Alliance, reactions to treatment, and counter-transference in the process of recovery from suicidal phenomena in long-term dynamic psychotherapy.

OBJECTIVE:

We studied therapeutic processes associated with improvement in suicidality in a naturalistic study of long-term dynamic psychotherapy.

METHODS:

In a naturalistic study of long-term dynamic psychotherapy (n = 53), 31 patients reported suicidal ideation, eight of whom also reported prior suicide attempts, while 22 were non-suicidal. Suicide ideation and attempts and components of therapy alliance were followed at 6 month intervals.

RESULTS:

Suicidal patients had more psychiatric diagnoses, were treated longer and reported more negative reactions to treatment than non-suicidal patients. Alliance moderated (a) the relationship between negative reaction to treatment and improvement in suicidal ideation and (b) the relationship between quality of patient-therapist interaction and improvement.

CONCLUSIONS:

Suicidal patients manifest hostility and negative reactions to treatment, indicating negative transference. Avoiding therapist errors emanating from negative countertransference improves the therapeutic interaction, which is followed by faster rate of improvement in suicidality.