ABSTRACT
Introduction
The Session Rating Scale (SRS) is widely used to assess therapeutic alliance in clinical settings, yet its application in paraprofessional-delivered interventions for older adults remains underexplored. This study examined whether therapeutic alliance predicted improvements in suicide desire among community-dwelling older adults participating in a warm-calling intervention.
Methods
Binomial generalized linear mixed-effects models were used with dichotomized high-score responses for thwarted belongingness (TB) and perceived burdensomeness (PB) to evaluate the role of therapeutic alliance (SRS) over time. Participants were assigned to one of two 8-week conditions: (1) BE, emphasizing empathy and connection through befriending and reminiscence; or (2) BE + ASIST, which incorporated an aging-adapted LivingWorks Applied Suicide Intervention Skills Training (ASIST). Trained paraprofessionals delivered all sessions.
Results
For PB, the odds of being classified as elevated decreased over time, and this decrease was statistically significant. For TB, a three-way interaction among condition, time, and SRS further showed that higher SRS scores predicted greater reductions in the odds of elevated TB within the BE + ASIST condition.
Conclusion
Findings underscore the importance of therapeutic alliance in enhancing paraprofessional-led interventions for late-life suicide prevention.