A Process Model for Clinical Decision Making in High-Risk Outpatient Situations: the Therapeutic Alliance and Suicide

When a client is at risk for suicide, important counselling decisions must be made. This article presents a process model for decision making in high-risk outpatient situations. It is proposed that counsellors attend to 2 key dimensions of these situations: the strength of the therapeutic alliance & the degree of suicide risk. Therapeutic actions are then directed toward strengthening the alliance & toward implementing other risk-reduction interventions only when the risk cannot be adequately reduced via the alliance. Four case studies are presented to illustrate the application of the model to suicidal situations. (28 refs.)