Alliance rupture repair: A meta-analysis.

Abstract

A rupture is a deterioration in the therapeutic alliance, manifested by a disagreement between the patient and therapist on treatment goals, a lack of collaboration on therapeutic tasks, or a strain in their emotional bond. We present the most frequently used measures of alliance ruptures and clinical examples to illustrate their repair. To examine the relation of rupture repairs to outcome, and the impact of rupture resolution training on outcome, we conducted two meta-analyses. In the first meta-analysis, we examined 11 studies (1,314 patients) that examined the relation between rupture repair episodes and patient treatment outcomes. Results yielded an effect size of r ϭ .29, d ϭ .62, 95% confidence interval [.10, .47], p ϭ .003, indicating a moderate relation between rupture resolution and positive patient outcome. Our second meta-analysis examined the impact of rupture resolution training or supervision on patient outcome. We examined 6 studies (276 trainees/supervisees) that compared the outcomes of trainees who received rupture resolution training with a comparison group. Results did not find a significant relation, r ϭ .11, d ϭ .22, 95% confidence interval [Ϫ.09, .30], p ϭ .28. Moderator analyses indicated that the relation between training and outcome was stronger when the sample included fewer patients with personality disorders, when the training was more closely aligned with cognitive behavioral therapy than psychodynamic therapy, and when the treatment was brief. The article concludes with limitations of the research, diversity considerations, and research-informed therapeutic practices for repairing ruptures in ways that contribute to good treatment outcome. Clinical Impact StatementQuestion: How are therapists' abilities to address and repair alliance ruptures, or problems in the patient-therapist working relationship, related to treatment outcome? Findings: The findings suggest that clinicians may achieve better outcomes if they repair alliance ruptures. Meaning: Alliance rupture resolution was related to good treatment outcome, but training in alliance rupture resolution was not significantly related to better outcome. Next Steps: Additional research is needed drawing on multiple methods for assessing alliance ruptures and resolution from patient, therapist, and observer perspectives, as well as more research on the best ways to train therapists to recognize and address alliance ruptures.

Countertransference feelings and personality disorders: a psychometric evaluation of a brief version of the Feeling Word Checklist (FWC-BV)

“…There is a growing literature that underscores the importance of building a good working relationship with the patients [67][68][69]. Research findings demonstrate that alliance rupture repair is associated with positive psychotherapy outcome [68]. A brief instrument to measure CT feelings together with other process variables such as alliance can possibly give a better understanding of rupture-repair sequences in the therapeutic relationship.…”

Countertransference feelings and personality disorders: A psychometric evaluation of a brief version of the Feeling Word Checklist (FWC-BV)

“…There is a growing literature that underscores the importance of building a good working relationship with the patients [67][68][69]. Research findings demonstrate that alliance rupture repair is associated with positive psychotherapy outcome [68]. A brief instrument to measure CT feelings together with other process variables such as alliance can possibly give a better understanding of rupture-repair sequences in the therapeutic relationship.…”

Integrating clients' moment‐to‐moment ratings into psychotherapy research: A novel approach

“…Traditionally, psychotherapy research has utilised methods prompting clients, therapists or researchers to rate processes and outcomes for a given session or course of treatment (e.g. Eubanks, Muran, & Safran, ; Flückiger, Del Re, Wampold, & Horvath, ). While such methods provide insight into the role of those processes and outcomes overall, they are limited in their ability to capture the importance of micro‐processes (i.e.…”