Our practice-based research programme has devoted itself to the study of how psychotherapy works for over 30 years. It has focused on how to negotiate the therapeutic alliance: more specifically, on rupture resolution as a critical change process in psychotherapy. Rupture refers to moments in which the patient and therapist experience a disagreement in the tasks and goals of treatment, a deterioration in their emotional bond or a breakdown in the intersubjective negotiation of their needs. Resolution (or repair) refers to the dyadic process that patient and therapist engage in to restore the alliance and to effect a new or corrective emotional experience. Our research has not only sought to provide further definition to this process but has striven to define and evaluate training for psychotherapists to be better able to identify ruptures and resolve them. We will provide some review of the evidence-based change process literature and the cognitive, emotion and social sciences that have informed our programme, concluding with a brief introduction to our research on clinical practice.
Get full access to this article
View all access options for this article.
References
1.
AndradeE. B.ArielyD. (2009). The enduring impact of transient emotions on decision making. Organizational Behavior and Human Decision Processes, 109(1), 1–8. https://doi.org/10.1016/j.obhdp.2009.02.003
2.
Atzil-SlonimD.JuravskiD.Bar-KalifaE.Gilboa-SchechtmanE.Tuval-MashiachR.ShapiraN.GoldbergY. (2021). Using topic models to identify clients’ functioning levels and alliance ruptures in psychotherapy. Psychotherapy, 58(2), 324–339. https://doi.org/10.1037/pst0000362
3.
BakanD. (1966). The duality of human existence. Rand McNally.
4.
BarberJ. P.Crits-ChristophP.LuborskyL. (1996). Effects of therapist adherence and competence on patient outcome in brief dynamic therapy. Journal of Consulting and Clinical Psychology, 64(3), 619–622. https://doi.org/10.1037/0022-006X.64.3.619
5.
BarrettL. F. (2017). How emotions are made. Houghton Mifflin Harcourt.
6.
BaumeisterR. F.BratslavskyE.FinkenauerC.VohsK. D. (2001). Bad is stronger than good. Review of General Psychology, 5(4), 323–370. https://doi.org/10.1037/1089-2680.5.4.323
7.
BeckA. T.BredemeierK. (2016). A unified model of depression: Integrating clinical, cognitive, biological, and evolutionary perspectives. Clinical Psychological Science, 4(4), 596–619. https://doi.org/10.1177/2167702616628523
8.
BenjaminL. S. (2002). Interpersonal diagnosis and treatment of personality disorders. Guilford Press.
9.
BenjaminL. S. (1996). Introduction to the special section on structural analysis of social behavior. Journal of Consulting and Clinical Psychology, 64(6), 1203–1212. https://doi.org/10.1037/0022-006X.64.6.1203
10.
BenjaminL. S. (1974). Structural analysis of social behavior. Psychological Review, 81(5), 392–425. https://doi.org/10.1037/h0037024
11.
BlattS. J.BlassR. B. (2013). Relatedness and self-definition: A dialectic model of personality development. In NoamG. G.FischerK. W. (Eds.), Development and vulnerability in close relationships (pp. 309–338). Lawrence Erlbaum Associates, Inc.
12.
BordinE. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16(3), 252–260. https://doi.org/10.1037/h0085885
13.
BowlbyJ. (1969). Attachment and loss (Vol. 1). Attachment. Basic Books.
14.
CasparF.HoltforthM. G. et al. (2010). Klaus Grawe: On a constant quest for a truly integrative and research-based psychotherapy. In CastonguayL. G.MuranJ. C.AngusL.HayesJ. A.LadanyN.AndersonT. (Eds.), Bringing psychotherapy research to life: Understanding change through the work of leading clinical researchers (pp. 113–123). American Psychological Association. https://doi.org/10.1037/12137-010
15.
CastonguayL. G.BeutlerL. E. (2006). Principles of therapeutic change: A task force on participants, relationships, and techniques factors. Journal of Clinical Psychology, 62(6), 631–639. https://doi.org/10.1002/jclp.20256
16.
CastonguayL. G.ConstantinoM. J.BeutlerL. E. (Eds.). (2019). Principles of change: How psychotherapists implement research in practice. Oxford University Press.
17.
CohenA. S.SymeS. L. (1985). Social support and health. Academic Press.
18.
ConstantinoM. J. (2000). Interpersonal process in psychotherapy through the lens of the structural analysis of social behavior. Applied and Preventive Psychology, 9(3), 153–172. https://doi.org/10.1016/S0962-1849(05)80002-2
19.
ConstantinoM. J.VîslăA.CoyneA. E.BoswellJ. F. (2018). A meta-analysis of the association between patients’ early treatment outcome expectation and their posttreatment outcomes. Psychotherapy, 55(4), 473–485. https://doi.org/10.1037/pst0000169
20.
ElliottR.BohartA. C.WatsonJ. C.MurphyD. (2019). Empathy. In NorcrossJ. C.LambertM. J. (Eds.), Psychotherapy relationships that work: Volume I: Evidence-based therapist contributions (pp. 245–287). Oxford University Press.
21.
EubanksC. F.GoldfriedM. R. (2019). A principle-based approach to psychotherapy integration. In NorcrossJ. C.GoldfriedM. R. (Eds.), Handbook of psychotherapy integration (pp. 88–104). John Wiley.
22.
EubanksC. F.LubitzJ.MuranJ. C.SafranJ. D. (2019). Rupture Resolution Rating System (3RS): Development and validation. Psychotherapy Research, 29(3), 306–319. https://doi.org/10.1080/10503307.2018.1552034
23.
Eubanks-CarterC.MuranJ. C.SafranJ. D. (2010). Alliance ruptures and resolution. In MuranJ. C.BarberJ. P. (Eds.), The therapeutic alliance: An evidence-based guide to practice (pp. 74–94). Guilford Press.
24.
Eubanks-CarterC.GormanB. S.MuranJ. C. (2012). Quantitative naturalistic methods for detecting change points in psychotherapy research: An illustration with alliance ruptures. Psychotherapy Research, 22(6), 621–637. https://doi.org/10.1080/10503307.2012.693772
25.
EubanksC. F.MuranJ. C.SafranJ. D. (2015). Rupture Resolution Rating System (3RS): Manual. [Unpublished manuscript]. Mount SinaiBeth Israel Medical Center.
26.
EubanksC. F.MuranJ. C.SafranJ. D. (2018). Alliance rupture repair: A meta-analysis. Psychotherapy, 55(4), 508–519. https://doi.org/10.1037/pst0000185
27.
FlückigerC.Del ReA. C.WampoldB. E.HorvathA. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. https://doi.org/10.1037/pst0000172
28.
FrankJ. D. (1961). Persuasion and healing. John Hopkins University Press.
29.
Fusar‐PoliP.SolmiM.BrondinoN.DaviesC.ChaeC.PolitiP.BorgwardtS.LawrieS. M.ParnasJ.McGuireP. (2019). Transdiagnostic psychiatry: a systematic review. World Psychiatry, 18(2), 192–207. Portico. https://doi.org/10.1002/wps.20631
30.
GelsoC. (2014). A tripartite model of the therapeutic relationship: Theory, research and practice. Psychotherapy Research, 24(2), 117–131.
31.
GoldfriedM. R. (1980). Toward the delineation of therapeutic change principles. American Psychologist, 35(11), 991–999. https://doi.org/10.1037/0003-066X.35.11.991
32.
GrecucciA.SanfeyA. G. (2014). Emotion regulation and decision making. In GrossJ. J. (Ed.), Handbook of emotion regulation (pp. 140–156). Guilford Press.
33.
GreenbergL. S. (2011). Emotion-focused therapy. APA Books.
34.
GreenbergL. S. (2007). A guide to conducting a task analysis of psycho-therapeutic change. Psychotherapy Research, 17(1), 15–30. https://doi.org/10.1080/10503300600720390
35.
GreenbergL. S. (1986). Change process research. Journal of Consulting and Clinical Psychology, 54(1), 4–9. https://doi.org/10.1037/0022-006X.54.1.4
36.
GrossJ. J. (2014). Handbook of emotion regulation. Guilford Press.
37.
HarveyA. G.WatkinsE.MansellW. (2004). Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. Oxford University Press.
38.
HayesS. C.HofmannS. G. (2020). Beyond the DSM Toward a process-based alternative for diagnosis and mental health treatment. Context Press.
39.
HorvathA. O.SymondsB. D. (1991). Relation between working alliance and outcome in psychotherapy: A meta-analysis. Journal of Counseling Psychology, 38(2), 139–149. https://doi.org/10.1037/0022-0167.38.2.139
40.
KahnemanD. (2011). Thinking, fast and slow. Macmillian.
41.
KazdinA. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3(1), 1–27. https://doi.org/10.1146/annurev.clinpsy.3.022806.091432
42.
KazdinA. E. (2008). Evidence-based treatment and practice: New opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care. American Psychologist, 63(3), 146–159. https://doi.org/10.1037/0003-066X.63.3.146
43.
KieslerD. J. (1996). Contemporary interpersonal theory and research: Personality, psychopathology and psychotherapy. John Wiley.
44.
KleinG. A. (1998). Sources of power: How people make decisions. MIT Press.
45.
KleinM. H.Mathieu-CoughlanP.KieslerD. J. (1986). The experiencing scales. In GreenbergL. S.PinsofW. M. (Eds.), The psychotherapeutic process: A research handbook (pp. 21–72). Guilford Press.
46.
LaurenceauJ. P.HayesA. M.FeldmanG. C. (2007). Some methodological and statistical issues in the study of change processes in psychotherapy. Clinical Psychology Review, 27(6), 692–695. https://doi.org/10.1016/j.cpr.2007.01.007
47.
LazarusA. A.MesserS. B. (1988). Clinical choice points: Behavioral versus psychoanalytic interventions. Psychotherapy: Theory, Research, Practice, Training, 25(1), 59–70. https://doi.org/10.1037/h0085324
48.
LipnerL. M. (2019). Needle in the haystack: The identification of ruptures in the therapeutic alliance with implications for psychotherapy outcome. [Unpublished doctoral dissertation]. Adelphi University.
LuborskyL. (1984). Principles of psychoanalytic psychotherapy: A manual for supportive expressive treatment. Basic Books.
51.
MesserS. B. (1986). Behavioral and psychoanalytic perspectives at therapeutic choice points. American Psychologist, 4(11), 1261–1272. https://doi.org/10.1037/0003-066X.41.11.1261
52.
MitchellS. A. (1993). Hope and dread in psychoanalysis. Basic Books.
53.
MuranJ. C. (2019). Confessions of a New York rupture researcher: An insider’s guide and critique. Psychotherapy Research, 29, 1–14. http://dx.doi.org/10.1080/10503307.2017.1413261
54.
MuranJ. C.EubanksC. F. (2020). Therapist performance under pressure: Negotiating emotion, difference, and rupture. American Psychological Association.
55.
MuranJ. C.EubanksC. F.LiperL. M.Block-ElkoubyS. (2022). Renegotiating tasks or goals as rupture repair: A task analysis in a cognitive-behavioral therapy for personality disorder. Psychotherapy Research, 1–14. https://doi.org/10.1080/10503307.2022.2079439
56.
MuranJ. C.SafranJ. D.EubanksC. F.GormanB. S. (2018). The effect of alliance-focused training on a cognitive-behavioral therapy for personality disorders. Journal of Consulting and Clinical Psychology, 86(4), 384–397. https://doi.org/10.1037/ccp0000284
57.
MuranJ. C.SafranJ. D.GormanB. S.SamstagL. W.Eubanks-CarterC.WinstonA. (2009). The relationship of early alliance ruptures and their resolution to process and outcome in three time-limited psychotherapies for personality disorders. Psychotherapy: Theory, Research, Practice, Training, 46(2), 233–248. https://doi.org/10.1037/a0016085
58.
NewellB. R.LagnandoD. A.ShanksD. R. (2007). Challenging the role of implicit processes in probabilistic category learning. Psychonomic Bulletin & Review, 14(3), 505–511. https://doi.org/10.3758/BF03194098
59.
NorcrossJ. C.LambertM. J. (2019). Evidence-based psychotherapy relationship: The third task force. In NorcrossJ. C.LambertM. J. (Eds.), Psychotherapy relationships that work: Volume I (pp. 1–23). Oxford University Press.
60.
Pascual-LeoneA.GreenbergL. S.Pascual-LeoneJ. (2009). Developments in task analysis: New methods to study change. Psychotherapy Research, 19(4–5), 527–542. https://doi.org/10.1080/10503300902897797
61.
RiceL.GreenbergL. S. (1984). Patterns of change: Intensive analysis of psychotherapeutic process. Guilford Press.
62.
RiceL. N.KerrG. P. (1986). Measures of client and therapist voice quality. In GreenbergL. S.PinsofW. M. (Eds.), The psychotherapeutic process: A research handbook (pp. 73–105). Guilford Press.
63.
RogersC. R. (1951). Perceptual reorganization in client-centered therapy. In BlakeR. R.RamseyG. V. (Eds.), Perception: An approach to personality (pp. 307–327). Ronald Press.
64.
RosenzweigS. (1936). Some implicit common factors in diverse methods of psychotherapy. American Journal of Orthopsychiatry, 6(3), 412–415. https://doi.org/10.1111/j.1939-0025.1936.tb05248.x
65.
SafranJ. D.MuranJ. C. (1996). The resolution of ruptures in the therapeutic alliance. Journal of Consulting and Clinical Psychology, 64(3), 447–458. https://doi.org/10.1037/0022-006X.64.3.447
66.
SafranJ. D.MuranJ. C. (2000). Negotiating the therapeutic alliance: A relational treatment guide. Guilford Press.
67.
SafranJ. D.MuranJ. C.SamstagL. W. (1994). Resolving therapeutic alliance ruptures: A task analytic investigation. In HorvathA. O.GreenbergL. S. (Eds.), The working alliance: Theory, research, and practice (pp. 225–255). John Wiley & Sons.
68.
SafranJ. D.MuranJ. C.SamstagL. W.StevensC. (2002). Repairing alliance ruptures. In NorcrossJ. C. (Ed.), Psychotherapy relationships that work (pp. 235–254). Oxford University Press.
69.
StilesW. B.HorvathA. O. (2017). Appropriate responsiveness as a contribution to therapist effects. In CastonguayL. G.HillC. E. (Eds.), How and why are some therapists better than others?: Understanding therapist effects (pp. 71–84). American Psychological Association. https://doi.org/10.1037/0000034-005
70.
TishbyO.WisemanH. (2020). Countertransference types and their relation to rupture and repair in the alliance. Psychotherapy Research, Advance online publicationhttps://doi.org/10.1080/10503307.2020.1862934.
71.
TronickE. (2007). The neurobehavioral and social-emotional development of infants and children. WW. Norton.
72.
TverskyA.KahnemanD. (1974). Judgement under uncertainty: Heuristics and biases. Science, 185(4157), 1124–1131. https://doi.org/10.1126/science.185.4157.1124
73.
WallersteinR. S. (1986). Forty-two lives in treatment: A study of psychoanalysis and psychotherapy. Guilford Press.
74.
WallersteinR. S. (1989). The psychotherapy research project of the Menninger Foundation: An overview. Journal of Consulting and Clinical Psychology, 57(2), 195–205. https://doi.org/10.1037/0022-006X.57.2.195
75.
WampoldB. E.ImelZ. E. (2015). The great psychotherapy debate: The research evidence for what works in psychotherapy (2nd ed.). Routledge.
76.
WeinbergerJ. L.RascoC. (2007). Empirically supported common factors. In HofmannS. G.WeinbergerJ. L. (Eds.), The art and science of psychotherapy (pp. 103–129). Routledge.
