Forming a Support Group
Talking about
Suicide You’ll find few support groups so far. That hasn’t changed since the 1960s and 1970s, when the first few groups were tried. “Group therapy as a therapeutic procedure for self-destructive persons has been singularly neglected,” suicidologist Norman Farberow wrote back then. “Reports of programs in this area have been few despite the general impression of positive impact and almost specific usefulness of the group format for suicidal people.” Why? Farberow and Calvin Frederick were frank: Therapists were scared of us. “In general, psychotherapists recommend exclusion of suicidal persons from groups and are disinclined to work with such patients even on an individual basis,” they wrote. In an age before political correctness, perhaps, the researchers called attempt survivors a “special problem group” along with, among others, stutterers and paraplegics. And yet, Farberow encouraged such groups, and he took aim at another fear that still keeps some from forming today: The fear of legal liability if someone dies. “lt is not nearly as easy for the patient to blame several persons who share responsibility for treatment as it is to blame one particular therapist,” he wrote. In other words, it’s easier to protect yourself from a lawsuit with more people in the room. The groups mentioned here are in Los Angeles, Virginia, Illinois, Arizona, Toronto, New Jersey and Massachusetts. Most are affiliated with mental health centers, crisis centers, hospitals or community centers. If you’d like to have a group in your community, approach organizations like that and ask. Organizations that already host suicide survivors’ support groups for the bereaved might be sympathetic and equipped to help. How to know if there’s interest in forming a group? The crisis or mental health center can ask employees and volunteers for their thoughts. Ask local suicide survivor groups. Find a way to float the idea in the local media. “We would receive calls on the hotline looking for a group for attempt survivors.” _ Shari Sinwelski, Los Angeles Should the group be open or closed? Some are closed. “That helps with group bonding and helping people to really get to know each other.” _ Los Angeles. Some are open. “There ends up being sort of a core group that acts as a nest, so when someone new joins, there’s already a climate created. We experimented with having a closed group but realized that people don’t always ‘plan’ to be suicidal, so we want folks to be able to act with spontaneity in coming to our groups.” _ Janice Sorensen, Massachusetts What kind of atmosphere helps? “At the beginning, I found it pretty cold and sterile, so I always make sure we have refreshments, drinks and food, a more welcoming environment. At times we’ve done other things for fun. For example … we made one of our groups a Thanksgiving potluck.” _ Los Angeles Who can join the group? And how to publicize the group? Going by referral means a person’s therapist knows their suicidal background, and some don’t want that. But cooperation with therapists means having an established network. Being open to both referrals and walk-ins is an option. “We’ve been surprised that most of the referrals have been self-referrals.” _ Katie Ayotte, Arizona. ” We get a lot of doctor referrals. We put up posters in hospital emergency rooms, psych units of area hospitals.” _ Lisa Liedberg, Illinois. “Most people come from word of mouth. … I think it will take someone higher up in hospitals or the police department to say, ‘Tell them about this.’” _ Cory Cobern, Virginia. “We started calling churches and libraries, handing out fliers.” _ Massachusetts Should new members be screened, and how? “The individual goes through a telephone intake with me so I can learn a little more about their experience, to make sure that we both feel a group environment is something they’re ready for.” _ Los Angeles. “Anyone who wants to come to the group, they call the helpline and leave their information. I call back and do a phone interview to make sure they are actual attempters, make sure they are OK for the group. I don’t turn anyone away, but I don’t want anyone else there.” _ Virginia. “We rarely turn away. Maybe because of a psychotic disorder.” _ Yvonne Bergmans, Toronto. “You can’t come to the meeting drunk or under the influence of medication that is not prescribed.” _ Illinois. “We don’t screen, as we know how easily a person can be discouraged from attending.” _ Massachusetts What about confidentiality? And should records be kept? Basic personal information is usually taken but used only to contact the person. That and attendance records are helpful to track program statistics. “We have called a therapist without the patient’s consent, but only in emergencies.” _ Norman Farberow, earlier Los Angeles support groups. Are there any taboo topics? “This being an attempters’ group, there is no taboo subject, because anything can lead someone to another attempt. … I don’t want anyone to go home and say, ‘This was on my mind.’” _ Virginia. “One of the things we discourage in the Suicide Anonymous rooms is the methods.” _ Phillip Garber, New Jersey. “We want people to be able to say what’s happening to them, but we ask that they not paint a picture. So that means someone can say they’ve really been thinking about killing themselves, but we don’t really want to hear that someone purchased rope. We don’t want to hear someone’s story about the blood.” _ Massachusetts. “We haven’t really come up with any topics so far that would be prohibited. On the other hand, it is a group, so we are always checking in with the group to make sure that topics are comfortable for everyone. ” _ Los Angeles What’s the plan in case of crisis? “I can’t commit anybody. I don’t have that capacity. … I’ve been known to walk with people down to the emergency department. Or to my office, figure out a strategy, talk every few hours with them, ask them to let me know how they’re doing. Sometimes going to the ER can be more traumatizing than their actual feelings.” _ Toronto. “If they want us to take them to the hospital, we can. I leave it to them. I just do my absolute best not to leave them alone.” _ New Jersey. “The most important thing is to try and assess if people have enough immediate support in their lives that they will be able to stay safe until the next group starts.” _ Los Angeles. “We take them, there’s a hospital a 10-minute drive (away). _ Illinois What’s the plan in case of the death of a member? “We learned as we went. We felt that because everybody knew (the member who killed himself), we should talk about it. I announced he had done that, and we spent the evening talking about that and the things he had said. … And then when (the crisis center founder) asked his sister to come and tell us, that was a big help too because we weren’t left wondering.” _ Illinois How large should a group be? “If I ever get 12 people regularly, I’ll close the group and start another.” _ Virginia. “We have had as few as three, and I think our biggest group was seven.” _ Los Angeles. The Illinois group has had up to 15. What is the age requirement, if any? “No one under 18.” _ Illinois. “A broad span in age enables the suicidal individual to see that his problem is not unique to his own age group. Moreover, if a suicidal youngster is particularly dependent and in need a parental surrogate, the presence of older persons may be of value.” _ Farberow Who should lead the group? Usually a clinician, along with a peer facilitator or facilitators. “We’ve had some grads to come back and become peer facilitators. … When we do groups, I have many colleagues from various professions working with me, co-facilitating, so they develop a skill set. So they come to realize that when our clients are in good shape, they’re just a hoot and half, a human being you could meet anywhere.” _ Toronto. “We would take a peer who’s really at a good strong point in life to handle the intensity. When we started, we had an attempt survivor as my co-facilitator. After a while, it became overwhelming.” _ Los Angeles. “One of the main things of the group is, I’m the facilitator, but I’m not in charge. I could not possibly be in charge of everyone being alive. … We’ve had people walk in and not know who the facilitator was. This is a good thing. Everyone takes ownership.” _ Massachusetts. “Therapists should be emotionally stable, have basic knowledge in behavioral science and special familiarity and training in the area of suicide prevention. Beyond this there is no evidence that any particular type of therapist, psychologist, physician, clergyman or social worker, is more effective than any other.” _ Farberow How does a typical meeting go? “I actually told my story, which kind of loosened everyone else up. … For the most part, I start with, ‘How’s everyone?’ _ a quick wellness check. I can rely on (veteran members) to get others talking. If not, I know most of my group members now that I can say, ‘OK, what’s going on with you?’” _ Virginia. “A normal group starts with the check-in: How’s your day, what’s worked and what’s not worked for you the past couple of weeks. Myself or the other facilitator brings a discussion topic, unless a topic has already started during the check-in.” _ Arizona. “A lot of times we didn’t do anything that I had planned. In the first few weeks, we really just take some time for members to get to know each other. On the first night, we’d go over guidelines, things they can get from the group, the chance to introduce themselves. … Sometimes if they need more of a conversation starter, we show a National Suicide Prevention Lifeline video that shows stories of others who have survived a suicide attempt and they can relate, talk about stigma and other concerns. … If it was difficult, we encourage them to stick with it and follow up with every new member afterward to make sure they are comfortable.” _ Los Angeles. “We see if a common theme has emerged from our two-minute ‘check-in,’ and we will start with that. Sometimes we just talk about funny stupid stuff. We also share resources. There’s no directive we must talk about despair or of feeling suicidal, but we really try to hold the space open for that.” _ Massachusetts. “We introduce ourselves and how many times we’ve attempted suicide … And then if someone is really having problems, they speak first. We try to help them, give them coping mechanisms that they might not have thought of.” _ Illinois. “There’s a lot of work about developing a language of safety. Knowing early warning signs, knowing the tools to use. And being a teacher to the care providers you work with. We work from the perspective that everyone is a learner and teacher.” _ Toronto How long are meetings, how often do groups meet, and how long does the same group meet? It varies. “The eight weeks are kind of arbitrary. … It’s a way to allow people to join or come back again. … We meet once a week. Initially it was an hour and a half, but recently it went up to two hours because there were bigger groups and not enough time to get everything done.” _ Los Angeles. “The group therapy program … now includes two long-term insight-oriented groups (once a week, people joining at varying intervals, focus on social and interpersonal relationships), a postcrisis-oriented, time-limited group (twice a week for a specified period of eight weeks, maximum eight people), a drop-in group (five days a week, no waiting period, limit 10 people, focus on temporary stresses).” _ Farberow Are there any issues about completing and leaving the group? “Their separation anxieties are buffered by the fact that all of the patients have the option of continued participation in drop-in groups and/or of availing themselves of our 24-hour answering service. Thus, the patients find there is always someone available if an emergency arises.” _ Farberow What about any concerns about liability? “lt is not nearly as easy for the patient to blame several persons who share responsibility for treatment as it is to blame one particular therapist.” _ Farberow How do the group leaders take care of themselves? “We always make sure to have weekly supervision with all facilitators so we can stay honest about our emotions.” _ Toronto. “Although many patients who attend were extremely depressed and difficult to manage, the therapists have not felt overburdened because the responsibility and transference are shared by all.” _ Farberow Some parting thoughts: “It is important for people to feel safe in sharing their thoughts of suicidality. Many of us know that if we share these feelings in a clinical setting, and that agency has a policy requiring that anyone who shares such thoughts needs to be hospitalized, that person may end up with a section 12 and return home to find the police waiting to take them to the hospital. Such a thing would keep me from sharing those thoughts. It is counterproductive.” _ Massachusetts “Members can feel comfortable being completely open and honest with each other, knowing that they won’t be judged. They can also learn things from people who have walked in their shoes.” _ Los Angeles “If we’re available to people, it lessens other people’s and agencies’ burdens. And I think before too long, the numbers, in terms of budgetary benefits, are going to show themselves. I don’t know how people can track it well, but I know we are keeping people out of the hospital, and that’s where the huge expenses lie.” _ Massachusetts “The fact that other group
members speak directly about their own suicidal feelings,
breaking the taboo of silence around the subject of suicide,
is helpful. … Participants often strike up quick,
sympathetic friendships with each other, and there are
endless examples of self-help and assistance to each other
among members of the groups. We had not anticipated that so
many patients would continue to return after the crisis had
passed, or that they would drop out after a few visits, only
to return, sometimes months later when another crisis
developed or simply because they felt lonely and remembered
the drop-in group as a comfortable, friendly place.” _
Farberow |
96 pages