Understanding the relationship between the therapeutic alliance and suicidal experiences in people receiving psychotherapy

Student thesis: Unknown


The current Master of Philosophy in Clinical Psychology thesis investigates the relationship between the therapeutic alliance in psychotherapy and suicidal experiences. It is presented as an overall introduction, a systematic review (study 1), an empirical study (study 2) and overall discussion. To contextualise the work presented, historical information about the therapeutic alliance, alliance ruptures and resolution, psychotherapy endings, dose of psychotherapy and the importance of the therapeutic alliance for people with suicidal experiences and psychosis, are introduced. Study 1 systematically reviewed the literature to examine the relationship between the therapeutic alliance in psychotherapy and suicidal experiences (pre-, during and post-therapy). Seventeen studies met the inclusion criteria. It remains unclear how much impact suicidal experiences prior to and during psychotherapy may have upon the formation and maintenance of the therapeutic alliance. However, there is stronger evidence to suggest the therapeutic alliance during psychotherapy may be related to a reduction in suicidal experiences. Clinical implications and recommendations for future research are highlighted. Study 2 investigated the relationship between the therapeutic alliance in Cognitive Behavioural Suicide Prevention therapy for psychosis (CBSPp) and suicidal experiences in people with non- affective psychosis and whether dose of therapy impacted on such a relationship. Sixty-four participants with non-affective psychosis and suicidal experiences, who had received CBSPp were included in the study. Suicidal experiences did not impact negatively on the early therapeutic alliance. In fact, clients who had recently attempted suicide perceived a stronger therapeutic alliance. A robust, client perceived, therapeutic alliance was predictive of a decrease in suicidal ideation post-therapy after controlling for depression and hopelessness, which are well-known predictors of suicidal experiences. Dose of psychotherapy (up to 15.50 hours in psychotherapy) amplified the relationship between client viewed therapeutic alliance and suicidal ideation. Clinical implications and future directions for research are considered. To conclude the thesis, overall strengths and limitations, the therapeutic alliance and suicidal experiences in the context of remote psychotherapy during the COVID-19 pandemic and recommendations for future research, are discussed.
Date of Award31 Dec 2020
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorGillian Haddock (Supervisor), Patricia Gooding (Supervisor) & Daniel Pratt (Supervisor)


  • Suicide
  • Therapeutic alliance
  • Psychotherapy
  • Systematic review
  • Psychosis

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