Impact upon therapy and the therapist when working with suicidal patients: some transference and countertransference aspects

The suicide, or attempted suicide, of a client/patient is something that a substantial number of counsellors and psychotherapists have encountered during their career. The literature indicates that this can be a cause of anxiety for many. In this paper the experience of psychotherapists working with suicidal patients is explored. One hundred psychotherapists were surveyed, by means of a postal questionnaire. Five follow-up interviews were conducted. The findings indicate that suicidal patients can evoke intense feelings within the therapist, and the meanings of this are discussed. The links with the concept of projective identification are particularly considered. It is noted how such feelings, experienced within the transference relationship and the therapist's own countertransference, can reflect the inner world of the patient concerned. The psychotherapists described how they felt themselves to have been affected by the work, both personally and professionally. Commonly mentioned responses included feelings of hopelessness and helplessness and a sense of failure. Finally, the respondents outlined measures that they believed to be vital for their own support. The importance of firm boundaries and staying in the therapeutic role is discussed.