How the Treatment Experiences of Suicidal Patients Enriches Our Understanding of Effective Interventions

Although dealing with suicidal patients may appear to be more common among clinical, counseling, or school psychologists, all boarded psychologists have the potential to become involved with suicidal patients. Studies on patients’ experiences offer an additional perspective on the effectiveness of specific interventions and their acceptability to patients. This brief article reviews what suicidal patients think about the services they received and what they found helpful and not helpful. It concludes with ways to improve the quality of services to suicidal patients.

The samples and methodologies varied in these studies. These studies involved participants who survived suicide attempts (Gaily-Luoma et al., 2022; Hom et al., 2020; Hom et al., 2021; Shand et al., 2018), had suicidal thoughts (Schembari et al., 2016), or were suicidal inpatients (Berg et al., 2017). The methodologies also varied. Some studies analyzed the content of semi-structured interviews (Gaily-Luoma et al., 2022; Hom et al., 2020), and responses to open-ended survey questions (Hom et al., 2021), to online questions (Shand et al., 2018), or from forms used in treatment (Schembari et al., 2016).

Despite variations in samples and methodologies, four themes emerge that have implications for the treatment of suicidal patients. Patient reports of what was effective often aligned with what experts claimed to be the essential elements of effective interventions with suicidal patients. Nonetheless, some patients reported receiving substandard care, their opinions of the value of hospitalizations and medications were mixed, and they often attached great importance to the simple act of talking about their suicidal behavior.

Patients Confirmed the Importance of Essential Elements of Psychotherapy

Patients largely agreed with experts on the effective elements of interventions as identified by authorities such as Rudd et al. (2021) and Bryan and Rozek (2018). For example, patients appreciated the importance of the psychotherapeutic relationship, a thorough informed consent process (e.g., Hom et al., 2021), a collaborative approach (e.g., Hom et al., 2021), interventions designed to reduce emotional arousal, and the use of safety plans (e.g., Schembari et al., 2016).

Some Patients Received Substandard Care

Despite general agreement on what constitutes effective interventions, many patients believed they received substandard care. For example, when asked about negative experiences, 26% of the patients reported feeling stigmatized, 23% lacked trust in their service provider, 20% believed that the provider lacked expertise, and 14% felt that their service provider minimized their problems (Hom et al., 2020). When asked how treatment could be improved, 38% said providers should refrain from using stigmatizing or demeaning language, 36% recommended showing more empathy, and 24% encouraged providers to listen better to their patients (Hom et al., 2021). Other studies identified similar concerns. Many patients felt they were blamed for their problems by comments such as being told to “stop playing around” (Gaily-Luoma et al., 2022, p. 5). Patients with lower satisfaction often reported that the staff held negative attitudes toward them (Shand et al., 2018). Some patients reported that non-responsive or insensitive attitudes worsened their suicidal ideation and sometimes resulted in subsequent suicide attempts (Berg et al., 2017).

Medications and Hospitalizations Had Mixed Reviews

Hom et al. (2020) found that 27% of respondents rated their hospital experience positive and 44% negative. This is not to imply that hospitalizations should always be avoided. Sometimes, even a hospital experience described by a patient as negative may have been essential to saving their life. Nonetheless, the extent of negative experiences is notable. Hom et al. (2020) found that 40% of respondents rated medications as positive, although 47% identified negative experiences with medications, including lack of response and side effects.

Talking About Suicidal States Was Especially Important

The literature on effective assessments of suicidal patients describes the importance of talking to patients about their suicidal experiences, including their current thoughts, current plans for a suicide attempt, and past attempts. This information helps psychotherapists to craft safety plans or other interventions to reduce the likelihood of a future attempt. Nonetheless, from the patient’s perspective, talking about their experiences can be memorable and highly therapeutic in and of itself. It gives patients a sense of validation or the feeling that their psychotherapist understood how their experiences, personal history, and ways of thinking led them to consider suicide (Schecter & Goldblatt, 2011).

For example, Gaily-Luoma (2002) reported that “all participants viewed careful examination of the suicide attempt as important or even crucial for formulating meaningful recovery goals and treatment plans” (p. 6). A participant in the study by Hom et al. (2020) emphasized the same point and stated, “Really that’s all I wanted—to talk to someone, to have someone listen to what I was saying” (p. 176). In another study, another participant benefited from “just the fact that a person understood how bad I feel” (Schembari et al., 2016, p. 220).

This highlights Large et al.’s (2017) comments that psychologists should strive to make the assessment process helpful for patients. Often, psychologists can further the value of the assessment process by using a narrative approach, in which they encourage patients to tell their stories about how they became suicidal in their own words and at their own pace (Bryan & Rudd, 2018).