How can we in supervision contain counsellors working in a community which has been traumatised by six suicides in one year, four involving young people still at school? The community, in this case, is a fairly large town in the south of England which has a clear sense of its own identity and a strong community spirit flowing through its schools, churches and civic societies. The extensive local press coverage has taken awareness of these suicides into every home in the community and has evoked widespread consternation. A whole population of young people, their families, schools and teaching staff have been affected by these deaths.

This succession of suicides has been an extremely challenging situation for all who have been connected in any way, in a school, youth club, workplace, or just through being part of the youth culture in the town. We are struggling to come to terms with the loss of family, friends, peers or colleagues. As a supervisor working with school counsellors and counsellors in general practice, I have found that the impact of suicide is very different to other deaths. In one sense this is not surprising. Death by suicide, especially involving young people, strikes at the very raison d’être of the healthcare professional. Death by suicide can make us feel we have failed; it challenges our omnipotent fantasies, our belief in our capacity to help, to cure, to save.1

‘Survivor’ is how Alison Wertheimer2 describes people bereaved by suicide. She goes on to say that there is increasing recognition of the phenomenon of ‘secondary survivors’ of suicide deaths. Some secondary survivors, without support, can be at risk of developing anxiety, depression or symptoms of PTSD. These groups may be from the deceased’s school, workplace, club etc. The impact of suicide on counsellors who work with the survivors of the deceased (relatives, friends, peers) means the counsellors themselves can also become secondary survivors.

In our community many young people felt they were able to identify with their dead peers. This led to the counselling services being inundated by those seeking professional help. As a result, one of the issues counsellors had to bear in mind was the fear of ‘copycat’ or ‘cluster’ suicides3 being a very realistic possibility. When young people already have a suicide ideation, peer suicides can be interpreted as a way out of seemingly insoluble problems.4

Containing counsellors and supervisors

The need for counsellors to be contained by a supervisor who has previous experience of such occurrences and understands the issues likely to be raised is, in my view, of paramount importance. It became apparent, following these suicides, that there was a lack of training in both counselling and supervision courses to address issues arising from such a crisis. (Of course, some may argue that this issue can only be learned by going through such an experience.) Whilst there is much written about supervision for counsellors who have suicidal clients, there is very little written about supervising counsellors who are working within the community after suicides have occurred.

It is widely accepted that the supervisor is crucial for the professional care of the counsellor, particularly in the containment of work-related stress. The supervisor needs to be trained in the competencies demanded by crisis work and community disasters to help guide the counsellor as well as to provide support and prevent professional ‘burnout’. My experience of being involved in such a community crisis was to concur with the view expressed by Hellman5 that ‘supervision is an opportunity to consult, receive guidance and share the daily experience of working in a highly volatile and unpredictable situation’. I was fortunate to find a supervisor who had researched the implications of suicide and was also experienced in the far-reaching impact of such an act. Without his understanding and containment I would not have been able to ‘hold’ my supervisees who were struggling, not only with their clients, but also with their own feelings and insecurities.

With his containment of me, I became aware that during supervision sessions with supervisees they appeared much more comfortable focusing on how these suicides were affecting other people rather than themselves. As counsellors we often think or like to think that we are nicely ‘sorted’, but as a supervisor I will always check that a supervisee is receiving their own personal therapy if I feel the client work is touching their own issues. In my experience, suicide touches the very core of our being and our world-view. As supervisors we must be mindful of the possible unconscious depth of personal turmoil of emotional suffering that can be evoked in our supervisees.

Anxiety and counteracting feelings of helplessness

Perhaps one of the most striking features of suicide bereavement is the way in which the person who has taken their own life projects their unbearable feelings and, according to Shneidman and Cain, ‘puts their psychological skeleton into the survivors’ emotional closet... it can be a heavy load’.6 I also experienced my supervisees as carrying a heavy load. I noticed with two of the counsellors I supervised, their almost frantic feelings that they had to ‘do’ something to counteract the feelings of helplessness which the survivors face. It was as though they were preoccupied with rescuing others in order to prevent any more suicides. They were working with young people, which in my experience can often induce feelings of needing to ‘rescue’. (This is another reason why a supervisor working with school counsellors or working with young people needs to have experience and a wider understanding of the deeper and sometimes complex issues involved with this particular age group.)

An example of the need to attempt to control the situation is demonstrated by the supervisee who is a manager of a local counselling agency. She felt a pressure to act immediately and set up counselling groups for the young people affected. She also made provision for extra counselling to be provided, especially during the long school summer break when school counsellors and school support were not available. I had to contain her anxiety as it was spilling over into other areas of her work. She was not receiving personal therapy and it became very evident that these deaths were probably touching deep, unexplored personal issues affecting her ability to function effectively. ‘The traumatic nature of suicide bereavement can create an atmosphere of crisis: this thing has got to be dealt with immediately because if it isn’t something dreadful is going to happen.’2

Compassion fatigue

My supervisees’ anxiety in supervision sessions after these suicides was palpable and I was aware of how much I was becoming detached and in danger of appearing unfeeling and insensitive towards them. As a supervisor, I was surprised how difficult I found it to be empathic towards the counsellors I was supervising and I certainly did not relate with any anxiety they were feeling in connection with their clients. In fact I had an almost blasé, ambivalent feeling.

This of course was exactly the opposite of what everyone else was feeling. The suicides were impacting on the whole community, the telephone seemed to be continually ringing and I felt at one point that the world had gone mad. The madness of suicide was consuming everyone. I also became aware of impatient feelings and even anger towards some supervisees. I found myself asking questions such as: Why were they allowing themselves to step over the usual boundaries? Why could they not contain their clients’ distress? Why were their clients acting out in such a destructive way?

Of course anger is very much present in suicide, and in supervision I had to look at where mine really belonged. On reflection and subsequent discussion with a supervisee, I realised that she expected me to have all the answers, to take responsibility and offer a ‘rescue package’. It was her frustration and anger. She felt no one was coming in to really help the young people. A parallel process was being enacted, as her young clients were looking to her for answers, she was looking to me, and her frustrations were being projected onto me.

The only sanity I felt was in my own supervision, a safe haven where I could speak about everything and really try to understand what was happening both to me and others, and how best to respond and give guidance. I knew I needed to hold on, to be grounded and it was a relief to be able, in supervision, to accept my feelings as probable ‘compassion fatigue’ and reflect on my feeling of being ‘detached’. This enabled me to see both my supervisees’ issues more clearly as well as looking at the clients. I was not, because of this support, allowing myself to be pulled into the madness. The detachment I sometimes felt was perhaps similar to the shock and numbness which echoed the feelings of many people within the community and is particularly typical of the effects of suicide. However, as one supervisee commented, ‘There is a delay, shock, and numbness and then... wham! It’s like a land mine explodes.’ Six months after the first suicide there were at least six more known attempts of suicide by young people attending local schools.

Suicide can also be a painful reminder of failure, including at times our professional shortcomings or failings. I understand that my supervisees’ desire to rescue their clients was also a way of projecting their own unbearable feelings onto others. Not only does the suicide victim project their unbearable feelings onto the survivors, in this case the survivors could not bear to explore their own feelings so put all their efforts and energies into trying to ‘save’ the youth in the community. For example, one supervisee, a school counsellor, has a daughter of a similar age to one of the suicide victims, and much of the supervision was spent understanding that her frantic desire to hand out her telephone number and email address to her clients was about her fear that her daughter could also possibly take her own life. Identification with the parents of the dead children was common and when dealing with loss and grief we can be reminded of our own mortality as well as the possibility of losing someone close to us.

Another school counsellor became extremely anxious about the students in her school and was exhausting herself by holding extra sessions, giving out books on self-help and losing all her previous boundaries. This in itself was extremely unhelpful to students and certainly gave them no sense of holding. In her desire to keep them safe, the counsellor had created a feeling of chaos and a lack of safety.

Coping with feelings of rejection

Counsellors have to come to terms with the fact that as professionals and human beings we are not always able to prevent the death of another. We need to be aware of our own attitudes towards suicide as well as exploring these in personal and professional development. Supervisors must therefore allow the space for this in ongoing supervision.7 In particular, we have to look at our sense of rejection. Rejection is perhaps almost unique to suicide bereavement. In every suicide there is a component of rejection.8 The person who takes their own life implicitly rejects life but in so doing rejects family and friends too.9 Professionals who may have been able to help also feel a rejection at some level. The dead person has rejected what we have to offer in our professional role as therapists.

Maybe it is this ‘rejection’ that has inspired me to write this article; maybe I have been energised by the anger still around me. Certainly I feel I want to pass on my experience, but maybe I also want something creative to come out of something so potentially destructive. Although I have spoken about my experiences in my own therapy, writing this has been cathartic in itself. The importance of reflection on the response by professionals and key people involved in these suicides is crucial, in order that lessons can be learned and passed on. This experience has demonstrated the importance of professionals genuinely working together to avoid ‘knee jerk’ responses which can be a tendency in crisis situations. Recognition of the importance of counselling supervision with a supervisor who is knowledgeable in the issues surrounding suicide is imperative if counsellors are to make a valuable, safe and significant contribution.

Linda Eke trained at the University of Hertfordshire where she gained an MA in Counselling Inquiry. She later trained as a psychotherapist with WPF. She specialises in working with children and adolescents, and works as a school counsellor and supervisor. She has extensive experience in working with loss and bereavement. 

References

1. Boakes J. The impact of suicide on the mental health care profession in suicide and the murderous self. London: Department of Mental Health Sciences, St George’s Hospital; 1993.
2. Wertheimer AA. Special scar (2nd edition). Hove: Brunner Routledge; 2001.
3. Lukas C, Seiden H. Silent grief: living in the wake of suicide. Northvale, NJ: Jason Aronson; 1997.
4. Murray-Parkes C. In Wertheimer AA Special scar (2nd edition). Hove: Brunner Routledge; 2001.
5. Hellman S. A method of reflective development. In Holloway E, Carroll M Training counselling supervisors. London: Sage; 1999.
6. Shneidman ES. In Cain AC (ed) Survivors of suicide. Springfield, IL: Charles C. Thomas; 1972.
7. Wheeler S, King D. Supervising counsellors: issues of responsibility. London: Sage; 2001.
8. Hauser MJ. Special aspects of grief after a suicide. In Dunne EJ, Mcintosh J, Dunne-Maxim K (eds) The aftermath of suicide: understanding and counselling the survivors. New York: W Norton; 1987.
9. Silverman E. Bereavement from suicide as compared with other forms of bereavement. Omega. 1994: 30(1).

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