A systematic review and meta-ethnography of client and therapist perspectives of the therapeutic alliance in the context of psychotherapy and suicidal experiences

• Published in: Clinical psychology review 2024-11, Vol.113, p.102469, Article 102469
• Main Authors: Huggett, Charlotte, Peters, Sarah, Gooding, Patricia, Berry, Natalie, Pratt, Daniel
• Format: Article
• Language: English
• Subjects: Anthropology, Cultural; Humans; meta-ethnography; Professional-Patient Relations; Psychotherapy; Psychotherapy - methods; Qualitative; Suicidal Ideation; Suicide; Systematic review; Therapeutic Alliance
• ISSN: 0272-7358; 1873-7811; 1873-7811
• DOI: 10.1016/j.cpr.2024.102469

This review aimed to develop a conceptual model of the therapeutic alliance in the context of psychotherapy and suicidal experiences from therapist and client perspectives. The protocol was pre-registered on PROSPERO (CRD42021268273). MEDLINE, PsycINFO, Web of Science, Embase and CINAHL were systematically searched from database inception to April 2024. Eligible studies were peer-reviewed, qualitative, and included client and/or therapist's perspectives of the therapeutic alliance in the context of psychotherapy and suicidal experiences. Studies were critically appraised and analysed using a meta-ethnography approach involving a reciprocal translation of studies and line of argument synthesis. Thirty-seven papers were included, generating two overarching themes; ‘Working on the edge’ and ‘Being ready, willing, and able to build an alliance in the context of suicidal experiences’. 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. Clinical implications emphasise the need to improve 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. Flexibly interweaving risk assessment into therapeutic conversation was beneficial to the alliance with suicidal clients and enhanced their safety. •Alliance with suicidal clients is multifaceted and potentially lifesaving.•Readiness and ability of therapists and suicidal clients to build an alliance.•Challenges in nurturing the alliance with suicidal clients in remote therapy.•Interweaving risk assessment into therapeutic conversation benefitted the alliance.•Therapists need support in nurturing the alliance with suicidal clients.