Working with Guilt After Suicide
A Clinical Reflection A note before you begin
The reflections below are drawn from my own experience of supporting people bereaved by suicide. They are not intended to replace established theory or suggest that everyone experiences grief in the same way. Rather, they are observations that have emerged through sitting alongside many people whose lives have been changed by suicide.
If they help you think differently about your own work, or make sense of your own experience, then I hope they are useful.
Guilt Always Arrives
After hundreds of hours supporting people bereaved by suicide, there is one emotion I have never known to be absent.
Guilt.
Sometimes it arrives during the first conversation.
Sometimes it waits until the second.
Occasionally it hides behind practical discussions about funerals, inquests or police investigations before quietly making itself known.
But it always seems to arrive.
Not because people are guilty.
But because they loved someone.
Over the years I have come to expect that, sooner or later, almost every conversation will arrive at the same place.
“I should have known.”
“I should have seen it.”
“Why didn’t they tell me?”
“What if I’d answered the phone?”
“What if I’d gone round?”
“What if…”
Those two words can become relentless.
The Cruel Gift of Hindsight
One conversation has stayed with me, although versions of it have happened many times.
A client spends much of the session describing everything they believe they should have done differently.
Eventually I ask,
“If you could go back, knowing what you know now, what would you change?”
The answers usually come quickly.
“I’d have stayed.”
“I’d have gone to see them.”
“I’d have cancelled work.”
“I’d have answered every call.”
Then I ask another question.
“Why didn’t you?”
The room often falls silent.
Eventually comes the answer.
“Because I had no idea.”
Exactly.
Not because they didn’t love them.
Not because they weren’t paying attention.
Because they did not possess the information they possess today.
Guilt asks us to judge yesterday’s decisions using today’s knowledge.
It is an impossible standard.
Yet our minds seem determined to try.
Why Our Minds Do This
One of the things suicide seems to do is challenge our belief that the world makes sense.
If someone dies from illness, accident or old age, we may still ask why, but suicide often leaves behind a different kind of question.
Could I have stopped this?
The mind begins searching backwards.
Replaying conversations.
Reading messages again.
Looking for clues.
Trying to join dots that were invisible at the time.
In many ways, this search is understandable.
If we can find the moment where everything changed, perhaps we can believe the future was once different.
Perhaps we can imagine we had more control than we really did.
Painful though guilt is, it can sometimes feel easier than accepting the possibility that we never had the power to prevent what happened.
The Therapist’s Temptation
Earlier in my career, I wanted to make the guilt disappear.
I wanted to reassure people.
To explain.
To gently argue against their conclusions.
“You couldn’t have known.”
“It wasn’t your fault.”
Sometimes those words helped.
More often they lasted about thirty seconds.
The client would nod.
Take a breath.
Then quietly reply,
“Yes… but…”
I don’t think they were resisting reassurance.
I think the guilt simply hadn’t finished speaking.
Looking back, I wonder whether I was trying to reduce their discomfort…
…or my own.
Because sitting with unbearable guilt is difficult.
It asks something of the therapist too.
What Guilt Might Be Doing
These days I find myself becoming more curious.
Instead of asking,
“How do we get rid of this guilt?”
I wonder,
“What is this guilt trying to do?”
Sometimes it is trying to make sense of something that refuses to make sense.
Sometimes it is trying to regain a feeling of control.
Sometimes it is an expression of love.
Sometimes it is the continuation of a conversation that ended far too soon.
Occasionally I have even wondered whether guilt can become a way of staying connected.
Because if we stop asking ourselves what we should have done…
what does that say about the person we have lost?
Of course, guilt is painful.
But before we rush to remove it, it is worth understanding the purpose it may be serving.
Sitting Alongside Instead of Solving
I still hope guilt softens.
I still hope people become kinder to themselves.
But I no longer believe that my role is to rush them there.
Instead, I try to stay curious.
I listen.
I allow the story to be told again.
And sometimes again.
Not because repetition keeps people stuck.
Because repetition is often how people begin making sense of experiences that once felt impossible to speak about.
Over time, something usually changes.
Not because I have won an argument.
Because the client begins to hear their own story differently.
The guilt often starts to loosen its grip.
Not all at once.
Quietly.
Almost imperceptibly.
What This Has Taught Me
If there is one thing suicide bereavement has taught me, it is that guilt deserves curiosity before reassurance.
The urge to fix it is understandable.
The urge to explain it away is deeply human.
But healing rarely begins with being corrected.
More often, it begins with being understood.
Perhaps that is why I have become less interested in asking,
“How do I reduce this person’s guilt?”
And much more interested in asking,
“What has this guilt been carrying?”
Sometimes the answer tells us far more about love than it does about blame.
In Practice
I don’t actively introduce these ideas to every client.
Instead, I hold them quietly in the background.
If they help me understand the person’s experience, they are useful.
If they don’t fit, I leave them behind.
The client’s experience will always matter more than any framework I bring into the room.
Reflection for Practitioners
What happens in you when a client repeatedly blames themselves?
How quickly do you find yourself wanting to reassure?
What might happen if you allowed the guilt to be fully heard before trying to reduce it?
What purpose could the guilt be serving?
How might supervision help you distinguish between easing your client’s distress and easing your own?
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Working with Guilt After Suicide
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