Interventions for Suicide Survivors: A Review of the Literature

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346 Interventions for Suicide Survivors most of the services reported in the literature types of interventions. The quality of re- seem to involve some variation of the basic search methodology in intervention outcome bereavement support group, we believe that studies to date has generally been very poor, the first “wave” of research on interventions posing a major threat to the internal validity should involve naturalistic studies of the ef- of the studies and hence their usefulness for fectiveness of existing groups. This could in- drawing sound conclusions about the interclude data gathering about the perceived ventions. Future controlled studies in this needs, coping tactics, and sources of support second wave of studies should employ ran- employed by the participants. This type of dom assignment to treatment conditions and field research could evaluate the elements appropriate comparison groups, which could that appear to be common in most bereave- include both waiting list controls of survivors ment support groups. These include mutual, who have sought formal assistance along with nonjudgmental emotional support in a set- “community standard” controls who do not ting where survivors can tell their stories and seek treatment. The latter is particularly im- receive advice about coping from others with portant in bereavement outcome studies, since similar experiences. Comparison groups might no-treatment comparison groups are neces- be constructed of a community sample of sary to control for the natural tendency of matched controls that do not participate in bereavement related symptoms to remit over such groups. Such research should include time, with or without formal intervention. both quantitative and qualitative methods for Moreover, explicit delineation of the participants to describe their own under- treatment protocols involved, the theoretical standing of what aspects of the group experi- basis for the intervention, and evidence of ence are most helpful. Qualitative measures adherence to the treatment are also required of outcome that extend assessment beyond for methodologically sound investigations psychiatric symptoms to broader constructs and for the effective dissemination of treat- such as changes in the individual’s assumptive ment approaches to practitioners. Most early world, quality of life, and social adaptation studies are quite vague as to the actual proce- might also reveal a different type of intervendures employed in the intervention, although tion success. Furthermore, with a sufficient more recent studies have been based on man- sample size, the research could provide inforualized protocols (Murphy et al., 1998). These mation that may account for differences in second wave studies should focus on investi- outcome for different types of survivors, such gating interventions for specific groups of as timing of entry and duration of participa- survivors. For example, the general bereavetion, group format (e.g., time limited vs. onment intervention literature indicates that ingoing; structured vs. unstructured; psychoed- dividuals who are in high risk categories (e.g., ucational vs. expressive), and the background bereaved parents) and/or who already show and training of the leader (e.g., survivor vs. high distress levels (e.g., symptoms of clinical nonsurvivor, professional vs. nonprofessional) depression or PTSD) are the most likely to (see also Farberow, 2001). This more natural- benefit from professional intervention ( Joristic, effectiveness-oriented research on exdan & Neimeyer, 2003). Thus, “generic” suiisting groups could then lay the foundation cide survivor support groups may work well for a second wave of more controlled studies for many survivors, while specialized groups of specific intervention techniques for spe- (or other treatment modalities) for high-risk cific types of survivors. survivors may be preferable and more effica- With sufficient knowledge of the range cious at preventing future dysfunction, in- of the coping responses made by survivors, cluding future suicide. and of the factors that appear to enhance the These targeted interventions could in- effectiveness of existing interventions, we beclude approaches that have shown at least lieve that the field will then be in a position some promise in previous studies, such as to rigorously study the efficacy of particular writing interventions (Kovac & Range, 2000),
Jordan and McMenamy 347 psychoeducational and skills building pro- entifically based knowledge about how to as- grams (Murphy et al., 1998), and combisist survivors is far behind our ability to nations of informal “survivor-to-survivor” intervene with other at-risk populations (e.g., support and more structured group interven- trauma victims) or with many forms of psytions. Additional techniques that have been chiatric disorder (e.g., depression or anxiety shown to be of help in other types of trau- disorders). Although there are encouraging matic losses should be explored for possible signs that this is changing, it is our impres- adaptation for interventions with survivors sion that survivors have been a low priority (Doka, 1996; Figley, 1997, 1999). These in- for researchers and clinicians in suicidology, clude therapeutic modalities such as Eye whose main interest has focused on preventa- Movement Desensitization and Reprocessing tive work with suicidal individuals. It is our (EMDR; Solomon & Shapiro, 1997) and Trau- strong conviction, however, that “postvenmatic Incident Reduction (Descilo, 1999), tion is prevention” (Shneidman, 1981), and cognitive-behavioral therapies (Fleming & that work with survivors is an obvious and Robinson, 2001), family techniques (Horo- efficient way to contribute to the prevention witz, 1997), and narrative approaches (Ry- of future distress, psychiatric disorder, and nearson, 2001). even suicide itself. We hope that this review Conclusions will contribute to the growing interest within suicidology in studying and assisting suicide There is much work to be done (Far- survivors as they seek healing after this very berow, 2001; Clark, 201). Currently, our sci- difficult type of loss. REFERENCES Allumbaugh, D. L., & Hoyt, W. T. Campbell, F. R. (1997). Changing the leg- (1999). Effectiveness of grief therapy: A meta- acy of suicide. Suicide and Life-Threatening Behavanalysis. Journal of Counseling Psychology, 46, 370– ior, 27, 329–338. 380. Clark, S. (2001). Bereavement after sui- American Foundation for Suicide Prevention. (2003). AFSP releases report on survivors of suicide research workshop. Retrieved December, 2003, from http://www.afsp.org Apel, Y. H., & Wrobleski, A. (1987). Selfhelp and support groups: Mutual aid for survivors. In E. J. Dunne, J. L. McIntosh, & K. Dunne- Maxim (Eds.), Suicide and its aftermath: Understanding and counseling the survivors (pp. 215–233). New York: Norton. Bailley, S. E., Kral, M. J., & Dunham, K. (1999). Survivors of suicide do grieve differently: Empirical support for a common sense proposi- tion. Suicide and Life-Threatening Behavior, 29, 256–271. Brent, D. A., Moritz, G., Bridge, J., Per- per, J., & Canobbio, R. (1996). Impact of adoles- cent suicide on sibs and parents: A longitudinal follow-up. Suicide and Life-Threatening Behavior, 26, 253–259. Breslau, N., Kessler, R. C., Chilcoat, H. D., Schultz, L. R., Davis, G. C., & Andreski, P. (1998). Trauma and posttraumatic stress disor- cide—How far have we come and where do we go from here? Crisis, 22, 102–108. Constantino, R. E., & Bricker, P. L. (1996). Nursing postvention for spousal survivors of suicide. Issues in Mental Health Nursing, 17, 131–152. Constantino, R. E., Sekula, L. K., & Rubinstein, E. N. (2001). Group intervention for widowed survivors of suicide. Suicide and Life- Threatening Behavior, 31, 428–441. Crosby, A. E., & Sacks, J. J. (2002). Exposure to suicide: Incidence and association with suicidal ideation and behavior: Untied States, 1994. Suicide and Life-Threatening Behavior, 32, 321–328. Descilo, T. (1999). Relieving naumatic aspects of death with naumatic incident resolution and EMDR. In C. Figley (Ed.), Traumatology of grieving: Conceptual, theoretical, and treatment foun- dations (pp. 155–183). Philadelphia, PA: Taylor & Francis. Doka, K. J. (Ed.). (1996). Living with grief after a sudden death: Suicide, homicide, accident, heart der in the community: The 1996 Detroit area surattack, stroke. Washington DC: Hospice Founda- vey of trauma. Archives of General Psychiatry, 55, tion of America. 626–632. Dyregrov, K. (2002). Assistance from local
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