The desire to die by suicide has been linked with interpersonal difficulties and impeded clinical outcomes. Despite the emphasis on the therapeutic relationship in clinical guidelines for working with suicidal clients, little is known about how suicidal clients' interpersonal difficulties manifest in clinical contexts. Additionally, there is limited understanding of the therapeutic relationship in single-session suicidal crisis contexts. Our aim was to examine the trajectory of the therapeutic bond in mediating clients' suicidal desire and outcome in single-session suicidal crisis intervention. Single-session online text-based crisis intervention sessions (N = 354; Mage = 29.43, SD = 9.15; 64.5% women) were coded for suicidal desire, therapeutic bond (each quarter), and outcome. We examined the proposed sequential mediating model (suicidal desire to early bond to bond change to outcome) using structural equation modeling. The proposed sequential mediation model fits the data well, χ2(11) = 22.030, p = .0241, root-mean-square error of approximation = .053, 90% CI [.019, .085], comparative fit index = .983, Tucker-Lewis index = .977, and was a better fit than several alternative models. Further, the indirect effect from suicidal desire to outcome through early bond and bond change was significant (b = -0.474, 99% CI [-0.782, -0.203]). Our findings indicate that therapeutic bonds were beneficial for clients with elevated suicidal desire-and-elevated suicidal desire was negatively associated with therapeutic bonds. These findings highlight the importance of training clinicians to navigate the unique challenges of developing therapeutic bonds with acutely suicidal clients. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

中文翻译：

---

与自杀危机中的客户合作时治疗纽带的作用。


自杀的愿望与人际关系困难和阻碍临床结果有关。尽管在与自杀客户合作的临床指南中强调治疗关系，但人们对自杀客户的人际困难在临床环境中如何表现却知之甚少。此外，对单次自杀危机背景下的治疗关系的理解有限。我们的目的是检查单次自杀危机干预中治疗纽带在调解客户自杀欲望和结果方面的轨迹。单次在线文本危机干预会议（N = 354；Mage = 29.43，SD = 9.15；64.5% 女性）针对自杀欲望、治疗关系（每个季度）和结果进行编码。我们使用结构方程模型检查了所提出的顺序中介模型（自杀欲望从早期结合到结合改变到结果）。所提出的序贯中介模型与数据拟合良好，χ2(11) = 22.030，p = .0241，近似均方根误差 = .053，90% CI [.019, .085]，比较拟合指数 = 。 983，Tucker-Lewis 指数 = 0.977，比几个替代模型更适合。此外，自杀欲望通过早期关系和关系变化对结果的间接影响是显着的（b = -0.474，99% CI [-0.782，-0.203]）。我们的研究结果表明，治疗纽带对于自杀欲望升高的客户是有益的，而自杀欲望升高与治疗纽带呈负相关。这些发现强调了培训临床医生应对与急性自杀客户建立治疗联系的独特挑战的重要性。 （PsycInfo 数据库记录 (c) 2024 APA，保留所有权利）。