The Link between Baseline Suicidality and Alliance through Client Moderators

Open Access
- Author:
- Davis, Katherine
- Graduate Program:
- Psychology
- Degree:
- Master of Science
- Document Type:
- Master Thesis
- Date of Defense:
- May 05, 2021
- Committee Members:
- Louis Georges Castonguay, Thesis Advisor/Co-Advisor
Jose Angel Soto, Committee Member
Kristin Buss (She/Her), Program Head/Chair
Jeffrey Hayes, Committee Member - Keywords:
- therapeutic alliance
disparities
marginalization
social identities
suicidality
psychotherapy outcome
collegiate mental health - Abstract:
- The therapeutic alliance has emerged as a transtheoretical clinical predictor, accounting for 7.5% of variance in psychotherapy outcomes. Suicidal clients face a unique risk when it comes to alliance formation as alliance is an inherently interpersonal construct and suicidality is often accompanied by deficits in interpersonal variables. Members of marginalized racial/ethnic, gender, and sexual minority groups also tend to face unique disparities when it comes to mental health process and outcome, specifically regarding alliance formation, because of a variety of interpersonal factors. This study examines whether there is an association between suicidality and alliance and whether that potential association varies as a function of marginalized identity in a college student population. Presence of suicidality at baseline was negatively associated with average alliance scores, showing that clients who presented for treatment with any level of suicidality had lower average alliance scores with their therapist at their first session than clients who had no level of suicidality. Membership in a marginalized identity group did not moderate the negative association between suicidality and alliance. However, a significant main effect between marginalized status and alliance was observed. Secondary analyses revealed a significant simple effect of marginalized race/ethnicity on average alliance score. Overall effect sizes were very small, possibly due to limited range of the alliance instrument. Potential clinical implications of these findings are discussed.