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This thesis consists of a literature review, a research paper and critical review which report on the experiences that health and mental health professionals have whilst working with death and dying. The literature review includes a meta-synthesis of findings from 14 qualitative studies of varying methodologies exploring the experiences of health professionals providing care to dying patients in palliative care settings. Three themes were identified. These were, 'The sources and management of dissonance in the work place' 'Sources of job satisfaction; Recognition, understanding and personal growth' and 'The advantages and disadvantages of close interpersonal relationships with service users and their families' . Further consideration of the outcomes demonstrated that the primary research may have been influenced by the quality of the original papers and by health policies. Recommendations were made for individuals involved in service planning and those providing support for those providing care. The research paper explored the experience of clinical psychologists following client suicide. A qualitative methodology incorporating semi structured interviews and narrative analysis was conducted which generated two rich, detailed stories relating to the experience. From these it is concluded that for clinical psychologists, client suicide results in a pervasive experience of anxiety. Furthermore, the sense of professional growth that is expressed by some clinical psychologists following a client suicide should be considered as a coping strategy used during adaptation to the loss. The dual processing model (DPM: Stroebe, Schut & Stroebe, 2005) and the self complexity model (Liniville, 1988) have utility in providing theoretical explanations accounting for the experience. Recommendations are made regarding measures that should be taken by clinical psychologists in the event of client suicide. Finally, the critical review contains reflections concerning the decisions that I made whilst planning and conducting the research.

The Intention of this thesis was to help elucidate psychological mechanisms underlying suicidal behaviour. Chapter one Introduces risk factors and current treatments for suicidal behaviour before going on to investigate whether a cognitive model of suicidal behaviour, 'the cry of pain', could add to our understanding of discrepant treatment findings, and provide new opportunities for understanding proximal risk factors for suicidal behaviour (in combination with the differential activation hypothesis).

Suicide has attracted a wide interesti in research and prevention strategies. However suicide in the elderly remained a neglected area. The aim of this study is to review all identified cases of suicide in Birmingham and Solihull over five calendar years and provide a description of their epidemiological and social characteristics, their physical and psychiatric morbidity, level of involvement of the mental health services and primary care, methods of suicide, history and methods of previous attempts of deliberate self-harm, influence of alcohol, likelihood of confiding suicidal intention, legal aspects such as likelihood of attracting suicide verdict and causes of other associated deaths, seasonal distribution, and identified causes of stress in the period leading to suicide. This included a study of suicide notes left by the study subjects. The study also aims to comparce characteristics and attributes of suicide in older people and younger adults along the lines mentioned above. The main hypothesis is that there is no difference between suicide in older people and suicide in younger adults. The data source in this study was the coroner's files for inquests which took place between 1 January 1995 and 31d December 1999. All cases of suicide verdict and open verdict that died at or above the age of 18 were included. The study provided a descriptive analysis for the total group and a comparison between older people (65+) and younger adults (18-64). Conceptual qualitative analysis was carried out to study contents of suicide notes. This study shows that elderly suicides had different characteristics and attributes from those of the younger adults in most of the examined areas, however, conceptual analysis of suicide notes did not show any difference but the number was small. The author recommends that the difference between older people and younger adults should be considered in training for primary and secondary care staff and in suicide prevention programmes. The findings of this study also suggest that older people should be considered as a separate group in studying suicide in future research.

This research projects deals with the question of whether the paintings of artists who have committed suicide is reflective of their mental states both in terms of content and form. It specifically attempts to answer whether the deterioration in mental state from a time of better mental health to the time of their suicide is expressed graphically in the paintings of those artists and whether this can be reliably observed. It was discovered that paintings in the absence of contact with or interpretation by the artists, provided enough information to enable non-expert judges to make reliable global content-related judgements (e.g. destructiveness and hopelessness) as well as form-specific ratings (e.g. lack of detail) that distinguished between paintings created near the time of artists’ suicides and their paintings created at a time of better mental health as well as paintings from artists who were suffering from depression. It was also found that non-expert judges were able to correctly identify paintings that were created just before artists’ suicides as reflecting serious mental health problems. Furthermore, it was discovered that there was a general preference for paintings from depressed artists over the last paintings by artists who have taken their own lives. The implications of these findings for clinical work both in terms of assessment and treatment were discussed. Furthermore, several limitations of this research project were noted and suggestions for future research were provided.

What are the long and short term effects of working with suicidal clients on the person-centred counsellor? As suicide remains a major public health issue with the latest figures for the UK of 5706, an increase from 5377 in 2007 (ONS, 2010), suicide prevention strategies remain high on the public health sector agenda. With this statement in mind, and financial resources and funding at a low, an increased demand on psychological therapies can be assumed. As a result, the impact on individual practitioners will most likely intensify, personally and professionally. This research aims to explore the extent the impact may have, personally and professionally on the person-centred counsellor. The study was structured using semi-structured interviews with a purposeful sample of ten person-centred counsellors. A constant comparative method was applied to analyse transcribed data, from which four main categories emerged: ‘Experiencing the Therapeutic Encounter’, ‘Experiencing the Self within the Therapeutic Encounter’, ‘Seeking Solace – finding understanding’ and ‘Counsellor’s Grounding through Knowledge’, each subsumed by several lower order categories, from which a core category ‘The Counsellor’s Resilience’ emerged. The findings propose that, although the participants in this study were at times deeply affected, both personally and professionally, by their clients’ stories, they were able to reclaim their strength through seeking and finding support from supervisors, peers, holistic self-care and tacit knowledge, gained through personal experience and understanding. Formal training was identified as lacking in counselling training courses. The implications of the findings and recommendations are discussed.

In this dissertation the literature on suicidal behaviour is reviewed, with particular emphasis on professional conceptualizations and understanding as informed by the psychiatric and sociological paradigms. Basic postulates of the Ecosystemic paradigm, as it is informed by Maturana's second-order cybernetic approach was discussed. The effect of such an approach on therapy with suicidal individuals was pointed out. It became clear that perceived methodological problems experienced when researching suicidal behaviour from a Newtonian/realist paradigm can be side-stepped when viewed from an Ecosystemic paradigm. It was finally proposed that an ethic of participation, as informed by a second-order cybernetic approach, be adopted when viewing the suicide situation. In the process ethics was reconceptualized as an awareness of the therapist's participation in whatever is created, and not in finding the ''right" way when working with suicidal individuals. / Psychology / M.A. (Clinical Psychology)

In this dissertation the literature on suicidal behaviour is reviewed, with particular emphasis on professional conceptualizations and understanding as informed by the psychiatric and sociological paradigms. Basic postulates of the Ecosystemic paradigm, as it is informed by Maturana's second-order cybernetic approach was discussed. The effect of such an approach on therapy with suicidal individuals was pointed out. It became clear that perceived methodological problems experienced when researching suicidal behaviour from a Newtonian/realist paradigm can be side-stepped when viewed from an Ecosystemic paradigm. It was finally proposed that an ethic of participation, as informed by a second-order cybernetic approach, be adopted when viewing the suicide situation. In the process ethics was reconceptualized as an awareness of the therapist's participation in whatever is created, and not in finding the ''right" way when working with suicidal individuals. / Psychology / M.A. (Clinical Psychology)