Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Steven Vannoy

Second Advisor

Sharon Horne

Third Advisor

David A. Jobes


Mental health providers, including psychology trainees, are at the front lines of treatment who assess and treat individuals endorsing suicidality. With low suicide risk assessment training prevalence rates in academic psychology programs, many clinical providers do not have the necessary training to adequately assess individuals for suicide risk (Dexter-Mazza & Freeman, 2003; Gallo, 2016). Additionally, professional psychological guidelines and suicide prevention training programs generally promote the need to conduct assessments in a “therapeutic” manner, so providers do not become mechanical and detached from the therapeutic alliance, an essential ingredient to positive therapeutic outcomes. Nowhere is the therapeutic alliance more important, and possibly more difficult, than in assessing for suicide risk.

Most traditional risk assessment workshops educate clinical providers on suicide risk factors and how to gauge a client’s suicide risk level but fail to train them to maintain the therapeutic alliance while conducting the assessment. The goal of this study was to better understand the ability of clinical providers in maintaining the therapeutic alliance with a suicidal client while conducting a comprehensive suicide risk assessment. The study provided the following randomized suicide risk assessment trainings to graduate psychology trainees: Traditional lecture-based training, and a therapeutic alliance-focused workshop with a video demonstration. The study aimed to evaluate the effectiveness of the workshops in training trainees on how to conduct a comprehensive risk assessment and maintain the therapeutic alliance during the assessment. 50 trainees were randomized to view an online risk assessment workshop and were expected to conduct a risk assessment with a standardized patient during a video-recorded role play and produce a documentation report providing evidence for their determined risk level of the “client.” Licensed clinical providers evaluated the therapeutic alliance of each assessment encounter, while expert raters evaluated the risk assessment comprehensiveness via the documentation report.

Statistical analyses indicated poor risk assessment quality in the documentation reports provided by the trainees in both training groups. The therapeutic alliance did not mediate risk assessment quality and training condition, and participants had similar moderate-to-high averaged therapeutic alliance scores during the assessments. Limitations as well as social and clinical implications are further discussed.


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