Background <p>The physician–patient relationship is essential in the care of suicidal patients, yet factors shaping this relationship remain insufficiently explored. This study aimed to explore physicians’ emotional reactions to suicidal patients and how both physician- and patient-related issues influence these responses.</p> Methods <p>Interviews were conducted with six physicians from the Douglas Mental Health University Institute in Montreal. A thematic analysis was performed using Hayes’ structural model of countertransference as the analytical framework.</p> Results <p>Three primary emotional reactions emerged: emotional connection/avoidance, confidence/doubts, and powerlessness attributed to own limitations/to the patient. Clinicians’ core needs—the need to help, need for security, and need for efficacy—were found to be pivotal in shaping these emotional responses. Similarly, patient-related factors, notably life experiences, disease, suicidality, and attitudes significantly influenced these reactions. Patterns linking physicians’ emotional responses to their underlying needs and patient-related factors were analyzed, leading to the development of a conceptual framework.</p> Conclusions <p>This framework offers implications for research, clinical supervision, and medical training, fostering deeper insight into the physician–patient relationship in the context of suicidality.</p>