Repairing alliance ruptures.

Abstract

Increasingly, research on the therapeutic alliance has shifted its focus to clarifying the factors contributing to alliance development, including the processes involved in resolving alliance ruptures. This article provides a brief review of the empirical literature on ruptures in the alliance and their resolution or repair. In sum, the research is promising, indicating the relevance of ruptures and resolution to psychotherapy outcome. However, much of the research thus far consists of small samples or qualitative studies. In many respects, such research should be considered in the early stages of development. Provisional practice implications are presented, suggesting that therapists be more attentive to ruptures, explore patient negative feelings about therapy, and respond to those feelings in an open and nondefensive fashion.Much of the original research on the therapeutic alliance focused on providing empirical evidence for what had long been established clinical wisdom, that is, that a strong alliance is a prerequisite for change in psychotherapy. In the last decade or so, a second generation of alliance research This article is an abbreviated version of a chapter to be published in J. C. Norcross (Ed.).

Patient interpersonal factors and the therapeutic alliance in two treatments for bulimia nervosa

“…Three systematic meta-analyses of this association have demonstrated overall Cohen's (1988) d effect sizes between .21 and .26 (Horvath & Bedi, 2002;Horvath & Symonds, 1991;Martin, Garske, & Davis, 2000), showing a stronger relation with outcome than specific techniques (see Wampold, 2001). With the clinical importance of the patient-therapist relationship well-documented, a second wave of alliance research has focused on examining the factors that may foster or impede its development Safran, Muran, Samstag, & Stevens, 2001). …”

Telepsychiatry in Assessment of Vocational Potential of Unemployed Individuals in Denmark

“…It has also been observed, that a paradigm shift has taken place in many (if not all) psychotherapeutic traditions, that emphasizes the importance of relational factor, which manifests itself via therapeutic alliance [14]. Empathy, warmth and authenticity represent the most essential elements of the relational factor, that among other things allow therapist to attend to and explore subtle indications of ruptures in the alliance [15,16]. It is clear that in case of immigrants, direct contact, without the assistance of an interpreter, is more likely to contribute to the authenticity of the client`s experience and to the therapist's attention, thus establishing therapeutic alliance and a high level of satisfaction.…”

Ciclos Cognitivos Interpessoais: Desafios E Estratégias De Fortalecimento Da Relação Terapêutica

“…A intervenção focada na relação (relationally focused intervention) constitui uma proposta conceptual da autoria de Safran, em articulação com diversos colaboradores/as (e.g., Safran & Segal, 1990;Safran & McMain, 1992;Safran & Muran, 2000;Safran, Muran & Proskurov, 2009;Safran, Muran & Eubanks-Carter, 2011;Safran & Kraus, 2014), a qual se sedimenta (1984, 1990, 1993Safran & Segal, 1990;Safran & Muran, 2000) nas propostas pioneiras de Sullivan (1956) e de Bowlby (1973Bowlby ( , 1980Bowlby ( , 1982Bowlby ( , 1988. Segundo Safran (1990) ao se afastar dos conceitos freudianos mais tradicionais, de mente auto-contida e intra-psíquica, Sullivan (1956) ofereceu uma visão inovadora, que se revelou um potente embrião para uma elevada diversidade de teorias da mente, em que se reconhece a importância das interações sociais.…”

“…Igualmente indigitados como centrais para a abordagem da intervenção focada na relação (e.g., Safran & Segal, 1990;Safran & McMain, 1992;Safran & Muran, 2000;Safran, Muran & Proskurov, 2009;Safran, Muran & Eubanks-Carter, 2011;Safran & Kraus, 2014), são os contributos de Bowlby (1973de Bowlby ( , 1980de Bowlby ( , 1982de Bowlby ( , 1988, investigador responsável pela teorização dos referentes basilares da teoria da vinculação, em específico pela sua intelecção pioneira acerca da necessidade do ser humano de se relacionar, vincular, desde os primórdios da sua vida, a um/a cuidador/a, desenvolvendo, através dessa relação, modelos internos dinâmicos (internal working models), cuja influência se manifestará, ao longo do seu desenvolvimento, no estabelecimento e manutenção de diversos padrões relacionais. À semelhança do que ocorre para as personificações propostas por Sullivan (1965), também Bowlby defende que estes modelos internos dinâmicos se formam desde as primeiras experiências de vinculação, constituindo esquemas cognitivo-afetivos das experiências eu-outro.…”

“…na relação (relationally focused intervention), em concreto no que concerne aos ciclos cognitivos interpessoais e às estratégias de potenciação da aliança terapêutica (Safran & Seagal, 1990;Stevens, et al, 2007;Safran, Muran & Eubanks-Carter, 2011). A nossa opção prende-se, na sua essência, com a centralidade conferida, pelos seus proponentes, à relação interpessoal pacienteprofissional, enquanto ferramenta do próprio processo clínico, da qual resulta uma notória preocupação com o desenvolvimento e promoção do robustecimento da aliança entre os/as envolvidos/as.…”