Making the alliance and taking the transference in work with suicidal patients

This article focuses on two components of psychodynamic psychotherapy with suicidal patients. First, the value and importance of establishing and maintaining a clearly defined therapeutic alliance is noted and explored. A carefully negotiated alliance can become an edge or boundary across which the survival of the therapy, as well as the patient, can be negotiated. Attention to the vicissitudes of the alliance is hypothesized to be the central initial therapeutic action with suicidal patients. Second, the author explores the importance of "taking" rather than "refusing" the transferences offered by the suicidal patient, particularly negative and erotic transferences. Case examples are offered as illustrations.