In one in all my first classes as a therapist, a 60-year-old outpatient with physique dysmorphic dysfunction and persistent melancholy mentioned to me: “This psychotherapy is the final likelihood that I’ve obtained.”
Her desperation was devastating, and her phrases positioned an immense weight on me. How may I probably reply to that? Initially, my strategy was to lean on established therapeutic strategies—however as our classes progressed, I started to grasp that the bond we have been constructing was simply as essential, if no more so, in serving to her.
“One of the vital issues we will do is create a bond with a suicidal individual,” emphasised Prof. Ute Lewitzka, a German psychiatrist, on World Suicide Prevention Day 2024. Whereas it could appear apparent that the therapeutic alliance is vital to assist individuals vulnerable to suicide, this matter stays understudied in analysis. What do therapists and suicidal sufferers actually take into consideration their working alliance? Is it so simple as “Be good to sufferers and they’ll get higher?” Prof. Konrad Michel (2023), creator of The Suicidal Individual, presents simple steerage: “There’s a identify for it. It’s referred to as good medical follow. It’s about listening to our sufferers and creating a working alliance towards a shared purpose.”
To recap, a therapeutic alliance is known as a collaboration on shared targets, duties, and emotional bond, as outlined in Bordin’s pantheoretical mannequin (1979). This course of variable has been proven to be some of the vital elements in psychotherapy outcomes, as demonstrated by a meta-analysis (Wampold & Flückinger, 2023). Nevertheless, current opinions on the therapeutic alliance in suicidality by Dunster-Web page et al. (2017) and Huggett et al. (2022) reveal that findings are scarce and heterogeneous. Whereas the Significance of the Therapeutic Alliance in psychotherapy for self-harm was mentioned in one other Psychological Elf Weblog, this new research by Huggett and colleagues (2024) is the primary giant, qualitative research to incorporate views from each sufferers and therapists, filling an vital analysis hole.
A brand new systematic assessment and meta-ethnography synthesises each shoppers’ and therapists’ perceptions of the therapeutic alliance in suicide prevention.
Strategies
The authors systematically looked for qualitative research and performed a meta-ethnography to check, distinction, and synthesize related findings (Huggett et al., 2024). The research was pre-registered on PROSPERO (CRD42021268273). The literature search coated articles obtainable from the inception of the databases—MEDLINE, PsycINFO, Internet of Science, Embase, and CINAHL—by means of April 2024. Following the Crucial Appraisal Expertise Programme (CASP; 2018) guidelines for systematic opinions, the authors included peer-reviewed qualitative research centered on “consumer and/or therapist views of the therapeutic alliance within the context of psychotherapy and suicidal experiences.” The standard of eligible research was ensured by an adaption of CASP for qualitative proof synthesis (Lengthy, French, & Brooks, 2020). Information extraction and synthesis have been carried out in keeping with a revised strategy to the seven phases of meta-ethnography by Noblit and Hare (1988).
Outcomes
After screening 3,654 titles, 37 out of 82 papers have been evaluated as eligible and included within the systematic assessment and synthesis. The research have been performed worldwide, primarily in Europe (n = 21). Total, 22 articles reported solely the therapists’ perspective, 11 articles reported solely the consumer’s perspective, and 4 articles included each views. The performed knowledge evaluation methods have been Thematic Evaluation, Interpretative Phenomenological Evaluation, and Grounded Idea.
The interpretation and synthesis of the research revealed two major themes: “Engaged on the Edge” and “Being Prepared, Keen, and Capable of Construct an Alliance within the Context of Suicidal Experiences,” every with two subthemes, which can be summarised as follows:
Engaged on the sting
The primary major theme, “Engaged on the Edge,” refers to a quote by a therapist who used the metaphor of standing on a cliff edge to explain the therapeutic alliance with suicidal sufferers, emphasising the “high-risk, life-or-death nature” of the collaboration (see Huggett et al., 2024; Therapist: Fogarty, Houghton, Galavan, & O’Súilleabháin, 2021, p. 12). This theme includes two subthemes. A number of the key factors are:
Sense of accountability and management over a consumer’s life, e.g.
- Inner rigidity between the consumer’s free will and the therapist’s accountability
- A way of goal and ‘heroism’ vs. lack of management on this “life-death scenario”
Balancing empathy for ‘suicide want’ and holding hope, e.g.
- Inside battle to navigate the stress between empathising with the consumer’s suicidal emotions and fostering a shared sense of hope
- Significance of exhibiting understanding for ambivalence of want to dwell and want to die
Being prepared, prepared, and in a position to construct an alliance within the context of suicidal experiences
The second major theme had two subthemes of ‘human connection’ and ‘reciprocal belief’ to explain the standard of the therapeutic relationship. Key factors included:
Human connection, e.g.
- Sturdy, emotionally invested reference to suicidal shoppers
- Therapists’ self-disclosure accompanied by emotions of vulnerability
Reciprocal belief, e.g.
- Belief wants time to be constructed up on either side
- Unfavourable earlier experiences with reactions to suicidality must be addressed
To synthesise the outcomes, the dynamic of the client-therapist relationship was conceptualised inside a fancy mannequin, which could be accessed right here and within the paper by Huggett and colleagues (2024; p.8). This mannequin gives an outline of the processes underlying relationship constructing, starting from suicide-specific micro-processes to systemic macro-processes that affect the therapeutic alliance.
A key discovering is that validating the emotional ache of the consumer—reasonably than solely specializing in their sources—is an important driving think about establishing and sustaining the alliance.
The sense of readiness and skill of each therapists and suicidal sufferers was vital to attain a therapeutic alliance.
Conclusions
It is a very insightful and thought-provoking article that’s the first one to synthesise the qualitative literature on the dynamics between therapists and sufferers vulnerable to suicide. The authors concluded:
Therapeutic alliance within the context of suicidal experiences is exclusive, fluid, doubtlessly lifesaving, and influenced by a number of inter-connected inner and exterior processes and methods.
Huggett’s mannequin (2024) not solely enhances our understanding of the therapeutic alliance but in addition serves as a worthwhile software for clinicians in tailoring their strategy to higher assist shoppers vulnerable to suicide.
The authors concluded that “Therapeutic alliance within the context of suicidal experiences is exclusive, fluid, and doubtlessly lifesaving”.
Strengths and limitations
The research’s strengths and limitations, as knowledgeable by the CASP standards for synthesising qualitative proof (Lengthy, French, & Brooks, 2020) are mentioned beneath:
a. Are the outcomes of the research legitimate?
The assessment addresses a centered analysis query utilizing an acceptable vary of sources. Whereas the info high quality was rated nearly as good to glorious, challenges within the revision course of and limitations have been brazenly described. There was an ongoing dialogue concerning the worth of qualitative strategies in suicidology (e.g., White, 2016; Kabir, Wayland & Maple, 2023) and whether or not they provide scientific rigour past “speculation technology” (Joiner, 2011, p. 471). Nevertheless, qualitative strategies can contribute worthwhile insights into lived experiences and underlying processes.
b. What are the outcomes?
Huggett and colleagues aimed to develop a qualitative, conceptual mannequin of the therapeutic alliance in psychotherapy with suicidal sufferers, incorporating each therapist and consumer views. The findings provide detailed insights into therapist-patient dynamics however stay restricted by their qualitative nature.
c. Will the outcomes assist regionally?
In medical follow, the outcomes could also be transferred to the native inhabitants with cautious consideration. A power of the assessment is the worldwide scope of the collected research. Regardless of the detailed description of the dynamics between therapist and affected person, these findings can’t be generalised as a result of their qualitative nature and the shortage of demographic knowledge within the research. As an alternative, they supply an outlook for additional analysis that should examine these proposed subjects in additional element.
The authors developed an insightful conceptual mannequin of the therapeutic alliance in psychotherapy with suicidal sufferers; nevertheless, restricted by its qualitative nature.
Implications for follow
Forming a therapeutic alliance with suicidal shoppers is crucial for suicide prevention and could possibly be enhanced by means of focused coaching for therapists in “suicide-specific alliance methods”, along with the joint improvement of security plans (Nuij et al., 2021). Furthermore, the chance of therapist burnout ought to be saved in thoughts, particularly for these primarily working with suicidal people. Efficient communication and considerate language are essential in assessing suicide threat, as they assist preserve belief and forestall rigidity that would jeopardise the therapeutic relationship.
The authors concluded: “Medical implications emphasise the necessity to enhance coaching, supervision, and assist for therapists to equip them with the extra abilities required in navigating the intricacies of the therapeutic alliance with shoppers who’ve suicidal experiences.” Huggett and her co-authors (2024) additional highlighted that “the nuances of the therapeutic alliance with suicidal shoppers are at present absent from pointers.” They subsequently advocate for the inclusion of each consumer and therapist views in medical pointers, in addition to a “multi-disciplinary staff strategy to suicide prevention.”
Future analysis ought to discover how these processes could be additional operationalised in therapeutic settings to enhance outcomes for shoppers going through suicidal ideas and behaviours. As an example, micro-processes comparable to lively listening and empathetic responses, alongside macro-processes like social assist methods, play vital roles in fostering a powerful therapeutic alliance. Moreover, it is very important report each intercourse and ethnicity, as their omission in earlier research has been criticised by the authors.
Wanting again on the expertise with my affected person, I recognise each recognized themes in working along with her. I’ve learnt that it is very important be clear and empathetic with a suicidal affected person. To allow them to take accountability for their very own lives, however to do the most effective I can to supply assist and create a bond. Additionally to mirror on the method with an advisor and prioritise self-care. Much like the primary creator’s insights, I imagine that many psychological well being professionals will discover elements of their very own experiences mirrored on this article.
The therapeutic alliance benefited from a versatile mixture of suicide threat evaluation and therapeutic conversations.
Assertion of pursuits
Laura is aware of one of many authors (CH). She has written an article on the therapeutic alliance and suicidal ideation.
Hyperlinks
Main paper
Huggett, C., Peters, S., Gooding, P., Berry, N., & Pratt, D. (2024). A scientific assessment and meta-ethnography of consumer and therapist views of the therapeutic alliance within the context of psychotherapy and suicidal experiences. Medical Psychology Evaluation, 102469. https://doi.org/10.1016/j.cpr.2024.102469
Other references
Bordin, E. S. (1979). The generalizability of the psychoanalytic idea of the working alliance. Psychotherapy: Idea, analysis & follow, 16(3), 252. https://psycnet.apa.org/doi/10.1037/h0085885
Crucial Appraisal Expertise Programme. (2018). CASP Cohort Research Guidelines. Retrieved by the authors on March 29, 2023, from https://casp-uk.internet/casp-tools- checklists/.
Dunster-Web page, C., Haddock, G., Wainwright, L., & Berry, Okay. (2017). The connection between therapeutic alliance and affected person’s suicidal ideas, self-harming behaviours and suicide makes an attempt: A scientific assessment. Journal of Affective Problems, 223, 165–174. https://doi.org/10.1016/j.jad.2017.07.040
Fogarty, B., Houghton, S., Galavan, E., & O’Súilleabh´ ain, P. S. (2021). Clinicians’ expertise of collaboration within the remedy of suicidal shoppers throughout the collaborative evaluation and Administration of Suicidality Framework. Omega Journal of Loss of life and Dying. https://doi.org/10.1177/00302228211020579, 302228211020579. Advance on-line publication.
Huggett, C., Gooding, P., Haddock, G., Quigley, J., & Pratt, D. (2022). The connection between the therapeutic alliance in psychotherapy and suicidal experiences: A scientific assessment. Medical Psychology & Psychotherapy, 29(4), 1203–1235. https://doi.org/10.1002/cpp.2726
Joiner, T. (2011). Editorial: Scientific rigor because the guiding heuristic for SLTB’s editorial stance. Suicide and Life Threatening Conduct, 41(5), 471–473. https://doi.org/10.1111/j.1943-278X.2011.00056.x
Kabir, H., Wayland, S., & Maple, M. (2023). Qualitative analysis in suicidology: a scientific assessment of the literature of low-and middle-income nations. BMC Public Well being, 23(1), 918. https://doi.org/10.1186/s12889-023-15767-9
Lengthy, H. A., French, D. P., & Brooks, J. M. (2020). Optimising the worth of the vital appraisal abilities programme (CASP) software for high quality appraisal in qualitative proof synthesis. Analysis Strategies in Medication & Well being Sciences, 1(1), 31–42. https://doi.org/10.1177/2632084320947559
Michel, Okay. (2023). The suicidal individual: a brand new have a look at a human phenomenon. Columbia College Press.
Noblit, G. W., & Hare, R. D. (1988). Meta-ethnography: Synthesizing qualitative research. Sage Publications.
Nuij, C., van Ballegooijen, W., De Beurs, D., Juniar, D., Erlangsen, A., Portzky, G., O’Connor, R. C., Smit, J. H., Kerkhof, A. & Riper, H. (2021). Security planning-type interventions for suicide prevention: meta-analysis. The British Journal of Psychiatry, 219(2), 419-426. https://doi.org/10.1192/bjp.2021.50
Wampold, B. E., & Flückiger, C. (2023). The alliance in psychological well being care: conceptualization, proof and medical functions. World psychiatry, 22(1), 25–41. https://doi.org/10.1002/wps.21035
White, J. (2016). Qualitative Proof in Suicide Ideation, Makes an attempt, and Suicide Prevention. In: Olson, Okay., Younger, R., Schultz, I. (eds) Handbook of Qualitative Well being Analysis for Proof-Based mostly Observe. Handbooks in Well being, Work, and Incapacity, vol 4. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2920-7_20
Picture credit
In one in all my first classes as a therapist, a 60-year-old outpatient with physique dysmorphic dysfunction and persistent melancholy mentioned to me: “This psychotherapy is the final likelihood that I’ve obtained.”
Her desperation was devastating, and her phrases positioned an immense weight on me. How may I probably reply to that? Initially, my strategy was to lean on established therapeutic strategies—however as our classes progressed, I started to grasp that the bond we have been constructing was simply as essential, if no more so, in serving to her.
“One of the vital issues we will do is create a bond with a suicidal individual,” emphasised Prof. Ute Lewitzka, a German psychiatrist, on World Suicide Prevention Day 2024. Whereas it could appear apparent that the therapeutic alliance is vital to assist individuals vulnerable to suicide, this matter stays understudied in analysis. What do therapists and suicidal sufferers actually take into consideration their working alliance? Is it so simple as “Be good to sufferers and they’ll get higher?” Prof. Konrad Michel (2023), creator of The Suicidal Individual, presents simple steerage: “There’s a identify for it. It’s referred to as good medical follow. It’s about listening to our sufferers and creating a working alliance towards a shared purpose.”
To recap, a therapeutic alliance is known as a collaboration on shared targets, duties, and emotional bond, as outlined in Bordin’s pantheoretical mannequin (1979). This course of variable has been proven to be some of the vital elements in psychotherapy outcomes, as demonstrated by a meta-analysis (Wampold & Flückinger, 2023). Nevertheless, current opinions on the therapeutic alliance in suicidality by Dunster-Web page et al. (2017) and Huggett et al. (2022) reveal that findings are scarce and heterogeneous. Whereas the Significance of the Therapeutic Alliance in psychotherapy for self-harm was mentioned in one other Psychological Elf Weblog, this new research by Huggett and colleagues (2024) is the primary giant, qualitative research to incorporate views from each sufferers and therapists, filling an vital analysis hole.
A brand new systematic assessment and meta-ethnography synthesises each shoppers’ and therapists’ perceptions of the therapeutic alliance in suicide prevention.
Strategies
The authors systematically looked for qualitative research and performed a meta-ethnography to check, distinction, and synthesize related findings (Huggett et al., 2024). The research was pre-registered on PROSPERO (CRD42021268273). The literature search coated articles obtainable from the inception of the databases—MEDLINE, PsycINFO, Internet of Science, Embase, and CINAHL—by means of April 2024. Following the Crucial Appraisal Expertise Programme (CASP; 2018) guidelines for systematic opinions, the authors included peer-reviewed qualitative research centered on “consumer and/or therapist views of the therapeutic alliance within the context of psychotherapy and suicidal experiences.” The standard of eligible research was ensured by an adaption of CASP for qualitative proof synthesis (Lengthy, French, & Brooks, 2020). Information extraction and synthesis have been carried out in keeping with a revised strategy to the seven phases of meta-ethnography by Noblit and Hare (1988).
Outcomes
After screening 3,654 titles, 37 out of 82 papers have been evaluated as eligible and included within the systematic assessment and synthesis. The research have been performed worldwide, primarily in Europe (n = 21). Total, 22 articles reported solely the therapists’ perspective, 11 articles reported solely the consumer’s perspective, and 4 articles included each views. The performed knowledge evaluation methods have been Thematic Evaluation, Interpretative Phenomenological Evaluation, and Grounded Idea.
The interpretation and synthesis of the research revealed two major themes: “Engaged on the Edge” and “Being Prepared, Keen, and Capable of Construct an Alliance within the Context of Suicidal Experiences,” every with two subthemes, which can be summarised as follows:
Engaged on the sting
The primary major theme, “Engaged on the Edge,” refers to a quote by a therapist who used the metaphor of standing on a cliff edge to explain the therapeutic alliance with suicidal sufferers, emphasising the “high-risk, life-or-death nature” of the collaboration (see Huggett et al., 2024; Therapist: Fogarty, Houghton, Galavan, & O’Súilleabháin, 2021, p. 12). This theme includes two subthemes. A number of the key factors are:
Sense of accountability and management over a consumer’s life, e.g.
- Inner rigidity between the consumer’s free will and the therapist’s accountability
- A way of goal and ‘heroism’ vs. lack of management on this “life-death scenario”
Balancing empathy for ‘suicide want’ and holding hope, e.g.
- Inside battle to navigate the stress between empathising with the consumer’s suicidal emotions and fostering a shared sense of hope
- Significance of exhibiting understanding for ambivalence of want to dwell and want to die
Being prepared, prepared, and in a position to construct an alliance within the context of suicidal experiences
The second major theme had two subthemes of ‘human connection’ and ‘reciprocal belief’ to explain the standard of the therapeutic relationship. Key factors included:
Human connection, e.g.
- Sturdy, emotionally invested reference to suicidal shoppers
- Therapists’ self-disclosure accompanied by emotions of vulnerability
Reciprocal belief, e.g.
- Belief wants time to be constructed up on either side
- Unfavourable earlier experiences with reactions to suicidality must be addressed
To synthesise the outcomes, the dynamic of the client-therapist relationship was conceptualised inside a fancy mannequin, which could be accessed right here and within the paper by Huggett and colleagues (2024; p.8). This mannequin gives an outline of the processes underlying relationship constructing, starting from suicide-specific micro-processes to systemic macro-processes that affect the therapeutic alliance.
A key discovering is that validating the emotional ache of the consumer—reasonably than solely specializing in their sources—is an important driving think about establishing and sustaining the alliance.
The sense of readiness and skill of each therapists and suicidal sufferers was vital to attain a therapeutic alliance.
Conclusions
It is a very insightful and thought-provoking article that’s the first one to synthesise the qualitative literature on the dynamics between therapists and sufferers vulnerable to suicide. The authors concluded:
Therapeutic alliance within the context of suicidal experiences is exclusive, fluid, doubtlessly lifesaving, and influenced by a number of inter-connected inner and exterior processes and methods.
Huggett’s mannequin (2024) not solely enhances our understanding of the therapeutic alliance but in addition serves as a worthwhile software for clinicians in tailoring their strategy to higher assist shoppers vulnerable to suicide.
The authors concluded that “Therapeutic alliance within the context of suicidal experiences is exclusive, fluid, and doubtlessly lifesaving”.
Strengths and limitations
The research’s strengths and limitations, as knowledgeable by the CASP standards for synthesising qualitative proof (Lengthy, French, & Brooks, 2020) are mentioned beneath:
a. Are the outcomes of the research legitimate?
The assessment addresses a centered analysis query utilizing an acceptable vary of sources. Whereas the info high quality was rated nearly as good to glorious, challenges within the revision course of and limitations have been brazenly described. There was an ongoing dialogue concerning the worth of qualitative strategies in suicidology (e.g., White, 2016; Kabir, Wayland & Maple, 2023) and whether or not they provide scientific rigour past “speculation technology” (Joiner, 2011, p. 471). Nevertheless, qualitative strategies can contribute worthwhile insights into lived experiences and underlying processes.
b. What are the outcomes?
Huggett and colleagues aimed to develop a qualitative, conceptual mannequin of the therapeutic alliance in psychotherapy with suicidal sufferers, incorporating each therapist and consumer views. The findings provide detailed insights into therapist-patient dynamics however stay restricted by their qualitative nature.
c. Will the outcomes assist regionally?
In medical follow, the outcomes could also be transferred to the native inhabitants with cautious consideration. A power of the assessment is the worldwide scope of the collected research. Regardless of the detailed description of the dynamics between therapist and affected person, these findings can’t be generalised as a result of their qualitative nature and the shortage of demographic knowledge within the research. As an alternative, they supply an outlook for additional analysis that should examine these proposed subjects in additional element.
The authors developed an insightful conceptual mannequin of the therapeutic alliance in psychotherapy with suicidal sufferers; nevertheless, restricted by its qualitative nature.
Implications for follow
Forming a therapeutic alliance with suicidal shoppers is crucial for suicide prevention and could possibly be enhanced by means of focused coaching for therapists in “suicide-specific alliance methods”, along with the joint improvement of security plans (Nuij et al., 2021). Furthermore, the chance of therapist burnout ought to be saved in thoughts, particularly for these primarily working with suicidal people. Efficient communication and considerate language are essential in assessing suicide threat, as they assist preserve belief and forestall rigidity that would jeopardise the therapeutic relationship.
The authors concluded: “Medical implications emphasise the necessity to enhance coaching, supervision, and assist for therapists to equip them with the extra abilities required in navigating the intricacies of the therapeutic alliance with shoppers who’ve suicidal experiences.” Huggett and her co-authors (2024) additional highlighted that “the nuances of the therapeutic alliance with suicidal shoppers are at present absent from pointers.” They subsequently advocate for the inclusion of each consumer and therapist views in medical pointers, in addition to a “multi-disciplinary staff strategy to suicide prevention.”
Future analysis ought to discover how these processes could be additional operationalised in therapeutic settings to enhance outcomes for shoppers going through suicidal ideas and behaviours. As an example, micro-processes comparable to lively listening and empathetic responses, alongside macro-processes like social assist methods, play vital roles in fostering a powerful therapeutic alliance. Moreover, it is very important report each intercourse and ethnicity, as their omission in earlier research has been criticised by the authors.
Wanting again on the expertise with my affected person, I recognise each recognized themes in working along with her. I’ve learnt that it is very important be clear and empathetic with a suicidal affected person. To allow them to take accountability for their very own lives, however to do the most effective I can to supply assist and create a bond. Additionally to mirror on the method with an advisor and prioritise self-care. Much like the primary creator’s insights, I imagine that many psychological well being professionals will discover elements of their very own experiences mirrored on this article.
The therapeutic alliance benefited from a versatile mixture of suicide threat evaluation and therapeutic conversations.
Assertion of pursuits
Laura is aware of one of many authors (CH). She has written an article on the therapeutic alliance and suicidal ideation.
Hyperlinks
Main paper
Huggett, C., Peters, S., Gooding, P., Berry, N., & Pratt, D. (2024). A scientific assessment and meta-ethnography of consumer and therapist views of the therapeutic alliance within the context of psychotherapy and suicidal experiences. Medical Psychology Evaluation, 102469. https://doi.org/10.1016/j.cpr.2024.102469
Other references
Bordin, E. S. (1979). The generalizability of the psychoanalytic idea of the working alliance. Psychotherapy: Idea, analysis & follow, 16(3), 252. https://psycnet.apa.org/doi/10.1037/h0085885
Crucial Appraisal Expertise Programme. (2018). CASP Cohort Research Guidelines. Retrieved by the authors on March 29, 2023, from https://casp-uk.internet/casp-tools- checklists/.
Dunster-Web page, C., Haddock, G., Wainwright, L., & Berry, Okay. (2017). The connection between therapeutic alliance and affected person’s suicidal ideas, self-harming behaviours and suicide makes an attempt: A scientific assessment. Journal of Affective Problems, 223, 165–174. https://doi.org/10.1016/j.jad.2017.07.040
Fogarty, B., Houghton, S., Galavan, E., & O’Súilleabh´ ain, P. S. (2021). Clinicians’ expertise of collaboration within the remedy of suicidal shoppers throughout the collaborative evaluation and Administration of Suicidality Framework. Omega Journal of Loss of life and Dying. https://doi.org/10.1177/00302228211020579, 302228211020579. Advance on-line publication.
Huggett, C., Gooding, P., Haddock, G., Quigley, J., & Pratt, D. (2022). The connection between the therapeutic alliance in psychotherapy and suicidal experiences: A scientific assessment. Medical Psychology & Psychotherapy, 29(4), 1203–1235. https://doi.org/10.1002/cpp.2726
Joiner, T. (2011). Editorial: Scientific rigor because the guiding heuristic for SLTB’s editorial stance. Suicide and Life Threatening Conduct, 41(5), 471–473. https://doi.org/10.1111/j.1943-278X.2011.00056.x
Kabir, H., Wayland, S., & Maple, M. (2023). Qualitative analysis in suicidology: a scientific assessment of the literature of low-and middle-income nations. BMC Public Well being, 23(1), 918. https://doi.org/10.1186/s12889-023-15767-9
Lengthy, H. A., French, D. P., & Brooks, J. M. (2020). Optimising the worth of the vital appraisal abilities programme (CASP) software for high quality appraisal in qualitative proof synthesis. Analysis Strategies in Medication & Well being Sciences, 1(1), 31–42. https://doi.org/10.1177/2632084320947559
Michel, Okay. (2023). The suicidal individual: a brand new have a look at a human phenomenon. Columbia College Press.
Noblit, G. W., & Hare, R. D. (1988). Meta-ethnography: Synthesizing qualitative research. Sage Publications.
Nuij, C., van Ballegooijen, W., De Beurs, D., Juniar, D., Erlangsen, A., Portzky, G., O’Connor, R. C., Smit, J. H., Kerkhof, A. & Riper, H. (2021). Security planning-type interventions for suicide prevention: meta-analysis. The British Journal of Psychiatry, 219(2), 419-426. https://doi.org/10.1192/bjp.2021.50
Wampold, B. E., & Flückiger, C. (2023). The alliance in psychological well being care: conceptualization, proof and medical functions. World psychiatry, 22(1), 25–41. https://doi.org/10.1002/wps.21035
White, J. (2016). Qualitative Proof in Suicide Ideation, Makes an attempt, and Suicide Prevention. In: Olson, Okay., Younger, R., Schultz, I. (eds) Handbook of Qualitative Well being Analysis for Proof-Based mostly Observe. Handbooks in Well being, Work, and Incapacity, vol 4. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2920-7_20
