ABSTRACT Objective This study explored the therapeutic skills and attitudes mental health care (MHC) workers draw on when engaging with existential concerns in working with individuals with a persistent death wish related to unbearable psychiatric suffering (DWUPS) and examined whether sustained exposure to specialised existential care settings shapes existential responsiveness and relational presence. Method A qualitative design was employed, following Elliott and Timulak's descriptive‐interpretative methodology. Eighteen in‐depth interviews were conducted with two samples: non‐specialised (Sample A) and specialised MHC‐workers affiliated with Reakiro, a care centre for persons with DWUPS which operates from an existentially grounded, presence‐based palliative and recovery‐oriented framework (Sample B). Interview transcripts were organised into thematic categories through inductive analysis. Comparative frequency analysis identified specific patterns. Findings Four core domains characterised MCH‐workers' engagement with persons with DWUPS: existential, relational and palliative skills and attitudes, alongside the importance of self‐care. Across both samples, participants described personal existential processing, presence, and existentially oriented interventions, relational engagement within the therapeutic space, facilitating connection with significant others and openness to the death wish as central to their work. Differences between samples were secondary and context‐related. Specialised MHC‐workers showed less hesitation in addressing the death wish, whereas non‐specialised MHC‐workers more strongly emphasised life‐affirming interventions and reported greater ethical and emotional burden. Conclusion Working with individuals with DWUPS requires an existentially grounded therapeutic stance that integrates openness to both life and death. The findings highlight the need for clinical training, peer support, and reflective supervision focused on existential presence, relational engagement and dual‐track care.
Verdegem et al. (Fri,) studied this question.