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A phenomenological study of family adaptation after a suicide attempt

Louise Anne D. Luces
De La Salle University - Manila

Claudelle S. Pulido
De La Salle University - Manila

Ma. Carmela Teresita B. Sison

De La Salle University - Manila

The purpose of this study is to discover the lived experiences of family members in adapting to a suicide
attempt. A descriptive method using a qualitative approach was employed through semi-structured interviews,
and themes were extracted through the use of Thematic Analysis as the framework for analysis and
Interpretative Phenomenological Analysis as the lens of research strategy. Results presented two clustered
themes which are emotional struggles and adaptation process. Findings of the study presented adaptation as a
dynamic process on which individual capacity of adapting and communication within the family are of primary
importance in collectively adapting from the adversity of suicide attempt and enhancing the system of the

Nearly one million people across the globe
die by suicide every year and it is among the top
ten leading causes of death across age groups
(Young, Iglewicz, Glorioso, Lanouette, Seay,
Ilapakurti, & Zisook, 2012). Considered as the third
leading cause of death in the United States, the
second leading cause in the rest of the refined
world (Wilkinson, Kelvin, Roberts, Dubicka, &
Goodyer, 2011), and the leading cause of death in
the Philippines (Redaniel, Lebanan-Dalida, &
Gunnell, 2011), suicide continues to take lives on
different populations. In executing the act of selfkilling, mixed methods are employed, usually
consisting of overdose, cutting and carbon
monoxide poisoning (Beautrais, 2004). Delving
further into the emotions involved with committing
suicide, hopelessness has been found to be
connected with suicide although other studies
found this factor to be confounded by the existence
of depression (Bridge, Goldstein, & Brent, 2006).
King & Merchant (2008). On the other hand,
identified possible environmental stressors such as
family psychopathology, family discord, abuse, and
loss of a parent through death or divorce have also
been associated with suicide. However, these facts
on suicide do not just pertain to certain digits and

trivia regarding an act of self-killing but rather, it

imposes an underlying meaning of communication
of their distress to the public.
Suicide is a classical phenomenon that has
been regarded as a form of communication between
the person and the significant people in their lives
(Wasserman, Thi Thanh, Thi Minh, Goldstein,
Nordenskiold, & Wasserman, 2008). Individuals
who have been plagued by their negative ideations,
come up with the solution of inflicting harm to their
body with a hope to send a certain message of help
to those around him. After the distressed
experience, families are left with overwhelming
responsibilities (Coggan & Bennett, 2002) in
preventing another attempt to happen (Heckler,
1994) and to stabilize the relationship of the family
members after the attempt (Jordan, 2001). This is
further explained by Family Systems Theory as it
regard suicide attempt to be interconnected in
family dynamics and therefore, triggers change in
the whole family system (Whitchurch &
Constantine, 1993). Moreover, the communication
patterns that will occur during this crucial time
after the suicide attempt will define the nature of
relationship that will emerge within the family
(Becvar & Becvar, 1999). In this regard, the
manner of adaptation of the family depends on the
relationship. As Everall, Altrows and Paulson
(2006) stated, support and secure attachments are

significant factors in the recovery process of

individuals after an attempt. Bostik and Everall
(2007) further emphasized that these attachments
can aid a suicidal individual in moving on from the
destructive thoughts to perceptions that are filled
with hope and meaning in living.
This study aims to discover the adaptation
process of the family as response to the suicidal
individuals call for help. With the lack of studies
concerning the actual responses of the family in
suicide attempts, the actual changes that occurred
on family members in adapting to the recovery of
the suicidal individual and to the changes within
the family will be documented. By choosing the
families of those who have attempted rather than
those who have completed, the proponents can
capture and gain deeper understanding on the
meaning of what it means to survive a suicide
attempt and thrive (Van Manen, 1984). As Gulbas,
Baumann and Pena (2011) stated that by
emphasizing the roles of every family member
towards the suicide attempt, comes the key to
enrich the understanding of the interaction among
the members of the family. Provision of this
understanding may lead professionals to come up
with intervention strategies and promote the wellbeing of survivors after the attempt (Bowden,
2006). In this case, the adaptation of the family
together with the suicidal individual may become a
venue for overcoming the negative impact of the
event and reconnect with hope as response to the
call of changes embedded in the act of suicide
The study is about the lived experiences of
families in adapting to a suicide attempt of a family
member. Previous qualitative studies used the
psychosocial approach in presenting the impact of
suicide on the bereaved family and significant
others of the suicidal individual. This approach
explains that negative experiences of grief such as
immobilization, shame, and guilt are among the
common responses to a suicide. However, these
approaches were not able to capture and explore
the distinct effects of suicide attempt in the
families functioning and adaptation. Therefore, it
phenomenological analysis, the lived experiences of
families in adapting to a suicide attempt forges
changes in the relationship dynamics within the


Suicide is a phenomenon that is related to
several and repeated mental distress and claims
life among different ages (Redaniel, LebananDalida, & Gunnell ,2011). Redaniel, LebananDalida and Gunnell (2011) further presented that
suicide will continue to be the leading cause of

death in the Philippines and the number of suicidal

death will increase over the years. Moreover, data
across nations consistently show men having a
higher rate of suicidal tendencies and/or behavior
as compared to women (Nock, Borges, Bromet, Cha,
Kessler, & Lee, 2008). These data shows that
despite different developments in health care
services in the US, there is little change in the rate
of suicide and suicidal behavior over the past
decade. However, suicide does not stop at being a
simple act of killing oneself as it upholds a
significant meaning of communicating the distress
to other people. It is not a mere act of self-killing
but rather, an important form of communication to
Suicide attempt commonly embodies a bid
to communicate distress to important figures such
as the family and friends (Kreitman, 1986; Stengel
& Cook, 1958). Suicidal communication is a
manifestation of personal style, reflecting a
persons capacity to ask for help (Wasserman, Thi
Thanh, Thi Minh, Goldstein, Nordenskiold, &
Wasserman, 2008). With this statement, it is
important for the motive to be decoded especially
by the people who are in a close relationship with
responsibilities that entail this task require more
than a crucial and tedious intervention.
Wasserman et al (2008) further added that family,
friends, colleagues and peers have roles in suicide
prevention and this responsibility poses a challenge
considering that the resources they need to
contribute significantly are not clear. For the
reason that communication is a two-way process,
the suicidals message may not be clear enough for
the receiver to interpret and respond to. Moreover,
it is also possible that the individual is sending a
clear message but the receiver fails to recognize
and act on it not only because of their lack of
knowledge, but also because of their own uncertain
attitudes and behavior concerning self-destructive
individuals coming forward when they are
confronting suicidal communication (Wasserman,
Thi Thanh, Thi Minh, Goldstein, Nordenskiold, &
Wasserman, 2008). In addition, significant others
frequently fail to detect and recognize suicidal
communication and respond to warning signals due
to certain factors such as difficulties faced by the
suicidal in communicating distress, difficulties
experienced by the family and significant others in
decoding and heeding distress signals, and
difficulties of significant others in taking a
preventive action.
relationship between the social support and the
suicidal has been presented as essential,
communication of the suicidal to others may not be
clear and may lead to misunderstanding between
family and the significant others (Owens, Owen,

Belam, Lloyd, Rapport, Donovan, & Lambert,

2011). On the topic on suicide, families are
considered to be buffers to suicide risk for highly
suicidal individuals (Kleiman, Riskind, Schaefer, &
Weingarden, 2012). According to Wasserman et al
(2008), personal conflicts and lack of support were
determined to be the main reasons for committing
suicide. However, certain measures and relations
can still prevent a person to kill himself.
Researches show that assistance from peers and
family takes on a role when it comes to suicidal
process and prevention. In line with this, the
family, who is in close proximity with the
individual, seems to be most influential and
ubiquitous when it comes to shaping a suicidals
behavior, feelings, and decisions. Family members,
friends and colleagues may be the people who can
possibly testify the distress of the individual and
therefore, may be accountable to the burden of care
to the suicidal (Owens, Owen, Belam, Lloyd,
Rapport, Donovan, & Lambert, 2011). Sharaf,
Thompson, & Walsh (2009) explained that feeling
of unitedness with the family reduces feelings of
social isolation and loneliness that may lead to
suicide behaviors. Wasserman et al (2008) further
emphasized the importance of family as a
protective factor to intervene in the impending
suicide. Having knowledge on problem-solving
capacity and also maintaining a good relationship
with the family and significant others may reduce
the stress experienced by the individual, which
otherwise left unchecked could lead them to commit
suicide. Moreover, researchers affirm that external
resources in terms of accessibility of social support,
most importantly from the family, can decrease the
risk for suicidal behavior and can be invaluable
during instances of increased stress (Compton,
Thompson, & Kaslow, 2005). To present evidence
on how social support system can affect the
psychological well-being of an individual, a study
by Kumar & George (2013) showed findings that
positive coping behaviors were low among suicide
attempters and desirable life events such as
commendable education and consistent social
support were identified to be protective against
suicide. From the studies about the relationship of
the suicidal individual and the family, it can be
considered that the family is an efficient and
systematical determinant of an individuals actions
and decisions in committing suicide. Suicidal
behavior is considered receptive but by being
involved in social relationships, there may be
reduction of pain and creation of hope for the
suicidal victims. Receiving help of orally expressing
their existential thoughts and freely discussing
possible solutions to it serve as factors of great
Duberstein, & Jordan, 2008).




Suicide attempters are technically termed

as survivors of suicide, but it has come to refer
also to the family and friends of those who complete
and die from suicide (Sudak, Maxim, & Carpenter,
2008). By undergoing the painful process and
suffering from the effects of the event, suicide
survivors are definitely in dire need of greater
understanding. At the same time, suicide
prevention programs in the form of support groups
in the community are much needed (Miers, Abbott,
& Springer, 2012). Considering that suicide occurs
within families, focusing on the aftermath of
suicide is a crucial succeeding step to determine
exactly how to help survivors (Biong & Ravndal,
2007). Previous studies have pointed out several
ways to better help these individuals. Shneidman
(1993) defined postvention as the appropriate and
helpful acts after the suicide. Though interventions
are currently existing, previous studies have been
subject to flaws and limited data such as the peerreview process in the intervention. With this,
concerns of suicide risk should be further studied to
determine whether risks are related to gender,
ethnicity, or other demographic factors. Family
interventions may also be considered as a
treatment (Kleespies, Van Orden, Bongar,
Bridgeman, Bufka, Galper, Hillbrand, & Yufit,
2011). Studies have suggested that mental health
professionals should deeply look into both
internalizing and externalizing behaviors as
pathways for suicide attempts among these
patients (Cintron, Hausmann-Stabile, Kuhlberg,
Nolle, & Zayas, 2012). Kaslow, Ivey, BerryMitchell, & Franklin (2009) on the other hand,
suggested that interventions should address the
shifts in family dynamics following a suicide,
support family members and help them support one
another. The programs mentioned are those
interventions needed for the survivors to overcome
their experience of suicide within the family.
However, despite these supervised programs,
personal healing is also needed to help the survivor
from within. According to Hoffmann, Myburgh, &
Poggenpoel (2010), in some time, the survivors may
experience healing once they acknowledge these
painful and tragic events. Eventually, they will
move on towards a normal life and adjust into the
changed world around them. However, some
suicide survivors can still find themselves stuck
due to guilt and anger, and thus holding them back
from moving on.
The triggering factors that lead to suicide
are also evident on suicide attempts however,
suicide attempt has distinct effects on the
survivors functioning which engage the family to
adaptation. Beautrais (2001) claimed that risk
factors and life processes that lead to suicide are

similarly evident for those making serious suicide

attempts (p. 844). Suicide attempts serve as a call
and a catalyst for changes to occur in the family
(Bryan, Brophy, Cunningham, & Schwarz, n.d.). In
this case, suicide attempt leaves a mark that aims
for changes within the social groups as response to
their communication. However, improvements are
not the usual responses to this call as profound
series of family changes such as routines and
functioning including heightened caution and care
in dealing with the suicide attempter are different
(Bryan, Brophy, Cunningham, & Schwarz, n.d.).
Prior expressions of suicide communication comes
as a shock to the family members and thus,
resulting them to stay in silence for fear that
further discussing the attempt can cause the
individual to pursue their intention (WolkWasserman, 1986). Moreover, suicide attempts can
cause uncertainty on the part of the family
regarding the words and actions they would show
to the family member. Following these distresses
experienced, families are indeed faced with
overwhelming responsibilities in line with worry
that the attempt will happen again (Coggan &
Bennett, 2002). Researchers found that the initial
time after the suicide attempt is most stressful and
emotional for the individual and their families
(Coggan & Bennett, 2002). According to Fisekovic
& Celik (2012), the suicide attempt is a risk factor
for completed suicide and majority of those who
commit suicide have made previous attempts.
Heckler (1994) further stated that failed attempts
do not necessarily demolish the ideation and the
thought of ending their lives still remain. In this
case, the presence of family is very essential in
helping and preventing another attempt. On the
other hand, pre-existing interactional patterns of
some families in which a suicide attempt takes
place may be different from other families, and the
suicide attempt itself may reinforce these
dysfunctional family dynamics (Jordan, 2001). The
suicide attempter after the event may end up
having difficulty or strained relationship with the
family members (Beautrais, 2004). Moreover,
family members may experience difficulty in
dealing with the suicide attempter such as decrease
in cohesion (i.e. emotional bonding that family
members have toward one another) and
adaptation (i.e. the ability of a marital or family
system to change its power structure, role
relationships, and relationship rules in response to
situational and developmental stress) (Cerel,
Duberstein, & Jordan, 2008, p. 38). Furthermore,
misunderstandings, withdrawals, and avoidance
between the family and others which may lead to
withdraw from their social networks. Self-imposed
isolation (Wolk-Wasserman, 1986) and health
problems such as stress (Magne-Ingvar, 1999b) and

disturbances in sleep patterns, mood, and appetite

can arise (Magne-Ingvar, 1999a). Lastly, family
members at the process of coping with suicide
attempt may also be at the same risk of committing
suicide themselves (Talseth, Gilje, & Norberg,
However, suicide attempts do not reduce
itself to negative adaptations only as studies also
found a positive adaptation to suicide attempt
within the family. Secure attachment after the
event may serve as means for the suicidals
recovery and forge strong bonds within the family.
A study by Ram, Darshan, Rao, Honagodu &
Abhijit (2012) was conducted to discover whether
individuals who attempted suicide and recovered
perceived that their suicide attempt could have
been stopped or prevented. Results show that
majority of the subjects recruited for the study
recovering from the suicide attempt perceived that
their suicide attempt could have been prevented by
family members and the society. Support and
secure attachments have been identified as
significant factors in the recovery process of young
individuals after a suicide attempt (Everall et al.
2006; Bostik and Everall 2007; Paproski, 1997; and
Taylor, 2002). These family attachments and
support decreases the probability of suicide attempt
especially if the family exhibits high collective
efficacy (Maimon, Browning, & Brooks-Gunn,
2010). Bostik and Everall (2007) stated the
importance of secure attachments in helping
suicidal individuals to move on from the destructive
self perceptions into changing their emotional and
cognitive states which therefore inflict hope and
meaning to lives after suicide attempt. Bergmans
(2008) further emphasized that suicidal individuals
initially have to learn that their emotions are not
the sole indicators of their identity but rather in
seeing themselves with others and others in
themselves. Taylor (2002) identified that the
support systems enabled suicidal individuals to
overcome the negativities and eventually connect
with hope. Belonging bestows this feeling of
connection (King, Cathers, Brown, Specht,
Willoughby, Polgar, MacKinnon, Smith & Havens,
2003) and it is in belongingness that a person can
be assured they are alive (Bergmans, 2008). In
totality, the provision of families and friends in
fulfilling the suicidals need for understanding
marks the removal of their suicide ideations. With
mutual reassurance and supportive responses from
people whom they share the same experiences with,
survivors are able to move above isolating sadness
of loss and visualizing possibilities for future
hopeful and positive actions (Feigelman &
Feigelman, 2008). Curtis (2003) further elaborated
that what helps an individual overcome his
inclination towards taking his own life is the
overwhelming feeling of being loved and valued by

his family and the guilt from making his significant

people worry. Finally having a chance to talk about
their problems provides them a venue to identify
their problems and figure out what kind of help
they are seeking (Hill, 1995). On the other hand, a
wider perspective allows suicide survivors to
refrain from personal blame, but rather start to
switch their grief into social action and serve as a
positive transformative experience (Fielden, 2003).
This transition process is rigorous as it involves a
dynamic procedure from suicide ideation through a
period of limbo to willingness to connect with
living (Bergmans, 2008). Mandelbaum (1973)
defined major transitions as events that occur as
turning points in life while King et al (2003)
identified these points as emotionally compelling
experiences and realizations that involve meaning
acquired through the routes of belonging, doing, or
understanding the self or the world. (p. 184). An
example of this transition is the case of Jim
McCarthys life which showed the impact of a
family members suicide. His family worked hard to
move on from the reality of their family members
suicide and recovered the love they had for him.
Jim stated that the whole process was painful but
on the brighter side, it forged stronger bonds within
the family (Eimer, 2003). On the other hand,
Heckler (1994) formulated the five stages of
recovery which are the dissolution of suicidal
trance, rebuilding of the self, building new
relationship with the self, opening up to others, and
give back the learning to a bigger group. Previous
studies have reported that participants experienced
heightened well being and personal sense of
community by sharing narratives of loss with each
other. In accordance, Feigelman and Feigelman
(2008) confirmed these findings as positive effects
of support groups for those bereaved by suicide and
having professionals provide guidance and clarity
in assisting the family or groups healing journey.
The most preventive strategies against attempted
suicide would suggest improving or enhancing the
individuals life events such as social support,
adapt good coping skills, expose to positive life
psychological health and health environment
(Kumar, & George, 2013). Clinicians and suicidal
patients should have a collaborative effort in
dealing with suicidality. In this case, instead of
delivering the message that suicide is unacceptable
and must stop, the clinician validates the pain of
the patient and makes sense of the process by
which the pain led to suicidal ideation and
behavior. Thus, having a shared understanding is a
fundamental objective towards an effective working
relationship (Ellis, Daza, & Allen, 2012). The lived
experiences of people in the process of adaptation
professionals studying suicide for intervention

initiatives and promotion of well-being (Bowden,

2006) especially in the case of the family who
equally has destructive feelings after a suicide
attempt. Through this, the researchers can go
beyond the context of simple adaptation but delve
further into capturing and decoding understanding
on the nature of adaptation (Van Manen, 1984).
Adaptation can be viewed through the
family systems perspective to further understand
how a suicide attempt forges changes in the family.
The family systems theory is a systemic perspective
view of the reality of individuals and their role in
the familys sense of wholeness (Jenkins, 1989). In
this case, the attempters experience is not
understood through the causes but rather on how
his presence has affected the roles of the family
members. There are three basic processes involved
namely the individual process (i.e. development of
resilience), dyadic process (i.e communication), and
systematic process (i.e. family functioning). As the
systems theory basically focuses on the family
dynamics after the suicide attempt, family becomes
a promising venue for intervention on the
occurrence of depression and suicidallity (spirit).
Despite affecting the entire family system
(Zimmerman & Lasorsa, 1995), suicide attempt can
also have the power to generate increased empathy
and care in the family (Richman, 1986).
Family systems theory regards family as a
system wherein interconnectedness between the
family members are emphasized (Becvar & Becvar,
1999). Families are considered as systems because
it is composed of interrelated elements that exhibit
coherent behaviors, has regular interactions and is
independent of one another (Morgaine, 2001). In
other words, a family system embodies wholeness
or holism (Gilbert, 2010) which indicates that in
fully understanding a system, it should be regarded
as a whole rather than breaking the system into
parts. Batenson (1973) compared family system to
a steam engine with a valve. When steam pressure
increases the forces act on the valve so it allows
steam to escape, and when the pressure decreases
the valve closes the system again. In general,
family is the initial starting point for recovery
when the family wishes to the mend the symptom
behaviour in family member (Groholt, 1993).
Involvement will be of vital importance in the
removal of the suicide ideations and for the family
to adapt as a whole after the suicide attempt.
The most important process in the family systems
theory is the family communication. It is in the
exchange of information among family members,
the quality of communication (Gilbert, 2010), and
interaction patterns where the familys equilibrium
and functionally are maintained (Morgaine, 2001).
After a suicide attempt, families are left with
questions concerning how they would establish
communication and connection with the attempter.

In ensuring that the family system is still intact,

there should be sufficient communication between
and beyond the childrens and parents subsystems
(Samm, 2012). The behaviour that will emerge in
adapting to the suicide attempt will serve as the
output from communication among its components)
and therefore, change the overall behaviour of the
system (Whitchurch & Constantine, 1993) In this
system, family communication is of vital
importance as it is significantly related to the
persons psychological well being and poor
functioning can lead to a higher suicide ideation
(Kwok, 2010).
The systematic process of Family Systems
Theory functions as based from the Composition
Law which states that the whole is more than the
sum of its parts. (Morgaine, 2001). Even though a
family is made up of individual members, it is
considered as a whole. In this situation, events
such as a suicide attempt that take place within
the family shifts the pattern of interaction and
provides the means to create a different history in
the course of family interaction (Groholt, 1993).
Minuchin (1985) claimed that this transition point
for a family member is a challenge for the entire
system. In this case, the onset of suicide attempt
becomes a turning point for the attempter as well
as the family in stabilizing the dynamic system.
During this process, it is important to identify the
strengths and weakness of the family and help each
other in sharing the responsibilities during the
course of a changing family dynamics (Spirito,
1997). If social support successfully provided, it can
reduce stress and at the same time strengthen
family relationships (Groholt, 1993). Furthermore,
through the perspective of a family system
dynamics, family mutuality and cohesion can be
enhanced by guiding the family members to love,
care, concern, trust, support, and understand one
another (Kwok, 2010).
To further explore on the possible factors that are
ingredients to adaptation, proponents formulated a
conceptual framework showcasing the interactions
between suicide attempt-suicide communication,
suicide communication-family, and family-suicide
attempt. Suicide attempt serves as a form of
communication for help and for changes to occur
within the group of significant people particularly
in the family. In responding towards the suicide
attempt, adaptation within the social group may
establish itself as the outcome of these three
interactions. In addition, linkages were found to
exist between the three factors which are the
manifestations of suicide attempt as a cry for help,
the misinterpretations of this communication by
the family, and their initial responses to the suicide
attempt that has been done. This assumption may
be understood through the concept of Family
Systems Theory which states that the component of

the system is interconnected with the rest of the

components in a manner that a change triggers a
change in the whole system (Whitchurch &
Constantine, 1993). Even though the framework is
presented in a seemingly equal diagram, each of
the three variables does not indicate the same
gravity on the type of adaptation that will occur. In
addition, the presentation of the suicide attempt,
family, and social communication does not follow a
stable process and therefore, not causal in nature.
In totality, the interaction of the three variables
does not assume itself as primary qualifiers for the
adaptation because the uniqueness of the lived
experiences of the family members throughout the
whole event of a suicide attempt in the family are
still taken into consideration.
This research study focuses on the process
of adaptation of family members in dealing with a
suicide attempt. With the lack of studies focusing
on the documented recovery responses of families
towards the suicide attempt in adaptation, the
actual experience of adaptation and its impact will
be documented. Previous studies have focused on
limited aspects of suicide and have not explored its
entirety when it comes to markers of recovery and
adaptation. Several researches focused on the
experiences of grief after suicide but rarely on the
effects of suicide in the family itself (Cain, 1972),
and only on one type of survivor on which the
perspective of the family members toward the
suicide act are not documented (Cerel, Duberstein,
& Jordan, 2008).By covering the experiences of
families with suicide attempters, the proponents
will obtain a clear grasp on the understanding of
what it means to overcome and surpass a suicide
attempt (Van Manen, 1984). At the same time, the
road to recovery of the family may serve as a
learning experience where the negative impact of
the event can be transformed into changes and
hope. Specifically, this research seeks to answer the
question, What are the lived experiences of each of
the family members in adapting to a suicide
attempt of a family member?

In answering the main research question,
this research utilized a descriptive method using a
qualitative approach with a semi-structured
Phenomenological Analysis as the strategy and
with the use of Thematic Analysis as the
framework for analysis. By understanding how
families view the suicide attempt in the family, the
study aims to explain how suicide attempters and
their families go through the process of struggles
towards adaptation after the suicide attempt. This
approach would be beneficial in fully extracting the
meaning from the lives of family members,

including the feelings and behaviors resulting from

effects of the suicide attempt. An interview guide
was provided and proponents of the study ensured
the confidentiality of the data with the
participants. Participants of the study were chosen
based on purposive sampling and formulated
criteria to ensure validity. The criteria includes the
participant to be a first-degree relative of the
individual who previously attempted suicide
regardless of any suicidal means, and a parent,
spouse or child of the individual that are of legal
age. On the other hand, proponents of this study
recognize some limitations in utilizing the
mentioned research design to answer the main
research question. These limitations may include
the standard cut off criteria of suicide attempt in
the family, time interval of interview from the
onset of the incident, language used in the
interview and conflicting thoughts between the
beforehand, proponents of the study cannot ensure
a pure and unbiased data from the accounts of the


With the use of qualitative method, the
results surfaced seven (7) clustered themes of
emotional struggles. Feelings of immobilization due
to disbelief of the suicide occurrence, Feelings of
guilt and self-blame over perceived responsibility in
the attempt, Feelings of grief as response to the
suicide attempt, Exercise of denial as means of
diversion from the incident, Feelings of shame from
public misconceptions, Perceived normality in the
attempters detachment from the family, and
Voluntary monitoring of attempters actions after
the incident were obtained in the data from the
three participants interviewed in this study. These
seven (7) initial themes of experiences presented
the emotional struggles that family members went
through at the perceived occurrence of the suicide
attempt, as well as their behavioral responses
towards it. From this clustered theme, adaptation
process was identified involving the Sense of
having effective communication with each other,
Feelings of role fulfillment towards the family
member, Feelings of determination and optimism
to overcome the adversity, Sense of acceptance over
the reality of suicide attempt in the family,
Feelings of self-empowerment over inferiority and
shame, Feelings of unity through open engagement
with each other, and Availability of support system
in the midst of adversity. These seven (7) initial
themes clustered under the adaptation process
were analyzed and matched with the corresponding
struggle it addressed at the first clustered theme of
emotional and behavioral struggles at the
occurrence of suicide attempt.

Family adaptation after a suicide attempt

has been embedded along path of obstacles
involving anguish towards the detrimental effects
of the incident and distress towards the
misconceptions revolving around the suicide
attempt phenomenon. In studying suicide attempt
and the family adaptation after the event, a better
understanding of the phenomenon emerged and
presented how frequently occurring misfortunes in
life are not as detrimental as the feelings that can
be brought upon by a possible loss of a family
member. Findings of this study supplied evidences
which negate the common stigma about families as
the contributing factors of the suicide event.
The first initial theme which is feelings of
immobilization due to disbelief of the suicide
occurrence pertains to the inability of the family
involved to believe the incident. This theme was
matched with Sense of having effective
communication which pertains to the interchange
of thoughts and opinions or passing of information
by speech, writing, or signs exercised by the family
members. The next theme involves the Feelings of
guilt and self-blame over perceived responsibility
and this refers to the remorse caused by the feeling
of responsibility in committing something wrong
and attributing fault into accident. This was paired
with Feelings of role fulfillment towards the family
which further explains how a family member
satisfies his or her role to adapt from the incident.
Another emotional struggle which surfaced from
the data is the Feelings of grief as response to the
suicide attempt which has been overpowered by the
adaptation theme of Feelings of determination and
optimism to overcome the adversity. This describes
the disposition to look at the positive side of events
in facing struggles and adversities.
The next set of themes involves Exercise of
denial as means of diversion from the incident
which refers to the psychological defense
mechanism employed by the family members
wherein the painful reality is refused. This is then
paired up with the adaptation factor involving
Sense of acceptance over the reality of suicide
attempt in the family which refers to the
experience of emotional ease and freedom by the
act of accepting the suicide attempt. Next theme
involves Feelings of shame from public
misconceptions which portrays their suffering from
feelings of inferiority and embarrassment from
peoples scrutiny outside the family in relation to
the suicide attempt. However, findings show that
these emotional struggles can be transformed into
Feelings of self-empowerment through upliftment
of self-respect and appreciation of the gravity of the
occasion and situation, instead of dwelling on
negativity. The emotional struggle of Perceiving
normality in the attempters detachment from the
family is explained as the behavioral response of

detaching ones self from others and the

indifference of the family member to the situation
of the suicide attempter. Findings of the study
presented this detachment to be mended by
Feelings of unity through open engagement with
each other. This adaptation process theme
describes the unification of family members and the
experience of becoming more engaged with each
The last set of themes presents Voluntary
monitoring of attempters actions after the incident
which pertains to a behavioral response exhibiting
the showing of responsibility and giving watchful
attention to the suicide attempter after the
incident. This response after an attempt focuses on
the family members cautious behavior towards the
suicidal individual out of fear for another attempt.
However, a deeper type of support develops
through time which presents Availability of support
system in the midst of adversity to demonstrate
family as providers of practical or emotional
support to the suicide attempter.
Adaptation as an individual and collective dynamic
Examining the forms of adaptation
through the framework of suicide attempt, family
and communication interaction provided a possible
dynamic pattern on how families manage to adapt
and thrive after an unfortunate incident. Groholt
(1993) refers to family as the initial point of
recovery process when they are attempting to mend
the symptom behaviour in a suicidal family
member. Emotional and behavioural responses in
the data have shown similarities with the studies of
Sommer-Rotenberg (1998) and Cerel, Jordan, &
Duberstein (2008). The process of adaptation also
presented some themes that compliment the
studies of Taylor (2002), Maimon (2002), and
Everall (2006). However, additional themes apart
from the related literatures emerged among the
responses and the form of adaptation from the
gathered data in this study.
Results of the study presented adaptation
as an active process which starts in the individuals
experiences of resilience and coping before this
process becomes collective and effective within the
familys adaptation. Findings of this study
highlight the importance of communication in
rebuilding the connection of the family and in
leading to adaptation from the suicide attempt.
These results are basically supported by the studies
on the importance of communication and cohesion
as vital tools in adaptation including the study of
communication as an important factor that is
significantly related to psychological well-being
and functioning; Bostik and Everall (2007) which
stated the importance of secure attachments in
helping the suicidal family member in shifting from

destructive self-perceptions into transforming their

emotional and cognitive states, leading to hope and
meaning after a suicide attempt; and Curtis (2003)
who further elaborated that the overwhelming
feeling of being loved and valued by the family
helps the individual overcome his inclination
towards taking his own life. By restating the
account of the daughter whose mother attempted
suicide, she stated that though the process of
communicating the problem was not a good choice
(i.e. suicide attempt), the suicide attempt paved the
direction for them to start rebuilding the
relationship in the family and communicate
effectively by reaching out the feelings that were
once not be expressed successfully.
Communication and cohesion within the
family after the suicide attempt became the basis
on the shift in the dynamics of the family. As
mentioned by the family members involved in the
study, helplessness embodied the distress and
challenged the relationship of the family; In fact,
this transition point for a family member is a
challenge for the entire system (Minuchin, 1985).
The patterns that occur during this period may
reinforce dysfunctional family dynamics (Jordan,
2011) or enable suicidal individuals to overcome the
ideations and eventually connect with hope (Taylor,
2002). Family Systems Theory further explains the
importance of identifying the strengths and
weaknesses of the members and helping each other
in sharing the responsibilities (Spirito, 1997). This
process of resilience is afterwards followed by the
most important process of communication which is
the indicator of how the familys equilibrium and
functionality will be maintained (Gilbert, 2010). In
ensuring an effective family system, there should
be a sufficient amount of communication between
the members of the family (Samm, 2012).
Furthermore, for family systems to be stabilized or
improved, changes are necessary ingredients
(Becvar & Becvar, 1999). Family members involved
in the study also emphasized how communication
served as the key for rebuilding the family after the
suicide attempt, and for serving as platforms to
move on and thrive afterwards.
By capturing the factors associated with
adaptation through the data gathered in the study,
researchers presented a process of adaptation to
further illustrate the findings of the study. The
diagram below showed how suicide attempt
perturbs the familys emotional balance and
homeostasis, and in effect, pushes them below their
baseline level of functioning. This disruption,
however, becomes the starting point for families to
move on by effectively communicating with each
other, and thrive towards total recovery and

Figure 1. Adaptation process covering the onset of suicide attempt and the role of communication towards

The onset of the suicide attempt brings the

family into a state of emotional imbalance which
impels family members to become each others
support system and prevent another suicide event
from happening again. This is shown by supplying
the immediate basic needs of monitoring and
emotional support to the attempter. Afterwards,
the process is followed by how the family members
develop their own sense of strength and source of
optimism. Through the presence of this support
system, family members are now drawing a strong
mindset from the family to be better equipped in
performing actions to fulfill their role towards the
family by becoming more emphathic, caring and
willing to lend their ears with each other.
Afterwards, acceptance becomes the next step
towards adaptation when families accepted the
suicide attempt in the family and internalized it as
a life-changing process involving growth and
rebirth, instead of treating it as a shame embedded
in the family. This step of adaptation was
presented by the assurance that the negative
emotions brought by the incident are now replaced
by positive feelings of ease, happiness, and
hopefulness towards their future. Through this
step, family members have became empowered by
believing that they came out as stronger
individuals after the event and thus, propelled
them to have better respect and confidence with

oneself, as well as to become better individuals for

the family. By acquiring these individual
characteristics, families have been presented the
output of having a better sense of communication
and relationship with each other. The suicide
attempt did not serve as a hindrance for the family
to break apart but instead, impelled them to
become stronger individuals who are seeking the
same goal of keeping the family intact and unified.
By drawing significant lessons from the experiences
that the family went through and survived
together, family members incorporated these
values and meaning through their lives and kept
them as resources that will aid them in further
thriving towards the future.
Previous qualitative studies used the
psychosocial approach in presenting the impact of
suicide on the bereaved family and significant
others of the suicidal individual. This approach
explains that negative experiences of grief such as
immobilization, shame, and guilt are among the
common responses to a suicide (Sommer-Rotenberg,
1998). In the current study, the process of
adaptation were shown and captured in a dynamic
process wherein communication and interactions
are vital indicators in determining the family
system after the suicide attempt. Aside from the
quality of communication and interaction within
the family, every individuals strengths and

perspectives towards the event present an active

position towards contributing to the family system
and their collective adaptation.
In emphasizing the vital importance of
communication within the family in adaptation,
results of the study propose some practical
implications to be addressed by different fields of
studies and institutions. Family members of the
study stated to not have undergone the help of
professionals and this is due to financial matters
and the undermining lack of mental health
programs in the country.
As mental health
professionals from the clinical and counseling
setting serve as frontrunners in the suicide attempt
phenomenon, they should fulfill the role of helping
suicide attempters, the families, and as well as the
society to understand the phenomenon revolving
around suicide.
Support for adaptation should not just
focus on the relationship building but also on the
emotional and cognitive processes that every
individual are experiencing in relation to the
suicide attempt. The lived experiences of families
in adaptation provide professionals with knowledge
for intervention initiatives and promotion of wellbeing after a suicide attempt (Bowden, 2006)
especially in the case of the family who equally has
destructive feelings after a suicide attempt.
Postvention is defined as the appropriate and
helpful support measures after the suicide attempt
(Shneidman, 1993) and this may be exhibited
through family interventions therapy (Kleespies,
Van Orden, Bongar, Bridgeman, Bufka, Galper,
Hillbrand, & Yufit, 2011). Other postvention
strategies may address the shifts in family
dynamics by helping the family members support
and help one another (Kaslow, Ivey, Berry-Mitchell,
& Franklin, 2009).
On the other hand, individual needs are
necessary to be addressed in the same manner as
results of this study suggest that individual mental
health and determination serve as positive
indicators of adaptation in the family. According to
Hoffmann, Myburgh, & Poggenpoel (2010), in some
time, the survivors may experience healing once
they acknowledge the painful and tragic events in
their lives. In order to address this concern, mental
health professionals are encouraged to formulate
counselling methods that focuses in developing a
strong mental health, optimism and determination
among the family members in order to accept the
tragic incident and reconnect with hope.
The role of mental health professionals
does not end with postvention strategies in
rebuilding families because they also play an
important role in imparting a thorough
understanding of the phenomenon of suicide.
Clinicians and suicidal patients should have a
collaborative effort in understanding suicide and

this can be accomplished by exhibiting the skills of

validating the pain of the patient and making sense
of the suicidal process during counselling sessions.
By having a shared understanding of suicide, there
will constitute a fundamental objective towards an
effective working relationship (Ellis, Daza, & Allen,
2012). On the other hand, professionals should also
address the varying suicide stigma that continues
to embody distress upon survivors (Cerel, Jordan &
Duberstein, 2008). Sommer-Rotenberg (1998)
stated that the association of the family with
suicide further adds experiences of immobilization
to the family. Addressing this concern can be
conventions about the nature of suicide and the
social responsibilities of everyone in dealing with
families of suicide attempters
Aside from the aid of mental health
professionals, the community can also contribute in
the campaign by establishing suicide prevention
programs in the form of support groups (Miers,
Abbott, & Springer, 2012). By having an ample
understanding on the experiences of families after
a suicide attempt, institutions may provide venues
for suicidal individuals to transform their negative
energies and thoughts into social action while
families can turn their struggles to positive
transformation (Fielden, 2003). Through these
changes, professionals may formulate new
interventions for the promotion of survivors wellbeing (Bowden, 2006) such as interactive programs,
socio-civic activities, and healing camps.
Studying suicide attempt and the family
adaptation provided a better understanding
revolving around the phenomenon presenting the
detrimental feelings that can be brought upon by
the idea of almost losing a family member. Family
constitutes more than just a connection because
despite the quality of their ties, every family
member will always find themselves returning and
treasuring the significant experiences they have of
each other. The weight of the suicide attempt yields
pain to every member of the family and sometimes,
will yield greater gravity towards the member with
the greatest perceived responsibility towards the
victim. Studies on suicide presented how families
with completed suicide attempts have nothing left
but emotional struggles and the loss of chance in
rebuilding the family relationship. However, in
families with unsuccessful suicide attempts, a lifechanging opportunity was given for them to
reevaluate and restructure the relationship of the
The disruption of the suicide attempt in
the familys homeostasis did not trap them into a
web of negative emotions but instead, became a
ground for opportunities of family rebirth. Suicide
attempt brings forth the anguish to families along
with the dreadful questions of their shortcomings,

and it is in this void where families are enlightened

to the realization that their presence alone is not
fulfilling enough if theres no emotional and
psychological support flowing among each other. In
this manner, communication became the most
effective thread of families to connect with each
other, understand one another, and to learn that
change is the only path for them towards recovery
and adaptation. Through this journey, family
members discerned that needing each other and
giving themselves to each other physically and
psychologically can comprise the reward of
overcoming the catastrophe and rebuilding the
relationship within the family. Their structure is
bound for transformation and through the familys
desire of seeking the path towards change, recovery
and adaptation, is the promising aftermath of
having a family reborned with irreplaceable unity
and openness with each other.
In conclusion, adaptation over a suicide
attempt constitutes rebirth. While not every family
is directed towards the same process of adaptation,
they are still grounded in reconnecting with hope
and moving towards the same road of recovery and

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