Negative Emotional Responses in Clinicians Treating Clients With Suicidal Ideation and Behavior: A Qualitative Descriptive Phenomenological Study

Abstract

As suicide continues to be a leading cause of death, making contact with a suicidal person is a critical and potentially life-saving moment. Mental health professionals are often the frontline responders for suicidality. The existing literature shows that clinicians find working with suicidal clients to be stressful and report negative emotional responses when treating suicidal clients. Those responses include anxiety, fear, sadness, shock, distress, helplessness, powerlessness, and more. Intense emotional reactions can impact how a clinician responds to a client, assessment and intervention, their beliefs about their ability to help a client stay safe, and outcomes for clients. The purpose of this study was to uncover clinicians' negative emotional responses and how they shaped assessment and treatment or influenced the therapeutic relationship. Horowitz's stress response theory served as a framework for understanding clinicians' reactions, as the theory outlines what occurs within an individual in response to a distressing situation or event. Giorgi's descriptive phenomenological method was used to capture detailed descriptions of clinicians' experiences. Six licensed masters-level clinicians shared their experiences with emotional responses while treating suicidal clients during semi-structured interviews. Giorgi's method was applied for data analysis. Ultimately, 10 constituents emerged as integral to the experience of clinicians' emotional responses related to working with suicidal clients. The results of this study indicate that clinicians experience negative and paradoxical emotional responses to client suicidality. These emotional reactions were present during disclosure events in which clinicians assessed and intervened, and in subsequent sessions. Additionally, results revealed that clinicians experienced challenges related to self-efficacy, establishing and maintaining the therapeutic relationship, self-care, and the continued impact of their work. The study expanded on Horowitz's theory by demonstrating stress responses in clinicians. Emotional responses uncovered in this study strengthen existing research. Also, the results emphasize the importance of the therapeutic relationship. Essentially, negative emotional responses play a critical role in responding to suicidal disclosures, treating clients, and therapist well-being. This study led to recommendations for practice and future research, including the application of suicide intervention skills; avenues for psychoeducation, supervision, and self-care; and streamlining organizational policies. Future research may further examine disclosure events and ruptures in the therapeutic relationship.