Can You Stay With Me? Existential Skills and Attitudes in Relating to Persons With a Persistent Death Wish Related to Psychiatric Suffering: A Qualitative Study

IF 1.3 Q3 PSYCHOLOGY, CLINICAL

Counselling & Psychotherapy Research Pub Date : 2026-04-03 DOI:10.1002/capr.70106

Sofie Verdegem, Zara Gelders, Jitske Naessens, Elisabeth Vandenberghe, Marie Jaenen, Joris Vandenberghe, Jessie Dezutter, Thijs Vanhie, Siebrecht Vanhooren

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引用次数: 0

Abstract

Objective

This study explored the therapeutic skills and attitudes mental health care (MHC) workers draw on when engaging with existential concerns in working with individuals with a persistent death wish related to unbearable psychiatric suffering (DWUPS) and examined whether sustained exposure to specialised existential care settings shapes existential responsiveness and relational presence.

Method

A qualitative design was employed, following Elliott and Timulak's descriptive-interpretative methodology. Eighteen in-depth interviews were conducted with two samples: non-specialised (Sample A) and specialised MHC-workers affiliated with Reakiro, a care centre for persons with DWUPS which operates from an existentially grounded, presence-based palliative and recovery-oriented framework (Sample B). Interview transcripts were organised into thematic categories through inductive analysis. Comparative frequency analysis identified specific patterns.

Findings

Four core domains characterised MCH-workers' engagement with persons with DWUPS: existential, relational and palliative skills and attitudes, alongside the importance of self-care. Across both samples, participants described personal existential processing, presence, and existentially oriented interventions, relational engagement within the therapeutic space, facilitating connection with significant others and openness to the death wish as central to their work. Differences between samples were secondary and context-related. Specialised MHC-workers showed less hesitation in addressing the death wish, whereas non-specialised MHC-workers more strongly emphasised life-affirming interventions and reported greater ethical and emotional burden.

Conclusion

Working with individuals with DWUPS requires an existentially grounded therapeutic stance that integrates openness to both life and death. The findings highlight the need for clinical training, peer support, and reflective supervision focused on existential presence, relational engagement and dual-track care.

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你能和我在一起吗？与精神疾病相关的持续死亡愿望相关的人的存在技能和态度：一项定性研究

目的本研究探讨了精神卫生保健（MHC）工作者在处理与无法忍受的精神痛苦（DWUPS）相关的持续性死亡愿望个体时所采用的治疗技巧和态度，并考察了持续暴露于专门的存在主义护理环境是否会影响存在主义反应和关系存在。方法采用定性设计，遵循Elliott和Timulak的描述-解释方法。对两个样本进行了18次深度访谈：非专业（样本A）和隶属于Reakiro的专业mhc工作人员（样本B）。Reakiro是一家DWUPS患者护理中心，以生存为基础，以在场为基础的姑息治疗和康复为导向的框架（样本B）。访谈笔录通过归纳分析分为专题类。比较频率分析确定了特定的模式。mch工人与DWUPS患者接触的四个核心领域：存在、关系和姑息技能和态度，以及自我照顾的重要性。在这两个样本中，参与者描述了个人存在的处理、存在和以存在为导向的干预、治疗空间内的关系参与、促进与重要他人的联系以及对死亡愿望的开放是他们工作的核心。样本之间的差异是次要的，与环境有关。专业的mhc工作者在处理死亡愿望时表现出较少的犹豫，而非专业的mhc工作者更强烈地强调生命肯定干预，并报告了更大的道德和情感负担。与患有DWUPS的个体一起工作需要一种基于存在的治疗立场，将对生命和死亡的开放结合起来。研究结果强调了临床培训、同伴支持和关注存在存在、关系参与和双轨护理的反思性监督的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Counselling & Psychotherapy Research PSYCHOLOGY, CLINICAL-

CiteScore

4.40

自引率

12.50%

发文量

期刊介绍： Counselling and Psychotherapy Research is an innovative international peer-reviewed journal dedicated to linking research with practice. Pluralist in orientation, the journal recognises the value of qualitative, quantitative and mixed methods strategies of inquiry and aims to promote high-quality, ethical research that informs and develops counselling and psychotherapy practice. CPR is a journal of the British Association of Counselling and Psychotherapy, promoting reflexive research strongly linked to practice. The journal has its own website: www.cprjournal.com. The aim of this site is to further develop links between counselling and psychotherapy research and practice by offering accessible information about both the specific contents of each issue of CPR, as well as wider developments in counselling and psychotherapy research. The aims are to ensure that research remains relevant to practice, and for practice to continue to inform research development.