A reflexive thematic analysis of the experiences of psychotherapy of adult men with a history of suicidality

Male suicide is an ever-pressing issue that presents a unique challenge to society. The impact of male suicide in the UK is considerable, and for every female suicide death, there are approximately 3.5 male deaths. For every successful suicide attempt, researchers speculate that there are twenty unsuccessful attempts and attempting suicide increases the likelihood of further attempts by up to 45 times. Despite significant research into the phenomenon, the number of successful suicides remains stubbornly high in the UK amongst men. Ultimately, a middle-aged man who has had a previous suicide attempt is at a very high risk of death by suicide. Despite the wide acknowledgement of the severity of male suicide, its disproportionate impact on families and society, and the encouragement of men to access formal and informal mental health support, there is minimal research on the experience of help-seeking for men recovering from a suicide attempt.
This research aimed to explore the experience of therapy of men aged between 25 and 65 who had a history of suicidality to generate much-needed information on their experience of help-seeking and how best to help men who have an arrested or unsuccessful suicide attempt.

Six male participants/co-researchers who had previously had an unsuccessful or arrested suicide attempt and had participated in individual long-term therapy (of at least 20 weeks) took part in the research. Data was collected through semi-structured interviews and analysed using reflexive thematic analysis within a critical realist paradigm. From this, three themes were identified: (1) Creating a safe space in therapy, (2) The push and pull of gender proximity, and (3) Iatrogenic harm in institutional care. Innovative methods of scriptwriting, acting, and filming were used to consolidate and display findings.

The data revealed the necessity for time and resources to develop safe therapeutic relationships to fully meet clients' needs and facilitate and support possible traumatic history revelations. Findings highlight a complex dynamic between the client’s and therapist’s gender, in the form of maternal representation, avoidance of competitiveness masculine traits and erotic transference within the therapeutic dyad. The experience of ineffective therapeutic help and high levels of bureaucracy from institutions, such as the NHS and their over-reliance on psychiatric medication, highlighted a significant issue and constituted a level of iatrogenic harm, which was a considerable influence in them seeking alternative provision in the form of private therapy or alternative medication.