Open Access Highly Accessed Research article

Distinctive emotional responses of clinicians to suicide-attempting patients - a comparative study

Zimri S Yaseen*, Jessica Briggs, Irina Kopeykina, Kali M Orchard, Jessica Silberlicht, Hetal Bhingradia and Igor I Galynker

Author Affiliations

Department of Psychiatry, Beth Israel Medical Center, New York, NY 10003, USA

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BMC Psychiatry 2013, 13:230  doi:10.1186/1471-244X-13-230

Published: 22 September 2013

Abstract

Background

Clinician responses to patients have been recognized as an important factor in treatment outcome. Clinician responses to suicidal patients have received little attention in the literature however, and no quantitative studies have been published. Further, although patients with high versus low lethality suicidal behaviors have been speculated to represent two distinct populations, clinicians’ emotional responses to them have not been examined.

Methods

Clinicians’ responses to their patients when last seeing them prior to patients’ suicide attempt or death were assessed retrospectively with the Therapist Response/Countertransference Questionnaire, administered anonymously via an Internet survey service. Scores on individual items and subscale scores were compared between groups, and linear discriminant analysis was applied to determine the combination of items that best discriminated between groups.

Results

Clinicians reported on patients who completed suicide, made high-lethality attempts, low-lethality attempts, or died unexpected non-suicidal deaths in a total of 82 cases. We found that clinicians treating imminently suicidal patients had less positive feelings towards these patients than for non-suicidal patients, but had higher hopes for their treatment, while finding themselves notably more overwhelmed, distressed by, and to some degree avoidant of them. Further, we found that the specific paradoxical combination of hopefulness and distress/avoidance was a significant discriminator between suicidal patients and those who died unexpected non-suicidal deaths with 90% sensitivity and 56% specificity. In addition, we identified one questionnaire item that discriminated significantly between high- and low-lethality suicide patients.

Conclusions

Clinicians’ emotional responses to patients at risk versus not at risk for imminent suicide attempt may be distinct in ways consistent with responses theorized by Maltsberger and Buie in 1974. Prospective replication is needed to confirm these results, however. Our findings demonstrate the feasibility of using quantitative self-report methodologies for investigation of the relationship between clinicians’ emotional responses to suicidal patients and suicide risk.

Keywords:
Suicide; Suicidality; Suicide risk assessment; Patient death; Affect; Counter-transference questionnaire; Therapist response; Counter-transference; Counter-transference hate; Therapy