Grief Counseling Across the Lifespan

Chapter One: Grief and Loss 

Loss is part of life and growth. Understanding the functions of grief and loss is influenced by life changes and maturation. The understanding of maturation and life changes are facilitated by losing (changes) in a behavior pattern, a prior lifestyle, an attachment relationship, or modifying the status quo. There are various types of losses, which occur commonly during different stages of development. These include typical losses, which refers to losses that are common to a specific age group. However, since this type of loss is considered "normal", very little support is provided. Examples of typical loss include loss of a romantic relationship and pet loss. Off-time losses refer to losses that occur during a phase of life where they are unexpected. This is a more challenging loss because the peers may not offer an appropriate response to grieving due to discomfort or unfamiliarity of loss and grieving. An example of this loss is the death of a parent when a child is in their emerging adulthood or adolescence. Maturational losses are typical losses that occur as a result of development. It is described as a type of "disenfranchised grief". An example of maturational loss includes when a person marries and loses their freedom of singlehood. 

The biopsychosocial aspects of grief describe grief's social contexts, psychological experiences, and biological impacts. The biological effects of grief provide an understanding of how grief influences body systems, putting grievers' health at risk. The interactions of trauma, stress, emotions and physical health are facilitated through neurological, hormonal, and immune genetic functions and affect organ functioning. Psychological effects of grief discuss the impact of grief and loss on cognitive development and functioning on the different developmental stages of life. Grief always causes various impacts on psychological health, including rumination, sadness, psychic pain, irritation, and challenges in coping.  

Social Aspects of Grief discusses the role of social rituals in providing a deep social way of mourning death and losses. Evidence reveals that since the 1990s, very few citizens in America took part in shared religious rituals to share their grief. Technological advancement has changed the way people socialize in the realm of dying and death. Some communities opt to use internet sites such as Facebook to share grief. In addition, creative activities that memorialize the dead are increasingly being used to assist the grieving.  

The types of grief theory include Classical Grief Theory, which involves Task-Based Theories, Stage-Based theories and the dual-process model. The task-based theories state that grievers undergo five stages of emotions: denial, anger, depression, and acceptance. The theory postulates that a grieving person should sever ties with the deceased in order for them to heal after loss. The stage-based theories state that griever's experience four stages of emotions, including numbness, separation anxiety, despair and disorganization, and acquisition of new roles. The dual-process model states that a grieving person is allowed time to actively process and focus on the loss and restore time to move into new activities and roles.  

Meaning-Making and grief can be achieved through grief therapy. Grief therapy is a process of listening to people's stories about their lives and losses and encouraging grievers to create meaning in their lives and allow them to move into their new lives. People struggling with loss can receive support through Continuing Bonds and Grief, which involves maintaining bonds with the deceased, which can be a healthy part of the life journey of the griever. On the other hand, disenfranchised grief is described as grief that is not supported, validated, or recognized in the griever's social world. Disenfranchised grief means that grieving individuals are not provided with social support that will allow them to process grief and move on in healthy ways. The little support and social isolation increase the pain of loss and grief.  

Mindfulness has increasingly become accepted as an Intervention for Grief. It is applied to practitioners' practices to grievers to help them become more accustomed to their internal responses, emotions, and sensations and become attuned with others. Mindfulness comprises intentional attentiveness, responsiveness, and empathy that allows every individual to observe and acknowledge suffering and pain and positive emotions. 

Chapter two: Perinatal Attachment and Loss  

The fundamental task of pregnancy is the development of the emotional bond between fetus and mother. The attachment of the fetus develops rapidly once a woman conceives, and the attachment is strengthened as the fetus grows. This attachment makes a woman more vulnerable to pain if the woman experiences a loss. The development aspects of pregnancy, including social, psychological, and biological aspects, impact the development of the maternal-fetus bond. The mother's emotional state plays an important role in creating a bond between the mother and fetus. The poor emotional state could lead to poor pregnancy outcomes and affect the mother-fetus attachment. Perinatal loss comes in different types, including neonatal death, stillbirth, miscarriage, and infertility.  

Interventions for perinatal grief include meditation techniques such as yoga and mindfulness can help in minimizing stress levels in pregnant women. In addition, the Five Vs (validating, valuing, verifying, ventilating, and visionary) is a framework used as an intervention for perinatal loss. It offers a guide for grief practitioners to allow the grieving to follow their preferences. It needs to achieve healing, help them anticipate pregnancies in future, and help them identify and manage anxiety in future.  

A personal experience that I have been made aware of is that nurses grieve when their clients die. However, nursing grief is not always discussed or acknowledged. Less attention is offered towards preparing nurses for this experience. This knowledge impacted me positively because I learned that obstetrical and neonatal nurses face grieving when taking care of families who experience loss after perinatal death. As a counselor, I will develop coping skills that will allow me to handle other clients effectively as they go through grieving.  

Week #2: Chapter 3 and 4 

Chapter three: Infancy, Toddlerhood, and Preschool 

Children in elementary school experience significant changes socially, physically, psychologically, and cognitively. Childhood is a crucial stage for the development of trust, which is acquired through trustworthy caregiving. Therefore, engaging in caring and trusting relationships enhances the development of trust, which is important in their future relationships. 

A child experiences rapid changes in biological, psychosocial, and social development. Children depend on others for care in their biological development. As they develop physically, the underlying greater independence profoundly influences the psychology of a child. Social development opens other abilities of a child, including the beginnings of symbolic thought, imagination, empathy, play, and memory.  

The experiences of loss in infancy or early childhood are different. The death of a caregiver has adverse impacts on children. Children under three years do not have the ability to process death, but they experience separation anxiety and display reactions of despair and protest. The major intervention for young children is for the caregiver to offer responsive, nurturing and consistent care. However, children between 4-5 years of age understand that death is the separation between the living and dead and have difficulty coping with the loss. This means that caregivers play a critical role in facilitating the ability of toddlers and infants to develop in optimum ways.  

The death of a child is always experienced as trauma. Parents often develop feelings of guilt for failing to offer care that allows children to survive. Grieving is perceived as comfort for parents because it offers a continuous connection to their dead child. Parents tend to maintain the bond with their deceased children by memorializing them in groups such as Compassionate Friends.  

Maternal depression occurs prenatally or in the postpartum period. It may have a severe impact on the ability of a mother to use prenatal care or offer self-care during gestation or in the postpartum period. Findings indicate that approximately 10% to 20% of mothers will suffer depression in their first year after birth. Depressed mothers are vulnerable to increased levels of stress chemicals, which changes the immunological systems of infants and their patterns of prenatal growth. Infants and toddlers of depressed mothers demonstrate higher levels of distress; they are more difficult to soothe, exhibit behavioral problems, have problems with making eye contact and interaction, have delays in language development, and have minimal ability for emotional regulation. Relationships between infants and caregiver are very crucial for developing children because caregivers are the fundamental assistants in ensuring the wellbeing of young children and infants. Therefore, assessment and intervention are crucial practice areas for mothers experiencing depression.  

Chapter four: Elementary School-Aged Children 

Children in elementary school experience rapid change, and their psychosocial growth involves shifting from a family environment to an outside world as they join the school. The family environment provides unconditional love as opposed to school, where peers and teachers judge them. This means that the school environment provides children with an experience that prompts them to navigate through the challenges and establish a sense of self-efficacy. If they are incapable of navigating these challenges, they may experience a sense of failure.  

Children in this group have different coping abilities if they lose a pet, sibling, parent or other significant relationship. They may not have the adequate verbal facility to process loss and feelings and may become aggressive or hostile or withdraw if the loss is beyond what they can process. As they grow, these children may be reluctant to express emotion openly, but their ability to process loss verbally has increased. They are able to cope by keeping the linking objects and important memories.  

A support group is an important intervention, which is very useful for school-age children. Although children have high social connections, they have little networks, including those who have experienced similar losses. Support groups provide children with the opportunity to share experiences, which assist them to feel isolated. In addition, support groups offer opportunities for shared problem solving with peers and provide professional support to assist in clearing up the misconception and provide supportive opportunities. A professional can help children work around the fears and misconceptions and have a positive impact.  

Intervention strategies that support grieving children tend to be systematic to enable professionals to focus on care within three domains, including behavioral, affective, and cognitive. The professional can interact with children, convey appropriate information to their developmental stage, provide support, and validate their responses and feelings. In addition, a professional can assist in interpreting a child's behaviours to the family members to reduce reactivity. Although younger children have limited resources for processing a loss, they benefit more from nurturing caregivers and steady security. They have different newly identified resources and skills for gaining support and processing the loss. Developmental phase and age state that a child who has experienced loss must amend the loss utilizing their new understanding. However, there is a possibility that a child may re-experience their previous losses or loss later in their elementary school as they start to think about learning to drive or graduation. These are secondary losses because a child needs acknowledgement or recognize their achievements, among other things. Moreover, mindfulness techniques can help to reduce stress in a child. Mindfulness techniques on school-aged children focus on acceptance and feasibility instead of efficacy.  

I encountered a personal experience that of maternal depression. During my internship, I worked beside my supervisor, who was working with a new mother who was depressed. This situation affected the mother's ability to care for the infant effectively. I learned about effective intervention techniques applied that helped the client. This experience positively impacted my client with a similar challenge by using the interventions I learned, which include mindfulness skills, incorporating a 20-minute daily relaxation, ensuring she receives help from her friends and family, and CBT. These techniques helped to improve the client's mood and energy significantly.  

Week #3: Chapter 5 and 6 

Chapter five: Tweens and Teens 

Tweens are defined as individuals aged between 11 to 13 years, while teens refer to individuals between 14 to 18 years. Identity development and adaptation are crucial components in processing loss, especially among mid-adolescents. In some cases, the loss is directly related to identity; for instance, in a case where a teen loses a mother, they may tend to identify themselves as a motherless child. The abstract thinking abilities among adolescents is still thus may have difficulty finding a way to make meaning of death. However, the mid adolescents have an improved developed ability to examine the demands of loss situations and enhanced empathic abilities. They have an understanding of the nature of death. Their coping capacities are often challenged because, during this period, adolescents have a developmental urge to achieve independence and are present as adults, thus tending to suppress their emotional expression. In addition, teens tend to inhibit their emotions because they feel others need their support. Lack of support for teens can be isolating and distressing during this developmental period when they require support for identity connection. In addition, lack of support hinders the ability of adolescents to process their grief. Adolescents utilize the limited support of family members and friends with similar loss experiences. They refrain from displaying their emotional reaction to loss resulting in deprived support needed for them to process their loss.  

Evidence reveals that silence makes adults believe that adolescents are not feeling the degree of loss like adults; therefore, they tend not to offer the needed support. Teen grief can be supported through interaction with adults, including attentive parents, empathic school staff, or grief counselors, who can help them, share their feelings, emotions, and meaning-making of the loss to enable them to achieve their developmental needs. According to Walter and McCoyd (2015), sensitive and attuned adults act as fundamental sources of support. In addition, adolescents can benefit from learning mindfulness-based techniques to manage their emotional struggles. These techniques help to teach adolescents various skills such as emotion management, empowerment, and self-compassion, which are effective in helping them cope with grief. Supporting adolescents will enhance their understanding of grief and mourning, which will enable them to help others in future to manage their emotions in grief.  

Chapter six: Emerging Adults 

An emerging adult is defined as a period between adolescence and adulthood, which include individuals aged between 18 to 25 years. They have different perspectives regarding death, which is often associated with changing views of religion and spirituality. Emerging adults usually have the perception that bad things only happen to bad people, meaning the world is just a place. However, the death of a loved one can change this belief, making them recognize that bad things also happen to good people, including themselves, meaning the world is not always. Loss causes a huge challenge for emerging adults because of poor coping skills that may result in long-lasting maladaptive coping. 

Various emotional reactions can happen during emerging adulthood during the death experience. Sadness is among the common and most natural responses related to lose. It minimizes an individual's energy level, decreases heart rate, and lowers the mood, therefore allowing for the meditation and reflection required to grief. Emerging adults may find it challenging to allow themselves to go through this reflection process, especially when they are required to take on new roles such as caring for their young siblings in the event of the death of a parent. Loneliness can emerge in these individuals because they might feel that other people may not understand their experience level. 

Emerging adulthood is a developmental period where adolescents try to reconnect and establish a cordial relationship after the pressures of adolescents. Feelings of guilt may emanate from bottling strong anger for not preventing the death of a loved one or not having done enough. There may be feelings of fear and anxiety of themselves or other loved ones. Loss can affect an emerging adult, causing changes in functioning, including working or studying to their full capacity. They may experience profound disturbances within themselves. It may decrease their academic performance, thereby leading to poor grades, the possibility of dropping out of school and limiting their career development. The findings indicate that disruption is a natural and anticipated response to coping with the death of a loved one.  

Emerging adults is a new area of research. Most of the literature used has been derived from earlier studies. The old coping mechanisms have been used to support the needs of emerging adults but have proved to be inadequate. New coping mechanisms are required to meet emerging adults' coping and support needs, which include sharing their emotions and feelings with others, engaging in exercises, yoga, and strengthened religious affiliations. According to Walter and McCoyd (2015), therapists working with emerging adults can apply Worden's Four Tasks of Mourning in helping them through grief and loss. It is crucial for competent support of grievers to explore the cultural standards of the parents, including death and morning expectations. Supporting grieving emerging adults requires the capacity to establish a helping relationship that is supportive and authentic to offer psychosocial education regarding grief. In addition, activities such as using songs and pictures can help emerging adults articulate their grief. Moreover, mindfulness training is useful in helping grieving emerging adults. 

A personal experience that I had that I have been made aware of that might cover the chapters' topics is the coping capabilities of teens with grief. I learnt that the best intervention method to provide grieving teens is supporting them, offered through companionship. With this knowledge, I was able to impact the client in a positive fashion because I was to offer the teen client the support and care he needed. I provided companionship by supporting him, allowing him to decide how they cope, allowing him time to grieve the way they want it and talking honestly and open and listening. 

Week #4: Chapter 7 and 8 

Chapter seven: Young Adulthood 

Young adulthood defines individuals between mid-20s to early 40s. Developing intimate relationships is a crucial task for young adults. Intimacy is a reflection of the ability of an individual to experience a relationship that is open and supportive without the fear of losing their identity in the process. An intimate relationship inspires the release of personal feelings and sharing ideas and plans. It enables them to feel special and meaningful to one another. Young adults form relationships and connect in different ways to enable them to test the levels of differentiation and togetherness. In addition, finding a personal place in an adult world is an important developmental task of young adulthood. Explorations of identity allow young adults to focus more on others, feel safe in their independence, and look forward to attaining their future goals.  

Young adults have projected an attitude that everything is possible because they are future-oriented and goal-oriented. Grieving can be challenging in young adulthood due to a lack of support, which results in complicated mourning. The death of a parent can cause more challenges in the identity development of a young adult because the parent is longer there to authentic their pursuit for identity. Identity is more fluid at a younger age, which makes it easy for them to remake their lives and carry on with their life normally despite the pain. Therefore, the loss experienced by young time is off time, which makes it difficult to overcome their emotions.  

Interventions for young adults may include group support where they are able to interact with other people experiencing off-time losses. This helps to eliminate the sense of oddness and isolation that most young adults often experience when coping with loss. In addition, assisting young adults in remaining focused on their future goals helps them move forward and find their place in the world. 

Technology is increasingly changing grief and loss experiences. Young adults are using the internet to form attachments and connect with others. The internet offers a platform for finding other people who share similar experiences that promote recovery loss; it provides increased control over relationships and anonymity so that the griever can control the amount of information they are willing to share. Young adults are more comfortable using the internet to share their bereaved stories, including websites such as Open to Hope (www.opentohope.com). The internet provides opportunities for exploration and comprehension of loss in a safe and caring online community. Open to Hope website empowers the bereaved and assists them in feeling understood. The majority of young adults are actively using social media to continue bonding with the deceased and grieve with other people through shared experiences.  

Chapter eight: Middle Adulthood 

Middle adulthood refers to individuals between 45 and 70 years of age. Midlife adults have increased anxiety about their death. It is also a time of re-examining their priorities and life. The endurance of bereavement in this developmental period differs from that in early adulthood because adults have faced major death loss in their middle adulthood. They have experienced coping before and anticipate more support from friends and family because they share similar experiences and thus have a deeper understanding of the experience. 

In the middle adulthood phase, most of the energy is channeled into self-transformation in the perceived predicated nature of life. Losses in middle adulthood are understood by the recognition that people are mortal. This prompts them to focus on contributing to society in a meaningful way to leave a positive mark on their lives. Counselors and social workers can work with these adults to assist them in identifying their weaknesses and strengths as well as assist them in recognizing their achievements in life, which is commonly deprived during transitions of loss. Individuals in their middle adulthood experience various potential losses, including jobs, parents, health, siblings, cousins, and partners/spouses. The use of continuing bonds and meaning-making interventions may help middle adults to transition through loss. Midlife adults who have suffered parental loss require assistance with their intrapersonal resources. The ability to recognize and maintain a sense of meaning while utilizing close and supportive relationships is associated with more positive adaptation to loss. 

Integrating purpose-finding and meaning-making and applying them as coping strategies for pain and fear of loss after death can enhance their coping abilities and skills. These interventions will assist midlife adults in realizing the meaning they make on other people's lives and channel them to their future, and make them heal from the challenging, life-changing loss. Some middle adults make use of their spirituality and faith to assist them in coping with their losses. Moreover, meditation can be used as an intervention to achieve healing for individuals suffering a loss. A grief support group allows adults to express their emotions through talking and crying, an important aspect of loss processing. Middle adults who feel unsupported in grief tend to mourn privately. They may hide their emotions, believing that the intensity of the pain makes others reluctant to share it. This is a similar reaction to isolating concern and shame regarding judgments that happen among survivors of suicide. Therefore, engaging middle adults in group support provides them with a platform to release their emotions and help them in coping. 

A personal experience that I can attest to is that technology is changing the way we mourn. I have learned that social media is becoming a valuable tool for grieving. It helps support people dealing with grief and loss and make sense of death by talking about it. This experience had a profound positive impact on my client. I encouraged my client to utilize social media tools such as programs that offer grievers a "community of mourners" and teach them coping skills. 

Week #5: Chapter 9, 10 and 11 

Chapter nine: Retirement and Reinvention 

Middle adulthood refers to individuals between 50 and 80 years of age. Identity is also an important part of life transitions in this age gap. Leaving a career encompasses several transitions and contribute to a life qualitatively compared to the working life. It involves ceasing work and means the loss of structure of interpersonal relationships, lifestyle, and work identity. Adults in this transition period must shift from traditional adulthood just the way teenagers shift from childhood. This is a continuing midlife task of struggling with mortality and discovering that time is very limited, and not much is left to accomplish their goals. This transition phase is marked by the significance of setting priorities and making decisions on what is important in their life. Identifying a new sense of activities and purpose that an individual enjoys helps guide the way into the reinvention/retirement stage of life.  

An important way an adult can plan for this transition before retirement is to think about how life is going to change. Re-evaluating assumptions, routines, relationships, and roles prior to and after retirement can assist with retirement preparation. When older adult leaves a career, they have to learn to cease identifying themselves with the industry, title, or company. Loss of work identity and reinventing self is a bit easy when adults reframe regrets as lessons. Grief and loss provide adults with an opportunity to share this experience with others, recognize their passions, and change at their own pace. Preparation and planning have been identified as a solution to uncertainty. In addition, engaging in new activities and trying out new options assists in discovering themselves. Adults who are forced to retire out of anxiety, depression, and positions may be faced with an unexpected loss that may overwhelm their chance to enjoy exploring retirement and reinvention. Therefore, practitioners working with adults should assist them in recognizing their strengths and have a meaningful new life.  

Chapter ten: Older Adults 

Older adults refer to individuals above 70 years of age. Older adults who have experienced loss previously have enhanced coping skills thus are better prepared to manage the pain or emotions of death. Findings reveal that death anxiety is much lower in individuals who have experienced multiple deaths. Older adults tend to focus more on living a fulfilling, productive, and healthy life. They do not withdraw after retirement but rather focus on mortality. They embrace their retirement age and make most of their time by providing wisdom and service to their communities. The only reason why people seem to fear death most is due to the inability to process dying and foresee the future. 

Although various losses encompass later adulthood, it offers a chance for growth in reinvention and self-reflection. This life stage brings a steady release from several daily families and work demands, which is determined by an individual's health and resources. In addition, this phase of life offers an opportunity to create a new structure in life. Therefore, this means that although older adults have several issues in common, they also have differences, including different lives and how long they have lived.  

Social support has been identified as one of the most crucial aspects of alleviating loss's adverse effects and promoting resilience. However, the meaningfulness of this support is determined by the perception of older adults and whether it provides comfort. New research highlights the significance of social support networks when working with older adults. Therefore, older adults need to maintain strong relationships.  

Meditation has been suggested as an intervention technique for older adults. Research has shown that meditation techniques positively impact the cognitive ability of older adults. It increases their cognitive abilities, thus improving their ability to manage and regulate emotions. Therefore, meditation is beneficial for grieving older adults because the traumatic death often elicits a pattern of avoidance of memories, thoughts, and emotions surrounding the grief experience. Avoidance behavior inhibits the capacity of grieving older adults to process the loss. Mindful meditation can be used in therapy to help older adults surrender to their grief and process the loss, resulting in the development of a more meaningful perspective on life. 

Chapter eleven: Conclusions 

The majority of students, especially in social work, are reluctant to work with grieving individuals due to a lack of adequate knowledge on the available techniques to apply in these situations. In addition, the belief that they must eliminate sadness in their client or, in a way, work magic to help heal and transition loss makes them feel hesitant in working with people experiencing loss.  

Walter and McCoyd (2015) provide concepts or theories that can be applied by therapists or other people to help grievers in processing loss and coping with their pain. It is important for grievers to achieve physical, social, and emotional wellbeing. Examples of these intervention concepts include structured approaches in treating grievers. Examples of structured approaches involve exposure therapies, particularly when talking about death and cognitive behavioral strategies used to re-evaluate negative thoughts. The key mechanisms of such treatment involve utilizing money, storytelling, revisiting the world, establishing connections, fostering self-regulation, and creating the lay of the land. Other important intervention strategies that are useful in helping grievers cope with bereavement include dual-process models, continuing bonds, and meaning-making.  

A personal experience that I had that might cover the chapters' topics is the significance of interventions strategies in grief and loss. Death or loss is inevitable, and the ability to heal from loss is very crucial. These experiences positively impact my client and me because I have learned about the intervention techniques to apply with clients, enhancing their coping ability, expressing their emotions, processing their loss, and achieving healing. Therefore, I believe that the most important aspect of loss and bereavement is the intervention techniques because helping people experiencing grieve with process loss, manage their emotions, and transition effectively through the loss is crucial. 

Reference 

Walter, C. A., & McCoyd, J. L. (2015).  Grief and loss across the lifespan: A biopsychosocial perspective . Springer publishing company. 

Week #6 Suicide 

Suicide and its impacts on the family, community and society at large 

The American Foundation for Suicide Prevention states that suicide is ranked 10th among the major causes of death in America, resulting in deaths of about 47,000 people every year. Suicide can occur in people of all ages. The suicidal behaviors and thoughts occurring can happen in individuals experiencing feelings of hopelessness and helplessness and may consider suicide as their only way out of their misery. Causes of suicide always seem to be a complex mix of different life events, mental and physical makeup, family and cultural background, geographical and social isolation, the level of support of friends and family, socioeconomic disadvantage, and the ability of an individual to have coping skills that will enable them to bounce back from life challenges (Stone, Jones & Mack, 2021). 

The presence of risk and protective factors can make an individual less or more susceptible to suicide. Risk factors cause an individual to be more vulnerable, thus increasing the possibility of suicide. Examples of risk factors include poor coping skills, social isolation, lack of support services, separation and loss, abuse and violence, and exposure to environmental stressors. Protective factors enhance a person's ability to cope with difficult situations, thus reducing the possibility of suicide. However, it is critical to understand that protective factors are not necessarily a guarantee that a person is not at risk of suicide. Examples of protective factors include good coping skills, a sense of meaning and purpose in life, supportive social relationships, access to support services, and a safe and secure living environment. Protective and risk factors of suicide-related to their broader community, environment, family, and individual. The population groups at heightened risk of suicide include people in custody, indigenous people, people with mental illness, people from minority populations such as the lesbian and gay population, and those from linguistically and culturally diverse backgrounds (Gili et al., 2019). 

Important things to know about suicide are that it is crucial to have an awareness that it is not easy to recognize a person at risk of suicide. In addition, internal and external factors can quickly change a person's suicide risk level. Moreover, it is important to understand that suicidal ideation is temporary, and most people having suicidal thoughts can be helped by a health professional to reduce the risks. In addition, suicide can be carefully planned or can occur impulsively without warning. Therefore, it is critical to take all threats, suggestions, and communications about suicide seriously. Furthermore, people who have suicidal thoughts need care and support from the community, friends, family, and health professionals (Stone et al., 2021). Therefore, it can be helped by encouragement and emotional support.  

The warning signs that a person is at risk of suicide include: threatening to hurt or kill themselves, talking about having feelings of hopelessness, isolation, or trapped, searching for means of killing themselves such as purchasing a gun, engaging in risky behavior such as excessive drug or alcohol consumption, withdrawal from the community, friends, and family, and abnormal sleeping pattern (less or more sleep) (Stone et al., 2021). 

A person can show support to an individual with suicidal thoughts by maintaining calmness and speaking in a comforting tone, acknowledging their feelings, providing encouragement and support, and informing them that help is available and that receiving treatment will make them feel better. Listening and showing support is ideal for assisting a suicidal person (Jimenez et al., 2021). 

Other interventions for suicide include cognitive behavioral therapy, which is a kind of talk therapy where a counselor works with a client to challenge their negative thoughts. It helps minimize suicidal attempts, feelings of hopelessness, and thoughts about suicide. In addition, dialectal behavior therapy focuses on teaching people how to cope with stress, how to live in the moment and regulate emotions, thus reducing thoughts about suicide. Other interventions include hope-based interventions and programs that help promote a person's wellbeing. Hope interventions place individuals in a unique position to enhance positive outcomes and reduce depression and other challenges. Mechanisms that foster hope programs include developing positive emotions, which assists people to establish long-lasting psychosocial resources, the process of creating a goal and pursuing it, and recognizing optimum integration of personal intention techniques and goals, and characteristics (Berardelli et al., 2018). 

Personal experiences I have had in my professional life that might be relevant 

While working as an intern at Texas Woman's University, I worked with a client suffering from major depression and was suicidal. I had worked with the client for three months, and when she felt better and reached a point where she was no longer feeling suicidal, I had terminated the services. She was discharged and embarked on her new journey. However, as I was finishing my internship mid this year, I got the news that the client had killed herself. I did not have the realization that it would be this painful to hear such news. I was unprepared for the intense reaction I felt. I was devastated both professionally and personally. As a new counselor, this experience prompted me to grow up quickly.  

According to Hill et al. (2020), client suicide often affects trainees deeply than experienced therapists. The reason is that interns tend to be more committed to the benefits of therapy and less experienced when handling very troubled clients. However, as students get more experience when dealing with troubled clients, they come to understand that although therapy can be useful and helpful, it is not always a solution or cure. Unfortunately, some graduate programs do not train students sufficiently on suicide and suicide prevention. It is evident that these programs fail to provide adequate training for these students to work for suicidal behavior. It is important for students to be consistently trained on suicide. There are different resources available to assist interns in coping and growing in the event they experience trauma.  

Impact of this experience on my client and me 

This experience impacted positively on me because I learned that there are available resources to help practitioners or interns following a client's suicide. You can talk to people who can help, such as finding a mentor or a good supervisor. Talking to others who had similar experiences was the most healing part for me. They offered me a lot of encouragement and validation, which eventually helped me come to terms with the situation. In addition, organizations such as the Clinician Survivor Task Force of the American Association of suicidology (AAS) offered significant help to me. This organization is committed to understanding suicide and its prevention. Therefore, I gained an understanding that talking about these events is very beneficial for us practitioners and as humans experiencing such a devastating thing.  

In addition, from this experience, I learned to avoid extreme reactions. It can be tempting for practitioners to isolate themselves or try to overcompensate the loss by being a "super therapist" with other clients, which is not a healthy way to handle things. Instead, it is advisable to discuss your feelings with a supervisor who can assist you in resolving concerns of perceived professional insufficiency, evaluate the feelings of guilt, and avoid doubting about the past professional decisions. Therefore, the most important part of the healing process is acknowledging that you cannot control everything. 

Moreover, I learnt that it is important as a practitioner to take time to grieve. Grieving has its course, so it is important to allow yourself to work through the feelings. I believed that within a week or two after the death of my client, they would have overcome the grief. However, I was surprised to find that the impact of client suicide took a while for me to get over it. Therefore, receiving therapy can assist a person in processing those feelings.  

The experience helped me put things into perspective. Other external forces can trigger suicide even though suicide is usually an impulsive act, or that most practitioners experience client suicide, or that the client is at high risk of suicide such as a history of trauma or abuse, mental disorders, and have a history of suicide attempts. I came to learn that a client's suicide can be triggered by a strong grief reaction, such as the death of a member of a family, and this assisted me to normalize my experience.The experience has deepened my therapeutic understanding of other people with suicidal ideation. The support I received and my commitment to processing the event helped me learn more about suicide. Working through the feelings helped me focus on being the kind of therapist I want.  

The most important topic to my practice and me 

The topic that I found to be most important from the topics covered in suicide prevention through hope based interventions. This is important to my practice because I will be able to instill hope in people who feel hopeless and see suicide as a viable option. It is likely that a person who has hope will not end their life. Things may be difficult at the moment, but a person will hang on if they know there is hope and things will get better. 

As a professional counselor, I assist individuals in seeing that suicide is not the way out of a challenge and that there is hope for the future.Hope is a crucial concept in the realm of counseling . It has been given inadequate attention by counselors, practitioners and researchers because it is associated more with religion and not connected to scientific credibility. However, hope can be used in the therapeutic change process as an approach to individuals with suicidal ideation to enhance their coping skills. The aspect of coping involves helping a person bring a challenging situation to a positive outcome. In a clinical context, hope is defined as the realistic anticipation that a positive change or outcome will take place and perceives the future as welcoming, acceptable, and experienceable. This means that enhanced hope rehabilitates individual willpower to overcome difficult situations and influence positive change (Berardelli et al., 2018). Therefore, hope can be a powerful asset in assisting individuals who are suicidal.  

According to Berardelli et al. (2018), a professional history of hope indicate that hope is a powerful concept in the human phenomenon. The prisoners in World War II who maintained a positive sense of expectation that they would one day be free from the poor conditions subjected in were able to live. However, those who gave up died because of a lack of a sense of hope. The absence of hope is a common aspect in people contemplating suicide. Therefore, hope prompts a person to think about life and the future, while lack of hope causes one to abandon life and end it. 

Different mechanisms can be used to assess the level to which a person has lost hope. These include Synder's (1994) Scale of Hope and Beck et al. (1974) Hopelessness Scale. The various approaches that counsellors can use to help clients with suicidal ideation include the crisis approach, cognitive approaches, reality therapy approach, and existential approaches such as assisting a client in recognizing their freedom and choice and helping them rebuild a reliable meaning system. A counselling program tailored towards hope can be beneficial to individuals contemplating suicide. In addition, these individuals can benefit from enhancement of hope, which helps them to contemplate more about life and living in its future (Berardelli et al., 2018) 

References 

Berardelli, I., Corigliano, V., Hawkins, M., Comparelli, A., Erbuto, D., & Pompili, M. (2018). Lifestyle interventions and prevention of suicide.  Frontiers in psychiatry ,  9 , 567. 

Gili, M., Castellví, P., Vives, M., de la Torre-Luque, A., Almenara, J., Blasco, M. J., ... & Roca, M. (2019). Mental disorders as risk factors for suicidal behavior in young people: A meta-analysis and systematic review of longitudinal studies.  Journal of affective disorders ,  245 , 152-162. 

Hill, N. T., Robinson, J., Pirkis, J., Andriessen, K., Krysinska, K., Payne, A., ... & Lampit, A. (2020). Association of suicidal behavior with exposure to suicide and suicide attempt: A systematic review and multilevel meta-analysis.  PLoS medicine ,  17 (3), e1003074. 

Jimenez, A. L., Della, C. D., Arcenas, A. M. A., & Esling, K. T. R. (2021). Caring for the Suicidal Person. In  Suicide by Self-Immolation  (pp. 201-215). Springer, Cham. 

Stone, D. M., Jones, C. M., & Mack, K. A. (2021). Changes in suicide rates—United States, 2018–2019.  Morbidity and Mortality Weekly Report ,  70 (8), 261.