Can we agree we just had a rupture? Patient-therapist congruence on ruptures and its effects on outcome in brief relational therapy versus cognitive-behavioral therapy.

Abstract

To draw clinically meaningful evidence-supported implications about the alliance-outcome association, recent studies have investigated patient-therapist congruence on ruptures in alliance. The present study investigated patient-therapist congruence on ruptures and its consequences on subsequent session outcome in 2 types of treatments that differ in the training therapists receive to identify ruptures: brief relational therapy (BRT), in which therapists receive alliance-focused training, and cognitive-behavioral therapy (CBT), in which no training specifically focused on the alliance is provided. We implemented polynomial regression and response surface analysis, and the truth and bias model on data of 162 dyads reporting weekly on their levels of ruptures, for 30 sessions, during either CBT or BRT. Therapists and patients exhibited substantial temporal congruence in their session-by-session rupture ratings. Therapists showed a tendency to detect more ruptures than did their patients. This tendency correlated with higher levels of congruence and was more evident in BRT than in CBT. Agreement and disagreement between patients and therapists on the question of whether a rupture had occurred was found to have a greater effect on subsequent session outcomes in BRT than in CBT. These findings may suggest that therapists who are more attuned to their patients may demonstrate greater vigilance in identifying ruptures than their patients do. This vigilant stance may be taught. Greater congruence may result in better subsequent session outcome throughout treatment in BRT than in CBT. Public Significance StatementThe findings of the present study join those of previous research showing that therapists tend to show a more vigilant stance and report more alliance ruptures than their patients do. The current study is the first to suggest that therapists can be trained to adopt a more vigilant stance, to carefully monitor the alliance, and to show greater sensitivity to minor nuances in the alliance. The findings further suggest that in brief relational therapy, in which alliance rupture resolution is conceptualized as a main mechanism of change, patients' and therapists' agreement and disagreement on whether a rupture in the alliance has occurred has a greater impact on subsequent session outcome than in treatment in which this is not the case (cognitive-behavioral therapy). This finding supports the underlying therapeutic processes conceptualized to bring about therapeutic change in brief relational therapy, in which negotiating such agreement and disagreement is perceived as a main mechanism of change.

“Where is the relationship” revisited: Using actor-partner interdependence modeling and common fate model in examining dyadic working alliance and session quality.

“…This may be because of these therapists’ higher self-efficacy in general than the other therapists. On the other hand, as Zilcha-Mano, Eubanks, Bloch-Elkouby, and Muran (2020) found out, therapists who were more attuned to their patients may demonstrate greater vigilance in identifying alliance ruptures; therefore, it’s possible that the therapist’s general level of attunement with the client may help the therapist better see from the client’s perspective, leading to less unique individual perceptions on the therapist’s part. Further along this line, therapists who are more skilled in working within the therapeutic relationship may be more able to communicate and discuss with the client about their alliance and the therapy process (Samstag & Muran, 2019) and thus develop a greater shared collective perception of the therapy process and outcome and have less individual unique perceptions.…”

Effects of patient–therapist interpersonal complementarity on alliance and outcome in cognitive–behavioral therapies for depression: Moving toward interpersonal responsiveness.

“…We also included the main effects of the targeted IIP-32 dimensions in the regression. Considering that in the present sample, we had repeated measures of both the predictors and the outcome variables, we followed the procedures presented by Zilcha-Mano, Eubanks, Bloch-Elkouby, and Muran (2020) to adjust for time effects by including the session number (centered at the first session) as a predictor. Before calculating the quadratic and interactive terms, the predictors were grand-mean centered (Marmarosh & Kivlighan, 2012).…”

Proof of Concept of the Contribution of the Interaction between Trait-like and State-like Effects in Identifying Individual-Specific Mechanisms of Action in Biological Psychiatry

“…A recent meta-analysis based on 295 studies suggested that a stronger alliance is a significant predictor of better treatment outcome across treatment orientations and patient populations [ 5 , 6 ] This finding may be an indication of a robust TL effect, where, on average, patients who form a stronger alliance also exhibit greater treatment response. However, such TL finding does not translate directly into clinical practice so that therapists will be able to improve the alliance with individual patients to facilitate therapeutic change [ 7 , 8 , 9 , 10 , 11 ]. Contemporary theoretical conceptualizations suggest that the effect of the alliance varies with different subpopulations of patients and across different treatments.…”