Clinician emotional response to patients at risk of suicide: a review of the extant literature

Suicide is a major public health concern, representing the 10th leading cause of death in the United States, claiming the lives of over 48,000 individuals each year. Globally, estimates of annual suicide deaths reached 817,000 in 2016, with the number of global suicide attempts reaching an estimated 25 million each year. While such staggered rates has prompted countless efforts by researchers and clinicians to identify precursors and establish diagnostic tools, our ability to identify individuals at high risk for suicide and predict the occurrence of suicidal thoughts and behaviors (STBs) has not meaningfully improved, nor has our ability to predict when suicidal behaviors will occur. Accordingly, there remains a need to improve our assessment and prevention of STBs in the short term, as well as develop and validate clinical instruments to aid in this effort. One avenue in which prevention efforts have focused is that of health care, specifically mental health professionals. Indeed, clinician judgement remains one of the most relied upon tools for establishing suicide risk among patients as identifying signs, symptoms, or precipitating events are difficult to accurately distinguish. In this paper, we explore clinician countertransference as a potential indicator of patient STBs, beginning with the history of countertransference through the lens of the psychological field, diving into the different types that can be experienced by clinicians (positive, negative, mixed), and arguing that the presence of a mixed response could hold the keys to future patient suicidal action. While research in the realm is still in nascent stages, these findings present an optimistic avenue through while future energy can be focused to further develop the use of such responses for suicide prevention in the future.