Dissociation and therapeutic alliance

Abstract

The creation and maintenance of the therapeutic alliance is of the utmost importance when treating suicidal patients. This can be challenging, because there is a strong link between dissociation and suicide. This chapter defines dissociation and describes its manifestations, developmental roots, and the relationship between dissociation and suicide. A suicidal patient’s ability to dissociate is often the result of attachmentdifficulties in childhood, stemming from “adverse childhood events,” early traumatic experiences. Traumatized children identify with the aggressor and take in destructive attitudes toward themselves. They develop an anti-self that is turned against the self andcontributes to self-destructive behavior and, at its ultimate end, suicide. The trust issues, negative expectations of others, and dissociative tendencies that result from experiencing interpersonal trauma can make it difficult for these patients to develop a strong therapeutic alliance. Effective psychotherapies with suicidal patients require the therapist be able to provide a relational experience, where the suicidal person is respected, and their experience is listened to in a compassionate, empathetic manner.Therapists who can provide the patient with a sense of safety, a feeling of being “seen” as whohe/she really is, and soothing to alleviate unbearable psychological pain, help heal the patients’ attachment system byproviding a secure base from which the patient can explore their pain, understand its roots, and learn to regulate and tolerate it without the need to dissociate. Research has shown that a number of suicide specific therapies which embody these principles are effective in treating suicidal patients.