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Understanding therapist experiences when organisational risk management protocols are implicated by the suicidal ideation and intent of clients

Cox, A. M. (2020). Understanding therapist experiences when organisational risk management protocols are implicated by the suicidal ideation and intent of clients. (Unpublished Doctoral thesis, City, University of London)


Background: Client suicidality has been identified as one of the most significant stressors experienced by therapists in their work (Deutsch, 1984; Chemtob et al., 1989). The anxiety occasioned thereby is liable to be heightened in organisational settings on account of the attendant sense of external observation, and awareness of the potential implications vis-à vis reputation and status should the clinician ‘fail’ in their duty of care (Reeves & Mintz, 2001). However, literature attending to the therapist's internal process in such moments is sparse, with greater attention typically having been directed towards client ‘risk factors’.

Aims: In addressing this gap in the literature, the current study seeks to illuminate the subjective experience of therapists confronted by client suicidality and associated requirements to attend to organisational risk management protocols.

Participants: Eight therapists were recruited from HE organisational settings in the UK, all of whom had previously worked with suicidal clients. Participants were aged 41 to 64, and currently practicing within a variety of therapeutic modalities.

Methodology: In-depth, semi-structured interviews were conducted, inviting participants to reflect upon past encounters with client suicidality that demanded attention to organisational risk management protocols. Interpretative Phenomenological Analysis (IPA) was subsequently used to identify pertinent themes across the transcripts (Smith et al., 2009).

Findings: Four superordinate themes, each comprising six subordinate themes, were identified within the participant narratives. The first theme, “Stirred up”, highlighted that participants were often emotionally unsettled by their encounters with client suicidality. “Goldilocks and the Three Bears”, the second theme, evidenced that participant efforts at risk management were experienced as either being ‘too much’, ‘not enough’, or ‘just right’. The third theme, “It’s good to ask for help”, showcased the conclusion reached by participants in the wake of experiencing both isolation and organisational support when working with client suicidality. “Noisy, but unhelpful”, the fourth and final theme, recognised that institutional expectations and anxieties occasioned by client suicidality often complicated the clinician’s attempts at managing risk.

Discussion: Implications of the emergent themes for Counselling Psychology were explored, particularly with a view to understanding how best to manage therapist reactions when squeezed between needy suicidal clients and demanding protocols, thereby minimizing any interference in the therapeutic process.

Publication Type: Thesis (Doctoral)
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Departments: Doctoral Theses
School of Health & Psychological Sciences > Psychology
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
[thumbnail of Final Submission Doctoral Thesis Adam Cox December 2020.pdf]
Text - Accepted Version
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