The resolution of ruptures in the therapeutic alliance.

Abstract

This article outlines some of the main features of a research program on ruptures in the therapeutic alliance and reports some of the major findings to date. A rupture in the therapeutic alliance is a deterioration in the quality of the relationship between patient and therapist; it is an interpersonal marker that indicates a critical opportunity for exploring and understanding the processes that maintain a maladaptive interpersonal schema. Following the task-analytic research paradigin, a preliminary model of the resolution process was developed and then tested and revised with 2 different data sets. A series of lag 1 sequential analyses were used to confirm the hypothesized sequences of events within resolution sessions and to demonstrate a difference between resolution and nonresolution sessions. This article describes the evolution of a model of rupture resolution and then discusses its implications for treatment development and evaluation.

Cites (2)

1. Development and validation of the working alliance inventory
   Horvath, Adam O., Greenberg, Leslie S. · 1989 · Journal of Counseling Psychology
2. Relation between working alliance and outcome in psychotherapy: A meta-analysis
   Horvath, Adam O., Symonds, B. Dianne · 1991 · Journal of Counseling Psychology

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