The authors emphasize that the therapeutic relationship is a mechanism for modeling support, trust, acceptance, attachment, and, ultimately, separation and growth. For the vast majority of chronically suicidal patients and repeated attempters, interpersonal issues are at the core of their suicidality. The therapeutic alliance is the vehicle for change. The quality of the relationship, the authors emphasize, is the single most significant factor in predicting therapeutic outcome and assessing risk. Without a strong therapeutic relationship, it is unlikely that the patient will invest the energy and endure the pain that are often required for productive change.