Suicidal Clients Research Articles

Clinical Confidence in Risk Assessments of Suicidal Clients: An Intervention Study

Clinical Confidence in Risk Assessments of Suicidal Clients: An Intervention Study

Navigating suicidality: swedish social workers’ approaches to identifying and supporting suicidal clients

ABSTRACT This study examines how Swedish social workers across various social work agencies identify and support suicidal clients. Thematic analysis of interviews with seven social workers reveals a reliance on strong client relationships and past experiences with suicidal clients. The social workers consistently assess severity of suicidal intent in clients. Despite variations in roles, social workers generally express comfort in dealing with suicidal clients by using intuition, discretion and professional and organizational logics to support suicidal clients in personalized ways. The exercise of professional discretion and interventions varies based on roles, work conditions, and relationships with suicidal clients. Notably, social workers in addiction recovery outpatient care exhibit a high degree of discretionary power, while youth treatment workers in residential care units prioritize continuity of care, involving psychiatry when needed. Case workers often view psychiatry as responsible for decisions about suicidal clients and routinely refer them to psychiatric care.

Experiences of mental health practitioners after clients' suicide: a qualitative systematic review protocol.

The objective of this qualitative systematic review will be to understand the experiences of mental health practitioners after clients' suicide. Mental health practitioners inevitably encounter client suicide during their careers, which can significantly affect their personal lives and professional outcomes. A deeper understanding of mental health practitioners' experiences in the aftermath of clients' suicide is necessary to provide effective support and assist with adaptation to this situation. This systematic review will consider qualitative studies that explore the experiences of mental health practitioners, including psychotherapists, psychiatrists, psychological counselors, clinical psychologists, psychiatric mental health nurse practitioners, and social workers following clients' suicide. Experiences may include emotional responses, coping strategies, changes in social relationships, and reflections on practice. This review will follow the JBI methodology for qualitative systematic reviews. The databases to be searched will include PubMed, CINAHL (EBSCOhost), Embase, PsycINFO (EBSCOhost), SocINDEX (EBSCOhost), Web of Science, CNKI, Wanfang, VIP, Bibliographia Medica Čechoslovaca, and Bibliographia Medica Slovaca. Gray literature sources will include Google Scholar, and ProQuest. Studies in English, Czech, Slovak, and Chinese will be assessed for inclusion regardless of publication date. Studies that are initially selected will be assessed for methodological quality using the JBI critical appraisal tool for qualitative studies. Then, findings with illustrations will be extracted for subsequent meta-aggregation and ConQual assessment. All the above steps will be conducted by 2 independent reviewers. PROSPERO CRD42023410523.

Suicide Prevention Training for Social Work Students in Rural Practicum Placements: Current Opportunities and Areas for Growth

ABSTRACT Students and practicum instructors in a primarily rural state were surveyed about suicide prevention practice and training opportunities provided to social work trainees during their practicum placements. A cross-sectional, electronic survey was administered to N = 86 students and N = 64 practicum instructors and descriptive statistics were analyzed. Most students (87.1%) and practicum instructors (86.6%) felt that students should have the opportunity to engage with suicidal clients while in practicum. Many students reported having had contact with a suicidal client while in practicum (70.6%) and had engaged in some sort of practice related to suicide prevention (82.6%). The most frequently reported practice behaviors were suicidal inquiry (62.8%), risk assessment (60.7%), disposition planning (51.0%), and safety planning (49.0%). Over half (52.9%) had not used any evidence-based tools for screening and follow-up and only one quarter (25.5%) had provided postvention services. Many students (72.9%) were concerned about iatrogenic risk. Although most practicum instructors felt comfortable addressing suicide prevention in supervision (74.4%), many (64.1%) also reported the desire for additional training. Although students appear to have opportunities to engage in suicide prevention in practicum, there are specific knowledge and practice gaps regarding evidence-based tools, postvention, and the “myth” of iatrogenic risk.

A Phenomenological Investigation of Counselors’ Perceived Preparedness With Suicidal Clients

The purpose of this phenomenological study was to understand the essence of counselors’ perceived preparedness working with suicidal clients and to provide suicide prevention and assessment recommendations for the counseling profession. We identified a structural-textural description that highlights the perceived amount, quality, and components of training preparedness, as well as suicide assessment and intervention knowledge. This phenomenological investigation included 10 professional counselors who described the degree to which they felt prepared to work with suicidal clients and their perceptions of the suicide prevention and assessment training they have completed during their training program and in their agency work setting. Counselors did not generally feel that their training had been adequate and subsequently sought more through personal learning or on-the-job training. Counselors should seek out evidence-based trainings that best meet the needs of their clients.

Pluralistic psychotherapists' and counsellors' experiences of working with actively suicidal clients: A qualitative interpretative phenomenological analysis

AbstractBackgroundClients presenting as suicidal have been widely recognised as one of the most challenging presenting issues for psychotherapists and counsellors. There is a wealth of literature exploring risk assessment, collaboration, goals, tasks, methods, shared decision making and client preferences employed in therapy with this presenting issue. Yet, no literature explicitly explores combining these approaches or provides a framework that integrates them. Working with actively suicidal clients as a pluralistic psychotherapist and counsellor (PCP) has not been thoroughly examined to date, even though this framework and philosophy for therapy combines many of the aforementioned approaches. Therefore, it is imperative that ways of working safely with this presenting issue, for both the client and the practitioner, are explored and researched through the lens of PCP.ObjectiveTo interpret and explore pluralistic psychotherapists' and counsellors' experiences of working with actively suicidal clients to find what might be added to the body of knowledge.MethodsA qualitative interpretative phenomenological analysis of PCP with actively suicidal clients was conducted via four semi‐structured recorded interviews. Four participants were recruited purposively. Four themes and two subthemes were identified and explored.DiscussionThe findings showed PCP to be a robust holistic approach to actively suicidal clients that is safe for both client and practitioner. Furthermore, the results point towards the need for further research into the idea that PCP is useful when working with actively suicidal clients in line with recommended best practice from the client's perspective.

Criminal Defense Attorneys and Client Suicide: Survey and Recommendations From Washington State.

The connection between suicide and incarceration is well documented, in particular after recent arrest. Criminal defense attorneys may be one of the few people in meaningful contact with this population, and lawyers have a unique window into their clients' well-being. In this Viewpoint, we explore the experiences of attorneys who work with clients with suicidal thoughts and behaviors. We developed and administered a survey to criminal defense attorneys in the State of Washington, ascertaining their experiences with client suicide. A total of 44 responses were collected, with over 95% of respondents having been concerned about a client's risk for suicide. We conclude that client suicide widely impacts criminal defense attorneys, and lawyers' role with justice-involved clients uniquely positions them to be a potential asset in suicide prevention efforts.

Slovene Translation of the Difficulties in Suicidal Behaviors Intervention Questionnaire (DSBQ).

Background: Mental health professionals encounter numerous difficulties when working with suicidal clients. To understand these difficulties in clinical practice better, a valid instrument measuring them is needed. Aims: This study aimed to translate the Difficulties in Suicidal Behaviors Intervention Questionnaire (DSBQ) to Slovene, validate it, and explore Slovenian professionals' experiences with it. Method: The participants were 106 professionals (19 men, 87 women), aged 26-66 years. Apart from the DSBQ, scales on attitudes toward suicide prevention and coping strategies in difficult clinical situations were used. The data were collected between October 2017 and January 2019. Results: Although slightly diverging from the originally reported component structure, the Slovene translation of the DSBQ measures difficulties in working with suicidal clients with acceptable/good reliability and sensitivity, and adequate construct validity. Slovenian professionals most commonly experience difficulties related to working with children, followed by technical, system and setting, and other types of difficulties. Limitations: The sample of participants was relatively heterogeneous. Conclusion: Further studies of the DSBQ structure and validity, as well as difficulties, especially those related to working with children/adolescents and facing the theme of death, are warranted. Considering the difficulties most frequently reported in this investigation, more efforts are also needed in Slovenia to address technical and logistic aspects.

Treating suicidal clients during the COVID-19 pandemic: One rural university clinic’s transition to telepsychology.

Treating suicidal clients during the COVID-19 pandemic: One rural university clinic’s transition to telepsychology.

The role of the therapeutic bond when working with clients in suicidal crisis.

The desire to die by suicide has been linked with interpersonal difficulties and impeded clinical outcomes. Despite the emphasis on the therapeutic relationship in clinical guidelines for working with suicidal clients, little is known about how suicidal clients' interpersonal difficulties manifest in clinical contexts. Additionally, there is limited understanding of the therapeutic relationship in single-session suicidal crisis contexts. Our aim was to examine the trajectory of the therapeutic bond in mediating clients' suicidal desire and outcome in single-session suicidal crisis intervention. Single-session online text-based crisis intervention sessions (N = 354; Mage = 29.43, SD = 9.15; 64.5% women) were coded for suicidal desire, therapeutic bond (each quarter), and outcome. We examined the proposed sequential mediating model (suicidal desire to early bond to bond change to outcome) using structural equation modeling. The proposed sequential mediation model fits the data well, χ2(11) = 22.030, p = .0241, root-mean-square error of approximation = .053, 90% CI [.019, .085], comparative fit index = .983, Tucker-Lewis index = .977, and was a better fit than several alternative models. Further, the indirect effect from suicidal desire to outcome through early bond and bond change was significant (b = -0.474, 99% CI [-0.782, -0.203]). Our findings indicate that therapeutic bonds were beneficial for clients with elevated suicidal desire-and-elevated suicidal desire was negatively associated with therapeutic bonds. These findings highlight the importance of training clinicians to navigate the unique challenges of developing therapeutic bonds with acutely suicidal clients. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Phenomenological Analysis of Mental Health Providers’ Experience of Client Suicide

A Phenomenological Analysis of Mental Health Providers’ Experience of Client Suicide

Clinical Psychology Interns' Lived Experiences With Suicidal Clients

This paper explores the lived experiences of clinical psychology interns who have encountered suicidal clients during their internship. Employing qualitative phenomenological investigation, semistructured interviews were conducted and analyzed using interpretative phenomenological analysis (IPA). The study employed purposive sampling and gathered valuable data from 8 clinical psychology interns who were all taking a master's degree in Clinical Psychology. The results highlighted that those encounters with suicidal clients triggered various reactions among interns, leading to self-doubt and a sense of unpreparedness in handling such cases. Many interns struggled with managing their emotions, especially when clients' traumas mirrored their experiences. The study emphasized the importance of a robust support system in helping interns cope with the challenges of their work. The results included a heightened need for supervision among interns, as they faced intense emotional challenges when working with suicidal clients. Supervision emerged as a critical component in helping them process these experiences. Regular check-ins with supervisors not only provided emotional support but also offered practical strategies for managing client interactions. This guidance helped interns develop coping mechanisms and build resilience, fostering their professional growth and confidence in handling difficult cases. Despite the challenges, the interns found purpose in witnessing significant client progress and emphasized the importance of self-care and ongoing training to prepare future clinicians for similar experiences.

The impact of adolescent suicide on clinicians: a mixed-methods study.

Clinician reactions to client suicide may include shock, grief, guilt, self-doubt, shame, anger, and fears of blame and medico-legal consequences. Clinicians will often differ in their reactions to the suicide and the type of supports required. Adolescent suicide-specific literature is limited. We sought to explore clinician reactions and perceptions of support following child and adolescent suicide. One hundred and fifteen staff working for a Child and Adolescent Mental Health Service were invited to complete an online survey with quantitative and qualitative components, and an in-depth semi-structured interview. Results were presented to teams for reflection and further feedback. Eight clinicians participated in the semi-structured interview, and 33 in the online survey. Thirteen were the primary clinician, and 21 were part of a multi-disciplinary team when a client suicided. Respondents were predominantly female, from a range of disciplines. Fifty per cent of primary clinicians found the support good to very good. The rest were neutral. However, 26% of team members found support poor to very poor. Clinicians reported questioning their clinical effectiveness and chosen vocation. Some reported a need to disconnect or withdraw to preserve motivation and empathy for the work. They received significant support from their team, and teams were very anxious for the well-being of primary clinicians. Health services must find ways of helping staff feel that their sense of vocation is valued and nurtured. These strategies will likely include fostering team cohesiveness and mutual support and allowing opportunities to temporarily step back and recover after challenging experiences.

Confidential grief: How counselors cope with client suicide

AbstractWe engaged in this study to better understand how counselors cope with and process client suicide. A researcher who also experienced a client suicide conducted interviews with licensed professional counselors (N = 7). Using interpretive phenomenological analysis, we identified eight superordinate themes: (a) professional counseling culture, (b) intense emotional reaction, (c) processing loss, (d) supports, (e) barriers, (f) impairment, (g) disillusionment, and (h) finding meaning. Findings have implications for the counseling profession, counselor educators, agencies and supervisors, counselors, and counselors‐in‐training.

외국인 유학생 내담자의 자살을 겪은 유학생 상담자의 경험에 대한 질적연구

Objectives This study was conducted to examine the difficulties of international student counselors who suffered suicide of a foreign student client and their experiences in the process of overcoming them. Methods An in-depth interview was conducted with a total of 9 counselors at the university counseling centers, and analyzed according to the consensual qualitative research method(CQR). Study participants were selected through significant sampling and snowball sampling. Results A total of 7 areas, 14 categories, and 57 subcategories were derived. Seven of these areas were “characteristics of the client's suicide-related experience,” “factors affecting the client's suicide experience,” “emotions experienced in counseling,” “difficulties experienced in counseling,” “experience after counseling,” and “expectations for multicultural crisis counseling.” Conclusions This study has the implication of expanding the scope of research related to domestic international student counselors, which is still in its early stages by confirming the characteristics of suicide crisis intervention in international student counseling, and is worth being used to lay the foundation for the development and protection system of international student counselors.

Ethical Issues in Psychotherapy with Suicidal Clients

Ethical Issues in Psychotherapy with Suicidal Clients

When Shame Becomes Deadly: The Relationship between Suicidality and Shame; a Personal Perspective

Following the death by suicide of a client of mine and after many years working with suicidal clients, I recognized a common thread: that of shame. Then my own brother committed suicide, and this brought back to me memories of my own suicide attempt decades before, and the years spent trying to understand and deal with it and with my own shame. I decided it was time to delve into the subject more deeply. I began my research. This article is the culmination of that research. In it, I describe toxic shame, the shame of existing, the sources of shame, the neurobiology of shame, and, most importantly, the effect of shame on the relationship to the Self.

A machine learning approach to identifying suicide risk among text-based crisis counseling encounters.

With the increasing utilization of text-based suicide crisis counseling, new means of identifying at risk clients must be explored. Natural language processing (NLP) holds promise for evaluating the content of crisis counseling; here we use a data-driven approach to evaluate NLP methods in identifying client suicide risk. De-identified crisis counseling data from a regional text-based crisis encounter and mobile tipline application were used to evaluate two modeling approaches in classifying client suicide risk levels. A manual evaluation of model errors and system behavior was conducted. The neural model outperformed a term frequency-inverse document frequency (tf-idf) model in the false-negative rate. While 75% of the neural model's false negative encounters had some discussion of suicidality, 62.5% saw a resolution of the client's initial concerns. Similarly, the neural model detected signals of suicidality in 60.6% of false-positive encounters. The neural model demonstrated greater sensitivity in the detection of client suicide risk. A manual assessment of errors and model performance reflected these same findings, detecting higher levels of risk in many of the false-positive encounters and lower levels of risk in many of the false negatives. NLP-based models can detect the suicide risk of text-based crisis encounters from the encounter's content.

Attitudes of Social Workers about Rational Suicide

Suicide is a major public health concern. It is the tenth leading cause of death in the United States. Social workers serve as the largest group of mental health care providers, and commonly intervene with suicidal clients. Despite the high rate of suicide and social workers interface with client suicidality, there is no research on the attitudes of social workers toward rational suicide. The notion of rational suicide challenges traditional views on suicide intervention and has complex ethical implications for the social work profession. Social workers adhere to the ethical standards set forth by the NASW and rational suicide involves two of those ethical standards, client self-determination and commitment to clients. This quantitative research study examined the attitudes of 2,157 licensed clinical social workers toward rational suicide. Findings revealed that social workers broadly agree (67.1%) that individuals can make a rational decision to die by suicide. Social workers’ personal characteristics (gender, age, race/ethnicity, state residency, religious affiliation and having personal thoughts of suicide) were found to predict their attitudes about rational suicide. The findings suggest that social workers’ attitudes about rational suicide are related to their personal characteristics. These findings have ethical considerations for the social work profession when intervening with suicidal persons with physical and psychological pain as well as value neutral practice. Keywords: Rational suicide, ethics, clinical social work, physical, psychological pain

A longitudinal analysis of person‐centred therapy with suicidal clients

AbstractBackgroundThere have been substantial research efforts demonstrating the effectiveness of person‐centred therapy. However, little research has investigated whether person‐centred therapy is effective in facilitating psychological growth amongst clients experiencing suicidal ideation and serious mental health difficulties.AimThis study aimed to determine whether suicidal clients who received person‐centred therapy experienced increased levels of authenticity, well‐being and psychological distress. The predictive validity of authenticity and well‐being upon psychological distress was also tested.MethodThe study utilised quantitative, longitudinal methodology. Data were collected from a clinical sample of clients receiving person‐centred therapy at a counselling research clinic (N = 56) over the course of 20 sessions.ResultsThere were statistically significant improvements in levels of authenticity, well‐being and psychological distress over 20 sessions of therapy; a minimum of 15 sessions were required for significant change to be observed. Authenticity and well‐being were negatively associated with psychological distress, whilst authenticity and well‐being were positively associated with each other. Early authenticity and well‐being predict levels of distress later in therapy. These results provide initial evidence to support Rogers' theory of therapy, which is suitable for clients experiencing both mild and severe distress; the findings refute the view that person‐centred therapy is only suitable for the “worried well.”ImplicationsThere is now preliminary justification for person‐centred therapy being suitable for suicidal clients. Person‐centred therapists could consider offering suicidal clients at least 15 sessions to achieve meaningful change; ethical considerations pertaining to this are explored.