How suicidal patients shape early career psychotherapists’ experiences of their professional competence : an interpretative phenomenological analysis

Abstract

Working with suicidal patients can be described as a challenging aspect for psychologists, particularly for psychologists early in their journeys of therapeutic practice and professional development. This research explores early career psychologists’ experiences of professional competence when treating suicidal patients, examining challenges and opportunities arising from working with patients presenting with suicidal ideation, intent, plans, attempts, or those who have completed suicide. The sample included 10 early career psychologists. Semi-structured interviews were conducted, and interpretative phenomenological analysis revealed four main themes: (1) the unique nature of psychotherapy; (2) the therapist as the tool; (3) the complexity of suicidality; and (4) interacting with South Africa’s mental health landscape. Participants reported uncertainty about treatment outcomes and difficulties in measuring therapeutic success with suicidal patients, as well as psychotherapy for this population being misunderstood by interdisciplinary teams. Despite generally feeling competent, self-doubt and imposter syndrome were periodic, highlighting the dynamic nature of professional competence. Clinical judgment relied on both research and intuition, with emotional responsiveness being crucial yet exhausting, putting participants at risk for burnout. South Africa’s healthcare system presented unique challenges including resource limitations and high patient volumes. Exposure to suicidality early in their careers meant that successfully working with suicidal patients was seen as integral to being a competent psychologist. Future research may further investigate how effective counselling/clinical masters-level programs prepare psychologists for working with suicidality.