Repairing alliance ruptures.

Abstract

In this article, we review the existing empirical research on the topic of therapeutic alliance ruptures in psychotherapy. Ruptures in the therapeutic alliance are defined as episodes of tension or breakdown in the collaborative relationship between patient and therapist. Two meta-analyses were conducted. The first reviewed studies examining the relation between rupture-repair episodes and treatment outcome (r = .24, z = 3.06, 95% CI [.09, .39], p = .002, k = 3, N = 148). The second meta-analysis reviewed the research examining the impact on treatment outcome of training therapists in the use of alliance rupture intervention principles (prepost r = .65, z = 5.56, 95% CI [.46, .78], p < .001, k = 8, N = 376). Both meta-analyses provided promising evidence regarding the relevance of alliance rupture-repair processes to therapeutic outcome. The limitations of the research reviewed are discussed as well as practice implications for repairing the inevitable alliance ruptures in psychotherapy.

Uncovering Interaction Structures in a Brief Psychodynamic Psychotherapy

“…Ruptures in the therapeutic alliance are episodes of tension or breaks in the collaborative work being undertaken by the patient-therapist pair. Repairs in the ruptures in the alliance are associated with positive results in psychotherapy (Safran, Muran, & Eubanks-Carter, 2011). Considering the outcome of the case studied, in conjunction with the elements which are more characteristic of the global process, and with the visual inspection of this structure's variation in the process, what is ascertained is the existence, in a general way, of a collaborative work supported by a solid therapeutic alliance, although, on average, the alliance was slightly negative (M = 4.26; SD = 1.07).…”

Impacto da relação terapêutica na efetividade do tratamento: o que dizem as metanálises?

“…O término prematuro de psicoterapia foi uma preocupação que levou Safran et al (2011) a investigar, em metanálise, que fatores podem ter impacto negativo na aliança e resultar em abandono de tratamento. Na perspectiva dos autores, o conhecimento desses fatores pode instrumentalizar o campo das psicoterapias, auxiliando os terapeutas na superação das adversidades na aliança e na obtenção de resultados positivos na psicoterapia.…”

“…Entre os interesses desses estudos destacam-se: (i) como tomar os indicadores de qualidade da relação terapêutica como prognóstico de efetividade (Horvath et al, 2011), e (ii) como estabelecer uma relação qualificada e continuada, sem rupturas e sobressaltos (Safran et al, 2011).…”

A thematic analysis of therapists' perspectives on therapeutic alliance rupture moments

“…Nevertheless, the problem of whether we can repair ruptures by using a technically or relationally oriented approach is an important and challenging issue in the frame of psychotherapy research literature, considering the results of the negative relationship between a high level of adherence and the therapeutic alliance and therapy outcome (Castonguay, Goldfried, Wiser, Raue & Hayes, 1996;Henry, Strupp, Butler, Schacht & Binder, 1993;Soygüt, 2015). Given that the therapeutic alliance and the resolutions of rupture in the alliance are associated with therapy outcome (Bickman et al, 2012;Safran et al, 2011;Samstag, Batchelder, Muran, Safran & Winston, 1998;Spinhoven, Giesen-Bloo, van Dyck, Kooiman, & Arntz, 2007;Zuroff & Blatt, 2006), a poor alliance is identified as being related to dropout (Sharf, Primavera & Diener, 2010). This tendency itself seems to be an inevitable difficulty in the change process.…”