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

Abstract Background: Almost half of people with psychosis have suicidal experiences including thoughts and/or behaviours. 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 both psychosis and suicidality, and who could also draw on these as a psychological therapy client. Methods: Semi-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. Results: There were four key psychological processes that contributed to resilience: 1. Not feeling controlled by persistent and powerful voices and the associated overwhelming thoughts and emotions; 2. Gaining a sense of hope facilitated by perceptions that ‘bad days do not last forever’, positive memories can be evoked and re-experienced, and that aspects of life have personal value and ‘moments of joy’; 3. Developing a sense of self-worth based on compassionate self-acceptance, self-understanding, and affirmation of personal qualities; and 4. Finding acceptance juxtaposed with being able to ‘stop the battle’ and living alongside distressing and negative memories, thoughts and emotions. . Conclusions: People who live with psychosis 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 and be open to exploring different ways of working with clients’ experiences of overwhelming thoughts and emotions and embracing acceptance.