Patterns of therapeutic alliance: rupture–repair episodes in prolonged exposure for posttraumatic stress disorder
Open accessAbstract
OBJECTIVE: To better understand the role of therapeutic alliance in posttraumatic stress disorder (PTSD) treatment, we examined patterns of and shifts in alliance. First, we identified individuals with repaired ruptures, unrepaired ruptures, and no ruptures in alliance. Then, we explored group differences in these alliance events for clients with common clinical correlates (i.e., co-occurring depression and childhood abuse history) and whether or not the presence of these events influenced treatment outcome. METHOD: At pretreatment, clients (N = 116)-76.1% female, 66% Caucasian, age M = 36.7 years (SD = 11.3)--completed measures assessing PTSD diagnosis and severity (PTSD Symptom Scale Interview and Self-Report), depression diagnosis and severity (Structured Clinical Interview for DSM-IV and Beck Depression Inventory), and trauma history. During 10 weeks of prolonged exposure therapy, alliance (California Psychotherapy Alliance Scale) measures were completed. At posttreatment, PTSD and depression were reassessed. RESULTS: Ruptures in alliance were quite common (46%). No significant differences emerged in the frequency of repaired ruptures, unrepaired ruptures, or no ruptures between those with and without co-occurring major depressive disorder, χ²(2, N = 82) = 2.69, p = .26, or those with and without a history of childhood abuse, χ²(2, N = 81) = 0.57, p = .75. Unrepaired ruptures predicted worse treatment outcome (β = .44, p = .001). CONCLUSIONS: The current study underscores the importance of attending to discontinuities in alliance throughout treatment.
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The capacity to establish and navigate an effective working alliance is essential to maximize the benefits of behavioral intervention and is particularly integral to the success of PE.
“The capacity to establish and navigate an effective working alliance is essential to maximize the benefits of behavioral intervention (Horvath and Luborsky, 1993), and particularly integral to the success of PE (Cloitre et al., 2004; McLaughlin et al., 2014).”
From Augmenting Prolonged Exposure therapy for PTSD with intranasal oxytocin: a randomized, placebo-controlled pilot trial (2018) · cites this paper as McLaughlin et al., 2014
Existing literature suggests that the rapport in PE is critical.
“existing literature suggests that the rapport in PE is critical (Keller et al., 2010; McLaughlin et al., 2014).”
From Augmenting Prolonged Exposure therapy for PTSD with intranasal oxytocin: a randomized, placebo-controlled pilot trial (2018) · cites this paper as McLaughlin et al., 2014
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- Authors
- McLaughlin, A. A., Keller, S. M., Feeny, N. C., Youngstrom, E. A., & Zoellner, L. A.
- Affiliations
- Case Western Reserve University (US)
- University of North Carolina at Chapel Hill (US)
- University of Washington (US)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2014
- Volume
- 82
- Issue
- 1
- Pages
- 112-121
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- PMC
- PMC3921691
- OpenAlex
- W2035614462
- Cited by
- 91
- References
- 58
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 7 · 2023: 11 · 2022: 10 · 2021: 11 · 2020: 6 · 2019: 4 · 2018: 8 · 2017: 7 · 2016: 8 · 2015: 8 · 2014: 2 · 2013: 2
- FWCI
- 7.41
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01 MH066347)
- William T. Dahms, M.D., Clinical Research Unit (UL1 RR024989)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- therapeutic relationship, alliance ruptures, alliance repair, prolonged exposure therapy, post-traumatic stress disorder, major depressive disorder, childhood abuse, treatment outcomes, therapeutic process
- MeSH terms
- Adult, Depression, Female, Humans, Implosive Therapy, Male, Middle Aged, Professional-Patient Relations, Stress Disorders, Post-Traumatic, Treatment Outcome, Adult Survivors of Child Abuse
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