Rupture Resolution Rating System

Eubanks, Catherine F.; Lubitz, Jessica; Muran, J. Christopher; Safran, Jeremy D.

doi:10.1037/t76711-000

Cited by 14 publications

(40 citation statements)

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“…In a clear disagreement on the tasks of therapy, the patient feels this has been done already with little to no effect. While there are several confrontation rupture markers in this segment, the patient also engages in withdrawal behavior by becoming absorbed in a depressive process of hopelessness, feeling that treatment may not be helpful, and that she may never improve (Eubanks et al, 2015).…”

Section: Resultsmentioning

confidence: 99%

V-episodes in the alliance: A single-case application of multiple methods to identify rupture repair.

Lipner¹,

Liu²,

Cassell³

et al. 2023

Psychotherapy

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The therapeutic alliance has been consistently found to be a robust predictor of therapeutic outcome across various modalities of psychotherapy. Alliance ruptures are thought to occur commonly within each therapeutic dyad and, if left unresolved, are associated with premature termination and worsened psychotherapy outcome. Research efforts have identified V-shaped shifts in the alliance, characterized by a high-low-high pattern of postsession alliance scores, as a meaningful method of operationalizing rupture-repair episodes, but these efforts rarely evaluate the within-session process of the identified sessions. As a result, it is often unclear whether these sessions identified by methods based on postsession alliance measures are reflective of clinically meaningful within-session rupture process. This article aims to further explore the V-episode operationalization of rupture-repair episodes by assessing for convergence between rupture process identified by between-session measures and the within-session observer-based Rupture Resolution Rating Scale (3RS) in a single patient-therapist dyad in a 30-session brief relational therapy. V-episodes were operationalized using various previously utilized methods to identify ruptures based on postsession measures of alliance. Results of this case study demonstrate that postsession patientrated V-episodes in the therapeutic alliance can be indicative of within-session rupture process, demonstrating convergence between within-and between-session measures of alliance process. Implications of these results for methodological approaches for identifying alliance ruptures are discussed. Clinical Impact StatementQuestion: Given that ruptures in the therapeutic alliance can weaken the strength of the alliance, and if unrepaired, can lead to treatment failure, this article seeks to address whether alliance measures are capable of accurately identifying clinically meaningful rupture process. Findings: When used to track the course of psychotherapy, commonly used alliance measures may capture clinically significant shifts in alliance development, including rupture and rupture repair processes. Meaning: Using V-episodes to operationalize alliance rupture repair process based on postsession alliance measures may help researchers and clinicians to identify and intervene on clinically meaningful psychotherapy process. Next Steps: Future studies might examine whether therapist ratings, rather than patient ratings, of alliance produce similar results.

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Section: Resultsmentioning

confidence: 99%

V-episodes in the alliance: A single-case application of multiple methods to identify rupture repair.

Lipner¹,

Liu²,

Cassell³

et al. 2023

Psychotherapy

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“…Based on studies using these observer-based measures (Colli & Lingiardi, 2009; Eubanks et al, 2017), ruptures are seen as quite prevalent, more so than what is yielded from patient-report. Withdrawal ruptures on the 3RS (n=46) and CIS (n=32) are found in every session (100%).…”

Section: What About Alliance Ruptures?mentioning

confidence: 99%

“…Our task analytic effort (Safran & Muran, 1996) was based on a method that indirectly related our stage process model to outcome –that was founded on an assessment structure linking observed in-session events to overall outcome (see Muran, 2002, for an explanation). Only Eubanks et al (2017) applying the 3RS demonstrated a statistically significant moderate relationship of a single index of resolution to outcome ( p < .05): Third-party raters rated, “To what degree were ruptures resolved over the course of the session.”…”

Section: What About Rupture Resolution?mentioning

confidence: 99%

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

Muran

2017

Psychotherapy Research

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It suggests some clinical conceptualizations (concerning agency and communion as well as mutual recognition), training implications (regarding emotion regulation and deliberate practice), and methodological considerations (promoting pluralism and contextualism), along with future directions. Clinical or methodological significance of this article: The paper provides a critical review of research on a possible risk factor and potential change process in psychotherapy, including related training strategies, that has important implications for treatment outcome and professional development.

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“…The Rupture Resolution Rating System (3RS; Eubanks et al, 2015) was used to assess ruptures in three sessions over the course of treatment (sessions 4, 8, and 12). All coders received a minimum of 6 months of training (approximately 100 hr) from an experienced coder until they achieved adequate reliability.…”

Section: Alliance Rupturesmentioning

confidence: 99%

Biological marker of withdrawal ruptures: Dyadic pattern of incongruence in oxytocin release.

Tal

Tchizick

Shamay‐Tsoory

et al. 2023

Journal of Counseling Psychology

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Despite widespread clinical, theoretical, and empirical support for the importance of alliance ruptures, little is known about the underlying biological level at times of rupture. The overarching goal of the present study was to investigate dyadic patterns of in-session oxytocin (OT) change between patients and therapists (e.g., patient's OT increases more than therapist's OT) as markers of withdrawal ruptures. Hypothesis 1 construed that OT incongruence (e.g., larger patient increase in OT in comparison to their therapist OT increase) will mark the occurrence of withdrawal ruptures. Hypothesis 2 construed that this effect of OT incongruence will be more pronounced when anxious attachment orientation is low. Surface analysis was conducted on 628 saliva samples that were gathered before and after therapeutic sessions of 53 patienttherapist dyads enrolled in a randomized control trial treating major depression. Only Hypothesis 2 received empirical support, meaning it was only when anxious attachment orientation was low that there were significantly more withdrawal ruptures when the patient's OT increase was higher than their therapist's OT increase. This is consistent with the literature, suggesting that in times of withdrawal ruptures, the patient and therapist are in an incongruent state. Findings suggest that this incongruence is mirrored at the biological level only when anxious attachment orientation is low. Results shed light on what may be happening between patients and therapists on a biological level during a withdrawal rupture. Public Significance StatementThis article provides the first empirical evidence of a potential biological marker for withdrawal ruptures. Findings suggest that a dyadic pattern of incongruence in oxytocin release emerges in times of withdrawal ruptures. This dyadic pattern of incongruence manifested as a patient's increase in OT that is higher than the therapist's increase in OT. This effect of OT incongruence was found only when anxious attachment orientation was low.

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Rupture Resolution Rating System

Cited by 14 publications

References 0 publications

V-episodes in the alliance: A single-case application of multiple methods to identify rupture repair.

V-episodes in the alliance: A single-case application of multiple methods to identify rupture repair.

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

Biological marker of withdrawal ruptures: Dyadic pattern of incongruence in oxytocin release.

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