When Grief Becomes a Crisis: How Therapy Can Help After Traumatic Loss

Grief can be difficult under any circumstances. But when a death is sudden, traumatic, or connected to suicide, the emotional aftermath can become especially complicated.

People may experience sadness, anger, numbness, guilt, confusion, relief, fear, or even emotions that seem contradictory. For some, the loss can become so overwhelming that it begins to affect their ability to function or creates thoughts of suicide themselves.

In these situations, therapy is not simply about encouraging someone to “talk about their feelings.” Effective crisis counseling involves understanding the person’s unique experience, carefully evaluating safety, identifying sources of support, and developing concrete strategies for getting through the most difficult moments.

To illustrate what this can look like, I’ll use a fictional case example adapted from a crisis counseling case I previously analyzed during my clinical training.

A Case Example: When Several Losses Collide

Imagine an adolescent named Ted who has recently experienced a series of devastating events, including the sudden death of his best friend. The person he lost had been part of his life since childhood, making the loss particularly significant.

In therapy, Ted initially appears withdrawn. He attends sessions and listens, but he has difficulty talking about what happened or expressing what he is feeling.

Eventually, those emotions begin to surface. He breaks down crying and reveals how deeply he cared for his friend. He also makes statements that could potentially suggest suicidal thinking.

At this point, therapy has to shift.

The immediate goal is no longer simply processing grief. The therapist must determine whether Ted is safe.

A crisis has been described as involving “(1) a precipitating event, (2) a perception of the event that leads to subjective distress, and (3) diminished functioning when the distress is not alleviated by customary coping resources” (Jackson-Cherry & Erford, 2014).

In other words, a crisis is not defined only by what happened. It is also determined by how overwhelmed someone feels and whether their usual ways of coping are still working.

Grief Can Look Different From Person to Person

One of the most important things I try to remember as a therapist is that there is no single correct way to grieve.

• Some people cry frequently.

• Others feel almost nothing at first.

• Some become angry.

• Some want to talk constantly about the person they lost, while others struggle to say their name.

People may experience guilt about something they did or did not say. They may replay events repeatedly, searching for an explanation. Sometimes grief even includes relief, particularly when the relationship with the person who died was complicated.

None of these reactions can be understood well without first understanding the person experiencing them.

This is why therapists also need to remain aware of their own experiences, beliefs, and biases. As Jackson-Cherry and Erford explain, “a multiculturally competent counselor examines any value conflicts and biases that arise as the client is telling his story and addresses them” (2014).

Therapists are human beings with their own histories of loss. Good clinical work requires recognizing when those experiences are being activated so that therapy remains focused on the client rather than the therapist.

This kind of self-awareness also helps reduce countertransference and allows therapists to remain present when clients discuss painful or emotionally intense experiences.

Professionals who regularly work with trauma must also pay attention to the possibility of vicarious trauma. Research-supported strategies include peer supervision, continuing education, limiting excessive trauma exposure, personal coping strategies, organizational support, and spirituality or other ways of maintaining connection to meaning (Trippany et al., 2004).

Grief After Suicide May Be Particularly Complicated

Suicide affects far more people than the individual who dies.

The CDC reported that more than 48,000 people died by suicide in the United States in 2021 (CDC, 2024). Conservative estimates have suggested that approximately one in six people may be directly affected by a suicide death (Jackson-Cherry & Erford, 2014).

People surviving the suicide of someone close to them may be considered “secondary victims,” with the individual who died being the primary victim and loved ones becoming survivors of the loss (Jackson-Cherry & Erford, 2014).

These survivors can experience elevated risks of depression, anxiety, trauma reactions, prolonged grief, and even suicidal thoughts themselves (Jackson-Cherry & Erford, 2014).

That does not mean everyone who loses someone to suicide will become suicidal.

It does mean therapists should take changes in mood, behavior, functioning, and communication seriously.

Recognizing When Grief May Have Become a Safety Concern

Someone experiencing traumatic grief may understandably withdraw, cry, struggle to concentrate, or experience dramatic fluctuations in emotion.

But certain changes warrant closer attention.

Potential warning signs can include hopelessness, helplessness, shame, pervasive sadness, sudden behavioral changes, reckless behavior, giving away possessions, settling affairs, saying goodbye, or making statements suggesting that the person does not expect to be around in the future (Jackson-Cherry & Erford, 2014).

In Ted’s fictional case, several details would concern me.

He had experienced a devastating loss, had been suppressing his emotions, suddenly became intensely emotional, and made an ambiguous statement suggesting he now knew “what to do.”

That statement might have been harmless or hyperbolic.

It might also have indicated suicidal intent.

A therapist should not simply guess.

The next step is assessment.

1. Conducting a Suicide Risk Assessment

When there are reasonable concerns about suicide, therapists should ask about it directly.

As Jackson-Cherry and Erford write, “Intervention begins and continues with effective assessment of suicide risk” (2014).

Suicide assessment is also not restricted only to situations where someone explicitly announces that they want to die. Risk assessment can begin during the initial counseling process and continue when clinically appropriate throughout therapy (Jackson-Cherry & Erford, 2014).

There are multiple structured instruments available for assessing suicidal ideation and behavior, and no single tool has emerged as the universal “gold standard” (Andreotti et al., 2020).

Two commonly discussed instruments include the Beck Scale for Suicide Ideation (BSI) and the Columbia-Suicide Severity Rating Scale (C-SSRS) (Andreotti et al., 2020).

The BSI, for example, is a 19-item clinical instrument designed to assess suicidal intention. Research has found high internal consistency as well as moderately high correlations with clinical judgments of suicide risk and self-report measures of self-harm (Beck et al., 1979).

But an assessment tool is only part of the process.

Therapy is still a human conversation.

When someone is grieving, frightened, ashamed, or overwhelmed, I believe it is important to approach these questions with warmth and respect rather than making someone feel as though they are simply completing a clinical checklist.

The purpose of asking these questions is not to judge someone for having suicidal thoughts.

It is to understand what they are experiencing so that we can determine what kind of support they need.

2. Creating an Actionable Safety Plan

When suicidal thoughts are present, one of the most important interventions may be developing a safety plan (Jackson-Cherry & Erford, 2014).

A useful safety plan should be individualized.

Depending on the person and situation, it might involve identifying warning signs, finding ways to regulate overwhelming emotions, staying connected with supportive people, reducing access to potentially lethal means, avoiding substances that could worsen impulsivity, identifying places where the person feels safer, and establishing what to do if suicidal thoughts intensify.

For someone grieving, the plan might also involve maintaining basic routines, staying connected with friends or family, attending therapy consistently, or participating in a grief support group.

If the situation becomes an immediate crisis, emergency or crisis services may also become part of that plan.

Safety planning is not merely theoretical. A systematic review found that safety planning interventions can improve suicidal ideation and behavior, decrease hospitalizations, and improve treatment attendance (Ferguson et al., 2021).

For someone in the middle of an emotional crisis, having concrete steps can be particularly valuable because intense distress can make problem-solving much more difficult.

3. Bringing Supportive People Into the Picture

Therapy should not always occur in isolation.

When someone is at elevated risk of suicide, supportive family members, friends, partners, or other trusted people can sometimes play an important protective role.

Jackson-Cherry and Erford (2014) describe social support as one of the potential “buffers” against suicidality.

Depending on the situation, supportive people may help someone remain connected to others, reduce access to potentially lethal means, avoid alcohol or substances, attend appointments, or access a higher level of care when necessary.

If a person appears to be at imminent risk of harming themselves, hospitalization or another emergency intervention may sometimes need to be considered.

The appropriate response depends on the individual situation, level of risk, available support system, and clinical assessment.

Culture Matters When We Talk About Grief

Grief does not occur in a vacuum.

Where someone lives, how their family communicates, their religious or spiritual beliefs, their gender expectations, their community, their socioeconomic circumstances, and their access to mental healthcare can all influence how they respond to loss.

Sue and Sue argue that “cultural competence is superordinate to counseling competence” (2019).

In Ted’s fictional case, for example, several environmental factors might influence his response.

He lives in a rural community with limited resources. His school appears poorly prepared to help students process sudden traumatic loss. Alcohol is readily incorporated into the way his peers cope with grief. Adults around him appear uncomfortable discussing what happened.

Young men may also encounter cultural expectations that discourage emotional vulnerability. Jackson-Cherry and Erford (2014) specifically encourage counselors working with adolescent males to consider whether substance use intersects with culturally expected rites of passage.

If the message someone repeatedly receives is “don’t talk about it,” it should not be surprising when they eventually stop talking.

Good therapy tries to understand these influences rather than treating every person as though they exist independently from their environment.

For people living in areas with limited access to mental healthcare, telehealth may also expand the availability of counseling and specialized services.

At a broader community level, education matters as well. Research examining suicide-prevention workshops has found that workshops can help transfer knowledge and shift attitudes surrounding suicide risk (Pisani et al., 2011).

The Therapist's Responsibility During a Crisis

When someone discusses suicide, therapists have both ethical and legal responsibilities.

One important concept is the duty to protect.

Jackson-Cherry and Erford explain that when a counselor arranges hospitalization for a client who has threatened to harm themselves, the intervention may fall under the concept of duty to protect (2014).

Suicide-related situations are also an important area of malpractice risk for mental health professionals (Jackson-Cherry & Erford, 2014).

This is one reason competent crisis care involves careful assessment, clinical documentation, consultation when appropriate, and adherence to professional and legal standards.

From a client's perspective, though, I think there is another important point:

You should be able to tell your therapist when things are getting bad.

Having suicidal thoughts does not make someone a bad client, difficult client, or failure at therapy. It gives the therapist important information about the severity of what the person is experiencing and allows treatment to respond accordingly.

Therapy After Traumatic Loss Is About More Than “Moving On”

I don't particularly like the idea that people simply “move on” from major losses.

Some experiences permanently become part of our personal history.

Therapy can instead help someone understand what happened, process the emotions surrounding it, develop ways of coping when grief resurfaces, reconnect with important people and activities, and eventually build a meaningful life that includes the reality of what they have experienced.

During an acute crisis, however, the first priority is safety.

Once someone is safer and more emotionally stable, therapy can begin addressing the larger questions that often accompany grief:

• Why did this happen?

• Could I have done something differently?

• Why am I angry?

• Why don't I feel as sad as everyone expects me to?

• What do I do with everything I never got to say?

• Who am I now that this person is gone?

Those questions often do not have simple answers.

Therapy gives people somewhere to explore them.

There Can Be Hope During an Acute Crisis

Suicide and traumatic loss are uncomfortable topics, but avoiding them does not make them disappear.

Evidence-based assessment, safety planning, social support, cultural awareness, and a strong therapeutic relationship can help therapists respond when someone's grief becomes a crisis.

There is also reason for hope.

Jobes (2006) notes that people experiencing acute suicide risk may respond more positively to intervention, resolution of suicide risk, and problem-solving than individuals experiencing chronic risk.

A crisis can feel endless while someone is living through it.

But an intensely painful period of life does not necessarily predict the rest of someone's life.

Part of therapy is helping someone survive the chapter they are currently in while gradually making room for the possibility that future chapters may contain very different emotions and experiences.

If you are considering psychotherapy following a traumatic loss, suicide loss, or another major life event, you do not have to arrive at therapy knowing exactly what to say. Sometimes the first step is simply acknowledging that what you are carrying has become difficult to carry alone.

Crisis note: If you are in immediate danger or believe you may act on suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline in the United States, or seek emergency assistance.

References

Andreotti, E. T., Ipuchima, J. R., Cazella, S. C., Beria, P., Bortoncello, C. F., Silveira, R. C., & Ferrão, Y. A. (2020). Instruments to assess suicide risk: a systematic review. Trends in Psychiatry and Psychotherapy, 42(3), 276–281. https://doi.org/10.1590/2237-6089-2019-0092

Beck, A. T., Kovacs, M., & Weissman, A. (1979). Assessment of suicidal intention: The Scale for Suicide Ideation. Journal of Consulting and Clinical Psychology, 47(2), 343–352. https://doi.org/10.1037/0022-006X.47.2.343 Beck et al., 1979

CDC. (2024, May 13). Suicide Data and Statistics. Suicide Prevention. https://www.cdc.gov/suicide/facts/data.html

Ferguson, M., Rhodes, K., Loughhead, M., McIntyre, H., & Procter, N. (2021). The Effectiveness of the Safety Planning Intervention for Adults Experiencing Suicide-Related Distress: A Systematic Review. Archives of Suicide Research, 26(3), 1–24. https://doi.org/10.1080/13811118.2021.1915217

Jackson-Cherry, L. R., & Erford, B. T. (2014). Crisis Assessment, Intervention, and Prevention. Pearson Higher Ed.

Jobes, D. A. (2006). Managing suicidal risk: A collaborative approach. Psycnet.apa.org. https://psycnet.apa.org/record/2006-12209-000

Pisani, A. R., Cross, W. F., & Gould, M. S. (2011). The Assessment and Management of Suicide Risk: State of Workshop Education. Suicide and Life-Threatening Behavior, 41(3), 255–276. https://doi.org/10.1111/j.1943-278x.2011.00026.x

Sue, D. W., Sue, D., Neville, H., & Smith, L. (2019). Counseling the culturally diverse: Theory and practice (8th ed.). John Wiley & Sons, Inc.

Trippany, R. L., Kress, V. E. W., & Wilcoxon, S. A. (2004). Preventing Vicarious Trauma: What Counselors Should Know When Working With Trauma Survivors. Journal of Counseling & Development, 82(1), 31–37. https://doi.org/10.1002/j.1556-6678.2004.tb00283.x

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