The Patient-Therapist Relationship in Suicide Loss
by Wayne Hankammer, MA, LPC
Loss is a large factor in suicide. Its impact on the suicidal person is well documented as well as the devastation of loss from the actual suicide. So, loss is a two-way street in suicidology. Suicide, felt as loss, ends life of one and changes forever the lives of others.
This is the story of my experience with death and how this reality changed my life. No stranger to death, I’ve seen it as a cop in accident scenes and elsewhere. While I was the commander for an Air Force Security Police unit one of our sergeants was murdered off-duty. I lost my father and dear friends, too. I also was a suicide hotline worker fielding one very lethal caller once. But nothing compares to the suicide death of a patient of mine who will be referred to here as “Dana.” At the time, I had been working as a therapist for about eight years professionally. The review of Dana’s suicide with staff was painful and necessary, but the impact to me was delayed.
One morning: I began to cry. It was about a year after Dana, my long-term, chronically suicidal patient, died. Maybe the anniversary was upon me, I couldn’t recall exactly since we were on a trip to Europe when Dana died. As I felt myself heaving that particular morning I withdrew to the guest bedroom for privacy not wishing to wake my wife. I could see Dana’s face, I recalled what I learned of the death, and I remembered the nearly last thing that was said, too, “I think God is preparing me to die.” He had said these kinds of things many times before. But the weird thing: I could NOT recall Dana’s actual name for some ten minutes.
“Loss of memory,” I told myself, was “a protective device against the pain.” Then I realized the two-way nature of loss was to numb me not shield me. Since this is a two-way street, did not Dana’s loss activate the same center of shame or pain in me that was also in Dana’s life? So to speak, like the wiring we all have deep within? That this loss through suicide also activated the same derealized and dissociated memory? Could this be the link to the contagion of suicide or the personal nature of the pain of this loss being so profound, so devastating that the recoil of it touches this center then cascades a series of thoughts, emotions, and behaviors that could lead to another suicide because this loss was still unresolved? I began to cry again….The answer is yes!
Intuitively, I know these are linked. That in the loss of Dana and because I had a stake in Dana’s life indicated an intense bond. Our relationship had been fruitful, processing much traumatic memory, dissociative states, and Dana’s self-described “sinister” side. I think this was based on our deep rapport and Dana’s acceptance of empathy that facilitated mutual trust. Literally, no conversation was taboo for us. Dana and I had been to the brink and back before. Death was a frequent topic of discussion, delving deep into trauma and disowned aspects of personality conversations were often dark and each session searched for any hint if suicide was near or not. No amount of second-guessing can change the sorrowful end to Dana’s life. Although sometimes I think Dana waited until I was away to die as– if that would shield me. If Dana thought that, it didn’t work. Time is an illusion, irrelevant when the connection between people is meaningful.
That death is profound for me, a horrible loss and one I still struggle with today, over a year later. I am not the same as I was. I still hurt but I’m better for the loss. There were so many possibilities at that point. Death was one, the thoughts were fleeting. I won’t deny that… but the possibility to resolve this was (and still is) very strong which offset the reactive impulse. I use this energy today to delve into the morass of pain and ferret out through my subjective experience, unique to self as it is, to get into the core of the suicide dynamic and make Dana’s death meaningful again: a positive sublimation. Literally, the impacts I felt upon myself compel me to understand both the complexity of suicide as well as what may help me understand what links one suicide to another.
There in the core of my experience I recognized the face of chaos. That in the experience of learning of this death, imagining it, too, also was the splitting moment that caused the cascade of changes within me. It impacted my subjective experience with this universal concept of suicide and the realities of each life: death and uncertainty. My assumption that Dana was safe as long as we discussed those impulses and stayed in treatment was not correct. Nor could I guarantee safety to any degree. Those are realities now. The changes were heavy and stressful. But, I am stronger now and have redoubled my efforts to understand myself and the personal nature of suicide. I will persevere.
About the Author
Wayne Hankammer, MA, LPC, has served 10 years as a therapist in the federal government and 20 years before as military law enforcement with 17 years in leadership posts. He is a former board member of the Suicide Prevention Partnership of the Pikes Peak Region in Colorado Springs, Colorado. He is the lead author of “Empathy as the primary means in suicide assessment” (2006) in The Journal for the Professional Counselor. He is married and lives in Artesia, New Mexico, in the United States.