Ruptures and repairs in group psychotherapy: Introduction to the special issue.

Abstract

Objectives: All relationships experience tensions and ruptures, but not all ruptures are acknowledged and repaired. Individual therapy researchers have shown that repairing ruptures in the therapy relationship is associated with an increased alliance, decreased dropout, and positive treatment outcome. Until recently, there has been less attention paid to ruptures in group psychotherapy. The current special issue is devoted to theory, assessment, research, and practice regarding ruptures and repairs in group treatment. Methods: Group researchers applied self-report and observational assessment methods to identify and study ruptures in group psychotherapy and group supervision. Designs of the studies included longitudinal analysis, case studies, meta-analysis, and a practice review. Results: Studies in this special issue identified that the alliance is related to outcomes and that different types of alliance ruptures, including microaggressions, occur in group therapy. Alliance ruptures manifest themselves at different levels of group interactions (member to member, member to leader, and member to group), which reflects the complex nature of this multiperson therapeutic context. Conclusions: The implications for practice are addressed as well as a call for future research to examine different types of ruptures in group therapy. Group member and leader factors influence the nature of the ruptures. The complexity of the group context suggests that repair processes that take into account levels of interactions in groups. Findings from these studies lay the foundation for future research needed to understand the impact of ruptures in groups. Highlights and Implications• Ruptures and repairs in group therapy can be measured using self-report assessments and through observer coding of group therapy sessions.• Ruptures in group therapy are more complex than in individual therapy given the multiple relationships within a group. Ruptures can occur between leaders and members, between members and members, and between members and the group-as-a-whole. They can also occur between coleaders.• Research is needed to understand the group, member, and leader factors that influence the process of rupture and repair. The type of group, stage of development, level of cohesion, and climate are group factors that will likely influence rupture repairs.• The level of experience, empathy, personality, and attachment style of the leader will likely influence the leader's capacity to identify ruptures and strategies for repair.

The alliance-outcome association in group interventions: A multilevel meta-analysis.

“…Regarding future research directions, our findings may support the relevance of examining the complex aspects of alliance rupture repair processes in group therapy (Lo Coco et al, 2019; Marmarosh, 2021). Only one evidence-based case study has examined the feasibility of using the Rupture Resolution Rating System (3RS; Eubanks et al, 2015) in group therapy (Garceau et al, 2021) and found that most ruptures occurred between members, and that one-third of all repairs were initiated by members.…”

“…However, the meta-analytic evidence regarding the association between group process factors and outcome is still limited. Group psychotherapy researchers have examined the relationship between cohesion and outcome extensively (Burlingame et al, 2018), but they have paid less attention to the alliance in group therapy (Marmarosh, 2021). Recently, a first meta-analysis of 29 studies of member-to-therapist alliance in group therapies (Alldredge et al, 2021) showed that the alliance was significantly associated with outcomes with a small effect ( r = .17).…”

Recent advances in the study of group cohesion.

“…Is the membership stable over time? Does the group deal with conflict effectively (e.g., Marmarosh, 2021)? Cohesion can also be intuited from direct observation of the group's communication and interaction patterns, as language use, influence tactics, conflict levels, and modes of resolving conflict likely differ systematically in relationship to a group's cohesion.…”

Alliance rupture and repair in group psychotherapy.

“…In essence, group members can be quiet and observing the interaction between other group members and the leaders. These bystanders members who are not directly involved in a rupture nevertheless can experience the effects of ruptures occurring to other members (Marmarosh, 2021c). For example, a group member experiences anger when a fellow group member interrupts them.…”