First Encounters with Patients after Attempted Suicide: A Conversation and Interaction Analytical Approach

Abstract

The main risk factor for suicide is the attempt to do. It boosts the risk of further attempts and heightens the risk of subsequent suicide considerably. We know the rate of suicide attempters willing to attend even an aftercare appointment to be  low. It is also known that if attempters do seek help, from the first encounter on the quality of the therapeutic alliance plays an important role in the formation of the patient's decision to continue the therapeutic relationship. Clinically, this implies the urgency to offer these patients a helping and trustful relationship from the beginning, since we might only get this one chance to reach and engage them in a helping relationship. But what are good encounters with such patients? How are positively experienced encounters characterized and how to pursue such questions on the basis of empirical material? The aim of this investigation into clinicians’ ways of interacting with these patients is to elicit characteristics of interaction from positively and negatively experienced encounters. Conversation and interaction analysis provide valuable access to these questions, because they allow a detailed investigation into the turn-by-turn unfolding of interaction. They demonstrate how the interactants mutually present themselves and how communicative moves are productive or not. Results of such an investigation into four such first-encounters are presented. Out of a pool of 40 videotaped first-encounters, held at the Bern University Hospital, two of the best and two of the worst encounters in patients’ rating were selected, transcribed, and analyzed. It was found that the interviewers of the positively experienced encounters were attentively and empathically present throughout the entire conversation. While giving patients ample opportunity to autonomously develop the story of their suicide-attempt, clinicians where nevertheless structuring and focusing the conversation and assisting the development of the patient's story. The two negatively experienced encounters were mainly characterized by a unilateral domination of the interaction. In these two conversations a pattern unfolded in which the significances of one party were unilaterally forced upon the other.

URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs120151