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Alliance ruptures and repairs in psychotherapy in primary care
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Center for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden.
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden. (Internet, health and clinical psychology research group)ORCID iD: 0000-0003-4753-6745
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
2018 (English)In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 28, no 1, p. 123-136Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The association between alliance level and outcome in psychotherapy has been extensively studied. One way to expand this knowledge is to study alliance patterns. The main aims of this study were to examine how frequent alliance patterns with ruptures or rupture-repair episodes were in a naturalistic sample of psychotherapies in primary care, and if three alliance patterns (a Rupture pattern, a Repair pattern, and a No Rupture pattern) were differentially associated with treatment outcome.

METHOD: The psychotherapies (N = 605) included a wide range of different treatment orientations and patient diagnoses. Alliance patterns were studied at session-to-session level, using patient-rated alliance scores. Outcome data were analyzed using longitudinal multilevel modeling with a slopes-as-outcomes model.

RESULTS: The Repair pattern accounted for 14.7% (n = 89) of the treatments, 10.7% (n = 65) exhibited a Rupture pattern, and 74.5% (n = 451) contained no ruptures. The Rupture pattern was associated with inferior treatment outcomes. The Repair pattern was, in longer treatments, associated with better outcomes than the No Rupture pattern.

CONCLUSIONS: The results support theory about the importance of ruptures in the therapeutic alliance and suggest that identification of alliance ruptures is important in alliance-outcome research, for feedback purposes in clinical practice, and in training of therapists.

Place, publisher, year, edition, pages
Routledge, 2018. Vol. 28, no 1, p. 123-136
Keyword [en]
alliance, alliance patterns, alliance ruptures, longitudinal multilevel modeling, naturalistic process and outcome research
National Category
Applied Psychology
Identifiers
URN: urn:nbn:se:liu:diva-143855DOI: 10.1080/10503307.2016.1174345ISI: 000418942800011PubMedID: 27139816Scopus ID: 2-s2.0-84965032354OAI: oai:DiVA.org:liu-143855DiVA: diva2:1168773
Available from: 2017-12-21 Created: 2017-12-21 Last updated: 2018-01-12Bibliographically approved

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Holmqvist Larsson, MattiasFalkenström, FredrikHolmqvist, Rolf

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