Psychotherapy for suicidal patients is effective in decreasing self-attack. For many clinicians, this involves instituting manualized treatments, or more usually, the clinician’s own version of such treatments. All the manualized therapies advocate an active participatory therapeutic style but differ in how this ‘activeness’ is to be carried out. This discussion focuses on the meanings of being active and how such an approach may be effective in connecting with the suicidal patient. Treatment inevitably include suicide risk assessment, safety interventions and in some way addresses internal issues and interpersonal relationships that cause unbearable distress. Psychotherapy adds a containing relationship to the suicidal patient who is isolated, self-critical and desperate. Patients respond to an engaging psychotherapist who is attuned to the patient’s internal subjective experience, and can help allow internal strengths to re-emerge, and prevent hopeless regressions to suicide. The therapeutic alliance allows the patient to deal with painful vulnerabilities that are suicide inviting. The therapeutic alliance emerges from the therapeutic frame but there are no clear technical guidelines for building the therapeutic frame, through which the dyad may interact and gradually re-form a safe holding environment that can facilitate growth. There are many ways of being an active therapist. The active therapist tries variously, within the context of neutrality to make contact with the patient who is withdrawn and fearful of repeating old injuries. Attunement to the patients internal subjective experience, support of ego functions, facilitation of hope, and careful attention to relationship issues, attention to affect, identifying themes and repetitive dilemmas are important in allowing therapeutic progress. All these principles involve an active therapeutic approach. Different patients or the same patient at different times may require different aspects of the therapist’s active engagement. Over time, there is a growing appreciation of the complexity in the therapeutic encounter and the molding of the ways the therapist and patient interact. The suicidal patient doesn’t have a strong conviction of the curative power of the treatment and may be too afraid to hope for internal change. The active therapist is an essential component in the creation of the therapeutic alliance that is suicide preventing, that validates the subjective experience and connections with self and others, including the therapist and facilitates hope towards a life-sustaining experience.