Therapeutic Alliance is Linked With Suicidality Trajectories in Psychotherapy for Late-Life Depression.

Authors

Miriam I Hehlmann, Delaney Callaghan, Julia Chafkin, Joohyun Kang, Lindsey Sankin, Oded Bein, Nili Solomonov

Published in

The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry. Volume 34. Issue 2. Pages 222-228. Epub Oct 01, 2025.

Abstract

Late-life suicidality is rapidly increasing; psychotherapy may reduce suicidality, but trajectories of change in suicidality remain unclear. A strong therapeutic alliance may protect against persistent suicidality. We examined the association of alliance with suicidality trajectories during brief, remote interventions for depression.
Sixty middle-aged and older adults with major depression were randomized to brief remote psychosocial interventions. Suicidality and alliance were assessed during treatment. Patients' suicidality trajectories were classified as: 1) absent; 2) improved; 3) persistent, based on pre- to post-treatment changes. All three groups were included in mixed-effects models to examine the association between suicidality and alliance.
At baseline, 53% of patients endorsed suicidality, with 45% in the absent group, 45% improved, and 10% persistent. Patients in the absent and improved groups showed stable, strong alliance while the persistent group showed worsening alliance.
Simple, remote psychosocial interventions are promising first-line treatments for late-life suicidality. A strong alliance may reduce suicidality and enhance outcomes, guiding timely, personalized interventions.

PMID:
42977689
Bibliographic data and abstract were imported from PubMed on 04 Nov 2026.

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