The Therapeutic Alliance and Suicide: When Words Are Not Enough

Abstract

Much has been written about the therapeutic alliance, and the concept has a long history in the psychoanalytic and psychotherapy literature. This paper endeavors to clarify certain aspects of the therapeutic alliance, and to highlight ways in which the concept is particularly important in the psychotherapy of suicidal patients. The realm of implicit relational knowing is emphasized as critical to understanding the therapeutic alliance and also as a major arena for psychotherapeutic change. A clinical example is presented of an intensive psychoanalytically oriented psychotherapy with a suicidal patient. The example demonstrates the importance of implicit relational knowing as essential to the therapeutic alliance as well as to psychotherapeutic change.