Teachers College, Columbia University, New York, NY, USA.
Psychother Res. 2020 Jan;30(1):124-136. doi: 10.1080/10503307.2018.1543977. Epub 2018 Nov 8.
To identify psychotherapy clients' motives for concealing suicidal ideation from their therapist, and their perceptions of how their therapists could better elicit honest disclosure. A sample of 66 psychotherapy clients who reported concealing suicidal ideation from their therapist provided short essay responses explaining their motives for doing so and what their therapist could do to help them be more honest. Content analysis was used to identify major motives and themes in these responses. Seventy percent of suicidal ideation concealers cited fear of unwanted practical impacts outside therapy as the reason they did not disclose. Chief among these unwanted impacts was involuntary hospitalization, a perceived outcome of disclosing even mild suicidal thoughts. Less concrete motives for concealment, such as shame or embarrassment, were significant but secondary concerns. Nearly half of suicide-concealing clients said they would be more honest only if the threat of hospitalization was somehow reduced or controlled. Fostering disclosure of suicidal ideation in therapy may require renewed attention to providing transparent, comprehensive, and easy-to-understand psychoeducation about the triggers for hospitalization and other interventions. Clients make risk-benefit calculations about whether to disclose suicidal ideation, but may operate with exaggerated or inaccurate ideas about the consequences of disclosure.
为了识别心理治疗客户向治疗师隐瞒自杀意念的动机，以及他们对治疗师如何更好地引出诚实披露的看法。我们选取了 66 名报告向治疗师隐瞒自杀意念的心理治疗客户作为样本，让他们提供短文回答，解释他们这样做的动机以及治疗师可以做些什么来帮助他们更诚实。我们使用内容分析法来识别这些回应中的主要动机和主题。70%的自杀意念隐瞒者表示，他们没有透露自杀意念是因为担心治疗以外的不必要实际影响。其中最主要的是强制性住院治疗，即使是轻微的自杀想法也会被认为是这种治疗的后果。隐瞒的动机不太具体，比如羞耻或尴尬，虽然重要，但只是次要的担忧。近一半的隐瞒自杀意念的客户表示，只有在某种程度上减少或控制住院治疗的威胁，他们才会更诚实。在治疗中促进自杀意念的披露可能需要重新关注提供关于住院和其他干预措施触发因素的透明、全面和易于理解的心理教育。客户会对是否披露自杀意念进行风险收益计算，但他们对披露后果的看法可能存在夸大或不准确。
