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Rupture and Repair in the Working Alliance: Relation to Psychotherapy Outcome and Within-Session Interaction
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.ORCID iD: 0000-0002-1890-3959
2019 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Alliansbrott och reparation : Relation till psykoterapiutfall och interaktion inom sessioner (Swedish)
Abstract [en]

Ruptures and repairs are processes related to shifts in the collaborative relationship Cthe working allianceJ between patient and therapist in psychotherapy. Ta study ruptures and repairs is one way ta disentangle mechanisms that might underlie the association between the working alliance and psychotherapy outcome. The overarching aim af this thesis was ta analyze the clinical relevance af the rupture and repair concepts at different process levels. The same three alliance patterns were investigated in the three empirical studies: the rupture pattern, the repair pattern, and the no-rupture/stable pattern. The analyses af the alliance patterns moved fromwhole treatments ta session segments. In Study I ruptures were found ta be associated with worse outcomes than treatments without ruptures. Repairs were, in longer therapies, shown ta be related ta better outcomes than norupture treatments. In Study Il it was found that the three alliance patterns could be discerned within sessions. Ruptures and repairs within sessions were found ta be associated with patient-ratings af the working alliance. In Study 111 the alliance patterns were found ta be related ta different  interaction patterns within sessions. In these analyses, importont patient contributions ta repairs af ruptures were found.

Abstract [sv]

Alliansbrott och reparationer är processer relaterade till förändringar i samarbetet och relationen mellan patient och terapeut i psykoterapi. Att studera alliansbrott och reparationer av dem kan utveckla kunskapen om sambandet mellan arbetsallians och psykoterapiutfall. Avhandlingens övergripande syfte var att pröva den kliniska relevansen av begreppen alliansbrott och reparationer på olika processnivåer. Samma tre alliansmönster undersöktes i de tre empiriska studierna: alliansbrottsmönstret, reparationsmönstret och icke-alliansbrott/stabila mönstret. Analyserna av alliansmönstren gick från hela behandlingar till sessionssegment. Studie I visade att alliansbrott hade samband med sämre utfall än behandlingar med mönstret icke-alliansbrott. Reparationer visade sig, för längre terapier, vara relaterade till bättre resultat än mönstret ickealliansbrott I Studie Il befanns de tre alliansmönstren vara urskiljbara inom sessioner. Alliansbrott och reparationer inom sessionerna visade sig vara associerade med patientskattad arbetsallians. I studie 111 befanns alliansmönstren vara relaterade till olika interaktionsmönster inom sessionerna. Det visade sig att patienterna bidrog på viktiga sätt till reparationer av alliansbrott.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2019. , p. 89
Series
Linköping Studies in Arts and Sciences, ISSN 0282-9800 ; 765Linköping Studies in Behavioural Science, ISSN 1654-2029 ; 216
Keywords [en]
Rupture and repair, working alliance, interpersonal interaction, psychotherapy outcome
Keywords [sv]
Alliansbrott och reparation, arbetsallians, interpersonell interaktion, utfall av psykologisk behandling
National Category
Psychology
Identifiers
URN: urn:nbn:se:liu:diva-154934ISBN: 9789176851111 (print)OAI: oai:DiVA.org:liu-154934DiVA, id: diva2:1294003
Public defence
2019-03-22, 1:101, Hus I, Campus Valla, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2019-03-06 Created: 2019-03-06 Last updated: 2019-06-27Bibliographically approved
List of papers
1. Alliance ruptures and repairs in psychotherapy in primary care
Open this publication in new window or tab >>Alliance ruptures and repairs in psychotherapy in primary care
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
Keywords
alliance, alliance patterns, alliance ruptures, longitudinal multilevel modeling, naturalistic process and outcome research
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-143855 (URN)10.1080/10503307.2016.1174345 (DOI)000418942800011 ()27139816 (PubMedID)2-s2.0-84965032354 (Scopus ID)
Available from: 2017-12-21 Created: 2017-12-21 Last updated: 2019-06-27Bibliographically approved
2. The Alliance and Rupture Observation Scale (AROS): Development and validation of an alliance and rupture measure for repeated observations within psychotherapy sessions
Open this publication in new window or tab >>The Alliance and Rupture Observation Scale (AROS): Development and validation of an alliance and rupture measure for repeated observations within psychotherapy sessions
Show others...
2019 (English)In: Journal of Clinical Psychology, ISSN 0021-9762, E-ISSN 1097-4679, Vol. 75, no 3, p. 404-417Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to test a new observer-rated instrument, the Alliance and Rupture Observation Scale (AROS). It was designed for repeated measurements of the alliance within sessions and to detect alliance ruptures.

Method: Videotaped therapy sessions with depressed adults were analyzed. Reliability was mainly assessed as inter-rater reliability. Convergent, predictive, and discriminant validity of the AROS was assessed by comparing the instrument with both observer-rated and patient-rated measures.

Results: The AROS exhibited excellent inter-rater reliability. Alliance levels measured with the AROS predicted patients’ ratings of the alliance in the same session and were highly correlated with another observer-rated alliance measure. Alliance patterns (rupture; repair; and no-rupture) based on AROS scores were significantly correlated with patients’ ratings of the alliance.

Conclusions: Preliminary support for convergent and predictive validity was found. It is yet to be determined whether AROS scores are related to psychotherapy outcomes.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
alliance ruptures and repairs, measurement, observer-based alliance measure, psychotherapy process, test development, therapeutic alliance, therapeutic relationship
National Category
Psychology
Identifiers
urn:nbn:se:liu:diva-154932 (URN)10.1002/jclp.22704 (DOI)000459626300006 ()30431649 (PubMedID)2-s2.0-85056660476 (Scopus ID)
Available from: 2019-03-06 Created: 2019-03-06 Last updated: 2019-06-27Bibliographically approved

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