The model of dynamic balance in therapists' experiences and views on working with suicidal clients: A qualitative study.

Abstract

Working with suicidal clients is frequently referred to as one of the most demanding and anxiety-provoking aspects of therapeutic work. The aim of this study was to obtain an in-depth understanding of therapists' experience in treating suicidal individuals and to develop a theoretical model of it. Eleven psychotherapists (four men and seven women) participated in individual semistructured interviews. The interviews were audiotaped, transcribed and analysed by the principles of grounded theory. We developed a model of dynamic balance in therapists' experiences and views on working with suicidal clients. The model includes six core themes, which represent aspects of therapists' experience and views where a dynamic balance is needed between two different poles. The core themes are as follows: (i) understanding of suicidality: the general versus specific; (ii) the role of alliance: protective factor versus no guarantees; (iii) attitudes: acceptant versus life-oriented; (iv) emotional response: worry versus trust; (v) responsibility: therapist's professionality versus client's autonomy; and (vi) focus: suicidality versus individual as a person. The model takes into account other variables that are relevant to the process and outcomes of the therapy: factors, related to the therapist and the client, as well as system regulations and therapeutic setting. The presented model may be helpful for mental health professionals in reflecting on their experiences of working with suicidal clients, describing the relevant topics and the way they relate to each other.