Impact of confrontations by therapists on impairment and utilization of the therapeutic alliance

Moeseneder, Laura; Ribeiro, Eugénia; Muran, J. Christopher; Caspar, Franz

doi:10.1080/10503307.2018.1502897

Cited by 14 publications

(8 citation statements)

References 40 publications

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“…This study also only looked at ratings for entire sessions: as the 3RS includes ratings every 5 minutes, there are many more sophisticated analyses that could be conducted in future studies to shed more light on rupture and resolution processes. For example, Moeseneder et al (2018) examined how much of a session was marked by ruptures and resolution strategies, and also investigated the co-occurrence of resolution strategies and other therapist interventions within the same five-minute segment. Future studies should take advantage of codes of more microprocesses in order to better understand how rupture processes develop and evolve over time within particular clinical contexts.…”

Section: Discussionmentioning

confidence: 99%

“…As research with the 3RS continues, it will also be important to consider how culture impacts how patients and therapists experience and express ruptures, and how observers interpret what they see. For example, Moeseneder et al (2018) noted that their raters observed subtler presentations of alliance ruptures in their Swiss sample as compared to the examples in the 3RS manual, which were primarily drawn from American cases.…”

Section: Discussionmentioning

confidence: 99%

“…A study of 44 Australian adolescents (74 sessions) who were diagnosed with borderline personality disorder and received either cognitive analytic therapy or a supportive therapy reported reliability coefficients for rupture and resolution markers ranging from .64 to .90 (Gersh et al, 2017). A study of 77 patients (154 sessions) primarily presenting with mood or anxiety disorders at a university clinic in Switzerland reported ICCs of .74 for rupture markers, and .63 for resolution strategies (Moeseneder, Ribeiro, Muran, & Caspar, 2018). This study also examined whether coders agreed on the incidence of a rupture or resolution attempt within each five-minute segment and obtained a Cohen's kappa of .46, which indicates only fair reliability (Cicchetti, 1994).…”

Section: Preliminary Psychometric Properties Of the 3rsmentioning

confidence: 99%

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

Eubanks

Lubitz

Muran

et al. 2018

Psychotherapy Research

121

152

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Preliminary Psychometric Properties Of the 3rsmentioning

confidence: 99%

See 1 more Smart Citation

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

Eubanks

Lubitz

Muran

et al. 2018

Psychotherapy Research

121

152

View full text Add to dashboard Cite

show abstract

“…It is possible that this active, intense engagement contributed to a corrective experience for a patient who usually withdrew from interpersonal interactions because he anticipated being ignored or abandoned. (See Moeseneder et al, 2019, for further consideration of therapist confrontation with regard to rupture.) Just as therapists may, at times, choose to engage in confrontation, there are also moments when a therapist may choose to join a patient in a withdrawal process, as illustrated by the example in the chapter on mentalizationbased therapy (see Chapter 10).…”

Section: Therapists Can Rupturementioning

confidence: 99%

Conclusion: Don't be afraid to get messy—Points of convergence in rupture and repair.

Eubanks¹,

Samstag²,

Muran³

2023

Rupture and Repair in Psychotherapy: A Critical Process for Change.

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Muran, 2021), we examined the clinical examples in the six articles from an intermediate level of abstraction-the level of clinical principles-at which convergence is usually easier to observe than at the more abstract level of theory or the more concrete level of therapeutic technique (see Castonguay et al., 2019;and Goldfried, 1980). We found that an important first step of rupture repair is therapist recognition of the rupture, which can be particularly challenging when the patient is engaged in subtle withdrawal behaviors, or movements away, that are easy to miss. We observed that confrontation ruptures, or movements against, are generally easier for therapists to recognize, and the challenge lies in responding with curiosity and compassion rather than counterhostility.Drawing on Stiles and colleagues' idea of appropriate responsivenessthat is, behaviors that are appropriate to the context of the therapeutic relationship (Stiles et al., 1998;Stiles & Horvath, 2017; see also Eubanks, Sergi, & Muran, 2021)-we explored how the clinical vignettes illustrated responsive repair. In some instances, therapists used immediate repair strategies that aimed to promptly attend to the rupture and get therapy "back on track." In other instances, therapists used expressive repair strategies, in which they explored the rupture with the patient. We noted that both types of repair strategies can facilitate corrective experiences for the patient by providing opportunities to experience and respond to interpersonal conflict or strain in a new and more flexible way (Christian et al., 2012).One common thread that we identified across several clinical examples in the In Session issue concerned therapist contributions to ruptures. We highlighted how therapists' withdrawal from their own experience can hinder their ability to recognize ruptures and how their efforts to repair a rupture by linking it to the patient's larger interpersonal patterns, while often clinically useful, can, at times, constitute an avoidant withdrawal from exploring what is happening in the therapeutic relationship. Drawing more attention to how therapists contribute to ruptures is consistent with the field of psychotherapy's growing recognition of the importance of the person of the therapist (Castonguay & Hill, 2017). While we have long maintained that ruptures and repairs are dyadic phenomena that are coconstructed by patient and therapist (Safran & Muran, 2000), our research has largely focused on how patients contribute to ruptures and how therapists can be trained to facilitate repair (e.g., Eubanks et al., 2019;Muran et al., 2018). We recognize that an important growing edge in our work is to attend more closely to how therapists contribute to ruptures (Eubanks, 2019;Muran & Eubanks, 2020) and to begin actively exploring how patients participate in repair.With this edited book, we have built on the In Session issue by including more in-depth explorations of rupture repair from 11 different approaches toCopyright American Psychological Association. Not fo...

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“…While therapists may feel wary about putting themselves into the spotlight and/or somehow triggering the patient, it may be helpful to remember that the rupture itself has already occurred and bringing it out in the open gives the patient permission to process these experiences. In one study, there was evidence to suggest that therapist attempts to openly address the issue and resolve the rupture were more strongly associated with symptom reduction, as compared to instances where therapists avoid confrontation and do not attempt resolution (multiple samples ns = 12 to 77 patients; N = 24 therapists in Moeseneder et al, 2019). Particularly with patients who frequently experience ruptures, the thoughts and feelings activated by the process can become so salient in therapy that it impedes therapeutic work.…”

Section: Rupture Repair Principles In Cbtmentioning

confidence: 99%

Alliance ruptures in cognitive‐behavioral therapy: A cognitive conceptualization

Okamoto

Kazantzis²

2021

J Clin Psychol

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The therapeutic relationship is crucial to the ethical and effective practice of any psychotherapy. In Cognitive Behavior Therapy (CBT) as formulated by Aaron T. Beck, the generic elements of the relationship including expressed empathy, expressions of positive regard, agreement on goals, and agreement on tasks within a therapeutic bond were considered a necessary condition for change. Alliance ruptures can therefore have a detrimental effect on therapy if left unrepaired. This article contributes to the In‐Session issue on rupture repairs by outlining the role of the alliance as a component of the therapeutic relationship in CBT and illustrates how ruptures can be identified and effectively resolved through detailed case examples. Given the central importance of using collaborative empiricism and Socratic dialogue for the therapeutic relationship in CBT, we demonstrate the distinctive role of these elements in repairing ruptures.

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Impact of confrontations by therapists on impairment and utilization of the therapeutic alliance

Abstract: Confrontations by therapists may temporarily impair the therapeutic alliance, but might also lead to better therapy outcomes when used to make an alliance rupture explicit as part of a resolution attempt.

Cited by 14 publications

References 40 publications

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

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

Conclusion: Don't be afraid to get messy—Points of convergence in rupture and repair.

Alliance ruptures in cognitive‐behavioral therapy: A cognitive conceptualization

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