Table 4 Recommendations for research and practice of suicide-focused psychological therapy

Past negative experiences of therapy

Unsatisfactory previous experience of therapy may prevent uptake of suicide-focused therapy.

May lead to avoidable dissatisfaction and attrition if therapist not aware of clients’ expectations and preferences.

Enquire about and consider the impact of any past experiences of therapy.

Provide clear information about the nature and demands of suicide-focused therapy and the potential for negative therapeutic reaction.

Confusion / lack of understanding of aims and functions of psychological therapy

Potential for disappointment if client’s expectations of therapy cannot be met.

Need to identify and manage realistic expectations.

Need for active client engagement during and in-between sessions.

Discuss and mutually agree expectations including client’s expectations of own and therapist’s role, and therapist’s expectations of client’s role.

Concerns about trust and confidentiality of information disclosed in therapy

Lack of trust and confidence in confidentiality may impact on continued uptake and engagement.

Demonstration of openness and transparency by therapist explaining own responsibility for breaking confidentiality if concerned for client’s safety may serve to build trust.

Therapist must inform ward team if actual or risk of harm to client or others disclosed in therapy.

Need to clarify client’s wishes of who non-risk information may or may not be shared with.

Allow time for trust to develop recognising the particular challenges for inpatients who may be involuntarily detained.

Demonstrate consistent reliable behaviour

Discuss limits of confidentiality with client.

Discuss when and how any disclosures of actual or risk of harm to self or others would be managed respecting clients’ preferences where possible.

Agree what and with whom other information may be shared with (e.g., ward staff, family).

Fear or unwillingness to talk about suicide

Willingness to discuss suicide is essential for suicide-focused therapy.

Covert fears of potential for harm may impede engagement in therapy.

Important to give full information about the need to talk about suicide to enable informed consent.

Proactive discussion to elicit any client fears about perceived dangers of talking about suicide.

Provide reassurance that client will retain control of the depth and pace of therapy.

Concerns about the ending of therapy

Anxiety about possibility of abrupt ending of sessions may affect ability to engage in therapy.

Involve client in discussions about preferences for ending of therapy.

Offer ways of gradual spacing of session intervals, follow-up or booster sessions.