THE EXPERIENCE OF A GROUP THERAPY PROGRAM FOR ADOLESCENT SUICIDE SURVIVORS: WHAT WORKS

1. Maude Léonard, M.Ps.
Centre for Research and Intervention on Suicide and Euthanasia
IASP - OSLO
THE EXPERIENCE OF A
GROUP THERAPY PROGRAM
FOR ADOLESCENT SUICIDE
SURVIVORS: WHAT WORKS?
Maude Léonard, M.Ps., Ph.D. candidate, CRISE, UQÀM
Virginie Hamel, M.Ps., RRS du CSSS de Laval, CRISE
27/09/2013
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2. Maude Léonard, M.Ps.
Centre for Research and Intervention on Suicide and Euthanasia
IASP - OSLO
Presentation outline
27/09/2013
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• Adolescent suicide survivors
• Group therapy program for adolescent
suicide survivors in Quebec, Canada
• Evaluation research :Goals and design
• What works? Main results
• Overall program satisfaction

3. Maude Léonard, M.Ps.
Centre for Research and Intervention on Suicide and Euthanasia
IASP - OSLO
27/09/2013
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Family history of mental illness and suicide
Socio-cultural environment
Family environment
Adolescent characteristics:
development stages
(cognitive, emotional,
physical)
Suicidal significant other
characteristics
Relationship
characteristics
Significant
other’s
suicide
Changes in family environment
Impacts on the adolescent:
Depression symptoms
At-risk behaviors
Suicidal ideations and behaviors
Post-traumatic stress disorder
Feelings of guilt
Isolation
Decrease of self-esteem
Loss of meaning
Feelings of rejection and abandonment
Extreme dependance or autonomy
Belief disruption
Shame
Academic difficulties
Feeling angry, rebellion
Impacts on other family members
Changes in family roles
Grieving process:
DPM of coping -
Oscillation between
loss oriented
coping and
restoration
oriented coping
Adolescent suicide survivors

4. Maude Léonard, M.Ps.
Centre for Research and Intervention on Suicide and Euthanasia
IASP - OSLO
Group therapy program for
adolescent suicide survivors
MAIN GOAL
To bring together adolescents suicide survivors aged between 13 to
18 years old
OBJECTIVES
① To normalize grief reactions
② To break isolation
③ To increase adolescents’ social support networks and tools
④ To increase adolescents’ feelings of control
⑤ To allow the expression of distress
⑥ To better understand grief reactions in the context of a suicide
⑦ To reject suicide as a solution to distress
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Created by Virginie Hamel, M.Ps. for the «Ressource Régionale Suicide Laval du CSSS de Laval»

5. Maude Léonard, M.Ps.
Centre for Research and Intervention on Suicide and Euthanasia
IASP - OSLO
Structure of the group therapy
• Designed for 6 to 7 adolescents
• Facilitated by 2 experienced psychotherapists
• Psychoeducative and cognitivo-behavioral
approaches
• 12-Week sessions
– 1-2 Getting to know each other and the person they lost by suicide
– 3-4 Better understanding the grieving process in the context of suicide
– 6 Exploring the relationship between the adolescent and the deceased
– 7 Normalizing feelings of anger, guilt and shame
– 8 Exploring problem resolution techniques
– 9-10 Explore feelings of responsability for the suicide and secondary
loss
– 11 Saying goodbye to the person we lost
– 12 Identifying the social support networks
27/09/2013
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6. Maude Léonard, M.Ps.
Centre for Research and Intervention on Suicide and Euthanasia
IASP - OSLO
Evaluation Research:
Main goals and design
① To measure changes between pre-test and post-test
① Depression symptoms
② Problem solving skills
③ Coping strategies
④ Grief reactions
⑤ Perception of social provisions
② To evaluate subject’s perception about individual and
collective goal attainment
Mixed method design – Descriptive and content analysis
① Observation - two groups in different organizations
② 29 subjects (adolescents, parents, psychotherapists, key
informants) – interviews and standardized questionnaire
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7. Maude Léonard, M.Ps.
Centre for Research and Intervention on Suicide and Euthanasia
IASP - OSLO
What works? I
• The program helps reduce depression symptoms
– Significant mean score diminution on the Beck
Hopelessness scale
PreT (M = 2,6 ; SD = 1,14) - PostT (M = 1 ; SD = 1), t(4) = 3,14, p = 0,04, d = 0,71
– Changes in the way sadness is manifested
« That’s right. You tell yourself: I cry and it’s ok. And then you cry not for anything, but
when it’s really appropriate » (Translated transcript – Poulet – 2nd interview)
– Positive effects on self-esteem and confidence
« She realized durind the activity that she was gaining in confidence » (Translated
transcript – Charlotte – Clinical file )
27/09/2013
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8. Maude Léonard, M.Ps.
Centre for Research and Intervention on Suicide and Euthanasia
IASP - OSLO
What works? II
• The program helps reduce depression symptoms
– Significant mean score diminution on the Beck
Depression Inventory (when controlled for extreme score)
PreT (M = 14,8 ; SD = 6,46) - PostT (M = 6,6 ; SD = 5,77), t(4) = 8,95, p = 0,001, d =
0,95
27/09/2013
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9. Maude Léonard, M.Ps.
Centre for Research and Intervention on Suicide and Euthanasia
IASP - OSLO
What works? III
• The program helps reduce feelings of shame
– Significant mean score diminution on the shame
subscale of the Grief Experience Questionnaire
PreT (M = 12,8 ; ÉT = 2,75) - PostT (M = 9,25 ; ÉT = 2,63), t(3) = 4,04, p = 0,03, d =
0,89
– Expressed by feelings of relief about not being alone
« I got to know new people who were saying the same stuff. I was feeling so alone in
this world and I’m not alone anymore. There are plenty of people in the same
situation. » (Translated transcript – Melz – 2nd interview)
– Linked with diminution of guilt feelings
« He remembers that their fathers’ death was not their fault. » (Translated transcript –
BSA – Clinical file)
« Before, I felt maybe a little bit more guilty, that’s fo sure. It’s often the maximum guilt
in the beginning. But, no, now it really changed for: I’m not responsible for this »
(Translated transcript – Poulet – 2nd interview)
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10. Maude Léonard, M.Ps.
Centre for Research and Intervention on Suicide and Euthanasia
IASP - OSLO
Overall satisfaction
• In general, the program was a satisfactory
experience for all respondents
• Adolescents:
– Find the activities to be relevant and helpful
– Prefer interactive activities and pictural models of grief
(instead of pure theoretical informations)
– Really liked their group facilitators
• Parents:
– Have trust in the group facilitators
– Are glad their child was able to participate in the program
• Facilitators:
– Rated their overall group experience from 7/10 to 9.5/10
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11. Maude Léonard, M.Ps.
Centre for Research and Intervention on Suicide and Euthanasia
IASP - OSLO
Thank you
Get my presentation at
http://www.crise.ca/fr/iasp2013.asp
For more information
leonard.maude@uqam.ca
27/09/2013
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