The Alternative Model of Personality Disorders (AMPD) integrates several theoretical models of personality functioning, including interpersonal theory. The interpersonal circumplex dimensions of warmth and dominance can be conceptualized as traits similar to those in AMPD Criterion B, but interpersonal theory also offers dynamic hypotheses about how these variables that change from moment to moment, which help to operationalize some of the processes alluded to in AMPD Criterion A. In the psychotherapy literature, dynamic interpersonal behaviors are thought to be critical for identifying therapeutic alliance ruptures, yet few studies have examined moment-to-moment interpersonal behaviors that are associated with alliance ruptures at an idiographic level. The current study examined the concurrent and cross-lagged relationships between interpersonal behaviors and alliance ruptures within each session in the famous Gloria films (“Three Approaches to Psychotherapy”). Interpersonal behaviors (warmth and dominance) as well as alliance ruptures (i.e., withdrawal and confrontation) were calculated at half minute intervals for each dyad. We identified distinct interpersonal patterns associated with alliance ruptures for each session: Gloria (patient)’s warmth was positively related with withdrawal ruptures concurrently in the session with Carl Rogers; Gloria’s dominance and coldness were related with increased confrontation ruptures in the session with Fritz Perls concurrently, while her coldness was also predicted by confrontation ruptures at previous moments; lastly, both Gloria’s dominance and Albert Ellis’s submissiveness were positively related with withdrawal ruptures. These interpersonal patterns demonstrated the promise of using AMPD dimensions to conceptualize momentary interpersonal processes related to therapy ruptures, as well as the clinical importance of attuning to repetitive, dyad-specific interpersonal cues of ruptures within each session.

In this study, we aimed to examine how moment-to-moment interpersonal behaviors of warmth and dominance in patients and therapists, as well as interpersonal complementarity, are related to withdrawal and confrontation ruptures as sessions unfold. Sixteen psychotherapy sessions from eight independent therapeutic dyads were sampled for the highest level of alliance ruptures from a naturalistic psychotherapy data set featuring evidencebased psychodynamic psychotherapy for patients with interpersonal problems and personality pathology. Interpersonal behaviors, complementarity, and alliance ruptures were generated every 30 s within each session. Subgrouping within group iterative multiple model estimation (S-GIMME) was used to identify an idiographic network structure for each session and examine generalizability at the nomothetic and subgroup levels. Nomothetically, patients' dominance negatively predicted therapists' dominance concurrently, but positively predicted therapists' dominance with a 30-s lag; additionally, therapists' dominance predicted their own concurrent warmth. At the subgroup level, therapists being less dominant than typical predicted more concurrent withdrawal ruptures. Idiographic modeling revealed a high degree of heterogeneity in how interpersonal behaviors are associated with ruptures. More confrontation ruptures concurrently predicted higher dominance complementarity in one subgroup. This study demonstrated the interconnection between patients' and therapists' in-session behaviors as well as the role of therapists' behaviors in momentary rupture development. This study highlights the importance of attuning and responding to individualized, momentary therapeutic contexts in navigating ruptures, and emphasizes the value of idiographic relational network approaches to aid in psychotherapy research and case conceptualization. Public Significance StatementAlliance ruptures between patients and therapists in psychotherapy threaten the alliance and thereby treatment outcomes. We examined how specific patterns of in-session interpersonal behaviors may contribute to, or result from, ruptures in psychotherapy. This study identified some relatively robust patterns that inform therapeutic processes at a moment-to-moment level. Differences in patterns across sessions and dyads highlighted the importance of distinguishing idiographic from nomothetic effects rather than assuming that all patients, therapists, dyads, and sessions are interchangeable.

ObjectiveThere is a strong evidence‐base for a psychodynamic approach, supporting primary theoretical tenets as well as the treatment effectiveness. Additionally, there are increasing calls from the field for more individualized treatment for clients, and the lack of training in multiple orientations limits the ability of students in clinical psychology Ph.D. programs in the United States to personalize their treatments. The accumulated evidence‐base for contemporary relational psychodynamic theory and therapy places it in good standing to return to the standard clinical psychology curriculum, along with other evidence‐based approaches.MethodsWe use data from the Insider's Guide (which describes clinical Ph.D. programs in the United States) from three time points over 20 years to document the waning psychodynamic approach in clinical psychology programs. We review the scientific evidence for four primary tenets of a contemporary psychodynamic approach: three related to development—from healthy to psychopathological: (1) unconscious processes; (2) internal representations of self and other; (3) dimensional model of psychopathology, and a fourth tenet that builds on these three and is the foundation for a contemporary psychodynamic approach to psychotherapy: (4) therapeutic relationship as a primary mechanism of change.Results/ConclusionsBased on the review of the evidence, we make specific recommendations for clinical psychology training programs about how to include a psychodynamic approach in the curriculum.

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