Search

The aim of this thesis was to explore the relationship between therapeutic alliance and suicidality. Three separate papers are presented: a systematic literature review, an empirical paper and a critical appraisal of the first two papers. Paper one, the systematic review, explored the relationship between therapeutic alliance and suicidality in existing research. Twelve papers were found which met the inclusion criteria: patients aged 18 or over, used a validated measure of alliance and explored the relationship between alliance and suicidality. Findings indicated that self-harm and suicidal thoughts are negatively associated with alliance measured from the patients' perspective: the higher the alliance, the lower the frequency or severity of self-harm and suicidal thoughts reported. There was less evidence for a relationship between alliance and suicidal attempts, possibly due to the infrequency of suicide attempts in the studies reviewed. Further research is also required to explore the relationship between suicidality and alliance rated by professionals or observers. Paper two, the empirical research, explored the relationships between therapeutic alliance, suicidality, defeat and entrapment in patients on a mental health ward. Alliance was explored between patients and nurses from both perspectives. Both patients' and nurses' perspectives of the patients' suicidality was also explored. Defeat, entrapment and suicidality were strongly correlated. Nurse-rated bond alliance and patient-rated external entrapment were also related, however, no other significant relationships were found between alliance and either defeat, entrapment or suicidality. Paper three, the critical appraisal, provides the reader with reflections on the methodology of both papers and the challenges completing the two research papers. Clinical implications and suggestions for future research are also presented.