The risk of a patient's suicide is a prominent occupational hazard for psychotherapists. The precise number of patients who attempt suicide while in treatment and then resume therapy with the same therapist is not known, but this situation is a relatively common occurrence in clinical practice. Such scenarios can pose significant challenges to the reestablishment of therapeutic trust and a workable treatment alliance. The aim of this paper is to identify the challenges facing a clinician treating a patient who resumes therapy following a serious suicide attempt, and to offer guidelines for maintaining the viability of the therapeutic alliance.