Robert William Orf is a 2014 graduate of the PsyD Program in Clinical Psychology at Antioch University, New England

Dissertation Committee

  • George Tremblay, Ph.D., Committee Chair
  • Lorraine Mangione, Ph.D. Committee Member
  • David Arbeitman, Ph.D. Committee Member


suicide, suicidal ideation, interpersonal theory of suicide, disclosure, working allliance, therapists, psychotherapy, clients, psychotherapists

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Approximately 36,000 people commit suicide in the U.S. each year, making it the fourth leading cause of death for adults between 18 and 65-years-old. Clients participating in psychotherapeutic treatment are at elevated risk for suicide, due to the emotional distress that drives their entry into psychotherapy. Therapists cannot know the full extent of their clients’ risk for suicide if clients do not fully confide their thoughts and intentions. The current study sought to discover factors that inhibit and promote client disclosure of these thoughts and behaviors. The study utilized the Suicidal Ideation in Psychotherapy Questionnaire (SIPQ), a questionnaire developed for this study that assesses attitudes and behaviors regarding suicidal ideation during psychotherapy. The Working Alliance Inventory-Short Version Revised (WAI-SR) was also used to assess therapeutic alliance. These questionnaires were administered online to a sample of 85 participants who were over 18-years-old, currently involved in psychotherapy, and had thoughts of suicide during treatment. A hierarchical linear regression was conducted to identify which factors are most predictive of suicidal ideation disclosure. Specifically, this study assessed the degree to which the following are predictive of client disclosure of suicidal ideation: working alliance, the degree to which the therapist asked interpersonal theory of suicide assessment questions from the perspective of the client, how the therapists asks about suicidal ideation, and client fear of negative consequences for disclosure. Results suggested that the strength of the working alliance, the degree to which interpersonal theory of suicide assessment questions were asked, and lower levels of biased or awkward therapist questions about suicidal ideation all significantly predicted client disclosure of suicidal ideation. Implications explored include the utility of these identified factors in promoting a psychotherapeutic environment that optimizes the conditions associated with disclosure of suicidal ideation. Limitations of the study include methodological restrictions of online data collection as well as the homogeneity of the sample. Future directions include the importance of continuing research to identify more specific and different factors that both promote and inhibit client disclosure of suicidal ideation. The importance of researching factors associated with increased disclosure with varying demographic factors and diagnoses is also suggested