The quality of the therapeutic alliance is a well-established factor for successful therapy process and outcome. When it comes to treating suicidal patients, a strong therapeutic alliance can quite literally save a person's life.

In this book, editors Konrad Michel and David A. Jobes have enlisted an elite group of clinicians and researchers to explore what has become known as the "Aeschi approach" to clinical suicide prevention.

According to this view, mental health professionals working with patients at risk for suicide must recognize a fundamental conflict at the heart of good clinical practice: while they are experts in the assessment of disorders of mental health, when it comes to the patient's story, the patient is the expert. Any successful intervention with a suicidal patient must therefore be based on an empathic understanding of suicidal thoughts and behavior that honors the patient's very personal perspective.

This exceptional volume addresses a wide range of issues, from the principles and method of establishing a working alliance, to patient-oriented therapeutic models, to practical clinical matters such as the therapeutic alliance within specific treatments across theoretical orientations. Most importantly, this book provides essential guidance for clinical suicide risk reduction that may help save lives.

Table of Contents


Marsha M. Linehan

Konrad Michel

I. The Therapeutic Alliance: Basic Considerations

  1. General Aspects of Therapeutic Alliance
    Konrad Michel
  2. Empathy and the Historical Context, or How We Learned to Listen to Patients
    John T. Maltsberger

II. The Therapeutic Alliance and the Suicidal Patient

  1. The Therapist and the Suicidal Patient
    David A. Jobes and Elizabeth Ballard
  2. The Narrative Interview With the Suicidal Patient
    Konrad Michel and Ladislav Valach
  3. Mentalizing Suicidal States
    Jon G. Allen
  4. Psychodynamic Therapy and the Therapeutic Alliance: Validation, Empathy, and Genuine Relatedness
    Mark A. Schechter and Mark J. Goldblatt

III. Patient-Oriented Concepts of Suicidality

  1. Taking an Inside View: Stories of Pain
    Israel Orbach
  2. Understanding Suicide as an Action
    Ladislav Valach, Richard A. Young, and Konrad Michel
  3. Attachment Theory and the Suicidal Patient
    Jeremy Holmes
  4. A Cognitive Theory of Suicide: Building Hope in Treatment and Strengthening the Therapeutic Relationship
    M. David Rudd and Gregory K. Brown
  5. Neurobiology and Patient-Oriented Models of Suicide—A Contradiction?
    Konrad Michel

IV. The Therapeutic Alliance in Specific Therapies for Suicidal Patients

  1. Suicidal Patients, the Therapeutic Alliance, and the Collaborative Assessment and Management of Suicidality
    David A. Jobes
  2. Psychotherapy With Suicidal People: Some Common Implications for Response
    Antoon A. Leenaars
  3. The Therapeutic Relationship in Dialectical Behavior Therapy for Suicidal Individuals
    Shireen L. Rizvi
  4. Cognitive Therapy for Suicidal Patients
    Gregory K. Brown, Amy Wenzel, and M. David Rudd
  5. Vicissitudes of the Therapeutic Alliance With Suicidal Patients: A Psychoanalytic Perspective
    Igor Weinberg, Elsa Ronningstam, Mark J. Goldblatt, and John T. Maltsberger
  6. Clinical Reality: The Case of Ms. AV
    Israel Orbach, Jeremy Holmes, John T. Maltsberger, Mark J. Goldblatt, M. David Rudd, J. Michael Bostwick, and Konrad Michel

V. The Therapeutic Alliance With Suicidal Patients in Specific Treatment Settings

  1. The Therapeutic Alliance With Hospitalized Patients
    Timothy W. Lineberry
  2. Pharmacotherapy and Therapeutic Alliance in the Treatment of Suicidality
    J. Michael Bostwick

VI: Conclusion

  1. Summary, Next Steps, and Conclusion
    David A. Jobes


About the Editors

Editor Bios

Konrad Michel, MD, MRCPsych, is a senior psychiatrist and psychotherapist at the outpatient department of the University Psychiatric Hospital in Bern, Switzerland, and is also in private clinical practice.

Dr. Michel has been a collaborator on the World Health Organization—European Multicenter Study on Suicidal Behavior. He has conducted several clinical research projects focusing on the role of general practitioners in suicide prevention and on various aspects of the patient–clinician clinical relationship.

Together with Ladislav Valach, PhD, Dr. Michel has developed a model of understanding suicidal behavior based on the theory of goal-directed action and narrative interviewing.

He is also the initiator of the Aeschi Working Group, a group of clinicians and researchers who are dedicated to improving clinical suicide prevention by developing and promoting patient-oriented models of understanding suicidal behavior.

David A. Jobes, PhD, ABPP, is a professor of psychology and associate director of clinical training at The Catholic University of America. His research and writing have led to numerous publications in suicidology, with a particular focus on clinical suicidology.

Dr. Jobes is a past president of the American Association of Suicidology and is the recipient of that organization's 1995 Edwin Shneidman Award in recognition of early career contribution to suicide research.

He has served as a consultant to the Centers for Disease Control and Prevention, the National Institute of Mental Health, the Institute of Medicine of the National Academy of Sciences, the Department of Defense, and the Department of Veterans Affairs.

Dr. Jobes is a board-certified clinical psychologist (American Board of Professional Psychology) who maintains a private clinical and forensic practice at the Washington Psychological Center, Washington, DC.