Long‐Term Therapy Experiences in Post‐suicidal Men: Safety, Gender and Iatrogenic Harm

ABSTRACT

Male suicide remains a persistent public health challenge, with men in England and Wales dying by suicide at 3.5 times the rate of women. After an attempt, the risk of a further episode rises dramatically, yet how men experience the long‐term psychotherapy that should follow remains almost entirely absent from the literature. A systematic search identified only two qualifying qualitative studies, confirming that this population's perspective has been critically overlooked. This study explored the lived experience of long‐term individual psychotherapy, 20 or more sessions, for men with a history of suicidality. Six men who had experienced an unsuccessful or arrested suicide attempt participated in semi‐structured interviews. Data were analysed using reflexive thematic analysis within a critical realist paradigm. Three themes were identified: creating a safe space in therapy; the push and pull of gender proximity; and iatrogenic harm in institutional care. Findings establish that long‐term relational work, not technique, was the primary agent of recovery. A preference for older female therapists reflects reparative developmental dynamics rooted in early relational trauma. Institutional care, characterised by pharmacological prioritisation and inaccessibility, constituted a source of harm that drove all participants towards private provision. Clinical and commissioning implications are discussed.