Article2018

Alliance rupture repair: A meta-analysis.

Catherine F. Eubanks · John Christopher Muran · Jeremy D. Safran

448 citations0/0 files storedPsychotherapy

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Psychotherapy Techniques and Applications Psychoanalysis and Psychopathology Research Counseling Practices and Supervision

Abstract

A rupture is a deterioration in the therapeutic alliance, manifested by a disagreement between the patient and therapist on treatment goals, a lack of collaboration on therapeutic tasks, or a strain in their emotional bond. We present the most frequently used measures of alliance ruptures and clinical examples to illustrate their repair. To examine the relation of rupture repairs to outcome, and the impact of rupture resolution training on outcome, we conducted two meta-analyses. In the first meta-analysis, we examined 11 studies (1,314 patients) that examined the relation between rupture repair episodes and patient treatment outcomes. Results yielded an effect size of r = .29, d = .62, 95% confidence interval [.10, .47], p = .003, indicating a moderate relation between rupture resolution and positive patient outcome. Our second meta-analysis examined the impact of rupture resolution training or supervision on patient outcome. We examined 6 studies (276 trainees/supervisees) that compared the outcomes of trainees who received rupture resolution training with a comparison group. Results did not find a significant relation, r = .11, d = .22, 95% confidence interval [-.09, .30], p = .28. Moderator analyses indicated that the relation between training and outcome was stronger when the sample included fewer patients with personality disorders, when the training was more closely aligned with cognitive behavioral therapy than psychodynamic therapy, and when the treatment was brief. The article concludes with limitations of the research, diversity considerations, and research-informed therapeutic practices for repairing ruptures in ways that contribute to good treatment outcome. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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References

1979The generalizability of the psychoanalytic concept of the working alliance.2000Negotiating the Therapeutic Alliance: A Relational Treatment Guide 2011Repairing alliance ruptures.

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2023The alliance in mental health care: conceptualization, evidence and clinical applications 2020The reciprocal relationship between alliance and early treatment symptoms: A two-stage individual participant data meta-analysis.2018Rupture Resolution Rating System (3RS): Development and validation 2022Distinct roles of state-like and trait-like patient–therapist alliance in psychotherapy 2021Alliance in group therapy: A meta-analysis.2020When adolescents stop psychological therapy: Rupture–repair in the therapeutic alliance and association with therapy ending.2021Alliance With an Unguided Smartphone App: Validation of the Digital Working Alliance Inventory 2023Digital twins and the future of precision mental health

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