are The Prominent Themes for Survivors? Are There Positive Effects of Survivorhood What Is the Impact On Families? Post-traumatic Growth After Suicide 16 Prominent Themes For Survivors WHY? - Making Sense of the Death RESPONSIBILITY - Guilt & Blame Role of magical thinking TRAUMA & HELPLESSNESS - Shock & Horror ANGER - Rejection & Abandonment RELIEF - The End Of Suffering 17 Prominent Themes For Survivors SHAME - Stigma SOCIAL AMBIGUITY – Isolation & Social Disruption SUICIDALITY – Why Go On? SORROW – Grief & Yearning 18 6 John R. Jordan, Ph.D. - The Family Loss Project Prominent Themes For Survivors: Family Impact Information Management – who and what to tell Powerful impact of secrets on families Disruption of family routines, rituals, & role functions Changes in role functioning Changes in emotional availability Changes in distance and power in relationships Communication Shut-down Perceived fragility of members Anger/ conflict management Coping Asynchrony - differences in grieving styles 19 Prominent Themes For Survivors: Family Impact Blame/Scapegoating Development of cut-offs and estrangement Struggle to construct a shared narrative Developmental anxiety about repetition (esp. for parents) Hypervigilence Problems with developmental separations “Are we cursed?” Result = Loss of Family Cohesion 20 Post-Traumatic Growth After Suicide Changed identity Development of a survivor identity Resilient & worthy of self-care Changed relations with others More priority on relationships More expression of love/ affection More compassion for others Ending dysfunctional relationships 21 7 John R. Jordan, Ph.D. - The Family Loss Project Post-Traumatic Growth After Suicide Changed outlook on life Purpose – sometimes a new purpose Greater appreciation/ gratitude Deeper spirituality/faith Hope End result = psychological/spiritual growth 22 WHAT CAN WE DO TO HELP? Tasks of Loss Integration & Goals of Postvention Treatment Postvention Options 23 Tasks of Loss Integration & Goals of Postvention Containment of the trauma & restoration of control Bio-rhythms Management of intrusive images, memories Creation of a “narrative” of the suicide Psychological autopsy & sense-making activities To understand the mental state of the deceased Sort out realistic responsibility for the death and develop a realistic perspective about the multiple causes To learn to live with the “blind spot” – not having all the information Note: AAS has a training/certification in Psych. Autopsy 24 8 John R. Jordan, Ph.D. - The Family Loss Project Tasks of Loss Integration & Goals of Postvention Self-dosing - Cultivating analgesia and finding psychological sanctuary For “grief pangs” & traumatic reliving Dual Process Model of grief – Alternating movement “towards” the grief and “away from” the grief Learn social management skills Eliciting support from helpful social networks Avoiding/managing “toxic” people 25 Tasks of Loss Integration & Goals of Postvention Repair and transformation of the relationship with deceased Idea of “continuing bonds” in thanatology Dis-identification with the deceased Internalizing positive connection with the deceased Develop a “durable biography” of the deceased Cultivating memories from others Honoring the life, not the death Reinvestment in living – reactivation of the “exploratory system” 26 Postvention Options – After Client Suicide: Family Contact “Is contact with the surviving family legal? Ethical? Can it be therapeutic? We believe that the answers are yes, yes and yes, given certain guidelines, clinical acumen, and care.” McGann, V. L., Gutin, N., & Jordan, J. R. (2011). Seek consultation for yourself Notify your malpractice insurer You may also want to contact an attorney for yourself May need to be a legally protected relationship if concerned about litigation – therapist or attorney Note: AAS website has Clinician – Survivor resources 27 9 John R. Jordan, Ph.D. - The Family Loss Project Postvention Options – Family of a Client Suggestions for a family meeting: Express condolences Offer psychoeducation about suicide & grief (see resource list) Help with “Why” questions (explain limits on confidentiality) Offer general observations on factors related to client’s suicide With permission of client’s legal representative, discuss details of the treatment that will be helpful in the healing process 28 Postvention Options – Family of a Client Assess family functioning and concerns family members have about each other Help with planning for family’s needs, including for Rx. Should you treat the survivor family? Offer to be available to help with further questions, referrals Offer to check back in at a later point in time 29 Postvention Options – Services Survivor outreach programs Family/Couples counseling Support groups Referrals – Online databases: AFSP - afsp.org AAS - suicidology.org Other forms of survivor to survivor contact Activism Individual therapy (see next slides) 30 10 John R. Jordan, Ph.D. - The Family Loss Project GRIEF THERAPY WITH SURVIVORS Foundations – Attachment & Grief Therapy Roles of the Therapist Use of Focused Techniques Summary: Guidelines for Clinical Work with Survivors 31 Foundations of Grief Therapy 32 An Orientation to Grief Therapy Head & heart work Medical vs. companioning models Symptom focused vs. person focused Technique vs. relationship Diagnosis vs. relationship building “Rules” of Therapy Goal = Integration, not resolution “Boulder” metaphor 33 11 John R. Jordan, Ph.D. - The Family Loss Project Therapist as an Attachment Figure Recall the Attachment Paradigm Attachment figures serve as “Safe Harbor” & “Secure Base” Caregiver & child as attuned, resonating system Repair of empathic failures Secure attachment results in internalization of and allows separation from attachment figure Child grows able to self-regulate, tolerate distress & “self-soothe” Insecure attachment results in one of three attachment “styles” Anxious (hyper-activation of attachment system) Avoidant (deactivation of attachment system) Disorganized Observations on Attachment & Grief Therapy The literature on attachment informed psychotherapy – (Schore, 2011; Obegi & Berant, 2009; Wallin, 2007) Therapist serves as transitional attachment figure – a “reparenting” experience The skill of the therapist at empathically attuning to client (including non-verbal communication) is crucial Ability to match the client’s attachment style Empathy forms the core of what is healing – empathic accuracy vs. empathic failure Re-working of internal attachment models - relearning what connection is about Mostly presumes therapy for people who have had maladaptive early attachment relationships 35 Grief Therapist as Attachment Figure “Grief counseling is a concentrated form of empathically attuned and skillfully applied social support from a clinician who serves as a transitional attachment figure and helps the mourner to integrate the loss” - JRJ 12 John R. Jordan, Ph.D. - The Family Loss Project Overview of the Grief Therapy Process ReactionDysregulation Reflection Crisis Therapy Grief Therapy Reregulation Integration Psychotherapy 37 Overarching Questions/ Themes of Grief Therapy How are you doing now? Death Narrative? Life Narrative (back story) What have you lost? What do you need to let go of? What do you need to hold on to? What have you learned? How have you been changed? What is your future? 38 Use Of Focused Techniques A Word About Technique In Grief Counseling Psychotropic Medication Trauma Reduction Techniques Restorative Retelling & Meaning Reconstruction Techniques Relational Repair Techniques 39 13 John R. Jordan, Ph.D. - The Family Loss Project The Use of Technique in Grief Therapy Without Wisdom Technique Is: At best useless At worst dangerous Wisely Used Technique Is: Invaluable The right technique At the right time With the right skillfulness 40 Psychotropic Medication The Controversy A Guiding Criterion: “Will the medication be in the service of the griefwork?” Some Examples 41 Trauma Reduction Techniques Underlying Principles Establishment of safety, control, & self-soothing skills Controlled re-exposure to traumatic images, memories, sensory data Perspective taking about the trauma EMDR - Eye Movement Desensitization and Reprocessing - (Shapiro, 2004) Background Protocol Retelling the Narrative of the Death Shear’s Complicated Grief Therapy (2205, 2006) 42 14 John R. Jordan, Ph.D. - The Family Loss Project Meaning Reconstruction Psychological Autopsy The procedure The possible benefits Note: AAS training in Psych. Autopsy Pennebaker Writing Protocol Background Protocol Uses of the technique Other Uses of Writing Neimeyer's Life Imprint Technique 43 The Life Imprint Exercise – Neimeyer (2012) Decide About Whom You Wish to Journal This person has had the following impact on: My mannerisms or gestures: My ways of speaking/communicating: My work and pastimes: 44 The Life Imprint Exercise – Neimeyer (2012) My feelings about myself & others: My basic personality: My values and beliefs: The imprints I would most like to affirm and develop are: The imprints I would most like to relinquish or change are: 45 15 John R. Jordan, Ph.D. - The Family Loss Project Restorative Retelling – Rynearson (2001, 2006) Rynearson Protocol Background Protocol – 10 Sessions 1 & 2 - Introductions & Identifying sources of support 3 & 4 - Prevailing (how do you cope) & Co-morbidity (distress, disorders, plan for 5) 5 & 6 - Commemorative presentations 7 & 8 - Death Imagery Presentations - self in a different, more empowered role. 9 & 10 - Family & Friends & Ceremonial Goodbye Underlying principle – revising the death narrative 46 Restorative Retelling & Trauma Reduction Goal = Cultivation of “pacified” imagery of the deceased “In Heaven” technique Guided imagery of deceased in a healed setting or condition Drawn from past images, or present imagination Examples 47 Relational Repair Techniques Letter writing Empty Chair Imaginal (guided imagery) Enactment Ritual (e.g., graveside) 48 16 John R. Jordan, Ph.D. - The Family Loss Project Relational Repair Technique – Guided Imaginal Conversation Guided imaginal conversation with the deceased – (Jordan, 2012) Background Procedures 49 Summary: Guidelines For Working With Suicide Survivors 50 Guidelines Revise your assumptions about the grieving process & clinician role Goal = Integration not resolution of the loss Duration & intensity of the grief response Expert companioning vs. “treatment” Overall goal = provide a safe & sheltered context for doing griefwork & expanding repertoire of coping skills Educate the survivor About suicide, trauma, grief, & recovery Encourage self-education Emphasize self-care; trial and error, and empowerment through skill acquisition 51 17 John R. Jordan, Ph.D. - The Family Loss Project Guidelines Attend to traumatization Combine therapies for PTSD & grief Facilitate confronting and reworking of the death narrative Dosed re-exposure to avoided triggers Imaginal & in-vivo Personal psychological autopsy/inquest “Walk in the shoes of the deceased” – Sands Differentiate the self from the deceased Go slowly with guilt Gently help with reality testing Consider “atonement” 52 Guidelines Support transformation of attachment to the deceased Development of continuing bonds Reparative work on the ruptured relationship Facilitate restoration of positive imagery, memories & connection Encourage memorialization of the deceased 53 Guidelines Address family & social network issues Facilitate contact with other survivors Groups Internet Reading personal narratives 54 18 John R. Jordan, Ph.D. - The Family Loss Project Guidelines Facilitate meaning making (Sense-making & benefit finding) Redemption - “Don’t Waste Your Grief” Bearing witness Spiritual search Honoring the life, not the death/ suicide Activism - Preventing reoccurrence & assisting other survivors Encourage Reinvestment in Life & Exploration Ritualize transitions New activities, goals Seek Growth In Your Clients 55 Two Final Thoughts Postvention is Prevention It Takes a Village to Journey with a Survivor 56 WRAP-UP Questions? Comments? What will you take with you? 57 19 John R. Jordan, Ph.D. - The Family Loss Project Video: Threads/Themes of Therapy Suicidality – why go on, can I have a future? Estrangement from work – phony vs. real? Continuing bonds and transformation of her world-view Continuing bond with David possible? Additional Losses Loss of her Father, his legacy of authenticity, and can she call on his internalized voice? Loss of family home Loss of marriage Loss of beloved dog Loss of safety at work Two “techniques” EMDR “In Heaven” 58 20 American Association of Suicidology American Foundation for Suicide Prevention SUICIDE BEREAVEMENT CLINICIAN TRAINING PROGRAM Case Study Presenting Problems: This married mother of three children entered treatment seeking help with her grief after the death of her young adult son to suicide more than three years earlier. The woman found her son, who lived at home, hanging in the basement of their home. She immediately called for her daughter (also at home), and then 911. She got her son down and attempted to revive him, but knew from his appearance that he was already dead. It took six hours for the medical examiner to arrive, and her memories of the entire day day, including the appearance of his face and body, the process of trying to revive him, dealing with the police and medical examiner, and the removal of her son’s body in a body bag remain a horrifying nightmare for her. Since his death, the client has suffered from many of the problems that a suicide loss survivor may experience. These include flashbacks of the events that morning, strong feelings of guilt for not preventing the suicide (“I killed my son”), disrupted sleep and appetite, significant anhedonia and suicidal ideation, and intense yearning for her son. She questions whether she can ever recover, and finds the prospect of living the rest of her life without her son and with the intense emotional pain to be very bleak. The client reports that the only place she can talk about the death and her grief is in a once a month survivor support group, which she finds moderately helpful, and with two of her sisters. The suicide has strained the relationship with her husband of many years, who is often reluctant to discuss his own feelings about the death, and frequently angry with her for her inability to recover. Her husband has recently asked for a divorce. Her two surviving children have been mostly supportive and protective of their mother, but she has significant concerns about her other son, who has been using drugs and ignoring the rules of the household. The client feels very estranged from her job and work colleagues as a teacher – she finds her work to be meaningless now. Lastly, the client presents with self-criticism about why she continues to be so distraught and why she is not further along in her healing. Background: The client was raised in a large, closely knit and unusual family. Both of her parents were highly educated and devoutly religious. In some ways, the family lived a life that blended religious fervor with a love of learning. “Self-sufficiency” was highly valued, as was skepticism of the larger society’s values, so the family lived in a rural area, raised most of their own food, and kept themselves relatively isolated from the larger society. The client had a very close relationship with her father, who died a difficult death of cancer a few years before her son’s death. The client’s mother died a year after the death of her son, also of cancer. The client’s son had also been very close to his grandparents, and the loss of his grandfather may have been an important contributor to his own depression and suicidality. Treatment Highlights: The treatment (about 8 months/20 sessions at the time of writing this case study) has included many elements. They include: discussion of the details of the morning the client found her son, and a single session of EMDR focused around that morning; work on developing a “pacified” imagery of her son; discussion of the “culture” of her family of origin, and the profound impact of the death of her father and impending loss of the family homestead (which is for sale); her conflicting beliefs about an afterlife and whether she will ever be with her son again; her concerns about her other children’s well-being; her dissatisfaction with her job and work environment, the felt need to “pretend” that everything is okay for her while at work, and whether she can take the risk of changing her career path; and her waves of suicidality and sense of despair at living a life without her son. This latter has intensified after the decision by her husband to seek a divorce. Suicide Bereavement Clinician Training Program Professional Reading List 1. American Foundation for Suicide Prevention (2011) After a suicide: A toolkit for schools. Available at: www.afsp.org/files/Surviving/toolkit.pdf. 2. Berman, A. (2011). Estimating the Population of Survivors of Suicide: Seeking an Evidence Base. Suicide and Life-Threatening Behavior, 41(1), 110-116. 3. Berman, A., & Pompili, M. (Eds.). (2011). Medical Conditions Associated with Suicide Risk. Washington, D.C.: American Association of Suicidology. 4. Berman, A., & Silverman, M. M. (2014). Suicide Risk Assessment and Risk Formulation Part II: Suicide Risk Formulation and the Determination of Levels of Risk. Suicide and Life-Threatening Behavior, 44(4), 432 - 443. doi: 10.1111/sltb.12067 5. Bolton Jm, A. W. L. W. D., & et al. (2012). Parents bereaved by offspring suicide: A population-based longitudinal case-control study. Archives of General Psychiatry, 1-10. doi: 10.1001/jamapsychiatry.2013.275 6. Burke, L. A., & Neimeyer, R. A. (2013). Prospective risk factors for complicated grief: A review of the empirical literature. In M. Stroebe, H. Schut & J. v. d. Bout (Eds.), Complicated grief: Scientific foundations for health care professionals (pp. 145-161). New York, NY, US: Routledge/Taylor & Francis Group. 7. Campbell, F. R., Simon, R. I., & Hales, R. E. (2006). Aftermath of suicide: The clinician's role The American Psychiatric Publishing textbook of suicide assessment and management (1st ed.). (pp. 459-476): American Psychiatric Publishing. 8. Campbell FR, Cataldie L, McIntosh J, & Millet K. (2004) An active postvention program. Crisis. 25(1):30-32. 9. Cerel J & Campbell FR. (2008) Suicide survivors seeking mental health services: A preliminary examination of the role of an active postvention model. Suicide and Life Threatening Behavior 38(1):30-34. 10. Cerel, J., Jordan, J.R., & Duberstein, P.R. (2008) The Impact of Suicide on the Family. Crisis 29(1): 38-44. 11. Clark, S. (2001). Bereavement after suicide – How far have we come and where do we go from here? Crisis, 22, 102-108. 12. Crosby, A.E. & Sacks, J.J. (2002). Exposure to suicide: Incidence and association with suicidal ideation and behavior: United States, 1994. Suicide and Life-Threatening Behavior, 32, 321-328. 13. Colt, George H. (2006) November of the soul: The enigma of suicide. New York, NY: Scribner. 14. Cozolino, L. (2010). The Neuroscience of Psychotherapy: Healing the Social Brain (2nd ed.). New York: W.W. Norton. 15. Cozolino, L. (2006) The Neuroscience of Human Relationships: Attachment and the Developing Social Brain. New York: W.W. Norton. 16. de Groot, M., de Keijser, J., Neeleman, J., Kerkhof, A., Nolen, W., & Burger, H. (2007). Cognitive behaviour therapy to prevent complicated grief among relatives and spouses bereaved by suicide: Cluster randomised controlled trial. British Medical Journal, 334(7601), 994. 17. De Leo, D., Cimitan, A., Dyregrov, K., Grad, O., & Andriessen, K. (2014). Bereavement after Traumatic Death: Helping the Survivors. Boston, MA: Hogrefe. 18. Dyregrov, K. (2003) The loss of a child by suicide, SIDS, and accidents: Consequences, needs, and provisions of help. Bergen: University of Bergen. 19. Dyregrov, K. (2002) Assistance from local authorities versus survivors' needs for support after suicide. Death Studies, 26: 647-668. 20. Dyregrov, K., Plyhn, E., Dieserud, G., & Oatley, D. (2012). After the suicide: Helping the bereaved to find a path from grief to recovery. London, England: Jessica Kingsley Publishers. 21. Dyregrov, K. & Dyregrov, A. (2008) Effective grief and bereavement support: The role of family, friends, colleagues, schools, and support professionals. Philadelphia: Jessica Kingsley Publishers. 22. Dunne, E.J., McIntosh, J.L., & Dunne-Maxim, K. (1987) Suicide and Its Aftermath: Understanding and Counseling the Survivors New York, NY: W.W. Norton & Co. 23. Elder, S. L., Knowles, D., & Webb, N. B. (2002). Suicide in the family. In Helping bereaved children: A handbook for practitioners (2nd ed.). (pp. 128-148): Guilford Press: New York. 24. Feigelman, W., Jordan, J.R., McIntosh, J, & Feigelman, B. (2012) Devastating losses: How parents cope with the death of a child to suicide or drugs New York, NY: Springer Publishers. 25. Feigelman, W., Jordan, J. R., & Gorman, B. S. (2009) Personal growth after suicide loss: Cross-sectional findings suggest growth after loss may be associated with better mental health among survivors. Omega: Journal of Death and Dying, 59(3), 181-202. 26. Feigelman, W., Jordan, J., & Gorman, B. S. (2009) How they died, time since loss, and bereavement outcomes Omega: Journal of Death and Dying, 58(4), 251-273. 27. Feigelman, W., Gorman, B. S., & Jordan, J. R. (2009) Stigmatization and suicide bereavement. Death Studies, 33(7), 591-608. 28. Feigelman W, Gorman BS, Chastain-Beal K, & Jordan JR. Internet support groups for suicide survivors: A new mode for gaining bereavement assistance. Omega: Journal of Death and Dying. 57(3):217-243. 2 29. Hedstrom, P., Liu, K.-Y., & Nordvik, M. K. (2008). Interaction domains and suicide: a population-based panel study of suicides in Stockholm, 1991-1999. Social Forces, 87(2), 713-740. 30. Institute of Medicine (2002) Reducing Suicide: A National Imperative. Washington, D.C.: National Academies Press. 31. Joiner, T. E., Van Orden, K. A., Witte, T. K., & Rudd, M. D. (2009). The interpersonal theory of suicide: Guidance for working with suicidal clients. Washington, D.C.: American Psychological Association. 32. Joiner, T.E (2005) Why People Die By Suicide Cambridge, MA: Harvard University Press. 33. Jordan, J. R. (2012). Guided imaginal conversations with the deceased. In R. A. Neimeyer (Ed.), Techniques of Grief Therapy: Creative Practices for Counseling the Bereaved. (pp. 262-265). New York: Routledge. 34. Jordan, J.R. & McIntosh, J.M. (2011) Grief after suicide: Understanding the consequences and caring for the survivors. New York: Routledge. 35. Jordan, J. R., & McIntosh, J. L. (2011 ). Is suicide bereavement different? Perspectives from research and practice. In R. A. Neimeyer, D. L. Harris, H. R. Winokuer & G. Thornton (Eds.), Grief and Bereavement in Contemporary Society: Bridging Research and Practice (pp. 223-234). New York: Routledge. 36. Jordan, J. (2009). After suicide: Clinical work with survivors. Grief Matters: The Australian Journal of Grief and Bereavement, 12(1), 4-9. 37. Jordan, J. R. (2008). Bereavement after suicide. Psychiatric Annals, 38(10), 679685. 38. Jordan, J. & McMenamy, J. (2004). Interventions for suicide survivors: A review of the literature. Suicide and Life-Threatening Behavior, 34, 337-349. 39. Jordan, J. R. (2001). Is suicide bereavement different? A reassessment of the literature. Suicide and Life- Threatening Behavior 31, 91-102. 40. Kaslow NJ & Gilman Aronson S. (2004) Recommendations for family interventions following a suicide. Professional Psychology: Research and Practice. 35:240-247. 41. Knieper, A. J. (1999). The suicide survivor's grief and recovery. Suicide and LifeThreatening Behavior, 29(4), 353-364. 42. Leach, M. M., & Leong, F. T. L. (2008). Suicide among racial and ethnic minority groups: Theory, research, and practice: New York, NY, US: Routledge/Taylor & Francis Group. 43. McIntosh, J.L. (2003) Suicide survivors: The aftermath of suicide and suicidal behavior. In C. D. Bryant (Ed.) (339-350). Handbook of Death & Dying: Volume One The Presence of Death. Thousand Oaks, CA: Sage Publications. 44. McMenamy J, Jordan JR, Mitchell AM. (2008) What do suicide survivors tell us they need? Results of a pilot study. Suicide and Life Threatening Behavior 38(4):375-389. 45. Michel, K., & Jobes, D. A. (Eds.). (2011). Building a Therapeutic Alliance with the Suicidal Patient. Washington, D.C.: American Psychological Association. 3 46. Mishara, B.L. (1995) The Impact of Suicide New York, NY: Springer Publishing. 47. Neimeyer, R. A. (2015). Treating Complicated Bereavement: The Development of Grief Therapy. In J. M. Stillion & T. Attig (Eds.), Death, Dying, and Bereavement: Contemporary Perspectives, Institutions, and Practices (pp. 307320). New York, NY: Springer. 48. Neimeyer, R. A. (Ed.). (2012). Techniques of Grief Therapy: Creative Practices for Counseling the Bereaved. New York: Routledge. 49. Neimeyer, R. A., Harris, D. L., Winokuer, H. R., & Thornton, G. (Eds.). (2011). Grief and Bereavement in Contemporary Society: Bridging Research and Practice. New York: Routledge. 50. Neimeyer, Robert A. (2001) Meaning Reconstruction and the Experience of Loss. Washington, D.C.: American Psychological Association, 2001 51. Obegi, J. H., & Berant, E. (2009). Attachment theory and research in clinical work with adults: New York, NY, US: Guilford Press. 52. Pearlman, L. A., Wortman, C. B., Feuer, C. A., Farber, C. H., & Rando, T. A. (2014). Treating traumatic bereavement: A practitioner's guide. New York, NY: Guilford Press. 53. Poussaint, A.L. & Alexander, A. (2000) Lay My Burden Down: Unraveling Suicide And The Mental Health Crisis Among African-Americans. Boston, MA: Beacon Press. 54. Pittman, A., Osborn, D., King, M., & Erlangsen, A. (2014). Effects of suicide bereavement on mental health and suicide risk. Lancet Psychiatiry, May. doi: http://dx.doi.org/10.1016/ S2215-0366(14)70224X 55. Provini, C.; Everett, J.R.; & Pfeffer, C. (2000) Adults mourning suicide: Selfreported concerns about bereavement, needs for assistance, and help-seeking behavior. Death Studies, 24: 1-20. 56. Qin, Ping; Agerbo, Esben; & Mortensen, Preben Bo (2005) Factors contributing to suicide: The epidemiological evidence from large-scale registers. In Keith Hawton (Ed.) Prevention and treatment of suicidal behavior: From science to practice. Oxford, England: Oxford University Press. 57. Rando, T. A. (2015). When Trauma and Loss Collide: The Evolution of Intervention for Traumatic Bereavement. In J. M. Stillion & T. Attig (Eds.), Death, Dying, and Bereavement: Contemporary Perspectives, Institutions, and Practices (pp. 321-334). New York, NY: Springer. 58. Ratnarajah, D., & Schofield, M. J. (2007). Parental suicide and its aftermath: A review. Journal of Family Studies, 13(1), 78-93. 59. Rudd, M. David, Joiner, T., & Rajab, M.Hasan (2001) Treating Suicidal Behavior: An Effective, Time-Limited Approach. New York, NY: Guilford. 60. Rynearson, E.K. (2001) Retelling Violent Death. Philadelphia, PA: BrunnerRoutledge, 2001. 61. Rynearson, E.K. (2006) Violent Death: Resilience and Intervention Beyond the Crisis. New York, NY: Taylor & Francis Group. 4 62. Sands, D. C., Jordan, J. R., & Neimeyer, R. A. (2011). The meanings of suicide: A narrative approach to healing Grief after suicide: Understanding the consequences and caring for the survivors. (pp. 249-282): New York, NY, US: Routledge/Taylor & Francis Group. 63. Sands, D. (2009). A Tripartite Model of Suicide Grief: Meaning-Making and the Relationship With the Deceased. Grief Matters: The Australian Journal of Grief and Bereavement, 12(1), 10-17. 64. Schore, A. N. (2011). The Science of the Art of Psychotherapy. New York, NY: W.W. Norton. 65. Shear, K., Frank, E., Houck, P. R., & Reynolds Iii, C. F. (2005). Treatment of Complicated Grief: A Randomized Controlled Trial. JAMA: Journal of the American Medical Association, 293(21), 2601-2608. 66. Shear, K., Gorscak, B., Simon, N., & Rynearson, E. K. (2006). Treatment of complicated grief following violent death. In E. K. Rynearson (Ed.), Violent death: Resilience and intervention beyond the crisis. (pp. 157-174): Routledge/Taylor & Francis Group: New York. 67. Shear, K., & Rothbaum, B. O. (2006). Adapting Imaginal Exposure to the Treatment of Complicated Grief Pathological anxiety: Emotional processing in etiology and treatment. (pp. 215-226): Guilford Press: New York. 68. Silverman, M. M., & Berman, A. (2014). Suicide Risk Assessment and Risk Formulation Part I: A Focus on Suicide Ideation in Assessing Suicide Risk. Suicide and Life-Threatening Behavior, 44(4), 420 - 431. doi: 10.1111/sltb.12065 69. Spiwak, R., Pagura, J., Bolton, J. M., Elias, B., Beesdo-Baum, K., Lieb, R., & Sareen, J. (2011). Childhood exposure to caregiver suicidal behavior and risk for adult suicide attempts: Findings from a national survey. Archives of Suicide Research, 15(4), 313-326. doi: 10.1080/13811118.2011.615694 70. Sprang, Ginny & McNeil, John (1995) The Many Faces of Bereavement: The Nature and Treatment of Natural, Traumatic, and Stigmatized Grief New York, NY: Brunner/Mazel. 71. Stroebe, M., Schut, H., & Van den Bout, J. (Eds.). (2013). Complicated Grief: Scientific Foundations for Health Care Professionals. New York, NY: Routledge. 72. Stroebe, M. & Schut, H. (1999) The dual process model of coping with bereavement: Rationale and description. Death Studies, 23(3): 197-224. 73. Sveen, C.A. & Walby, F.A. (2008) Suicide survivors’ mental health and grief reactions: A systematic review of controlled studies. Suicide and Life Threatening Behavior: 38(1): 13-29. 74. Tedeschi, Richard G. & Calhoun, Lawrence G. (2004). Helping Bereaved Parents: A Clinicians Guide. New York, NY: Brunner-Routledge. 75. United Community Solutions (2012): Suicide Grief Support Quick Reference. National Suicide Prevention Lifeline. Available at https://sites.google.com/a/personalgriefcoach.com/suicidegriefsupport/. 5 76. U.S. Public Health Service (1999) The Surgeon General’s Call to Action to Prevent Suicide. Washington, D.C.: Department of Health & Human Services. 77. U.S. Department of Health & Human Services, Office of the Surgeon General, & National Action Alliance for Suicide Prevention. (2012). National Strategy for Suicide Prevention: Goals and Objectives for Action. Washington, D.C.: HHS. 78. Wallin, D. J. (2007). Attachment in Psychotherapy: New York, NY, US: Guilford Press. 79. Walter, T. (1996). A new model of grief: Bereavement and biography. Mortality, 1(1), 7-25. 80. Weiner, K. M. (2005). Therapeutic and legal issues for therapists who have survived a client suicide: Breaking the silence: Haworth Press: New York. 6 JOHN R. JORDAN, Ph.D. 10 Exchange Court – Unit 401 Pawtucket, RI 02860-2261 USA E-mail: [email protected] Tel. 401-305-3051 SURVIVING AFTER SUICIDE LOSS Recommended Readings for Survivors _Baugher, Bob & Jordan, Jack After Suicide Loss: Coping With Your Grief. Available from Bob Baugher, Ph.D., 7108 127th Place S.E., Newcastle, WA 98056-1325 or [email protected], 2002. _Bolton,Iris My Son...My Son: A Guide to Healing After Death, Loss or Suicide Atlanta. GA:Bolton Press, 1983. _Cammarata, Doreen Someone I Love Died by Suicide: A Story for Child Survivors and Those Who Care for Them. Grief Guidance, Inc., 2001. (www.griefguidance.com). _Chalifour, Francis After. Tundra, 2005. _Collins, Judy Sanity and Grace: A Journey of Suicide, Survival, and Strength. Tarcher/Penguin, 2003. _Colt, George Howe November of the Soul: The Enigma of Suicide New York: Scribner: Books, 2006. _Dougy Center for Grieving Children. After Suicide: A Workbook for Grieving Kids. Dougy Center, 2001 (www.dougy.org/). _Feigelman, W., Jordan, J.R., McIntosh, J, & Feigelman, B. (2012) Devastating losses: How parents cope with the death of a child to suicide or drugs. New York, NY: Springer Publishers. _Fine, Carla No Time to Say Good-Bye: Surviving the Suicide of a Loved One New York: Doubleday, 1997. _Goldman, Linda Great Answers to Difficult Questions about Death: What Children Need to Know about Death Jessica Philadelphia, PA: Jessica Kingsley Publishers, 2009. _Jamison, Kay Redfield An Unquiet Mind: A Memoir of Moods and Madness. New York, NY: Knopf, 1995 _Jamison, Kay Redfield Night Falls Fast: Understanding Suicide. New York, NY: Knopf, 1999. _Joiner, Thomas Myths About Suicide Cambridge, MA: Harvard University Press, 2011. _Joiner, Thomas Why People Die by Suicide Cambridge, MA: Harvard University Press, 2006. _Kosminsky, Phyllis Getting Back to Life When Grief Won’t Heal New York, NY: McGraw-Hill, 2007. _Lester, David Making Sense of Suicide: An In-Depth Look at Why People Kill Themselves Philadelphia, PA: Charles Press, 1997. _Linn-Gust, M., & Cerel, J. Seeking Hope: Stories of the Suicide Bereaved (Eds.). Albuquerque: Chellehead Works (2011). _Linn-Gust, M., & Peters, J. (2010). A Winding Road: A Handbook for Those Supporting the Suicide Bereaved. Albuquerque: Chellehead Works, 2010. 7 _Linn-Gust, M. Rocky Roads: The Journeys of Families through Suicide Grief. Albuquerque, NM: Chellehead Works, 2010. _Linn-Gust, M. Do they have bad days in heaven? Surviving the suicide loss of a sibling. Atlanta, GA: Bolton Press, 2001 (Chellehead Works 2002). _Marcus, Eric Why Suicide? New York, NY: Harper-Collins, 2010. _Meyers, Michael & Fine, Carla Touched by Suicide: Hope and Healing After Loss New York, NY: Gotham Books, 2006. _Rappaport, Nancy In Her Wake: A Child Psychiatrist Explores the Mystery of Her Mother’s Suicide New York, NY: Basic Books, 2009. _Requarth, Margo After a Parent’s Suicide: Helping Children Heal. Sebastopol, CA: Healing Hearts Press, 2006 (www.HealingHeartsPress.com). _Rubel, Barbara. But I Didn’t Say Goodbye: For Parents and Professionals Helping Child Suicide Survivors. Griefwork Center, Inc. 2000. _Slaby, Andrew & Garfinkel, Lili No One Saw My Pain: Why Teens Kill Themselves New York, NY: W.W. Norton & Co., 1994. _ Solomon, Andrew The Noonday Demon: An Atlas of Depression New York, NY: Scribner, 2001. _Styron, William Darkness Visible: A Memoir of Madness. New York, NY: Random House, 1990. _Wise, Terry L. Waking Up-Climbing Through The Darkness Oxnard, CA: Pathfinder Publishing, 2004. _Wrobleski, A. & Reidenberg, D. Suicide: Why? 85 Questions and Answers, 3rd Ed. SAVE (Suicide Awareness Voices of Education), 2005. (http://www.save.org/) Book Services: These book services specialize in a wide range of books related to loss and bereavement, for children, adolescents, and adults. _ Compassion Books Burnsville, NC – Telephone - 1-800-970-4220 http://www.compassionbooks.com/store/ _ Centering Corporation – Omaha, NE – Telephone - 866-218-0101 http://www.centering.org/ Organizations and Online Resources: All of these groups have resources for survivors. _American Association of Suicidology - 5221 Wisconsin Avenue, NW Washington, DC 20015 Telephone 202-237-2280. www.suicidology.org/ _American Foundation for Suicide Prevention 120 Wall Street – 29th Floor, New York, NY10005 Telephone 888-363-3500. www.afsp.org/ _Center for Suicide Prevention Suite 320, 1202 Centre Street S.E. Calgary, AB T2G 5A5, Canada – Telephone: 403-245-3900. http://suicideinfo.ca/. 8 _National Action Alliance for Suicide Prevention - 1025 Thomas Jefferson St., NW, Ste 700 Washington, DC 20007. -202-572-3784 - http://actionallianceforsuicideprevention.org/ - A national public/private partnership dedicated to reducing suicide in the U.S. Includes a number of task forces on topics related to suicide, including the Survivors of Suicide Loss Task Force. _ Parents of Suicide and Friends and Families of Suicide - http://www.pos-ffos.com/ - online web resources for parents bereaved by suicide, and other family members/friends bereaved by suicide (siblings, children, spouses, friends, etc.). _ Samaritans Grief Support Services – 41 West St., 4th Floor - Boston, MA 02111 Telephone: 877 870 4673. www.samaritanshope.org/ _Samaritans of Rhode Island – Telephone: 401-272-4044 - www.samaritansri.org/home.htm _ SAVE (Suicide Awareness Voices of Education) - 8120 Penn Ave. S., Suite 470, Bloomington, MN – 55431 – Telephone 952- 946-7998. _Sibling Survivors.com - http://siblingsurvivors.com/sibling-grief/ - for survivors of the death of a sibling to suicide. _ Suicide: Finding Hope - http://www.suicidefindinghope.com/ _ Suicide Grief Support: Quick Reference – a comprehensive listing of support resources for suicide survivors. - https://sites.google.com/a/personalgriefcoach.com/suicidegriefsupport/ or sg.sg/griefreference _Suicide Grief Support Forum - http:www.suicidegrief.com 9 SUGGESTIONS FOR GUIDED IMAGERY: A Conversation with the Deceased John R. Jordan, Ph.D. © - 2015 - All Rights Reserved I. II. III. Preparation A. This exercise should be done only in the context of a productive and secure therapeutic relationship with the client. B. The clinician and client should carefully discuss the technique before participating in it. This discussion should include deciding on the goals (leave-taking, finishing unfinished business, reestablishing a sense of connection with the deceased, etc.), possible benefits, and possible risks. Particular fears that the client might have about doing the technique should be carefully explored, and should guide the decision about whether to try the technique. C. An extended session length (e.g., 90 minutes or more) may be advisable, given the need to process the material that is brought up in the technique. D. The technique should be used cautiously, if at all, with clients who are: 1. Recently bereaved, particularly after traumatic death 2. Traumatized or who have a history of childhood traumatization 3. Likely to find the emotional intensity produced by the technique more disturbing than helpful 4. Lacking a trusting relationship with the clinician 5. Reporting a history of dissociative or psychotic episodes 6. Actively suicidal Relaxation A. Make clear to the client that they can stop at any point in the process if they are feeling overwhelmed or find continuing too psychologically distressing. B. Begin with an exercise that helps the client both physically and mentally relax. The goal is to help the client “go inside” and attend to their internal physical and emotional state. Asking clients to close their eyes, take a deep breath and physically relax on the exhalation, and then focus their attention on diaphragmatic breathing for a short while is one way to do this. Setting up the encounter IV. V. A. When ready, ask the client to imagine coming into a comfortable room with two comfortable chairs. As they enter, they see that their loved one is seated in one of the chairs and waiting to meet and talk with them. B. Emphasize that the physical and psychological state of the deceased is one of being physically healed, psychologically at peace, and receptive to listening to the client. Regardless of past conflicts and relational problems between the deceased and the client, the deceased is now ready and willing to listen carefully and empathically to whatever the client needs to say. The deceased has come to the encounter wanting to understand the experience of the client. C. Ask the client to begin the conversation with the deceased. Note that this can be done completely silently within the client’s mind or it can be done out loud. If the client has difficulty getting started, the clinician can suggest a prompt, such as “What do you want them to know about what the relationship has meant to you? What do you want them to know about your regrets about the relationship? What do you want them to know about anger that you feel about the relationship? What do you wish that you had said to the deceased before they died? What do you want them to know about what it has been like for you since they died?”, etc. D. The technique can be done for 5 - 20 minutes. Generally, the clinician should be silent while the client is having the conversation, interrupting only if the client appears to be very distressed, or unable to proceed with the experience. Closing the technique A. Clients can be prompted that they will be asked to stop shortly. They can signal when they are ready to do so. The client should be asked to do a leave-taking with the deceased, with the explanation that the client can return for additional visits when needed. In other words, the conversation should not be framed as a “final farewell”, but rather as a meaningful visit with the deceased, which can lead to further visits as needed. B. The client can then be asked to go back to attending to their breathing, followed by opening their eyes and “coming back to the room” with the clinician, as they are ready to do so. Debriefing and integrating the experience A. It is very important to allow the client sufficient time to process this experience after closing it down. The goal of the debriefing is to help the client reduce the emotional intensity before they leave the session and to begin to integrate what the experience has meant for them. VI. B. Debriefing can include asking the client to discuss as much (or as little) of the conversation as they wish to share, discussing what the conversation means to them, and what steps they think might come next. Clients should also always be asked about their present emotional state, any strong physical or emotional reactions they are experiencing, what they found helpful or disturbing about the experience, and whether feel it would be helpful to use the technique in a future session. C. If warranted, clients should be asked about any concerns about their emotional well being after they leave the session, and a plan should be developed for how they will handle any anticipated problematic distress, such as inquiries from others about the session, suicidal feelings, retraumatization, etc. D. Clients can also be encouraged to journal about further thoughts about the experience and to bring those to future sessions with the clinician. Variations of the technique A. Clients can be encouraged to imagine the deceased responding to what they have heard from the client, so that more of an interactive conversation between the client and the deceased takes place B. Clients can be asked to not only to communicate their messages out loud, but to “enact” them by sitting in one chair and speaking to the deceased, and then in the opposing chair to speak back from the deceased. This is the classic “empty chair” technique. C. Instead of imagining the conversation with the deceased, after the induction of the encounter with the deceased, clients can be asked to write the conversation out on paper (both to the deceased and from the deceased). This can be kept by the client and re-read as desired. D. The session can be tape recorded, and the client asked to listen to the recording at home. They can also be asked to journal about their reflections on the conversation after listening to the recording. This can be discussed in future sessions. E. Depending on the dynamics of the family or other relationship and the issues involved, clients can also show the journaling or play the recording of the session to a significant other person in their life with whom they wish to share the experience. SUICIDE BEREAVEMENT CLINICIAN TRAINING PROGRAM Optional Clinician Referral Database A major goal of the Suicide Bereavement Clinician Training Program is to develop an online database by which people bereaved by suicide can find a clinician who is knowledgeable about bereavement after suicide and willing to provide grief therapy for survivors. Participation in this database does not constitute an endorsement or referral from the American Association of Suicidology or the American Foundation for Suicide Prevention. Rather, your name and contact information will be listed in the database only as mental health clinician who has completed the SBCTP, and has expressed a willingness to provide grief therapy to people bereaved by suicide. 1. Name & Degree as you want it to appear in the Database: _________________________________________________________ 2. Address of your Office: _________________________________________________________ 3. Office Phone: _________________________________________________________ 4. Office E-Mail: _________________________________________________________ 5. Years of Experience as a Mental Health Professional: _________________________________________________________ 6. Specializations or Other Information: (Adolescents: Children; Couples Therapy; Etc.: _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ SUICIDE BEREAVEMENT CLINICIAN TRAINING EVALUATION FORM Thank you for attending today’s workshop. We would very much appreciate your help in evaluating the training and in offering suggestions about how we could improve this workshop. If you could fill out this brief questionnaire, and leave it with Dr. Jordan before you leave, we would be very appreciative of your time and comments. Background: 1. Please tell us your professional discipline and work setting (e.g., psychologist in private practice, social worker in a medical hospital, etc.): ______________________________________________________________________ 2. Please tell us briefly why you decided to attend this training: ______________________________________________________________________ 3. Please describe how your work is related to bereavement care (whether after suicide or not): ______________________________________________________________________ Ratings: Please give us a numerical rating from 1 to 5 on each of the questions below – 1 = “Strongly Disagree 5 = Strongly Agree: 1. I have a better understanding of how to be of help to suicide survivors _____ 2. This training will help me directly in my professional capacity _____ 3. This training met or exceeded my expectations _____ 4. This training has increased my confidence in working with survivors _____ 5. I would recommend this training to other clinicians _____ 1 General Comments: Please help us understand your reactions to the specific sections of the training, so that we can make modifications. For each section listed below, please do two things: first, give us a numerical rating between 1 and 5 of how valuable to your work (or not) this section was for you (1 = Not Very Valuable to 5 = Very Valuable). Then, please provide some elaboration on why the section was valuable (or not) for your professional work, and what might improve this section. Section 1 – “Suicide Survivors: Who Are They?” Rating:_____ Please Elaborate _______________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Section 2 – “The Impact of Suicide” Rating:_____ Please Elaborate _______________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Section 3 – “What Can We Do to Help Survivors?” Rating: ______ Please Elaborate _______________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Section 4 - “Grief Therapy with Survivors” Rating:_____ Please Elaborate _______________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 2 The Video/Case Study Rating:_____ Please Elaborate _______________________________________________________ ______________________________________________________________________ ______________________________________________________________________ What additional suggestions do you have for us to improve the training? ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Please leave this form with Dr. Jordan before you leave, and thanks so much for your help! 3