Internet Editor’s Note: This article is a companion piece to Dr. Knapp’s “Helping Psychotherapists Adopt Productive Responses to Suicidal Patients” from Division 29’s Bulletin.
Effective psychotherapies, including treatments for suicidal patients, rely heavily on relationship skills for their success (Norcross & Lambert, 2018). Unfortunately, many suicidal patients have reported that their providers have not always displayed those essential relationship qualities (e.g., Blanchard & Farber, 2020; Hom et al., 2020; Hom et al., 2021; Richards et al., 2019a; Richards et al., 2019b). Consequently, it may help psychotherapy trainers and supervisors to supplement their presentations on evidence supported relationships with reports from suicidal patients about what in psychotherapy helped or did not help them. Qualitative studies of suicidal patients showed that they wanted psychotherapists who will listen to them without judgment, respond appropriately to their disclosures, and allow them to have a say in what happens to them during treatment.
Listen to Me
A foundational skill in psychotherapy is the ability to express empathy to patients (Norcross & Lambert, 2018). When asked how their providers could have improved the quality of services to them, nearly one-third of suicidal patients identified the importance of listening to them (Hom et al., 2021). One urged their providers to “actively listen to what the patient is saying” (Hom et al., 2021, p. 370). Another said, “Don’t interrupt when we’re trying to answer your question,” and a third urged providers to “listen to their [patients’] experiences and trust they know how they feel and what they need to stay well” (Hom et al., 2021, p. 370). When asked about what was helpful in psychotherapy, one former patient wrote that it was “the feeling of being heard, taken seriously,” and another wrote that it was “just the fact that a person understands how bad I feel” (Schembari et al., 2016, p. 220).
Unfortunately, many patients reported that their psychotherapists either overreacted or under reacted to their disclosures. Patients described professionals who concluded that they needed to be hospitalized without considering their perspectives or evaluating the situation thoroughly. One said, “I just always run into the issue where as soon as things start becoming difficult, they just immediately suggest that I go to the mental hospital” (Richards et al., 2019b, p. 44). Another said, “It just seems like . . . [the hospital is] one of their first options when it should be a last resort” (Richards et al., 2019b, p. 44).
For many patients, the fear of involuntary hospitalizations caused them to withhold information from their psychotherapists. One patient said, “Talking about suicide. . . leads to actions that have to be taken. I feared having to go to a psychiatric hospital” (Blanchard & Farber, 2020, p. 129). Another patient said, “I don’t know what would happen to me and whether something would happen involuntarily. . . I guess it’s just what I imagine in movies or something that whether I’d get—not be able to return home to my family” (Richards et al., 2019a, p. 2079).
On the other hand, other patients reported that their psychotherapists did not take them seriously. One former patient said, “It would have been nice to be treated like I actually knew what I was talking about. A lot of time I was just brushed off” (Hom et al., 2020, p. 178). Another suicidal patient was told, “‘You just want attention. You don’t need help.’ So I said, ‘No, I’m really suicidal and here’s my plan.’ They said, ‘Well, you’re not going to do it’” (Hom et al., 2020, p. 178).
Ideally psychotherapists will respond with concerned alertness, whereby they adopt an attentive and concerned but compassionate approach to their patients (Knapp, 2022). One patient described this experience:
“There was no judgment or overly zealous attempts to get me to love life. It was real and gritty and I said, “yo, I wanna die” and she said “damn that sucks. Glad you’re still alive though” and I thought it was amazing” (Love & Morgan, 2021, p. 539).
Another patient stated that “the guy I saw was great. . . He was the first person I had spoken to who listened and didn’t try to get me to take vitamins” and another appreciated that the psychologist “and I talked about suicide a lot, and she brought it out in the open so it wasn’t so scary” (Hom et al., 2020, p. 176).
Instead of arguing with patients that they will eventually find meaning in their lives, effective psychotherapists give patients a meaningful experience through a genuine connection with them.
Give Me a Say in What Happens
Patients respond better to treatments when psychotherapists involve them in decisions, and accommodate reasonable preferences (Norcross & Cooper, 2021). Similarly, suicidal patients wanted psychotherapists to involve them in treatment decisions. Almost three-fourths of former clients said that it was “helpful” or “very helpful” for psychotherapists to involve them in their treatment plans, while only 6% said that doing so was “unhelpful” (Shand et al., 2018). Patients commented how important it was to discuss treatment options with them including what the treatments were like and why they were selected (Hom et al., 2020). One survivor urged providers to work “together as a team” and another urged them to “collaborate around safety plans and treatment goals” (Hom et al., 2021, p. 370).
Patients also commented on the importance of having their psychotherapists explain the treatments to them. One patient said that providers should “take time to explain things and address concerns” (Hom et al., 2021, p. 371). Although this is important for all patients it is especially important for suicidal patients who may fear unwanted and intrusive interventions. One patient, when asked what psychotherapists could do to help them disclose more freely, noted the importance of listening carefully to them before deciding what to recommend. The patient opined, “Promise to listen to everything I say and take into consideration my emotional state at this time. . . Then see admitting to a hospital as a LAST resort” (Blanchard & Farber, 2020, p. 131). Another expressed a preference that psychotherapists would “explain what would happen if I talked about my suicidal thoughts” (Blanchard & Farber, 2020, p. 132).
Suicidal patients, like other psychotherapy patients, reported more dissatisfaction when psychotherapists excluded them from major decisions. One survivor complained, “Nobody asked me my thoughts. Nobody asked me my opinions. Nobody asked me what was or was not working” (Hom et al., 2020, p. 178).
Some psychotherapists may feel such distress when working with suicidal patients that they neglect the importance of evidence-supported relationship skills. These psychotherapists “take off their psychotherapist hat and put on a helmet” (personal communication, Dr. John Lemoncelli, February 13, 2017). Effective trainers and supervisors can use the words of actual patients to emphasize essential relationship skills when working with suicidal patients which include listening carefully to them, responding with concerned alertness, and involving them in decisions.
Cite This Article
Knapp, S. (2022, July). What do suicidal patients want from their psychotherapists? [Web article]. Retrieved from http://www.societyforpsychotherapy.org/what-do-suicidal-patients-want-from-their-psychotherapists
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