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(p. 549) Repairing Alliance Ruptures 

(p. 549) Repairing Alliance Ruptures
(p. 549) Repairing Alliance Ruptures

Catherine F. Eubanks

, J. Christopher Muran

, and Jeremy D. Safran

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date: 11 April 2021

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. This chapter presents the most frequently used measures of alliance ruptures and clinical examples to illustrate their repair. To examine the relation of rupture repairs to outcome, the authors conducted a meta-analysis on 11 studies (1,314 patients) that compared the treatment outcomes of patients with rupture-repair episodes to those of patients with unrepaired ruptures. 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. To examine the impact of rupture resolution training or supervision on patient outcome, the authors 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 chapter concludes with limitations of the research, diversity considerations, and research-informed therapeutic practices for repairing ruptures in ways that contribute to good outcome in therapy.

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