How individuals with psychosis develop and maintain resilience to suicidal experiences through psychological therapy: a qualitative study

BackgroundAlmost half of people with psychosis have suicidal experiences. There is limited understanding of the processes underpinning psychological resilience to psychotic and suicidal experiences especially in people who have engaged with psychological talking therapies. Hence, the current study aimed to redress this gap by examining the perspectives of clients who had recent lived-experiences of psychosis, suicidality, and psychological therapy.MethodsSemi-structured interviews were conducted with 35 participants who had psychosis and suicidal experiences in the three months prior to recruitment. Data were analysed using reflexive thematic analysis.ResultsThere were four key psychological processes that contributed to resilience: (1) gaining a sense of control by nullifying perceptions of being controlled by overwhelming emotional and psychotic experiences, and instead, acquiring confident autonomy; (2) gaining a sense of hope facilitated by experiencing mental health problems on a fluctuating continuum, translating immersive positive memories into future possibilities, and embracing meaningful personal values; (3) developing genuine self-worth based on compassionate self-understanding, and affirmation of personal qualities; and (4) finding acceptance by being able to live alongside psychotic and suicidal experiences. Specific resilience components that participants developed through psychological therapy, together with their own knowledge and observations, were identified.ConclusionsPeople who live with psychotic and suicidal experiences can, and do, experience psychological change and psychological resilience in response to psychological therapy. To promote resilience, practitioners should pursue a person-based, client-directed approach; embrace acceptance; and be open to exploring different ways of working with clients' experiences of overwhelming thoughts and emotions.