Alliance rupture and repair processes and therapeutic change in youth with borderline personality disorder

Gersh, Elon; Hulbert, Carol; McKechnie, Ben; Ramadan, Reem; Worotniuk, Tamara; Chanen, Andrew M

doi:10.1111/papt.12097

Cited by 32 publications

(37 citation statements)

References 118 publications

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“…Além disto, denotou-se o baixo número de sessões em relação ao tempo de tratamento deveu-se, sobretudo às faltas entre sessões (foram 9 faltas; destas, somente uma combinada com a terapeuta). Nota-se que as faltas iniciaram na 4ª sessão, justamente quando, segundo a literatura, espera-se que a AT comece a se desenvolver de modo mais efetivo (Gersh et al, 2017).…”

Section: Discussionunclassified

“…A avalição da AT analisada em um nível microscópico, ao longo do tratamento, permitiu identificar problemas na colaboração entre paciente e terapeuta no presente caso, já constatados em nível macro pelas faltas e atrasos mencionados. Identificou-se rupturas em todas as sessões, número elevado de rupturas (n=100), em comparação com outros estudos realizados com o 3RS com pacientes com TPB (Gersh et al, 2017). As rupturas foram predominantemente de evitação, mais frequentes nas sessões intermediárias (com a contribuição da terapeuta) e tiveram algum impacto na AT.…”

Section: Discussionunclassified

“…O sistema visa a codificação das rupturas da AT e intervenções de reparações, em segmentos de sessões de psicoterapia. Gersh et al (2017) realizaram uma pesquisa com 44 jovens com TPB, visando explorar os processos de ruptura e reparação da AT, por meio do 3RS. O estudo mostrou que as rupturas ocorreram em 53% das sessões e com o passar do tratamento tendem a aumentar, sendo as de confronto mais frequentes.…”

Section: Introductionunclassified

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Rupturas da Aliança Terapêutica: um estudo de caso malsucedido em psicoterapia psicanalítica com paciente borderline

2020

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Esse trabalho tem como objetivo compreender os processos de ruptura da Aliança Terapêutica (AT) de um caso de psicoterapia psicanalítica (PP) interrompida, realizada com paciente com Transtorno de Personalidade Borderline (TPB). Trata-se de estudo de caso sistemático, que contempla 15 sessões de PP, com um paciente com queixas impulsividade e dificuldades de relacionamento e sua terapeuta. As sessões foram gravadas em vídeo e transcritas. A identificação das rupturas na AT foi feita pelo Rupture Resolution Rating System. Foram encontradas 100 rupturas da AT, destas 69% são rupturas de evitação e 31% de confrontação. Foram verificadas 30 contribuições da terapeuta para as rupturas acontecerem. As rupturas de evitação são mais sutis e de difícil identificação, apresentando-se em maior frequência do que as de confrontação. Diante de pacientes com TPB, os terapeutas devem desenvolver habilidades para fazer intervenções com foco sobre a AT. Destaca-se a necessidade de outros estudos que busquem replicar a pesquisa em outros casos, de sucesso e insucesso terapêutico.

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Section: Discussionunclassified

Section: Introductionunclassified

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Rupturas da Aliança Terapêutica: um estudo de caso malsucedido em psicoterapia psicanalítica com paciente borderline

2020

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“…An examination of 38 dyads (201 sessions) that received cognitive behavioral therapy (CBT) at a university clinic in Portugal reported intraclass correlation coefficients (ICCs) of .73 for ratings of the clinical impact of withdrawal ruptures, and .96 for confrontation ruptures; this study did not examine resolution strategies . A study of 44 Australian adolescents (74 sessions) who were diagnosed with borderline personality disorder and received either cognitive analytic therapy or a supportive therapy reported reliability coefficients for rupture and resolution markers ranging from .64 to .90 (Gersh et al, 2017). A study of 77 patients (154 sessions) primarily presenting with mood or anxiety disorders at a university clinic in Switzerland reported ICCs of .74 for rupture markers, and .63 for resolution strategies (Moeseneder, Ribeiro, Muran, & Caspar, 2018).…”

Section: Preliminary Psychometric Properties Of the 3rsmentioning

confidence: 99%

Rupture Resolution Rating System (3RS): Development and validation

Eubanks

Lubitz

Muran

et al. 2018

Psychotherapy Research

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Objective: Our aim was to examine the reliability and validity of the Rupture Resolution Rating System (3RS), an observer-based measure of alliance ruptures and resolution processes. Method: We used the 3RS to rate early sessions from 42 cases of cognitive behavior therapy. We compared the 3RS to a simplified version of the Structural Analysis of Social Behavior (SASB), as well as patient and therapist self-reports of ruptures and the alliance. Results: Coders achieved high rates of interrater reliability on the frequency of confrontation and withdrawal ruptures and resolution strategies (ICCs=.85 to .98), as well as ratings of the therapist's contribution to ruptures and the extent to which ruptures were resolved (ICC=.92). Predictive validity analyses found that confrontation markers (d=.74), successful resolution (d=. 67), and ratings of the therapist's contribution to ruptures (d=.61) predicted dropout from therapy. Analyses of convergent validity with the SASB failed to meet predictions; however, we observed theoretically coherent relations between 3RS and SASB variables. Confrontation rupture markers were significantly associated with patient self-report of rupture (d=1.54) and therapist selfreported alliance (r = −.50, p = .002). Conclusions: This study provides evidence that the 3RS is a reliable and useful tool for examining psychotherapy process and predicting dropout.

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“…Statistical power to identify subgroup effects within the disorder groups was too low. Future research should also compare alliance-outcome associations in subgroups of patients within one specific mental disorder in adequately powered randomized controlled trials (e.g., bulimia vs. anorexia nervosa; Gersh et al, 2017).…”

Section: Limitationsmentioning

confidence: 99%

The therapeutic alliance in different mental disorders: A comparison of patients with depression, somatoform, and eating disorders

et al. 2017

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We found no differences in the strengths of alliance ratings and alliance-outcome associations in depressive, somatoform, and eating disorder patients. This indicates that the working alliance is of general clinical importance irrespective of the disorder group and should be a central target in all therapies. We found perspective incongruence in alliance ratings between patient and therapist in all three disorder groups. Perspective incongruence feedback of working alliance experiences could help to strengthen coordination between patient and therapist and thereby improve the therapeutic process.

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Alliance rupture and repair processes and therapeutic change in youth with borderline personality disorder

Cited by 32 publications

References 118 publications

Rupturas da Aliança Terapêutica: um estudo de caso malsucedido em psicoterapia psicanalítica com paciente borderline

Rupturas da Aliança Terapêutica: um estudo de caso malsucedido em psicoterapia psicanalítica com paciente borderline

Rupture Resolution Rating System (3RS): Development and validation

The therapeutic alliance in different mental disorders: A comparison of patients with depression, somatoform, and eating disorders

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