An exploration of therapists' experiences of responding to expressed suicidal ideation in their therapeutic work with older adult clients

Increasingly over the last two decades, risk has become the basis around which the
delivery of mental heath services has been organised. Recent government initiatives
target psychologists to play an important role in the proposed reduction in the rate of
suicide, making 'suicide prevention' a particularly relevant issue for those
psychologists working therapeutically with clients who disclose suicidal ideation.
Existing research literature has demonstrated that the therapeutic relationship is a
primary factor in effective approaches to therapy with clients who feel suicidal.
However, expressed suicidal ideation during the course of therapy has been found
to make therapists' actions defensive, focused solely on risk assessment rather than
therapeutic change. Being over the age of 65 is one of the biggest risk factors for
suicide across many cultures and societies. Current government initiatives place a
significant emphasis upon securing better mental health for older adults, and the
psychologist's role in the implementation of this. Despite recommendations to carry
out research in order to achieve these goals, there is still a dearth of research
literature in the area of older adult suicide.
The present study aims to address this imbalance by exploring therapists'
experiences of carrying out an assessment of suicide risk within a therapeutic
relationship, with older adult clients. Semi-structured interviews were conducted with
clinical and counselling psychologists and the data was analysed using interpretative
phenomenological analysis. Four superordinate themes were generated relating to
the process of the therapeutic relationship, being a therapist, making sense, and
noticing the narrative. Findings indicate that the interaction and alliance of therapist
and client factors within the therapeutic relationship can be protective against
suicide, rather than standardised risk assessment per se. Implications and
recommendations for further research and clinical practice are discussed.

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