Alliance-Focused Safety Planning and Suicide Risk Management

Patients' interpersonal vulnerabilities and problems represent major distal and proximal risk factors in the etiology of suicide. These can be triggered by the interpersonal demands of therapy and safety planning and impede the development of a strong therapeutic alliance, and thus, the effectiveness of safety planning. This article proposes that the principles put forth by the Alliance-Focused Training (AFT; Eubank 4-Carter et al., 2015; Muran & Eubank 2020), which view the therapeutic alliance both as a precondition to therapy and as an active change mechanism, present an ideal framework for addressing patients' interpersonal challenges in the context of safety planning and suicide risk management. After discussing the relevance of AFT principles to safety planning, we will propose an approach to incorporate AFT techniques into evidence-based safety planning interventions and to monitor their impact on the therapeutic alliance and treatment outcome. Last, we will provide a brief clinical report to illustrate the principles and techniques described in the article.