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The narrative interview with the suicidal patient.
... A suicidal episode, defined here as a period of time during which an individual thinks about or acts on thoughts of killing oneself, represents a more extreme, life-threatening exemplar of the upsetting events recalled in the initial studies of immersive and reflective processing. Clinical work with suicidal patients has indicated that the recall of a suicidal episode varies in both intensity and the extent to which the individual maintains a sense of control or perceived ability to manage or exit from the suicidal thoughts and feelings (Allen, 2011;Michel & Valach, 2011). As the frequency and intensity of suicidal thoughts and feelings increase, individuals become more vulnerable to remaining immersed or entrapped in a first-person perspective and less able to shift attention to more distanced perspectives. ...
... Clinicians have begun to examine the therapeutic benefits of interviews designed to elicit patients' narratives of past suicidal episodes. By helping individuals articulate suicidal thoughts and feelings to an empathic and reflective listener, narrative interviews may reduce the intensity and sense of isolation that accompanies entrapment in a suicidal state of mind and enhance patients' sense of agency and mastery over their suicidal thoughts and feelings (Michel & Valach, 2011). This also likely facilitates mentalization of the suicidal state by opening the possibility of deriving new perspectives and understandings of self and others (Allen, 2011;Fonagy, 1989). ...
Objective:
The present study tested the validity and clinical utility of adolescents' reports of two distinct modes of processing during the recall of a suicidal episode in the Suicide Narrative Interview (SNI). Recall Intensity (RI) items were designed to capture a tendency to become immersed in thoughts and feelings during the interview, while Meaning Making (MM) items were designed to assess more distant and reflective processing.
Method:
The construct and predictive validity of pretreatment MM and RI was tested in a 16-week randomized clinical trial (RCT) for depressed and suicidal adolescents (N = 113, Mage = 14.95, 84.1% female, 51.8% Black/African American). Adolescents rated MM and RI immediately following the SNI during a baseline assessment.
Results:
Baseline MM was associated with protective factors related to reduced suicidality, and RI was associated with several risk factors for suicidal symptoms. Adolescents who reported high MM and low RI reported greater reductions in both suicidal ideation and depressive symptoms during the RCT.
Conclusions:
The results support MM and RI as two distinct modes of how adolescents process memories of suicidal episodes and highlight the potential clinical utility of RI and MM in assessing and treating suicidal adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
... Suicide and attempted suicide reveal a deep struggle within people to effectively address a significant emotional problem. It represents the incapacity to successfully negotiate particular psychological and personal circumstances (Michel & Valach, 2011). Even though factors have an impact on people's views of themselves and their current circumstances, people who engage in suicidal behavior frequently demonstrate a noteworthy degree of narrative competency. ...
This research breaks down into two main goals: first, it aims to reveal the suicidal acts of the characters in Kathleen Glasgow's Girl in Pieces; second, it will examine the way in which the characters' suicidal narrative is constructed. The Sigmund Freud psychoanalytic theory and narratology were employed in this study to address the research objectives. Girl in Pieces, a novel by Kathleen Glasgow, serves as the data source for this qualitative investigation. This study demonstrates how the interaction between outside factors and internal conflicts illuminates the reasons behind suicide. The presence of ambivalent emotions, the impact of the superego's influence, and the regular reaction of loss to the withdrawal of libido caused the complex five characters to experience melancholy and mourning. This condition demonstrates how the novel's suicidal narrative is represented by the characters' psychological suffering. The manifestation of melancholy and its effects highlight the crucial role the superego plays in encouraging self-destructive behavior. The superego functions as a metaphorical "Thanatos," driving people toward self-destruction, including the potential for suicide, because of its punitive nature and internalized critical voice. With its intense sadness, self-loathing, and conflicting feelings about oneself, melancholia seriously jeopardizes people's wellbeing. The weight of melancholy and the destructive influence of the superego draw attention to how dangerous this mental state is.
... The goal of the brief therapy is to better understand suicidal crises and thus develop effective strategies to interrupt them. In the first session, a narrative interview (Michel & Valach, 2011) is conducted and videotaped. In the second session, the patient and therapist watch the recorded narrative interview together to identify and thus deepen their understanding of relevant life themes related to suicidal crises. ...
Introduction:
The Attempted Suicude Short Intervention Program (ASSIP) provides an effective and cost-effective treatment option for people who have attempted suicide. Studies suggest that longer treatment latency is associated with poorer response to therapy, more severe symptomatology, and more suicide attempts This study examined the influence of treatment latency (time between suicide attempt and initiation of therapy) on the number of suicide attempts over the long-term course of ASSIP and the influence of treatment relationship on the extent of suicidal ideation.
Method:
Survival and regression analyses were performed on 60 participants who had recently attempted suicide and received ASSIP at an outpatient psychiatric clinic. 60% were women and 40% were men.
Results:
The results found no significant association between treatment outcome in ASSIP and treatment latency (HR = 1.06; 95% CI: 0.92- 1.21, p = .44). Treatment relationship significantly influenced suicidal ideation at time t4 (B = - .35, t(55) = -3.21, p = .002), but treatment latency was not significantly associated with suicidal ideation (B = .02, t(55) = 0.87, p = .39).
Conclusion:
No relationship between treatment latency and treatment outcome could be found, suggesting that ASSIP can be implemented at any time after the last suicide attempt. In contrast, the treatment relationship plays a central role in ASSIP.
... Our study shows that the therapists' skilfulness in balancing between the general and the specific is helpful in advancing this process while strengthening the therapeutic alliance at the same time. Therapists' attempts to understand the client's experience are perceived as helpful in general (Modic & Žvelc, 2015) and may facilitate the development of alliance if the client has suicidal thoughts (Michel & Valach, 2011). Through exploration of the experience, the client's understanding of suicidality and themselves may change, which can contribute to overcoming suicidality (Kuzmani c, 2011). ...
Working with suicidal clients is frequently referred to as one of the most demanding and anxiety‐provoking aspects of therapeutic work. The aim of this study was to obtain an in‐depth understanding of therapists’ experience in treating suicidal individuals and develop a theoretical model of it. Eleven psychotherapists (4 men and 7 women) participated in individual semi‐structured interviews. The interviews were audiotaped, transcribed and analyzed by the principles of grounded theory. We developed a model of dynamic balance in therapists’ experiences and views on working with suicidal clients. The model includes six core themes, which represent aspects 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 takes into account other variables that are relevant to the process and outcomes of the therapy: factors, related to the therapist and the client, as well as system regulations and therapeutic setting. The presented model may be helpful for mental health professionals in reflecting on their experiences of working with suicidal clients, describing the relevant topics and the way they relate to each other.
Suicide capability is a multidimensional concept that facilitates the movement from suicidal ideation to suicide attempt. The three-step theory of suicide posits that three overarching contributors comprise suicide capability: acquired (fearlessness about death and high pain tolerance), dispositional (genetics), and practical (knowledge and access to lethal means) capability. Although extensive research has investigated relationships between individual contributors of capability and suicide attempts, little research has considered how an individual’s capability for suicide develops as a combination of contributors. Given suicide is multifaceted and complex, our understanding of capability development is relatively limited. This potentially negatively impacts prevention and capacity reduction–focused intervention efficacy. Therefore, this study aimed to explore how suicide capability develops. Fourteen community-based suicide attempt survivors were recruited using convenience sampling. Individual narratives were collected using open-ended interviews, and data were analysed using narrative analysis. Results indicated that participant narratives contained two elements. The first included how capability development and suicide attempt facilitation were often underpinned by the relational interplay between acquired and practical contributors. For example, participants without a high pain tolerance seeking attempt methods that were perceived to be painless. The second element contained a novel finding relating to the agentic role of participants when deciding and attempting suicide. Agency was revealed within and across narratives emphasising the active role the individual plays in their movement from ideation-to-action. The role of individual agency in coming to a decision to take one’s own life and then acting warrants further consideration within contemporary suicide theories.
Patients in specialist mental healthcare services who are at risk of suicide may experience their struggles as existential in nature. Yet, research on meaning in life has been relatively scarce in suicidology. This qualitative study aimed to explore how patients at risk of suicide perceived their encounters with specialist healthcare professionals after a suicide attempt (SA), with special reference to meaning in life experiences. The study was conducted in specialised mental healthcare services in Norway. Data were collected via individual interviews with eight patients aged 20–75 years. Using a four-step procedure, the interviews were analysed by systematic text condensation. The participants understood their feelings of shame, self-contempt and challenging life experiences as contributing factors to their SA. They perceived that existential themes in relation to financial difficulties, shame and trauma were resolved, while issues associated with the SA, such as death, loss and beliefs, were given less attention. The participants were either ambivalent about continuing to live or wished to rebuild a meaningful life. Overall, their experiences of meaningfulness were hampered. Assisting patients with meaning in life experiences may help them alter their life interpretations and increase their ability to rebuild their lives as meaningful. The present study should be seen as a contribution to meaning-informed approaches in specialist mental healthcare services. More research is needed to equip healthcare personnel in their overall aims of preventing suicide and supporting patients at risk in their efforts to live a meaningful life.
Objective:
Synthesize and reinterpret findings from primary qualitative studies on the emotional experience of mental health professionals in assisting people who have suicidal behavior.
Methods:
We conducted a systematic review of the literature with the SPIDER structured search strategy assessing six databases (PubMed, Web of Science, SCOPUS, PsycINFO, CINAHL, and LILACS). A meta-synthesis was performed with data from qualitative studies published between 2005 and 2021. Two independent reviewers screened and assessed the articles. They evaluated the methodological quality, extracted data from the articles and elaborated thematic synthesis.
Results:
From a total of 852 articles, 21 met the inclusion/exclusion criteria and were included. The meta-synthesis revealed three descriptive themes: coping with adverse experiences; coming across fortunate experiences; professional-personal implications. Based on these descriptive themes, we elaborated the analytical theme: bittersweet experiences of personal and professional transformations.
Conclusions:
Mental health professionals who work with people manifesting suicidal behavior cope with complex emotional experiences that involve controversial and ambivalent feelings. Such feelings have repercussions that generate transformations in the spheres of personal and professional life. The results contribute to implementing interventions that promote better overall mental health outcomes for healthcare providers.
Background:
The development of individual coping strategies for suicidal crises is essential for suicide prevention. However, the influence of a brief intervention and the effect on coping strategies is largely unknown. This study aimed to investigate the influence of the Attempted Suicide Short Intervention Program on the development of coping strategies, in comparison to a control group.
Method:
In this secondary analysis of a 24-month follow-up randomised controlled study, 120 patients (55% female; mean age of 36) with a history of suicide attempts were randomly allocated to either the ASSIP group or to a control group, in addition to treatment as usual.
Results:
The present study identified 11% less dysfunctional coping in the ASSIP group and 6% more problem-focussed coping compared to the control group after 24-months. The analysis of broader strategies showed a statistically significant group difference regarding self-distraction (after 12-months) and self-blame (after 24-months). In regard to the long-term association between coping strategies and suicidal ideation, active coping and substance use were negatively associated with suicidal ideation in the ASSIP group. Whereas, in the control group, behavioural disengagement and positive reframing were positively and self-distraction was negatively related to suicidal ideation.
Limitation:
The receipt of a clinical interview and suicide risk assessment in the control group could have potentially had an effect on participants' coping mechanisms.
Conclusion:
These results indicate that ASSIP may have an impact on the development of problem-focussed coping strategies. Although a reduction in dysfunctional coping seems to be essential in overcoming suicidal crises.
It is the new definition of relationship narratives in psychotherapy that has led to the 14 observations about them in our review and to recognition of their meaning for the process of psychotherapy. Among the most significant externally descriptive observations about relationship narratives were, their identifiability by trained judges, their frequency in almost all sessions and their focus on recent events in intimate relationships. Internal observations came from the Core Conflictual Relationship Theme (CCRT) method applied to the narratives, including: a high frequency of wishes for closeness as well as for independence, a high frequency of negative expectations of responses from others and self, a high pervasiveness of wishes both early and late in therapy, and an increase in positive responses from others and of self as patients improved in psychotherapy.
Psychodynamics, narrative and intentional causality' - Volume 173 Issue 4 - Jeremy Holmes
For the past decade, an increasing number of studies have demonstrated that when individuals write about emotional experiences, significant physical and mental health improvements follow. The basic paradigm and findings are summarized along with some boundary conditions. Although a reduction in inhibition may contribute to the disclosure phenomenon, changes in basic cognitive and linguistic processes during writing predict better health. Implications for theory and treatment are discussed.
[the author has] observed that in case after case suicidal people do not trust their bodies, do not like them, and do not feel at home in them / [survey] the range of body–self disturbances / [examine] what disturbances in the self-representation [of body–self] are found in suicide
body image disturbances and self-fragmentation / body alienation in suicidal patients / self–object confusion in the light of "mourning and melancholia" / confusions of self- and object-representations in suicide: the body as inescapable (PsycINFO Database Record (c) 2012 APA, all rights reserved)
begins with a history of the field [of human attachment], pointing first to J. Bowlby's early emphasis on the attachment figure as the infant's solution to experiences of fright and then to M. Ainsworth's discoveries regarding the 3 traditional forms of "organized" infant attachment—secure, insecure-avoidant, and insecure-resistant/ambivalent—together with their behavioral precursors and sequelae / [describe] the discovery of a 4th, disorganized/disoriented form of insecure infant attachment / discuss the "organized" insecure infant (avoidant and resistant) and adult (dismissing and preoccupied) attachment patterns in terms of defensive process / review earlier proposals that individuals disorganized with the primary caregiver in infancy may be more vulnerable than others to anxiety, phobia, and dissociative experiences / consider potential links among adult attachment, mental suffering, and the therapeutic process (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Contends that suicide is caused by psychache (hurt, anguish, soreness, aching, psychological pain in the psyche, the mind). A principal task for contemporary suicidology is to operationalize (and metricize) the key dimension of psychache. The prevention of suicide (with a highly lethal person) is primarily a matter of addressing and partially alleviating those frustrated psychological needs that are driving that person to suicide (i.e., mollify the psychache). Seven components in the progression to suicidal outcome are outlined, as are 7 beliefs about suicide that represent the author's current thought after 40 yrs of experience. (PsycINFO Database Record (c) 2012 APA, all rights reserved)