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  • Psychotherapists' experience of working with suicidal clients : doctoral thesis = Doživljanje psihoterapevtov pri delu s samomorilnimi klienti : doktorska disertacija
    Podlogar, Tina
    Suicidality does not fit into the traditional medical illness model. Working with suicidal clients requires unique therapeutic approaches and is frequently referred to as one of the most demanding ... aspects of therapeutic work. Providing effective treatment and care for help-seeking suicidal individuals is of crucial importance. However, it cannot be automatically assumed that all mental health professionals feel competent to work with clients who are suicidal. Intriguingly, specific training in suicidality is frequently overlooked by psychological and medical study programs, even though such training has the potential to improve suicide intervention skills. Mental health professionals encounter different difficulties and challenges when faced with clients that experience suicidal ideation and/or have engaged in suicidal behaviour before or during treatment. We believe that it is essential to study professionals' experiences both from the point of view of providing high-quality care for the clients, as well as from the point of view of professionals' own well-being and mental health. With the aim to gain an overview and at the same time and in-depth understanding of their experiences, we conducted a study with a combination of quantitative and qualitative methods. Participants of the quantitative part of the study were 106 professionals (19 men and 87 women) with an educational background in psychology, medicine or other fields, who are working in the field of mental health. They reported having at least one experience of treatment of a suicidal client. The collection of data with the questionnaires took place between October 2017 and January 2019. The questionnaires inquired about participants' socio-demographic and professional characteristics, difficulties experienced in working with suicidal clients, attitudes toward suicide prevention, and coping strategies (constructive and avoidant) used under challenging situations in therapeutic or counselling work. The analysis of quantitative data was carried out with the SPSS program. Eleven psychotherapists (four men and seven women) participated in the qualitative part of the study. Semi-structured individual interviews that lasted approximately one hour were conducted between January and November 2018. The interviews focused primarily on topics of therapeutic alliance, therapists' experiences of suicidality peak in the clients, therapists' suicidality-related attitudes, knowledge and understanding, therapists' emotions, difficulties experienced in practice with suicidal clients and resources, and crisis management. The qualitative data was analysed by the principles of grounded theory with the use of ATLAS.ti program. On average, participants are relatively confident in their competence for working with suicidal clients. On the other hand, they also experience a certain level of difficulties with regards to working with suicidal clients. Importantly, participants that received a suicidality-related training feel more competent than those who did not receive such training. Higher self-assessed competence is, in turn, related to a lower frequency of experiencing different types of difficulties in practice with suicidal clients. While other factors, related to experiencing difficulties (e.g. attitudes), were also identified, confidence in own competence seems to be a strong predictor of most types of difficulties. Analysis of qualitative data resulted in identification of nine themes and 32 subthemes. The themes are grounded on 919 quotations, coded with 261 codes and 18 smart codes. On the basis of the findings, we developed a model of dynamic balance in therapists' experiences and views on working with suicidal clients. The model includes six core themes, each of them representing an aspect of therapists' experience and views where a dynamic balance is needed between two different poles. The core themes are: (i) understanding of suicidality: the general vs. specific; (ii) the role of alliance: protective factor vs. no guarantees; (iii) attitudes: acceptant vs. life oriented; (iv) emotional response: worry vs. trust; (v) responsibility: therapist's professionality vs. client's autonomy; and (vi) focus: suicidality vs. individual as a person. The model also takes into account other variables that may be relevant to the process and outcomes of the therapy: contextual factors (variables related to system regulations and therapeutic setting) and variables, related to the therapist in a general sense and the client (including the client's family). Finally, the model considers the outcomes of the process for the therapist and the client. The findings have the potential to be useful for mental health professionals and psychotherapists in understanding different aspects of their experience and difficulties that they may encounter when working with suicidal clients. We believe that adequate suicidality-related training should be provided to professionals who are working with suicidal clients. Further on, the findings (especially the model) may also aid the therapists in identifying aspects of their experience that should be considered and worked on, e.g. in different forms of professional support.
    Type of material - dissertation ; adult, serious
    Publication and manufacture - Ljubljana : [T. Podlogar], 2019
    Language - english
    COBISS.SI-ID - 70048098

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