Understanding the nuances of the therapeutic alliance between clients with suicidal experiences and therapists during psychotherapy

Abstract

The present thesis examines the nuances of the therapeutic alliance in the context of psychotherapy and suicidal experiences. Three papers are presented: a systematic review and meta-ethnography, an empirical paper, and a critical appraisal of the studies conducted. Paper 1 involves a systematic search of the literature examining client and therapist perspectives of the therapeutic alliance in the context of psychotherapy and suicidal experiences. Findings from 31 studies were synthesised using a meta-ethnography approach. Two overarching themes were identified: 'working on the edge' and 'being ready, willing, and able to build an alliance in the context of suicidal experiences'. A narrative underlying two themes and four sub-themes is that the therapeutic alliance in the context of suicidal experiences is unique, fluid, potentially lifesaving, and influenced by multiple inter-connected internal and external processes and systems. Paper 2 examined how the therapeutic alliance develops between clients with suicidal experiences and psychosis and their therapists during initial sessions of suicide prevention focused therapy. Forty-one audio recorded therapy sessions were selected, from the initial phase of suicide prevention focused therapy, across 12 client-therapist dyads. Therapy session transcripts were analysed using reflexive thematic analysis. Three themes were identified; 'two humans connecting: therapist showing the client they are important in this world', 'learning how to navigate the dynamic and space in therapy', and 'co-creating a sense of safety'. Across papers 1 and 2, clinical recommendations are given for the training, supervision, and support for therapists to equip them with the additional skills required in navigating the intricacies of the therapeutic alliance with clients who have suicidal experiences (with or without psychosis). Paper three is a critical appraisal of the studies conducted and situates findings within the wider literature, policy, practice, and organisational initiatives. Further information is provided and reflected on in relation to the selection of topics and methods, working with experts by experience, and study conduct.

Date of Award	31 Dec 2023
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Patricia Gooding (Supervisor), Sarah Peters (Supervisor) & Daniel Pratt (Supervisor)