Confessions of a New York rupture researcher: An insider’s guide and critique

Muran, J. Christopher

doi:10.1080/10503307.2017.1413261

Cited by 57 publications

(59 citation statements)

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“…This article investigates the timing, the typology and the significance of alliance ruptures over the complete treatment course with the aim to enhance the understanding of the mechanisms of change of how the therapeutic alliance works. Only recently, the study of specific types of alliance ruptures and resolutions was encouraged (Muran, 2017 ; Zilcha-Mano & Errázuriz, 2017 ). On the basis of a session-by-session investigation in a clinical sample of adolescents with BPP, we addressed three research questions: 1) Is there a typical trajectory of alliance ruptures over treatment time?…”

Section: Introductionmentioning

confidence: 99%

Trajectories of alliance ruptures in the psychotherapy of adolescents with borderline personality pathology: timing, typology and significance

Schenk

Zimmermann

Fürer

et al. 2019

ResPsy

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Jeremy Safran and his research group suggest that rupture-repair processes are important for the therapeutic change in patients with personality disorders. In this exploratory study, we describe alliance ruptures and resolutions on a session-by-session basis in a clinical sample of adolescents with Borderline Personality Pathology (BPP). Three research questions are addressed: i) Is there a typical trajectory of alliance ruptures over treatment time? ii) Which rupture and resolution markers occur frequently? iii) Which rupture markers are most significant for the therapeutic alliance? Ten patients who presented with identity diffusion and at least three Borderline Personality Disorder criteria were studied and treated with Adolescent Identity Treatment. Alliance ruptures and resolutions were coded in 187 therapy sessions according to the Rupture Resolution Rating System. Mixed-effect models were used for statistical analyses. Findings supported an inverted U-shaped trajectory of alliance ruptures across treatment time. The inspection of individual trajectories displayed that alliance ruptures emerge non-linearly with particular significant alliance ruptures appearing in phases or single peak sessions. Withdrawal rupture markers emerged more often compared to confrontation markers. However, confrontation markers inflicted a higher impact or strain on the immediate collaboration between patient and therapist compared to withdrawal markers. Clinicians should expect alliance ruptures to occur frequently in the treatment of adolescents with BPP. The findings support the theory of a dynamic therapeutic alliance characterised by a continuous negotiation between patients and therapists.

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Section: Introductionmentioning

confidence: 99%

Trajectories of alliance ruptures in the psychotherapy of adolescents with borderline personality pathology: timing, typology and significance

Schenk

Zimmermann

Fürer

et al. 2019

ResPsy

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“…Research on the alliance (e.g., Flückiger, Del Re, Wampold, & Horvath, 2018) has provided empirical support for the idea that a strong alliance is essential for effective treatment. A small but growing body of research is building on this alliance literature by focusing on what happens when there is a problem, or rupture, in the alliance (Muran, 2017). Drawing on Bordin's (1979) tripartite conceptualization of the alliance, ruptures can be characterized as disagreements between patients and therapists on the goals of treatment, failure to collaborate on the tasks of treatment, and/or a strain in the emotional bond.…”

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confidence: 99%

Rupture Resolution Rating System (3RS): Development and validation

Eubanks

Lubitz

Muran

et al. 2018

Psychotherapy Research

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Objective: Our aim was to examine the reliability and validity of the Rupture Resolution Rating System (3RS), an observer-based measure of alliance ruptures and resolution processes. Method: We used the 3RS to rate early sessions from 42 cases of cognitive behavior therapy. We compared the 3RS to a simplified version of the Structural Analysis of Social Behavior (SASB), as well as patient and therapist self-reports of ruptures and the alliance. Results: Coders achieved high rates of interrater reliability on the frequency of confrontation and withdrawal ruptures and resolution strategies (ICCs=.85 to .98), as well as ratings of the therapist's contribution to ruptures and the extent to which ruptures were resolved (ICC=.92). Predictive validity analyses found that confrontation markers (d=.74), successful resolution (d=. 67), and ratings of the therapist's contribution to ruptures (d=.61) predicted dropout from therapy. Analyses of convergent validity with the SASB failed to meet predictions; however, we observed theoretically coherent relations between 3RS and SASB variables. Confrontation rupture markers were significantly associated with patient self-report of rupture (d=1.54) and therapist selfreported alliance (r = −.50, p = .002). Conclusions: This study provides evidence that the 3RS is a reliable and useful tool for examining psychotherapy process and predicting dropout.

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“…Furthermore, confrontations regarding a discrepancy between patient and therapist may be an integral part of successful resolution attempts, at least in our specific sample, as they seem to be associated with a significantly better therapy outcome. This possible enriching of resolutions attempts by confrontation seems to fit well into the concept of therapeutic metacommunication (Muran, 2017;Safran & Muran, 2000) defined as "a communication about the communication process" (Muran, 2017, p. 4). A confrontation might help to regain perceived freedom over a strained interpersonal situation by verbalizing it if we revisit the above-mentioned theory of psychological reactance (Brehm & Brehm, 1981) .…”

Section: Discussionmentioning

confidence: 62%