This review aimed to develop a conceptual model of the therapeutic alliance in the context of psychotherapy and suicidal experiences from therapist and client perspectives. The protocol was pre-registered on PROSPERO (CRD42021268273). MEDLINE, PsycINFO, Web of Science, Embase and CINAHL were systematically searched from database inception to April 2024. Eligible studies were peer-reviewed, qualitative, and included client and/or therapist's perspectives of the therapeutic alliance in the context of psychotherapy and suicidal experiences. Studies were critically appraised and analysed using a meta-ethnography approach involving a reciprocal translation of studies and line of argument synthesis. Thirty-seven papers were included, generating two overarching themes; ‘’ and ‘’. Therapeutic alliance in the context of suicidal experiences is unique, fluid, potentially lifesaving, and influenced by multiple inter-connected internal and external processes and systems. Clinical implications emphasise the need to improve training, supervision, and support for therapists to equip them with the additional skills required in navigating the intricacies of the therapeutic alliance with clients who have suicidal experiences. Flexibly interweaving risk assessment into therapeutic conversation was beneficial to the alliance with suicidal clients and enhanced their safety.

中文翻译：

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在心理治疗和自杀经历的背景下，对客户和治疗师对治疗联盟的观点进行系统回顾和元人种学研究


本综述旨在从治疗师和来访者的角度，在心理治疗和自杀经历的背景下开发治疗联盟的概念模型。该协议已在 PROSPERO 上预注册（CRD42021268273）。从数据库建立到 2024 年 4 月，系统地检索了 MEDLINE、PsycINFO、Web of Science、Embase 和 CINAHL。符合条件的研究经过同行评审、定性研究，并纳入了客户和/或治疗师在心理治疗和自杀经历背景下对治疗联盟的看法。使用元民族志方法对研究进行批判性评价和分析，涉及研究的相互翻译和论点综合。其中包括 37 篇论文，产生了两个总体主题： '' 和 ''。自杀经历背景下的治疗联盟是独特的、流动的、可能挽救生命的，并受到多个相互关联的内部和外部过程和系统的影响。临床意义强调需要改善治疗师的培训、监督和支持，使他们具备与有自杀经历的来访者进行复杂的治疗联盟所需的额外技能。灵活地将风险评估与治疗对话结合起来，有利于与有自杀倾向的来访者建立联盟，并提高他们的安全性。