To Treat or Not to Treat: The Effect of Hypothetical Patients’ Suicidal Severity on Therapists’ Willingness to Treat

Yossi Levi-Belz, Shira Barzilay, Dorin Levy, Or David

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Therapists’ intense negative emotional responses regarding suicidal patients raise questions about therapists' willingness to treat them; however, this issue has yet to be investigated. The aim of the current study is to examine to what extent the severity of suicidality of a hypothetical patient will influence therapists' willingness to treat and the likelihood of their referring out. Mental health professionals (N = 249) completed a questionnaire that presented a vignette of a hypothetical patient referred for psychological treatment. The vignette contained a manipulation of the severity of suicidality levels of the referred patient, with two randomly assigned conditions: suicidal or depressive symptoms. Participants were then asked about their willingness to treat the hypothetical patient. Our results showed that willingness to treat was significantly lower and the likelihood of referring out was significantly higher among therapists in the suicidal patient condition, relative to the depressive patient condition. Longer professional seniority and previous training in suicide prevention moderated these effects. Our findings highlighted therapists' reluctance, especially among young practitioners, to treat suicidal patients, an inclination that may have a critical impact on patient suicidal outcomes. Findings reinforced the need for specific training on suicide prevention in the mental health curriculum.

Original languageEnglish
Pages (from-to)355-366
Number of pages12
JournalArchives of Suicide Research
Issue number3
StatePublished - 2 Jul 2020
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2019 International Academy for Suicide Research.


  • countertransference
  • risk assessment
  • suicide
  • suicide prevention
  • therapist reactions


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