Working with suicidal clients: Psychotherapists and allied professionals speak about their experiences

Abstract

Objective To ascertain the impact that working with suicidal clients has on health professionals. Design This research study used an online survey, which covered a broad range of questions in relation to the impact of working with suicidal clients. Method A total of 110 practitioners completed the online survey. The responses were analysed using descriptive statistics and thematic analysis. Results The findings highlighted how overwhelmed practitioners felt at the time of their client's death, expressing shock, sadness, anger, guilt and helplessness. In addition, the findings revealed that even several years later practitioners were still marked by the experience, expressing statements such as, ‘you don't forget’, ‘thinking about it produces a feeling of horror’ and ‘it creates anxiety and apprehension when I encounter similar patients’. Conclusions Analysis from a mixed‐methods, pluralist perspective suggests that there is no single answer to supporting practitioners when a client dies. The research highlights that continuing professional development providers and practitioners should understand that such reactions are to be expected, and therefore prepared for. Pressures of work and lack of time were particularly emphasised as negatively impacting on respondents’ ability to take appropriate measures for their own self‐care and ability to continue to practise effectively. It is our opinion that organisations that do not take this into account are operating in a way that is short‐sighted. This adds to the likelihood of potentially serious negative effects for the personal well‐being and professional functioning of the individual practitioners directly affected.

Identifying Risk Factors for Self-reported Mental Health Problems in Psychiatry Trainees and Psychiatrists in Mexico

“…Having patients with severe suicidal ideation was the most common professional adversity reported by psychiatrists and psychiatry trainees and conferred a higher risk for having an anxiety disorder in the latter. Dealing with patients who express suicidal intention seems to be the greatest difficulty psychiatrists can face in their profession [ 34 , 35 ]. It is a particularly difficult stressor to cope with [ 36 ], with reports of severe stress levels (comparable to the loss of a parent) in treating therapists, a substantial proportion of whom develop posttraumatic symptoms when a patient under their care commits suicide [ 37 ].…”

“…It is a particularly difficult stressor to cope with [ 36 ], with reports of severe stress levels (comparable to the loss of a parent) in treating therapists, a substantial proportion of whom develop posttraumatic symptoms when a patient under their care commits suicide [ 37 ]. A sense of competence and confirmation of professional skills (when faced with this adversity) can only come from experience and training [ 35 ]. Accordingly, close supervision by a more experienced or attending psychiatrist working with established institutional protocols for providing additional resources to trainees to manage suicidal patients and reduce anxiety is required, together with help for them to deal with guilt and genuinely consider whether mistakes were made [ 35 ].…”

“…A sense of competence and confirmation of professional skills (when faced with this adversity) can only come from experience and training [ 35 ]. Accordingly, close supervision by a more experienced or attending psychiatrist working with established institutional protocols for providing additional resources to trainees to manage suicidal patients and reduce anxiety is required, together with help for them to deal with guilt and genuinely consider whether mistakes were made [ 35 ]. The high discrimination reported by trainees (mean score=35.6 vs. 21.3 of psychiatrists) and attacks by colleagues (51.6%) evidence the need for assessing how this supervision takes place, as it does not appear to be providing the constructive feedback one would expect in teaching facilities.…”

The impact of patient suicidal behavior on the personal and professional well-being of mental health providers: A systematic review.

“…Positive aspects included using this experience to review and enhance their practice as well as a tendency to increase their self-care and provide support to colleagues with similar experiences ( n = 3). Mental health providers also reported that the aftermath of the event brought changes in their practice such as working longer hours, increased patient surveillance and note taking, and adjusting their work schedule (Scupham & Goss, 2020).…”

“…Saini et al (2016) reported that closer and longer relationships with clients were two important relational factors associated with increased distress. Witnessing the event and completion of suicide rather than incomplete suicide were further denoted by Scupham and Goss (2020) as factors relating to the event of suicidal behavior that further increased impact.…”