The Cumulative Effects of Treating Suicidality in Young Adults: Understanding the Differing Needs of Early- and Late-Career Clinicians

Background and Purpose: The prevalence of suicide attempts and suicidal thinking among college-age youth has increased in recent years. Though treating suicidality is a common feature of therapeutic work with young adults, many therapists report being uncomfortable with the task and report anxiety, hopelessness, a sense of powerlessness, dread, or fear of liability.

While several qualitative studies have explored the emotional reactions of clinicians in treating suicidality, research to date has not focused on the ways in which clinicians at different stages in their career may experience and cope with the stress of treating suicidality differently. This paper helps to fill this gap through an exploration of the experiences of early- and late-career clinicians within a large college counseling center that reports a high prevalence of suicidality within its patient population.

Methods: In-depth, semi-structured interviews were conducted with twelve clinicians at a college counseling center at a large private university (22,000 students) in the northeast. The sample, which represented 18% of the total clinical staff, was predominantly female (75% female, 25% male) and White (75% White, 25% non-White); five were clinicians within their first three years of practice, and seven were clinicians with 15+ years of practice. Participants were recruited via email. Interviews focused on clinician experience of assessing for and treating suicidal thinking and behavior, and solicited clinician’s impressions of what has been most helpful in helping them manage any stress they experience around treating suicidality. Interviews were transcribed verbatim and coded thematically using NVivo qualitative software, guided by the principles of interpretive phenomenological analysis.

Findings: Data analysis reveals that, while all participants noted the cumulative stress of managing caseloads with prevalent suicidality (33-66% of clients), early and late career clinicians report consistently different reactions to and conceptualizations of suicidality. Early career clinicians report anxiety, dread, and dissociation during suicide assessments, whereas late career clinicians endorse a comfort and positive activation during assessments that leads to greater focus. Consistent differences emerge regarding the issue of losing a client to suicide: participants reported greater anxiety and a greater sense of power and control over preventing suicide early in their career (before loss), compared to an acceptance of the limitations of clinician power later in their career. All late career participants had experienced loss, and uniformly noted a sense of being “forever changed” as people and as clinicians. All participants report that opportunities to consult with colleagues are a vital support, but the type of support differs: early career therapists seek validation of their technique and a sense of shared responsibility, whereas late career therapists consult with others who have experienced loss.

Conclusion and Implications: Findings highlight the importance of providing support to clinicians operating in college settings with a high prevalence of suicidality, and suggest that support may need to be tailored to clinician experience. Given the increased anxiety and potentially unrealistic expectations around preventing suicide endorsed by early career clinicians, additional training and supervisory support may be especially important in the first years of clinical practice.