The Association between Therapeutic Alliance and Individuals’ Wish to Die or Live

Objective: The relationship between therapeutic alliance and the individuals’ expressed internal struggle about living or dying is investigated in this study. Additionally, the suicidal internal struggle and its relation to suicidal ideation are explored over time. Methods: Sixty suicide attempters from the ASSIP evaluation study were screened with the Helping Alliance Questionnaire and the Wish to Live and Wish to Die scales to assess therapeutic alliance and suicidal internal struggle at baseline, 6-, 12- and 24-months follow-up. Suicidal ideation was measured by the Beck Scale of Suicide Ideation. Results: Good therapeutic alliance and high satisfaction with therapy success are associated with a stronger wish to live in participants in the Attempted Suicide Short Intervention Program—ASSIP. Individuals’ internal struggle was related to lower rates of suicidal ideation over time. Individuals with lower internal struggle (more wish to die) require much more attention to prevent the risk of suicidal crises. Limitations: Loss of information in our longitudinal investigation was due to low response rates at some follow-up time-points. Individuals who still have the wish to die after attempting suicide are the minority in our sample, indicating that these individuals are less likely to enter suicide prevention programs. Conclusion: The quality of therapeutic alliance is critical to reducing suicidal ideation.