Earlier this year, Dr. Maurizio Pompili of Sapienza University of Rome invited Dr. Lisa Firestone to contribute a chapter to his edited volume, Phenomenology of Suicide: Unlocking the Suicidal Mind. (Springer, 2018).  In her submitted chapter, “Dissociation and the Therapeutic Alliance,” Dr. Firestone begins by emphasizing that “in psychotherapy, a patient’s ability to dissociate can seriously interfere with the formation and maintenance of a therapeutic alliance, making successful treatment outcomes more difficult to achieve.” She also stresses the fact that with patients who “display dissociative tendencies, it is especially important that the therapist make the creation and maintenance of the relationship with their patient their highest priority.”  

Dr. Firestone also provides recommendations for specific treatments shown by research to be effective in maintaining a therapeutic alliance with such patients. These include Cognitive-Behavioral Therapy for Suicide Prevention (CBT-SP), the Collaborative Assessment and Management of Suicidality (CAMS), Dialectic Behavior Therapy (DBT), and Attempted Suicide Short Intervention Program (ASSIP).  In summarizing the dimensions that characterize all of the above treatments, she cites Jobes’ and Ballard’s (2010) statement that “…a proper clinical engagement (in which a suicidal patient is effectively understood and appreciated) has the power to forge an extraordinary therapeutic bond that may prove to be lifesaving— a potentially important and memorable connection for both members of the clinical dyad” (p. 60).   


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