Emotion in an alliance rupture and resolution sequence: A theory‐building case study

Abstract

Aims: Alliance rupture and resolution processes are occasions for the client to have his or her core interpersonal patterns activated in the here and now of the therapy and to negotiate them with the therapist. So far, no studies have been conducted on emotional processing, from a sequential perspective using distinct emotion categories, in alliance rupture and resolution therapy sessions. This is the objective of this theory-building case study. Method: This client underwent a 34-session long, psychodynamic psychotherapy within the context of an open trial. An alliance rupture-resolution sequence of two subsequent sessions, along with a third control session, was selected from this case and these sessions were rated using the Classification of Affective-Meaning States (CAMS), an observer-rated method to classify distinct emotions, according to current emotion-focused models. Results: The results indicate that the rupture session was associated, above all, with core maladaptive fear, evoked in the actual here and now of the therapeutic relationship, whereas the resolution session was associated with the expression and experience of adaptive hurt as regards biographical issues of the client. Discussion: These results are discussed with regard to the alliance rupture and resolution model and the exploration of integrating client's emotional processing in the model.

New Developments for Case Conceptualization in Emotion‐Focused Therapy

“…The model presented herein highlights aspects of the client's perceptions, self‐processes and emotional experiences that can inform a therapist's understanding of client suffering and suggest actions to facilitate its transformation. The usefulness of this approach should be examined using empirically based case studies of transformation (e.g., McNally et al ., ; Kramer et al ., ). It would be also interesting to examine whether therapists using this model could increase their effectiveness in therapy.…”

“…Work by Pascual‐Leone (, ; Pascual‐Leone & Greenberg, ) and collaborators (e.g., Kramer, Pascual‐Leone, Despland, & de Roten, ; Paivio & Pascual‐Leone, ) led the [Ladislav Timulak] (led by first author) to a series of case studies that used the model developed by Pascual‐Leone and Greenberg () as a basis for observing emotional processing across all sessions of psychotherapy in particular cases (primarily of clients with depression, anxiety disorders and co‐morbid personality disorders and clients with chronic illness) and further complemented observations described in Pascual‐Leone's studies (e.g., Crowley, Timulak, & McElvaney, 2013; Keogh, Timulak, & McElvaney, 2013; Keogh, O'Brien, Timulak, & McElvaney, ; McNally, Timulak, & Greenberg, ; O'Brien, Timulak, McElvaney, & Greenberg, ; Timulak, Dillon, McNally, & Greenberg, ).…”

Developing Emotion‐Based Case Formulations: A Research‐Informed Method

“…While the initial research was conducted on experiential therapy, the concrete and observable criteria used in Pascual‐Leone and Greenberg's () model are a‐theoretical and describe sequences of emotional processing that intuitively appeal to psychotherapists across treatment approaches. The argument that this method of case formulation may apply trans ‐theoretically is based on the study of over 300 clients representing treatment cases from almost in all major orientations, including: emotion focused therapy (Choi et al, ; Haberman et al, ; Khayyat‐Abuaita, ; Pascual‐Leone & Greenberg, ; Timulak & McElvaney, 2015), clarification oriented psychotherapy (Kramer et al, 2015), short‐term dynamic therapy (Kramer et al, 2014, 2015), dialectical behaviour therapy (Kramer et al, 2015), attachment‐based family therapy (Lifshitz et al, ) and even a manualized general psychiatric treatment (Berthoud et al, ).…”

“…Three books to date, each on clinical practice, have used the sequential model of emotional process as a main interpretive lens to help clinicians map out their client's emotional change in emotion focused therapy (Kramer & Ragama, ; Paivio & Pascual‐Leone, ; Timulak, ). Following this budding direction, a number of papers have explicitly elaborated how to use this sequential model of emotional change for specific case formulations in working with depression (McNally et al, ), unresolved interpersonal trauma (Timulak & Pascual Leone, ), generalized anxiety disorder (Timulak & McElvaney, ), adjustment disorder (Kramer et al, 2014) and borderline personality disorder (Kramer & Pascual‐Leone, ). It is critical to understand that a process model focused on affect is not exclusively, or even necessarily tied to, an emotion‐focused approach, even if it was inspired by and contributes to that body of research.…”

Alliance rupture and repair processes and therapeutic change in youth with borderline personality disorder

“…This type of sophisticated analysis appears to be more promising than summary approaches that aggregate process to a single measure of the alliance taken at a session‐by‐session level. Previous research has examined how fluctuations in within‐session variables including emotional processing (Kramer, Pascual‐Leone, Despland, & de Roten, ) and mental state vacillations (Levy et al ., ) impact on the alliance. Similarly, in examining alliance rupture and repair, process‐based research that examines how multiple alliance processes can occur within a single session is likely to provide important insights.…”