Psychology

 

For this discussion, complete the following:

 Methods

“Phenomenological Research.”

“Grounded Theory Research.”

“Ethnographic Research.”

“Case Study Research.”

“Generic Qualitative Inquiry.”

• Select one of the three methodological approaches
• Choose and describe the sampling strategy that will be used in your proposed qualitative study.
• Provide a rationale for your sampling strategy.
• Identify and justify the sample size that you will use.
• Discuss the data collection procedures that will be used in your proposed study.
• Develop 10 open-ended questions to be used in a qualitative interview for your proposed study.

Article

The Role of Self-
Esteem in Suicides
Among Young Men

Mette Lyberg Rasmussen
1
, Kari Dyregrov

1,2
,

Hanne Haavind
3
, Antoon A. Leenaars

1
, and

Gudrun Dieserud
1

Abstract

This study explores self-esteem in suicide among young males with no earlier

history of suicide attempt(s) or treatment in mental health services. The data

come from an ongoing psychological autopsy study; 10 cases of young men aged

18 to 30, were selected to generate a phenomenologically based understanding of

the psychological mechanisms and processes involved in the suicidal process. The

analyses are based on in-depth interviews with 61 closely connected individuals,

as well as suicide notes. We used Interpretative Phenomenological Analysis. For

these young men, the transition to young adulthood, a period of major life chal-

lenges, seemed to be associated with personal defeats. According to their signifi-

cant others, the deceased seemed to have experienced intolerable discrepancies

between their actual performances and their ideal self standards. Four themes

emerged from the analysis: (a) striving to find a viable path to life as an adult man;

(b) experiencing a sense of failure according to own standards; (c) emotional self-

restriction in relationships; and (d) strong feelings of loneliness and rejection of

self. Improved understanding of suicides outside the mental illness paradigm may

have important implications for preventive strategies.

OMEGA—Journal of Death and

Dying

2018, Vol. 77(3) 217–239

! The Author(s) 2015

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DOI: 10.1177/0030222815601514

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1
Norwegian Institute of Public Health, Division of Mental Health, Oslo, Norway

2
Center for Crisis Psychology, Bergen, Norway

3
Department of Psychology, University of Oslo, Norway

Corresponding Author:

Mette Lyberg Rasmussen, Norwegian Institute of Public Health, Division of Mental Health,

P.O. Box 4404, Nydalen, Norway.

Email: mera@fhi.no

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Keywords

suicide, young men, self-esteem, shame, psychological autopsy, qualitative analysis,

suicide prevention

Our knowledge base for suicide prevention is largely based on studies of clinical
populations, often indicating a causal relationship between suicide and mental
disorder (e.g., Cavanagh, Carson, Sharpe, & Lawrie, 2003). However, several
studies have not supported this causal link, and there is growing evidence that
not all suicides are preceded by symptoms of serious mental disorder (Judd,
Jackson, Komiti, Bell, & Fraser, 2012; O’Connor, Sheehy, & O’Connor, 1999;
Owens, Booth, Briscoe, Lawrence, & Lloyd, 2003). From a preventive standpoint,
due to high suicide rates among young men, there is a need to understand more of
the complexity that places men in particular at risk (De Leo, 2002). Further, there
is a need for greater understanding of suicide among individuals who do not
present symptoms of serious mental illness prior to death (O’Connor & Sheehy,
2001; Shneidman, 1985). The transition from late adolescence to young adulthood
is a period of major life challenges and developmental changes in the self (Erikson,
1968; Harter, 1999), a phenomenon often overlooked by suicide researchers (King,
Apter, & Zohar, 2007; Leenaars, 2004). In particular, there is a need to understand
more of the psychological characteristics and mechanisms, such as self-esteem,
that regulate the dynamics of suicide in young individuals (Evans, Hawton, &
Rodham, 2005; King et al., 2007). In the present study, self-esteem was explored
in relation to suicide among young men from a nonclinical sample.

Self-Esteem and Suicide

Significant research on psychological processes leading to suicidal behavior has,
in various ways, focused on deficits in self-esteem. In analyses of the self eva-
luative component of the self-concept, negative self-evaluation in particular has
been identified as a key factor in the suicidal process (Fergusson, Beautrais, &
Horwood, 2003; Overholser, Adams, Lehnert, & Brinkman, 1995; Thompson,
2010). In several studies, suicide attempters have been found to have signifi-
cantly lower self-esteem compared with both normal controls (Dieserud,
Røysamb, Ekeberg, & Kraft, 2001; Grøholt, Ekeberg, Wichstrøm, &
Haldorsen, 2005; Overholser et al., 1995) and psychiatric outpatients with no
history of suicidal behavior (Dieserud et al., 2001). While these studies have
effectively linked negative self-evaluation to suicide attempts, the nature of
self-esteem in relation to suicide is still poorly understood (Harter, 2006).

A major problem of much of the research relating to self-esteem has
been the conceptualization of self-esteem as a global measure of self-worth

218 OMEGA—Journal of Death and Dying 77(3)

(Crocker & Park, 2004; Mruk, 2006). Consequently, research has been focused
on the examination of the level of self-esteem as the critical aspect in suicidal
individuals. However, there is evidence suggesting that self-esteem should be
conceptualized as a multidimensional developmental construct, including both
competence and worth as primary components (Harter, 1999). Self-esteem,
defined as, “the conviction that one is competent to live and worthy of living”
(Branden, 1969, p. 110), is a complex construct (Mruk, 2006). A person’s self-
esteem may be situation-specific as a person can have different perception of self-
esteem in different relational contexts (Harter & Whitesell, 2003). In one of
several studies, Harter and Whitesell (2003) found that while some adolescents
reported stable self-worth across social contexts with parents, teachers, and
classmates, others reported extreme variations. Other studies have shown that
people whose self-esteem depends on approval from others can be particularly
vulnerable toward acceptance and rejection and a need to live up to own/others’
expectations (Crocker & Park, 2004; Guay, Delisle, Fernet, Julien, & Sene_cal,
2008; Leary & Guadagno, 2011). Similarly, people whose self-esteem is based on
their own competencies may be very vulnerable toward failure or lack of success
in the domain in which they have invested their self-worth (Crocker & Park,
2004; Crocker & Wolfe, 2001; Deci & Ryan, 1995). Consequently, a major factor
in self-esteem regulation is the perceived discrepancy between the ideal and
actual self, such as might be illustrated when one falls short of expectations or
standards in domains of importance (Deci & Ryan, 1995; Harter, 1999; Harter &
Whitesell, 2003). Thus, a discrepancy between the ideal and actual self is sug-
gested to be of central importance for the suicidal self (Baumeister, 1990; Vohs &
Baumeister, 2010). Yet, such a discrepancy has been largely unexplored.

The Psychological Autopsy method (PA; Shneidman, 1993) has become a
primary approach to studying suicide. Qualitative methods of analyses are con-
sidered particularly suitable for studying the link between self-esteem and beha-
vior (Mruk, 2006). Thus, there is a need for PA studies based on in-depth
interviews with many informants, and qualitative methods of analyses if a
better understanding of the interplay between internal and external factors influ-
encing self-esteem in suicide is to be attained.

As a person’s self-esteem may vary by relationship context, it is important to
explore both the mother’s and the father’s perception of how the relationship
with their son has developed, and how they have handled the transition from
being a dependent son to an independent young man. In similar ways, due to
identification issues, the standards and ideals of significant male friends may be
highly influential on the standards and ideals of the deceased. The issue of sexual
identity and capacity for intimacy is of central existential value to young men
(Erikson, 1968). This may be explored by information from intimate partners of
the deceased. Through all significant relationships, self-esteem will be intrinsi-
cally connected to standards of masculinity in the transition to adulthood
(Connell, 2005).

Rasmussen et al. 219

The aim of the present study was to analyze the role of self-esteem in the
suicidal process of young men with no prior psychiatric treatment and no pre-
vious suicide attempts, in their transition from late adolescence to young
adulthood.

Method

A Phenomenological Approach

The study is based on data from an ongoing PA study (Dieserud, 2006) where
the main purpose is to generate a phenomenologically based understanding of
the psychological mechanisms and processes involved in the suicidal process, by
means of qualitative analyses. The study was based on in-depth interviews and
suicide notes when available.

Sample

A sample of 10 young men who died by suicide was studied by analyzing in
depth-interviews of four to eight key informants related to each suicide, as well
as six suicide notes. A total of 61 individuals, who were closely connected to the
deceased, were interviewed. All informants were over 18 years old.

The suicides of these 10 young men were selected from a total of 20 suicides
from the PA study, among individuals with no prior psychiatric treatment and
no previous suicide attempts. The selection was based on the first author’s first
reading, rereading, and the construction of case narratives of all 20 suicides (120
interviews). A bottom-up approach starting with no fixed notions as to what
would emerge from the narratives of the informants was used. As self-esteem
issues became more and more salient in the construction of the case narratives of
the young men due to a problematic doubleness in their self in the transition to
adulthood, the choice of sample was governed by a wish for a deeper exploration
of the role of self-esteem in these suicides. The doubleness was related to how
these young men apparently had normal and successful developmental processes
in the transition to adulthood, yet at the same time, struggled with difficulties
related to normal developmental tasks. The 10 young deceased were all between
18 and 30 years of age, and represent all men under the age of 30 in the PA
study. Both parents of the deceased were included as informants, with one
exception where the father not available. Additionally, in most cases, the siblings
of the deceased were also included as informants. Five of the deceased have had
serious relationships to girlfriends, all these young woman were included as
participants. All the deceased had between one and five close male friends
who were also included as informants. Three of the deceased young men
had lived together with their parents, five lived in rented apartments or
houses, and two were homeowners. Three of the deceased were students

220 OMEGA—Journal of Death and Dying 77(3)

(high school/university), five were employed, and two were unemployed. One of
the deceased was a father. The methods of suicide included hanging (8) and
shooting (2). Almost all interviews took place between 6 and 18 months after
the suicide; in one case, the interviews took place within 24 months of the
suicide.

Procedure

Data were collected from all municipalities in the 7 of 19 counties in Norway
with the highest number of suicides in 2003. All suicides took place during the
time period 2005 to 2009. Chief municipal medical officers in the selected muni-
cipalities were asked to (a) identify cases of suicide based on death certificates
and forensic reports; (b) ensure the exclusion of those with previous suicide
attempts and previous treatment in mental health services; and (c) contact the
General Practitioner of the deceased, who provided the name and address of
the deceased’s next of kin. The chief municipal medical officer sent a letter to the
next of kin with thorough information about the project and purpose of the
study. A consent form that the next of kin had to return to the project
leader should they wish to participate was also included. In the letter, the infor-
mants were asked to provide suicide notes, if available. To shorten the time
needed for data collection, some informants were recruited by Center for
Crisis Psychology in Bergen. As soon as the completed consent form was
received, the informant was contacted by phone, by the interviewer, and a
time and place for the interview was agreed on. After the interview, the infor-
mant was asked to provide names and addresses of at least four other infor-
mants who knew the deceased well. The procedure of sending a letter and
consent form was then repeated, but now the letter was sent from the project
leader (G. D.). Most of the interviews were conducted in the homes of the
informants, some in the researchers’ offices, and some at hotels, depending on
the preferences of the informants.

The interviews started with a narrative section, which opened with the
researcher posing a question about the informants’ perception as to what led
to the suicide: “What are your thoughts on the circumstances that led to the
suicide of . . .?” This part of the interview was governed primarily by allowing
the informant to speak without any interruptions or leading questions from the
interviewer. After this section was completed, a problem-focused part of the
interview was performed. In this part, the interviewer asked focused questions
about topics not previously covered in the narrative section. The informants
were also asked to clarify details from the narrative that needed to be fol-
lowed-up or verified to ensure that the information provided was correctly
perceived by the interviewer. A theme guide consisting of 16 categories based
on Shneidman (1993) was used. The themes in this study cover details of the
death, personal, and family history of the deceased, relationship issues,

Rasmussen et al. 221

personality, lifestyle, patterns of reaction to stress, alcohol or drug use, changes
in the deceased before death, and strengths and successes.

Three researchers with extensive experience and knowledge in the field of
suicidology and in-depth interviewing of bereaved individuals conducted the
interviews (M. L. R., K. D., and G. D.). The interviews, lasting an average of
2.5 hr (range 1.5–3 hr), were audio-taped and transcribed verbatim. Each inter-
view contained approximately 30 to 40 transcribed pages. To strengthen the
interrater reliability of the transcriptions, a coding system for paralinguistic
expressions including verbal pauses, laughter, and crying was used by two
trained transcribers.

Ethical Considerations

All procedures were conducted in accordance with the Helsinki declaration. The
study was approved by the Norwegian Regional Committee for Medical
Research Ethics and the Data Inspectorate of Norway. The informants were
contacted by letter in order to reduce pressure on informants concerning parti-
cipation. In the recruitment letter, the purpose, method, and procedure of the
study were described, and the informants were offered telephone contact with
the researcher for more information. The participants were assured of anonym-
ity, confidentiality, and freedom to withdraw from the study at any time. Thus,
care of the participants during the entire research process was performed accord-
ing to recommendations for research on vulnerable populations (Dyregrov,
2004). Informants were informed that data would be published in a nonidentifi-
able way. At the end of the formal interview, a debriefing conversation was held
to allow the participants ask questions, as well as for the researcher to ensure
that the participants were not left in distress. Arrangements with mental health
services were made for the participants who were in need for such.

Analysis of Data

Qualitative analysis was conducted following the flexible guidelines of
Interpretative Phenomenological Analysis (IPA; Smith, Flowers, & Larkin,
2009). Since this study is concerned with the exploration of psychological pro-
cesses and mechanisms involved in suicide, the procedure adopted involved
treating the interviews and suicide notes around each suicide as one set of
data. The analysis was carried out case by case, with an awareness of how
each informant filled the existential space between the deceased and the infor-
mant as a male friend, as a brother, as a son, and as a boyfriend. Additionally,
since it was another person who was telling about—or trying to imagine–what
was on the mind of the deceased, it was important that the informants were able
to locate their notions about what could matter to the deceased during his life
and in the period prior to the suicide, in actual experiences. Experiences could be

222 OMEGA—Journal of Death and Dying 77(3)

from their (longstanding) relationship and anchored in events that took place in
time and social space. Thus, each of these young men was the subject of the
analyses in relation to the existential issues (i.e., issues that matter for building
and sustaining a sense of freedom and self-determination) at stake in their life
prior to the suicide. In this sense, each informant was invited to contribute to an
“insider” perspective as they saw it. During the interviews, “how do we know
him” was an ongoing issue, open to interpretation and critical questions from
the interviewer. In the analyses, when all interviews around the same case were
pieced together, the researchers were concerned about construing the deceased
as a subject and the suicide as influenced by the existential places that the
deceased had inhabited. Thus, in line with the phenomenological and hermeneu-
tical obligations of IPA, critical questions about the interpretations were con-
tinually asked during the data analysis. By letting the deceased be the subject for
our analysis, the researchers interpreted the informants’ interpretations of the
deceased, through a triple hermeneutics (Smith et al., 2009).

The next stage of the analysis was to compare all the 10 cases with each other,
looking for emerging themes and dynamics in the regulation of self-esteem in the
transition to adulthood. For the first author, this involved returning to all the
transcripts connected to each suicide and transforming the initial thoughts
and questions to the data, based on notes from the first close readings, to
codes for the emerging themes. The search was for themes that emerged
across the cases. This involved both themes that emerged from comparing exis-
tential issues from informants who shared the same position, like being with
friends, being with mother, being with father, and so forth, and themes that
emerged as similar for some cases across all of the interviews connected to the
same suicide. Existential issues are telling the researcher about who one can—or
cannot—be in the world, and existential places connect people in specific posi-
tions. The regulation of self-esteem and the possible meanings of the suicidal act
could therefore be seen as a set of tensions and movements between “actual and
idealized existential places.” In keeping with the IPA idiographic commitment, it
was important to allow new themes to emerge within each case when they were
compared with other cases. In this way, the interpretation became an interactive
process where the researcher moved back and forth between the various analy-
tical stages, between the different informants around each suicide as well as
between the suicides—always sticking to what the participants said. The con-
cluding stage was to look for and connect all the superordinate themes across the
suicides.

The validity and credibility of the analyses was based on triangulation on
three levels. First, by using the PA-method, interviewing four to eight indivi-
duals with close relationships to the deceased and analyzing suicide notes, it is
assumed that it is possible to construct a valid picture of the deceased.
Second, through a critical examination by the interpreters, who were the
actual interviewers (M. L. R., K. D., and G. D.), attempts were made to

Rasmussen et al. 223

reduce interviewer bias. Third, the analysis was conducted by the first author
(M. L. R.). To ensure that the analysis is not confined to one perspective, the
developing analyses were continuously discussed within the other authors and
within the research team (Yardley, 2008). Regarding reflexivity, the first, second,
and fifth authors are female psychologists/sociologist with long experience in
working with suicide prevention, suicide attempters, suicide bereaved, and qua-
litative methodology. The third author is a female professor in clinical psychol-
ogy with considerable experience within developmental psychology and a nestor
within qualitative research. The fourth author is a male psychologist and a very
experienced suicidologist, with a strong international reputation.

Results

Based on the qualitative analysis (IPA), four superordinate themes emerged: (a)
striving to find a viable path to life as an adult man; (b) experiencing a sense of
failure according to own standards; (c) emotional self-restriction in relation-
ships; and (d) strong feelings of loneliness and rejection of self. Quotes are
used to substantiate each of the superordinate themes, although in an anon-
ymous way.

Striving to Find a Viable Path to Life as an Adult Man

All the deceased were described as coming from resourceful families in the sense
that the men had grown up with both parents, or a mother, and a father figure.
Parents, siblings, and friends would all describe the living conditions of the
deceased as quite ordinary (very good) and before the suicide, the men func-
tioned within the range of normality. The friends of these young men talked
about deceased as individuals who were more or less in the same life situation
as themselves, with respect to having good jobs, being financially stable, and
as having many of the same interests in life. Although some of the deceased
were described as excellent in their work, or as talented students, these men
still seemed to move in the direction of overachievers or as persons who, in
addition to being ambitious on their own behalf, also always helped others.
Friends linked their own understanding of the suicide to the discrepancy
between how the deceased constantly strived to live up to high self ideals,
while at the same time struggling to function and adapt effectively in love and
work. Some of the young men were described as being alone and too constrained
to be able to overcome personal difficulties. In one way or another, all the
deceased seemed to be striving to find their path in life through education or
work.

The following refers to one of the deceased who was described by all his
informants as a shy person and as being in limbo after high school. One infor-
mant focused on how the deceased was striving to live up to an ideal standard of

224 OMEGA—Journal of Death and Dying 77(3)

achievement while, at the same time lacking the capacity to find a viable path in
life,

And about that, yeah . . . that he couldn’t figure out what he should do with his life,

even though he did do something, he did apply for university in the end then

but . . . I don’t know if it was just like, for the sake of having a plan for show . . . it’s

difficult to figure things out you know, if you can’t find a path at all in life.

According to a friend, who was also shy, but who had managed to find a path
in love and work, the deceased

was still in the same place . . . he was at home a lot, just by his computer . . . he didn’t

dare to open up . . . he had not made any progress toward girls either,

I think . . . there was like no attachment or anything.

In another case, a best friend described how the deceased identified with and
tried to copy him, instead of making decisions for his life based on his own
values and desires:

. . . we have spent much time together, both leisure time and time at work. We were

always together . . . and I sort of became a model for him. Whatever I did, he would

do all the time . . . he got restless if he did not manage these things . . . He really

wanted to be like me.

The deceased seemed to have coped by adapting the life styles, plans, and
values of some “superior” others (friend, father, authorities, and boss). Many
informants point to the importance of significant others for emotion-regulation
and sense of self-worth, and described, like in the case above, how any discre-
pancy from their standard created emotional stress:

He really looked up to his dad, was actually very afraid of his dad, I think. And yet

he sort of saw up to him, you know, that he could always ask for advice and

always, yeah . . . and he did that quite a lot, he called his dad about every-

thing . . . but at the same time he could get really angry if he felt that he did not

manage things just as well as his dad did, so he could get really angry.

In these two examples, the informants are referring to the lack of reciprocity
in how the deceased compared himself to others. In another case, according to
the ex-girlfriend, the deceased only seemed to find inner balance and be relaxed
when he was very close to her (“as-one-with”). These young men seemed to have
a strong need to seek emotional stability, safety, identity, and a sense of worth
from another person. Thus, instead of drawing on their own capacities for
finding their path in life, the young men in this study were constantly striving

Rasmussen et al. 225

to reach a perceived ideal standard for successful achievement. As a group, they
were young men whose identities were tied up to a very high activity level,
successful performance at work (or studies), good looking bodies/clothes/
girlfriend, and a perfect facade. These young men could not rely on their own
judgments since they were in such great need for admiration, confirmation,
nurturance, and guidance from those they regarded as their superior others.
In one case, the ex-girlfriend described how she understood the striving of the
deceased to cover up for an “unsecure” part of his self:

. . . he has always been very insecure, so he became very dependent on, very inspired

by his success and the confirmation he got from other people . . . and very concerned

about proving to the world that in a way he did well. So he was very, or he always

felt very . . . inferior through the years. He was very . . . it meant a lot to him to

succeed in a way, so be able to show people and be good enough.

Their intensity in life and their need for successful achievement were, by many
friends and ex-girlfriends, understood as a compensation for a deeper sense of
insecurity, worthlessness, inadequacy, deficiency, inner emptiness, and dread of
being alone. Despite being described as successful professionals or students,
many were at the same time understood as immature young men, and some
were described as “not happy in life.” Thus, the deceased had difficulties related
to both being alone and being with others. The sibling of one of the deceased
said:

he thought it was incredibly difficult with girls. He didn’t quite know how to go

forward . . . how to create a stable relationship . . . that he didn’t function like this or

that, or that he couldn’t create good relationships.

Descriptions of difficulties related to finding a way to “connect with girls” or
“develop a healthy love-relationship” were common for all these young men.

Experiencing a Sense of Failure According to Own Standards

In all cases, the suicidal act was understood as relating to a “self” that was aware
of a failure to live up to a needed standard or expectations (own/other’s) and
thereby self-blame for the loss of a necessary stability in life. These standards/
expectations were not necessarily related to a high or ideal standard, but the
experience of this failure had been emotionally significant. Living up to a certain
standard seemed necessary to preserve “the self as a whole” and therefore give
the self a sense of worth.

For one of the men, although having had difficulties in being alone and
seemingly in desperate need for an intimate relationship, he had not been able
to establish a new relationship after a breakup with a woman several years

226 OMEGA—Journal of Death and Dying 77(3)

earlier. According to his informants, the deceased changed into to being
“nothing,” an “outsider” or “felt like a failure” because he was not at the
same place in life (with a girlfriend and a family) as his “superior” friend(s).
His mother described:

But I think that, well in relation to the suicide . . . that it had been a difficult period

just now . . . and if he felt he couldn’t cope with the situation . . . working was his life.

In general, most of the deceased were not satisfied regarding their need for an
intimate relationship, their need for matching their significant others’ standard
of living or for successful achievement at work. Thus, the cultural expectations
of the development of a more autonomous and independent self entering
adulthood were not met. Described as very sensitive when making only minor
mistakes, being criticized, or for perceived rejections, the deceased were thought
to no longer see themselves as superior. Many informants considered
this a critical factor related to the suicide. For some of the deceased, only a
minor work transition seemed to have led to an unmanageable sense of social
downfall.

In one case, the informants point to an observable change in the behavior of
the deceased a couple of months before the suicide, which they connected to an
upcoming separation in his love-relationship. He lost weight, got sleeping diffi-
culties, became stressed, and started to complain that he felt his achievement at
work wasn’t good enough any longer, although it was outstanding. Having
identified with his “superior” friend, he followed his friend’s advice as if there
was a powerful sense of obligation to do so,

I remember him saying that he was a man of principles, and he really was. He stuck

to his principles like a rock . . . even if he would want to act differently, he just could

not, due to his moral standard.

This may be understood as a desire to possess one’s self in a position of the
same confidence and self-assurance as the person he identified with, and thus
reflect the achievements and power of that person. However, facing conflicting
ideals, this young man was understood as caught in between two incompatible
“existential places.” Many of the deceased were described as being unable to put
their conflicts or sorrows behind and move on, and they seemed to be stuck in a
situation of self-blame.

The crucial impact of self-blame seems to have been central in all 10 suicides.
According to one of the fathers, the deceased’s standard was to be “perfect in
every way, afraid of making mistakes and fearing the consequences if he failed.”
Even after attempting to rectify mistakes, it seemed he still ended up in a self-
blaming situation. In his suicide note, he wrote that he could have done things
differently. Thus, when a person who does not allow himself room for failure

Rasmussen et al. 227

fails, it is not the size of the discrepancy that is important but the significance of
the discrepancy.

For several of the young men, a higher level of autonomy was expected from
them when entering adulthood than they seemed to manage. Many informants
stated that the deceased may have struggled with unmanageable feelings about
themselves in the light of real or imagined evaluations by significant others. One
informant described how he understood the situation when the deceased killed
himself:

He probably regretted what he had done. Probably didn’t feel so very big, to put it

like that, and quite simply probably felt a bit like a failure . . . disappointed his

parents and disappointed himself, he had really messed it up.

As most of the suicides were understood as relating to a breakup of a love-
relationship or the separation from the childhood home, the informants
regarded dependence on other people as a main problem area for the deceased.
Lacking a necessary inner base of self-worth, the deceased seemed to be depen-
dent on significant others for confirmation and support. According to one ex-
girlfriend, “So I’m not sure that he had regretted it in a way . . . the break
up . . . only he sort of needed so badly to have someone there . . .”

Emotional Self-Restriction in Relationships

To understand why these young men chose suicide, when they seemed to have
had other options, the informants turned to the emotional aspects of the
deceased. For the deceased, failing to live up to standard/expectations created
strong unbearable feelings of shame, disgrace, or anger. One of the deceased was
described by the informants as very ashamed after having had an emotional
break down some weeks before the suicide. One informant said: “. . . maybe he
felt he would be looked upon as a weirdo and . . . then it’s better then it, yes, to
keep the facade all the way until he could kind of escape from it all.” Exposing
his self and all his flaws, for all to see, was understood as too much for him, as a
private person, to bear. The awareness that his significant others, on whom he
was dependent for his social life, had seen him the way he “really was” made it
impossible for him to meet them again. Another of the young men wrote in his
suicide note that he wanted to be forgotten like he had never existed. This could
be interpreted like he was feeling too ashamed and worthless to even be worthy
of remembrance.

One of the deceased, who was no longer able to hide behind his great super-
iority, in a conversation with one of the informants only a few days before he
killed himself, expressed “anger towards the whole world.” He said that he could
not take another defeat, and that he hated himself. Not able to exist as the
person he saw, he tried to change into someone else (new clothes and behavior).

228 OMEGA—Journal of Death and Dying 77(3)

In another case, one informant who spoke with the deceased a few days
before he killed himself, observed, loneliness, shame, trapped anger, and
self-condemnation,

And then he cried . . . all these bad feelings. I believe that he felt very much alone, it

was as though it was like his dark secret you know, that he had in a way become

very lonely in a way . . . so I figure that he maybe became, was starting to become

the person he hated most you know . . . And that he felt he no longer had control . . .

These young men were no longer able to control themselves: In essence, these
young men had crossed a line. Once they had exposed what they may have
perceived as their inferior self, this could never be undone. For one of the
deceased, after being abandoned and violated in front of all his friends some
days before he killed himself, anger was understood to be his main affect, in
addition to shame. According to all his informants and his suicide note, this
exposure was the last straw; underneath he was weighed down by too much
trapped anger. In another case, the informants described the deceased’s aggres-
sive outburst the night he killed himself like a “volcano,” where he had kept
everything inside. When activated, it mobilized enormous powers that lasted for
hours. According to the informants, this was typical for him with his temper,
stubborn as he was, when he first decided on something, he could not stop. For
another deceased, according to his suicide note, longstanding anxiety seemed to
have been a main issue. Several of his informants pointed out that he lacked
emotional capacity to handle even minor anxiety, meaning he was unable to
handle even a small discrepancy between his ideal (perfect) and actual self, and
therefore was seen as very restricted in his behavior.

Thus, common to all the deceased, from whoever’s perspective one examines
it, was a lack of capacity to handle emotional distress or chaos, and a tendency
to act upon oneself. Described by many of their parents as “private” young men,
several siblings said “we never had deep conversations.” Their friends described
them as someone who “did not show emotions,” “kept difficulties inside,” or
“not the one we discussed emotional difficulties with.” According to their ex-
girlfriends, although some were described as “very emotional” young men, when
things were difficult “they withdrew,” or were “emotionally elusive.” Thus,
common in all informants’ understanding was a lack of self-regulation. The
deceased would try to keep a distance from the self through activities like work-
ing, shopping, partying, sleeping, or being on the computer. One friend
described how the deceased lacked emotional capacity to handle and act on
his problems like this:

He has gone and carried it around, that mistake he made . . . He was in a chaotic

situation . . . could not take it any longer . . . did not know how to deal with the

situation . . . he was going in circles, it built up.

Rasmussen et al. 229

Strong Feelings of Loneliness and Rejection of Self

In the process of striving to find a path in life, many of the informants described
a discrepancy between where the deceased’s “self” was located in real life and
where it no longer could be, as well as the “existential place” where they needed
to be. Unable to establish what they needed in their real lives, the suicidal act
was understood as the last act from a failing self in desperate need to restore
itself. One informant described how the deceased presented the discrepancy
between where his self was located, where he could not stay any more, and
the “existential place” where he needed to be:

And a week before he . . . took his life and, so he did call and say that he couldn’t

take it anymore like, “I can’t take it any longer,” . . . and he was so lonely and he

only wished he had a family. And . . . yeah, everything was so difficult, he was so

tired and like everything was just wrong you know . . . very hard to be by him-

self . . . and the only, the only thing he wanted was like to have a family you

know, and to be like safe and happy.

Similarly, in their suicide notes, many of the deceased described their self to
be in a place of unbearable pain; they couldn’t take it any longer or they couldn’t
live like this any more. Often, they blamed themselves for their misery. A few
also blamed others. According to the informants, many deceased seemed to have
idealized their longing instead of taking a problem-solving approach. Their
longing for a better life could be understood as a result of lacking strategies
to handle difficulties in their existing relationships, as well as a fear of being
alone.

Further, in their suicide notes, many of the young men seem to have posi-
tioned themselves as distributors of great love to everybody. Several presented
“heaven” or “God” as the existential place they were longing for to “get peace”
or “be free.” For some of the deceased, according to how it was understood by
the informants, having been rejected from their “existential places” in real life
only a short time before they killed themselves, heaven seems to have become
their ideal solution. They were hoping for a continuation of existence. However,
unable to handle the complex emotional situation in real life, from most of the
informants’ points of view, the suicidal act was understood as a conscious and
planned event, based on “choice of method,” “scene of the suicide,” and the fact
that many of the deceased left suicide notes. Several informants related to dif-
ferent suicides said that they had, “talked about death,” “death wasn’t unfami-
liar to him,” “he had planned to die.”

There seemed to have been a double movement in the deceased. According to
the suicide notes, the deceased “moved themselves” from a place in real life
where their self was located, describing themselves as worthless and having
had failed in life, to an alternative place—heaven/God—where they could be
at ease with themselves. Heaven/God seemed to have become their escape as a

230 OMEGA—Journal of Death and Dying 77(3)

place with no demands, where their self-idealization could again be realized, and
where their self was in a position of great power and worth. In his suicide note,
one of the deceased placed his “self” next to God, from where he would lay and
watch over his significant others and take care of them—as one who takes
responsibilities for others and is caring for their safety. Yet, at the same time,
the suicidal act was understood as a way of turning passive humiliation into
active mastering in their real life, as a “revenge,” or as a way to “show others
and to make them understand.” Thus, worthless on their own, unable to act
differently to regulate emotions and thereby be able to comfort themselves, the
suicidal act seems to have been a desperate operation by a failing self to restore
itself.

Discussion

On the basis of these themes, a model is proposed as to how self-esteem may be
involved in the process leading to suicide (see Figure 1). Taken together, these
four themes constitute a dynamic model for how the young men were entrapped
in what they may have experienced as an intolerable discrepancy between their
actual performances as young men and their ideal standards.

Consistent with some theoretical models of suicidal behavior (Baumeister,
1990; Vohs & Baumeister, 2010), it was found that the suicidal crisis appeared
to be related to an intense negative affect as a result of falling short of one’s own
standards. The deceased seemed to blame themselves; they interpreted a per-
ceived failure as a function of characteristics within the self. As shown by other
studies, there seems to be the discrepancy between the ideal self and the actual
performance that is crucial in suicide-related behavior (Chatard & Selimbegović,
2011; Cornette, Strauman, Abramson, & Busch, 2009; Orbach, Mikulincer,
Cohen, & Stein, 1998). Contrary to Baumeister (1990) and Franck, Raedt,
Dereu, and Van den Abbeele (2007), who suggested that it is the size of the
discrepancy between ideal self and actual performance that is crucial for initiat-
ing the suicidal process, these findings show that the size of the discrepancy is
insignificant for someone whose standard (ideal self) does not allow room for
any failure. When one’s self-esteem is threatened, it is the meaning of the failure
that is crucial (Crocker & Park, 2004; Harter, 1999). In addition, it was found
that the suicides in this study, despite being sudden and unexpected, were never-
theless understood as the end result of a process developed over time, related to
the capacity for ego development of the deceased (Erikson, 1968; Leenaars,
1991).

Using the psychosocial developmental theory of Erikson (1968), it could be
argued that these young men had not resolved the process of ego formation in
adolescence in a way that made them able to master the challenges of intimacy
or to live by their own standards. Thus, these young men could not regulate their
self-esteem or ambitions without approval from others. Instead, the deceased in

Rasmussen et al. 231

this study seemed to have arrived at adulthood without having consolidated
their identity. The young men either may have undergone premature identity
foreclosure, by assimilating into a significant other’s (father/friend/boss) identity
structure, or may have been unable to engage in any form of identity formation,
a state of identity diffusion (Kroger & Marcia, 2011). Consequently, one can
assume that the young men proceeded into adulthood with unconstructed iden-
tity elements based solely upon childhood identification. As a result, the young
men had a strong commitment to their childhood internalized “ideal self” for
self-esteem regulation (Kroger & Marcia, 2011). While “Ego identity refers to a
sense of who one is, based on who one has been and who one can realistically
imagine oneself to be in the future” (Marcia, 2002, p. 202), our findings suggest
that the deceased entered adulthood with an idealized standard of their self that
they were neither able to meet nor to defy. To protect a fragile self-esteem and to
maintain a cohesion of the self (Erikson, 1968), many seemed to have found a
viable path by becoming overachievers, driven by a high need for control and
avoidance of failure. A similar pattern has been found in a recent study of
suicide among the elderly (Kjølseth, Ekeberg, & Steihaug, 2009, 2010), in several
studies of suicide related to perfectionism (Bell, Stanley, Mallon, & Manthorpe,
2010; Fortune, Stewart, Yadav, & Hawton, 2007; King et al., 2007) and in
studies of suicide and narcissism (Ronningstam & Maltsberger, 1998;
Ronningstam, Weinberg, & Maltsberger, 2008). In addition, their need to be
in a love-relationship and to be a successful achiever may reflect the longing to
merge with whom or what these young men hoped for, to complete them and
fulfill their life aspirations and yearnings (Erikson, 1968; Morrison, 2009).

Discrepancy in self
entering adulthood

Ideal
self

Actual
self

1. striving to find aviable path

2. sense of failure

3. emotional
self-restriction

4. loneliness and
rejection of self

Shame/
anger

Death

Discrepancy in self
entering adulthood

Figure 1. A dynamic model of self-esteem regulation in the suicidal process.

232 OMEGA—Journal of Death and Dying 77(3)

The findings here suggest that the vulnerability in the self of the deceased
seems to be related to a lack of a more developed, differentiated, and autono-
mous self (Erikson, 1968; Leenaars, 1991). Deprived of inner resources to reduce
emotional distress and maintain their self-worth, they were dependent on
approval from significant others, successful achievements, good looking
bodies, perfect facades, and so forth, to keep their self-esteem in balance
(Crocker & Wolfe, 2001; Deci & Ryan, 1995; Maltsberger, 1986; Mruk, 2006).
Our findings further suggest that losing exterior self-sustaining resources may
precipitate a suicidal crisis among individuals who are dependent on them to
keep their self-esteem in balance (Ronningstam et al., 2008). This may be in line
with results from the qualitative PA study by Kjølseth et al. (2010), where self-
esteem among the elderly was linked to activity and achievement, and the experi-
ence of losing freedom of action had a strong negative effect on the self-esteem of
the deceased, as if they “were losing themselves.” The researchers suggest that
suicide can be seen as a way of attaining coherence in self. In the present study,
the suicides could be understood as a way of releasing inner tension and restor-
ing coherence in the self (Maltsberger, Ronningstam, Weinberg, Schechter, &
Goldblatt, 2010). Thus, the suicide actually serves to increase one’s self-esteem
(Maltsberger, 1997) and could be a final and desperate operation to restore one’s
self and be free.

Contrary to most existing studies, indicating a causal relationship between
suicide and mental illness, especially the occurrence of depression as an impor-
tant risk factor for suicide (Cavanagh et al., 2003), few informants in this study
mentioned depression or other mental illnesses in their narratives. This is in line
with the views of suicidologists, who highlight that suicide cannot be explained
by a diagnosis, as suicidal processes may or may not be linked to mental illness
(Judd et al., 2012; O’Connor et al., 1999; Owens et al., 2003; Shneidman, 1985).
In addition, although some of the informants point to impulsiveness as a char-
acteristic of the deceased, the suicidal act was not understood primarily as an
impulsive act (Wyder & De Leo, 2007). Instead, we found that the suicidal act
was understood as a “triggered event” related to a previous significant event
close in time (like a breakup with a girlfriend or a separation from family home),
which again was understood in the light of the life history of the deceased
(Rasmussen, Haavind, Dieserud, & Dyregrov, 2014). This is consistent with
Mruk’s (2006) description of critical “self-esteem moments,” where certain situa-
tions may challenge an individual’s current configuration of competence and
worthiness in a way that reopens the individual’s history of unresolved biogra-
phical self-esteem themes. This thereby puts self-esteem at stake. As expressed
both in the informants’ interviews and in the suicide notes, the triggered event
seemed to be related to how the deceased blamed themselves for not being able
to live up to what they had to be in the eyes of their significant others
(Baumeister, 1990; Crocker & Park, 2004; Harter & Whitesell, 2003).
Dependence on others and being unable to adapt maturely to issues of

Rasmussen et al. 233

separation and independence, the young men seemed to have questioned their
essential worth as human beings. This is consistent with some clinical descrip-
tions of suicidal adolescents (Maltsberger, 1986), showing that the sequence
leading to suicidal behavior seems to be set in motion by interpersonal conflict
(Dieserud et al., 2001; Judd et al., 2012) or when external events demand a step
that threatens to break the tie to a significant other (Wyder, Ward, & De Leo,
2009).

Toward the end of life, many of the deceased in the present study were
appealing to their significant others for reassurance of worthiness and to be
saved from an intolerable situation of loneliness and self-deceit. This aspiration
toward autonomy and to merging with significant others is a conflicting yearning
that will, according to Morrison (2009), result in inevitable shame for failures.
These findings suggest, although trapped anger, guilt (self-blame) and anxiety
seem to have been playing a part in this discrepancy, they all seem to have played
a secondary role, while the primary emotional mortification was due to shame.
Thus, it seems that the deceased may have felt that their personality simply did
not add up to their ideals of masculinity (Connell, 2005; Payne, Swami, &
Stanistreet, 2008). As shown by some other studies (Kalafat & Lester, 2000;
Lansky, 1991; Ronningstam & Maltsberger, 1998), our findings suggest that it
is the shame from having exposed the self as being unlovable or destructive or
from being unable to have or tolerate close relationships, and in turn, being seen
as unworthy, as a failure, defective, inadequate, out of control, and as a dis-
appointment, that was the dominating affect in these young men’ suicides. It was
the shame from being who one is, that was in the heart of these suicides
(Leenaars, 1991; Lester, 1997; Shneidman, 1995).

Based on these findings of the pronounced shame in these suicidal individuals,
it could be assumed that masculine gender-role stereotypes influence men in a
way that can limit their ability to involve others, ask for help, and thereby use
the health-care system, in times of personal difficulties (Connell, 2005; Payne
et al., 2008). In line with Leenaars (2004), it is believed that young men in serious
suicidal crises need to work with their self-concept, so that they can find their
own standard for adult life and be able to handle their pain and regulate their
emotions by themselves. In suicide preventive strategies targeted at young men, a
stronger self-esteem perspective should be included than presently seems to be
the case. The traditional expectations of men as “strong” and able to handle
problems by themselves need to be challenged.

The findings from the present study need to be seen from a developmental
perspective. More work is needed to identify the experiences that most power-
fully impact on the development of self-esteem in relation to suicide.

One major challenge in suicide research is the matter of obtaining suitable
data. Data based on interviews from third parties clearly has its limitations,
especially if such data are used to assign diagnoses to deceased individuals
(Hjelmeland, Dieserud, Dyregrov, Knizek, & Leenaars, 2012). Suicide notes

234 OMEGA—Journal of Death and Dying 77(3)

have proven to be a rewarding source of data as a starting point for compre-
hending the suicidal act (Leenaars, 1991; Shneidman, 2004). Unlike most pre-
vious PA studies (Cavanagh et al., 2003), this study used in-depth interviews
with four to eight closely connected individuals to each suicide case, as well as
examining the suicide notes. It was not possible to identify any other studies with
a contextual perspective on suicides among individuals with no previous history
of treatment in mental health or suicide attempt(s), utilizing such a large number
of knowledgeable informants. In addition, this may be the first study that has
investigated self-esteem regulation in nonclinical suicides, by using in-depth
interviews with many closely connected informants, as well as suicide notes.

In general, studying “something on the inside” like self-esteem, based on third
party interviews related to a small amount of cases has its limitations. However,
suicide prevention based on epidemiological studies of generalities (the nomo-
thetic approach) may miss some important specifics that we only can learn
by studying individuals (the idiographic approach). By utilizing the IPA
method of analysis, we were able to get closer to the complexities of psycholo-
gical mechanisms and processes in suicides outside the mental illness paradigm,
and thus generalize to theory. As theory plays a key role in understanding
suicidal behavior, the results from the present study may add some important
theoretical aspects of suicidology, which again may strengthen our preventive
efforts.

Acknowledgments

This work forms part of the doctoral thesis of the first author to be submitted to the
Department of Psychology, University of Oslo. The authors also want to thank the
informants who participated in the study, as well as Melanie Straiton for her valuable

assistance in preparation of this manuscript.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, author-
ship, and/or publication of this article: The project is supported by grants awarded by the
Research Council of Norway.

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238 OMEGA—Journal of Death and Dying 77(3)

Author Biographies

Mette Lyberg Rasmussen, PhD, is a clinical psychologist and a suicide researcher
at the Norwegian Institute of Public Health, Division of Mental Health.

Kari Dyregrov, professor Dr.philos, is a sociologist and a senior researcher at the
Norwegian Institute of Public Health, Division of Mental Health, and Center
for Crisis Psychology, Bergen.

Hanne Haavind, professor in Developmental Psychology, is a clinical psycholo-
gist and a senior researcher at the Department of Psychology, University of
Oslo, Norway.

Antoon A. Leenaars, PhD, is a clinical psychologist with private practice in
Windsor, Canada, and a suicide researcher at the Norwegian Institute of
Public Health, Division of Mental Health.

Gudrun Dieserud, PhD, is a clinical psychologist and a senior suicide researcher
at the Norwegian Institute of Public Health, Division of Mental Health.

Rasmussen et al. 239

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articles for individual use.

Example 1

Research Methodology

Transcendental phenomenology is a research methodology where researchers gain first-hand information about the participant’s experience with the specific phenomenon. The researcher then reports that information just as the participant expressed it, without adding in any biases or interpretations (Percy & Kostere, 2008). Creswall and Poth (2018) have said that transcendental phenomenology would be best used when the goal is to obtain the participant’s raw feelings and lived experience about a phenomenon.

The sampling strategy that will be utilized is utilization focused sampling. In this sampling strategy, cases are selected in order to provide researchers with in-depth information that can lead to better decision-making in the future (Patton, 2015). This sampling strategy was chosen because they study will focus on parent experiences with token economies, which will provide practitioners with better direction on token economy implementation. If researchers find out what the families liked and didn’t like about the token economy, then future implementation could potentially exclude some of those disliked portions to make the token economy more likely to be implemented by families.

 

 

Data will be collected through interview. In order to ensure that researcher bias is not included, the researcher will bracket her own beliefs in the margin (Capella, 2006). The sample size will be approximately 8 participants. Creswall and Poth (2018) reported that a sample size for phenomenology ranges from 3-15. By choosing 8 participants, there leaves room for participants to drop out, hopefully without falling below the recommended minimum.   

 

Interview Questions

1. Prior to this study, what were some experiences you have had with a token economy?

2.  What are your feelings about the token economy?

3. What did you like about the token economy?

4. What did you dislike about the token economy?

5. Can you describe a time where you experienced a complication with the token economy?

6. What were some things that were particularly easy about the token economy?

7. What were some things that were particularly difficult about the token economy?

8. How would you feel if you were asked to implement a token economy for another month?

9. How did your child adjust to the token economy?

10. What were some changes you had to make in order to develop the token economy?

Professor feedback

Below is general feedback that I am going to try to share with everyone:

Researchers have to be sure that they identify an appropriate sampling strategy and sample size, and then provide support for the choices that are made (support from primary sources, not textbooks). The decisions that are made regarding the strategies that are used to conduct the study need to be presented with a well-supported rationale. In other words, after you have read about the various sampling methods used within qualitative research, choose the method that best fits your study, and then provide the reasons that you decided to utilize the sampling strategy that was chosen. The reason should be related to the goal of your study, which is to obtain data capable of answering the research question, and presented with support.

It will also be necessary to determine the appropriate sample size. Capella requires 8 to 14 participants with the stipulation that data collection will continue until data saturation is achieved. The sample size will need to be supported. One way to support a specific ‘sample size’ is to locate similar, recently published studies using the same method, and review the sample sizes that were needed to complete the studies. You can then provide insight into the sample sizes that are typical, and utilize that range as a goal (and then stipulate that the overall goal is data saturation). For example, if you locate several similar studies using your method that were successfully completed using sample sizes ranging from 10 to 20 participants, you can state that your sample size aligns with these studies and will seek to secure 8 to 14 participants, but continue recruitment and data collection until data saturation is achieved.

When describing the data collection methods, keep in mind that data collection includes the methods that are used to capture, de-identify, transform, store, and manage the data that is collected. The methods that will be used to recruit participants and collect data will need to be described in detail. The main instruments that will be used to collect data include the researcher and the interview questions. For this reason, the researcher has to take steps to reduce bias and the interview questions have to be open (can’t be answered with one or a few words) and aligned closely to the research question. 

Since the only question that the researcher truly wants to answer is the research question, the first question posed to participants within an interview would simply be the research question posed as a question to the participant. You want to explore the behaviors, emotions, thoughts, and influential factors surrounding a particular experience. Questions that probe things outside of the experience, like anything that led up to or happened subsequent to the experience, wouldn’t be explored. When developing the interview questions, researchers have to avoid making assumptions and asking questions that are leading. They also should avoid asking compound question (multiple questions embedded in one question). This can overwhelm participants and reduce the amount of data that is collected. Participants will usually only answer one portion of compound question in detail. Framing questions in an open and non-leading manner provides researchers with the opportunity to collect large amounts of unbiased data capable of providing an in-depth answer to the research question.

Use this feedback to further develop what is presented.

Dr. Roberts

Professor feedbackTop of Form

The interview questions that you put together are good, Mashonda. You could also ask them to tell you about their personal experiences using this method, what they would tell someone else that was thinking about using this method, or to even tell you a story about using this method. A great way to end the interview is to simply ask them if there is anything else that they think is important to know that wasn’t shared in the interview. Thank you for what you contributed to this discussion this week.

Example 2

Topic: Burnout and stress among direct support professionals (DSPs)

 

Methodological Approach:
Phenomenological Research

 

Sampling Strategy: Purposeful Sampling- Typical Cases

 

Rationale: Purposeful Sampling
is the selection of cases that are best suited to provide insight into the research question (Patton, 2015). To select participants that can explain the average experience, the
typical case method
can be used (Patton, 2015). A sample of average aged people who have worked residential direct support for the mean years of tenure would help provide a clear picture of what could be a normal experience (Patton, 2015). This study does not serve to make definitive statements, just highlight the burnout in this population which this technique is illustrative of (Patton, 2015).

 

Sample Size: Sample size is important when considering the purpose and rationale of a study (Patton, 2015). Typically, phenomenological research has 5 to 25 participants included (Creswell & Poth, 2018). I would like to choose a slightly larger minimum sample size of 15 to maximize breadth across participants as I am looking to determine a cultural phenomenon of burnout (Patton, 2015).

 

Data Collection Procedures: After finding a sample that has experienced the phenomenon of burnout, typically phenomenology includes multiple interviews with the identified participants (Creswell & Poth, 2018). This data is transcribed into digital files and evaluated to create textual and structural descriptions (Creswell & Poth, 2018). Additional data that can be collected beyond self-reflection can include depictions of the unique experience outside of the context of the project although this may be challenging to obtain for this population (Creswell & Poth, 2018).

 

Open-Ended Questions:

1.  How do direct support professionals experience burnout?

2.  How does their workplace environment support their well-being?

3.  What stressors do DSPs experience at work?

4.  What stressors do they experience at home?

5.  How is burnout defined?

6.  How do they cope with their life stressors?

7.  What makes the role of a DSP unique?

8.  What do they hope for in their career?

9.  How long do they intend to stay in this role?

10.  How has burnout affected their perception of the people they work with?

Professor Feedback

Be careful to remain focused on inner experiencing, only explore the topic of interest, and not allow your personal assumptions to creep into the interview questions, Amanda. Phenomenology explores inner experience, and would ask questions such as the following: What was it like? What were the dimensions of the experience? What feelings were experienced? What bodily sensations were experienced? What stood out within this experience? Sometimes thinking about what you would want to ask participants helps determine the focus of the study. If you wanted to explore outer world experiencing then you would need to consider a different method. Keep everything focused on the internal world of the participant and you will remain aligned with this method. I hope that this helps.

Dr. Roberts

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