Rehab Kids

Grief After Suicide:

Transition Survivors from “Why?”
to “What’s Next?”
Rita A. Schulte, LPC

WELCOME!
Connecting Knowledge With Need is our mission. Thank you for joining us today!
We’d love to hear where you are and what you’re learning. Share your photos by tagging us
and using #PESISeminar and/or #LearningWithPESI. You’ll receive a special offer each time!
And be sure to follow us for FREE tips, tools, and techniques.

@PESIinc
linkedin.com/company/pesi www.youtube.com/c/PESIInc
@PESIRehabEdu

@PESIinc
www.pinterest.com/pesiinc
@PESIRehab

www.pesi.com/blog | www.pesirehab.com/blog | www.pesihealthcare.com/blog | https://kids.pesi.com/blog

 Grief After Suicide:
Transition Survivors from “Why?”
to “What’s Next?”
Rita A. Schulte, LPC

Rehab Kids

ZNM058025
4/21
Copyright © 2021

PESI, Inc.
PO Box 1000
3839 White Ave.
Eau Claire, Wisconsin 54702

Printed in the United States

PESI, Inc. strives to obtain knowledgeable authors and faculty for its publications and
seminars. The clinical recommendations contained herein are the result of extensive
author research and review. Obviously, any recommendations for client care must be
held up against individual circumstances at hand. To the best of our knowledge any
recommendations included by the author reflect currently accepted practice. However,
these recommendations cannot be considered universal and complete. The authors
and publisher repudiate any responsibility for unfavorable effects that result from
information, recommendations, undetected omissions or errors. Professionals using
this publication should research other original sources of authority as well.

All members of the PESI, Inc. CME Planning Committee have provided disclosure of
financial relationships with commercial interests prior to planning content of this
activity. None of the committee members had relationships to report

PESI, Inc. offers continuing education programs and products under the
brand names PESI HealthCare, PESI Rehab, PESI Kids, PESI Publishing and
Psychotherapy Networker. For questions or to place an order, please visit: www.
pesi.com or call our customer service department at: (800) 844-8260.

27pp

4/21

Rehab Kids
 Materials Provided By

Rita A. Schulte, LPC specializes in the treatment of depression,

suicidality, and grief. Rita is no stranger to loss and suffering
having lost her beloved husband to suicide in 2013. In addition
to her private practice, Rita is the creator and host of Heartline
Radio where she talks with counselors, authors and everyday
people about moving through the difficulties of life. Rita writes
for numerous publications and blogs and her articles have
appeared in Counseling Today Magazine, Thriving Family, Kyria
and LifeHack.org. She is the author of Shattered: Finding Hope
and Healing through the Losses of Life (Leafwood, 2013) and her
latest book Alongside: A Roadmap for Suicide Survivors and Those
Who Love Them is scheduled to be released in the fall of 2021.

Speaker Disclosure:
Financial: Rita Schulte is an author for Leafwood Publishers and receives royalties. She receives a
speaking honorarium from PESI, Inc.

Non-financial: Rita Schulte is a member of the American Counseling Association; American

Association of Christian Counselors; and the National Board of Certified Counselors.
Materials that are included in this course may include interventions and modalities that are beyond the
authorized practice of mental health professionals. As a licensed professional, you are responsible for
reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of
practice in accordance with and in compliance with your professions standards.
 Grief After Suicide: Rita A Schulte, LPC
Transition Survivors www.ritaschulte.com
from “Why?” to [email protected]
“What’s Next?”

Disclaimer
• Materials that are included in this course may include
interventions and modalities that are beyond the authorized
practice of mental health professionals. As a licensed
professional, you are responsible for reviewing the scope of
practice, including activities that are defined in law as beyond
the boundaries of practice in accordance with and in
compliance with your profession's standards. A licensee who
practices beyond the authorized scope of practice could be
charged with unprofessional conduct.

1
 WHY!!!

Traumatized
3 AREAS OF Brain PTSD
IMPACT
FUELING
“WHY” Crisis of
Guilt/Shame
Belief/Faith
QUESTIONS Existential
Complex
Trauma
Shattering

2
 • It’s a loss AND it’s highly
traumatizing
What Makes • It has many complex layers
this Loss • It carries stigma
Different? • It provides no closure
• It carries unfinished business
and shame

Dr. Edwin Shneidman

“The person who commits suicide

puts all his psychological skeletons
in the survivor’s emotional closet –
he sentences the survivor to deal with
many negative feelings and more, to
become obsessed with thoughts, (the
WHY questions) regarding their own
actual, or possible role in having
caused the suicidal act, or having
failed to abort it.”

3
 • WHY IS THIS HAPPENING?
Neurobiology/Somatic Experiences
• (PTSD/Traumatized Brain)

• WHY DID THIS HAPPEN TO ME?

CRISIS OF Belief (Existential Shattering)

• WHY WOULD HE DO THIS?

BETRAYAL (Shame/Complex Trauma)

• WHY DID HE LEAVE ME?

ABANDONMENT
(Guilt/Shame/Complex Trauma)

• WHY COULDN’T I HAVE

STOPPED IT?
HELPLESSNEESS
(Guilt/Shame/Complex Trauma)

FIRST STEPS
NORMALIZE

Strengths Based
Approach

Potential for
Resiliency

4
 IMPACT #1: TRAUMATIZED BRAIN
• Trauma impacts key structures in the brain underlying emotional
regulation. The emotional brain, is constantly hijacking the rational brain,
especially in the early stages of trauma
• Prefrontal cortex: goes offline. Limbic brain (amygdala) constantly
firing
• Breakdown of Thalamus explains why there is no coherent narrative of
trauma, only isolated sensory imprints/images, sounds, physical
symptoms accompanied by terror and helplessness
• Hippocampus encodes memory. Time and memory freezes.
• Anterior cingulate: works to help us filter out what’s relevant and what’s
not

Traumatized Brain
• Corpus callosum shrinks after 5 or more victimizations
• Effect's ability to develop secure attachment
• Greater deficits in frontal lobe functioning and meta cognitive skills
• Amygdala hijack interferes with development of coping skills. Hyperexcited
limbic system triggers ANS to go into overdrive
• Breakdown in executive functioning. Need to bring PFC back online
• Limited inhibitory control by cortical structures especially in PFC
• Disassociation: detached from mind/body, disconnect from self
• Derealization: world seems dreamlike, unreal, distorted, this isn’t happening

10

5
 • The brain releases 8 mg of morphine as it relives the trauma. Very powerful
dose making clients feel physically sick (nausea)
• Core beliefs driven by sympathetic activation have to do with safety. I’m
not safe, the world isn’t safe
• Parasympathetic nervous system is associated with energy conservation: be
invisible, submit, freeze, collapse.
• Traumatized brain: intrusive images, nightmares, flashbacks have now
become procedural memory for clients and become encoded in the brain

11

Resetting the Nervous System after Trauma

Safety
Mindfulness DBT
Net

Affect Outside
Breathe Regulation Resources

Ground Self-Soothe

12

6
 Exercises

• Containment
• Grounding Movement
• DBT
• Mindfulness Non-Judgment
• ACT

13

Pendulation: Finding Opposite Sensations

• Pendulation: the body’s natural restorative rhythm of contraction and
expansion
No matter how bad we feel, those feelings can and will eventually change
Whatever is felt is time limited. Suffering is not forever
• Focus on shifting sensations (the AND/BOTH)
• Brings a new perspective/feeling in the body and mind
• Learn to focus awareness from distress to ease

14

7
 HOW CAN WE OPEN PEOPLE UP TO
NEW POSSIBILITIES?
What meaning did they
attach to the
trauma/suicide?

Do they feel
responsible?

What do they need?

15

How Do We Help Clients Change Their

Filtering Systems?

3 T’S
CLIENTS ARE TRANSITION:
CAPABLE OF PTG IN
CLIENTS CAN BE
TALK—TELL THE FACE OF
MOVING TOWARD
SUFFERING
THE STORY PTG WHILE STILL
TIME BEING IN THE
STRUGGLE

TRANSFORMATION

16

8
 KEY TO HEALING

ALONGSIDE
PRESENT

PATIENT

PLANTING

17

Alongside
• In the aftermath of the crisis, the subject will have to understand the traumatic
situation and to deal with stress and loss. Therefore, he might look for help and
support from his family and friends (Tedeschi & Calhoun, 1996).
• As a result of increased self-disclosure about personal negative experiences,
the individual may perceive a higher emotional connection with others, as
well as a feeling of closeness and intimacy in interpersonal relationships
(Tedeschi & Calhoun, 1996, 2004).
• Subsequently, the subject begins to better accept the help given by others and
make better use of already existing social networks or invest in new ones
(Calhoun & Tedeschi, 2001).In fact, it may occur a reflexive thinking about
relationships, thus, some relations may become more meaningful while others
may be weakened or even end (Tedeschi & Calhoun, 2004).

18

9
 Ball of Grief
19

Jar of Grief

20

10
 Phototherapy
Explore and put into safekeeping the memories of what
we’ve lost

Connecting with photo’s helps to honor what was lost

and put words to pain

Willingness will teach clients how to sit with painful

emotions and not avoid grief

Search for visual messages, themes, beliefs, and

feelings

It’s not just viewing the photos it’s how the client is
connecting to them
21

Phototherapy

Ask:
How do these images reconnect you with the details
of your life?
How can the past serve as a bridge for the future?

What do you discover about yourself? Your loved

one?

What, if anything remains unresolved?

What patterns or repeated themes do you notice?

22

11
 SHATTERED VASE
A BOMB WENT OFF IN MY LIFE
MY LIFE HAS NO MEANING
I’M RESPONSIBLE
MY LIFE IS IN RUINS
I DON’T KNOW WHO I AM
THE WORLD IS A SCARY PLACE
I HAVE NO REASON TO LIVE

• Honor broken pieces

• Create something new

23

IMPACT #2:
GUILT/SHAME/COMPLEX TRAUMA
• WHAT MEANING DID THE CLIENT ATTACH TO THE SUICIDE?
• Examine Beliefs and Cognitive Distortions
• PERSONALIZING:
• I’m responsible
• It’s my fault
• I caused this

24

12
 • DEPRESSION
• DESPAIR
• ANXIETY
• LONELINESS
Wounded
• FEAR
• ISOLATION
parts need a
• HOPELESSNESS voice
WOUNDED • SILENCE
PARTS NEED A • ANGER
VOICE • SELF-BLAME/SHAME

25

PARTS • CONSIDER THE CONCEPT OF

WORK: POSSIBILITY:
PLANTING “Is it possible that it wasn’t your fault?”
SEEDS OF
POSSIBILITY • WHAT WOULD IT MEAN IF YOU
COULD EMBRACE THE IDEA
THERE WAS NOTHING YOU
COULD HAVE DONE TO STOP IT?

26

13
 REMEMBERED
RESOURCE
PERSON

27

• How is shame connected to the

trauma/loss?
• How does shame affect the way
the client lives?
• How is shame effecting client's
connection to others?
Shame • In what story is the the client
living? What conclusions has the
client drawn about self?
• Vulnerability is the key to healing
shame

28

14
 • Belief’s exercise
• Continually re-enforcing the idea of self-
compassion
Assess • Suggest the possibility that their
Clients Self- compassionate part may be able to reframe
Talk negative self talk and be open to explore facets
of PTG
• Can they feel empathy and compassion for
any mistakes and learn from them? Can they
forgive themselves? Others?

29

• What are some of the myths

you have bought into about
how to handle grief/loss?
• How have they impacted
your behavior?
Myths • How have they impacted the
way you do relationships?
• Grief, loss, trauma force us
to reassess our values and
re-evaluate our belief
system. That may include
letting go of some things
and embracing new ways of
being
30

15
 Narrative Therapy
• Loss is viewed as an event that can profoundly perturb one’s taken-for-granted
constructions about life, sometimes traumatically shaking the very
foundations of one’s assumptive world (Janoff-Bulman, 1989)
• One of the key deficiencies in traditional models of grieving is their implicit
presumption of universality—the idea that all or most bereaved persons
respond similarly to loss at an emotional level
• A meaning-reconstruction view emphasizes the subtle nuances of difference in
each griever’s reaction, so that no two people can be presumed to experience
the same grief in response to the “same” loss (Gilbert, 1996)
• Working from this perspective requires ways of helping clients interrogate their
own tacit assumptions about life that were challenged by a particular loss,
while groping their way toward new sustaining frameworks of meaning

31

Newer Models of Mourning

• Skepticism about the universality of a predictable “emotional trajectory” that leads
from psychological disequilibrium to re-adjustment, coupled with an appreciation
of more complex patterns of adaptation (Attig, 1991; Attig, 1996);
• A shift away from the presumption that successful grieving requires “letting
go” of the one who has died and moving toward a recognition of the potentially
healthy role of maintaining continued symbolic bonds with the deceased (Klass,
Silverman, & Nickman, 1996; Stroebe, Schut, & Stroebe, 1998);
• Attention to meaning-making processes entailed in mourning, supplementing
the traditional focus on the emotional and symptomatic consequences of loss
(Horowitz, 1997; Janoff-Bulman, 1989; Viney, 1991)

32

16
 Interventions: Narrative Therapy

Life Imprint (Neimeyer, 1999)

Metaphoric Images: draws on words that are rich in resonance and imagery

Poetry/Journaling 15 mins. per day

Linking objects: Natalie Cole’s duet “Unforgettable.” Carrying on

someone’s life work or legacy
• Loss timeline (Alison J. Dunton) (Neimeyer, 2012).Provides opportunity for
clients to recall previous similar situations to identify strengths

33

Self-
Compassion:
3 Keys

34

17
 WHAT IS RESILIENCE

• Resilience is not a trait that

individuals either have or don’t
have. Resilience involves behaviors,
thoughts and accompanying feelings
that can be nurtured, developed and
learned
• Resilience is more accessible and
available to some people than
others, but everyone can strengthen
their resilience

35

Resilience
• Strengths such as gratitude, kindness, hope, and bravery have been shown to
act as protective factors against life’s adversities, helping us adapt positively and
cope with difficulties such as physical and mental illness (Fletcher & Sarkar,
2013).

• Hope, bravery, and zest had the most extensive relationship with positive
adaptation in the face of challenge. Authors Martínez-Martí and Ruch speculate
that processes such as determination, social connectedness, and emotional
regulation were important predictors of resilience

36

18
 Building Resilience
• Greene and colleagues’ (2004) research also investigated the strategies and skills
social workers relied on to boost the resilience of their clients. Some included:
• Providing clients with safety and necessities when faced with adversity or
traumatic events – for example, talking calmly with distressed individuals,
reassuring them of their capabilities and ability to get through adversity
• Listening, being present and honest, and learning from individuals’ stories while
acknowledging their pain
• Promoting interpersonal relationships, attachments, and connections between
people in a community or society
• Encouraging them to view themselves as part of a society

37

4 Types of Resilience
• Bouncing Back
Recovery Resilience
• Bouncing With
Adaptive Resilience
• Bouncing forward
Transformative Resilience
• Bouncing outward
Spreading Resilience

38

19
 What would a story of
resilience look like?
Here is what happened Here is what happens next

ME FACING…..
WHAT HELPS IS….
39

Tools in the Toolbox

• Strengths: What are they?
• Coping Strategies: Which are adaptive?
• Wise Mind
• Values
• Support System: Who can I turn to for
support?

40

20
 What makes me vulnerable?

Exhaustion, stress, sadness, poor sleep, feeling depressed,

lack of exercise
What makes me well resourced?
The Setup
Rested, eating well, exercise, good self-care skills,
connection

Chris Johnstone: Seven Ways to Build Resilience

41

What was the

Prompting event?

What things made me

vulnerable?

42

21
 Grow and Develop
Resilience
• What strategies can I employ?
• What strengths can I draw upon?
• Where can I turn for support?
• What insights do I have?

43

WHY YOGA?

• Yoga helps clients learn to

be “comfortable being
uncomfortable”

• Helps clients become

attuned to their bodies

• Helps clients reorient to

their bodies and feel safe

44

22
 IMPACT #3: CRISIS OF BELIEF/FAITH

EXISTENTIAL SHATTERING
NOTHING IS SAFE

LIFE IS UNPREDICTABLE

GOD IS UNTRUSTWORTHY

45

Spirituality

How has the We use

suicide ourselves:
Silence/Solitude
impacted their ALONGSIDE
concept of
God? Prayer

GOD Contemplation

46

23
 Research on Spirituality
• As a result of individual strength in confrontation with the stressful
conditions, the trauma survivors’ experiences are, in some way, an
opening to religious questions or a perception of growth regarding
religious or spiritual matters (Lindstrom et al., 2013).

• The faith in a higher religious entity may increase after trauma and also
contribute as a coping mechanism in the cognitive process of finding
meaning (Calhoun & Tedeschi, 2001). Nevertheless, nonreligious people
may experience some growth in the spiritual domain, which is not
exclusive to those who already have a strong spiritual or religious
connection (Tedeschi & Calhoun, 2004).

47

• The experience with spiritual growth is variable among

trauma survivors and it depends on the previous
relationship and commitment to religiosity and
spirituality, as well as on the causal attribution to the
event (i.e., if the subject has the sense of security or,
conversely, feelings of anger and injustice with the higher
religious power) (Pargament, Desai, & cConnell, 2006).

48

24
 POST TRAUMATIC
GROWTH
When clients can hold the idea that there was nothing they could have done to
stop the suicide
When they can focus on the fact they have survived and honor the help they
received from others. ALONGSIDE

Use what happened as an opportunity for personal growth, the results will be:

Empowerment—I’m a survivor

Connectedness—with friends, family and community

Gratitude –For that which remains

Spiritual Growth—God is good even when we suffer

49

Post Traumatic Growth Inventory

• Self-report tool
• Assess for 5 areas of growth
• Relating to Others
• New Possibilities
• Personal Strengths
• Spiritual Change
• Appreciation of Life

50

25
 Post Traumatic Growth Inventory
• (Tedeschi and Calhoun, 1996) self report tool to help clients and
therapists assess for PTG in 5 domains
• http://www.emdrhap.org/content/wp-
content/uploads/2014/07/VIII-B_Post-Traumatic-Growth-
Inventory.pdf

51

Self-
Self-Report Questionnaire for PTG
• The Psychological Well-Being-Post Traumatic Changes Questionnaire
(PWB-PTCQ)
• Joseph S. Maltby, J. Wood, A.M. et al (2011) Psychological Trauma:
Theory Research, Practice, and Policy, 15-19
• The Stress Related Growth Scale (SRGS)
• Park, C.L., Cohen, L.H., Murch, R.L. (1996) Journal of Personality, 64
71-105

52

26
 Self-
Self-Report Questionnaire for PTG
• The Personal Growth Initiative Scale-II
• Robitchek,C. Ashton, M.W. Spering, C.C et al (2012) Journal of
Counseling Psychology, 59, 274-287
• The Thriving Scale (TS)
• Abraido-Lanza, A.F., Cuier C., Colon M.R. (1998) Journal of Social
Issues, 54, 405-428
• The Siliver Ling Questionnaire (SLQ-38)
• Sodegren S.C., Hyland, M.E. (2000) Psychology and Health, 15, 85-97

53

27
NOTES
NOTES