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Therapeutic Alliance

Building a strong therapeutic alliance with the young person is one of the most important components of therapeutic work with suicidal clients. It is a stance or attitude that is characterized by warmth, trust, empathy and care and serves to instill hope in the client. For youth, who often drop-out of treatment prematurely or do not follow-through with formal treatment recommendations, developing a strong therapeutic alliance from the outset is critical.

Key issues to address that can serve to strengthen the therapeutic alliance include:

  • Identify opportunities for youth involvement in treatment planning and decision-making.
  • Clearly outline the rules of and exceptions to confidentiality.
  • Clarify issues of availability and accessibility after-hours.

Personal and professional characteristics that can enhance the therapeutic relationship include: flexibility, warmth, appropriate self-disclosure, empathy, sense of humour, and maintenance of professional authority.40

Other specific strategies for enhancing the therapeutic alliance when working with youth include: 41

  1. Role expertise should be fostered while interpersonal distance reduced (e.g. face-to-face seating instead of sitting behind a desk).
  2. Flexibility in session length is often useful.
  3. Adolescent clients may be encouraged to come to treatment with a friend who will wait for them and with whom they can leave at the end of a session.
  4. Warmth and comfort in the office setting are important (e.g. allowing food/drink during the session).
  5. Warmth within the therapeutic relationship is critical, including appropriate self-disclosure, sense of humour and general flexibility.
  6. Changes in routine can be helpful (e.g. leaving the office, going for a walk).