The Alliance and Rupture Observation Scale (AROS): Development and validation of an alliance and rupture measure for repeated observations within psychotherapy sessions

Abstract

Objective: The aim of this study was to test a new observerrated instrument, the Alliance and Rupture Observation Scale (AROS). It was designed for repeated measurements of the alliance within sessions and to detect alliance ruptures.Method: Videotaped therapy sessions with depressed adults were analyzed. Reliability was mainly assessed as inter-rater reliability. Convergent, predictive, and discriminant validity of the AROS was assessed by comparing the instrument with both observer-rated and patient-rated measures.Results: The AROS exhibited excellent inter-rater reliability. Alliance levels measured with the AROS predicted patients'ratings of the alliance in the same session and were highly correlated with another observer-rated alliance measure. Alliance patterns (rupture; repair; and no-rupture) based on AROS scores were significantly correlated with patients' ratings of the alliance.Conclusions: Preliminary support for convergent and predictive validity was found. It is yet to be determined whether AROS scores are related to psychotherapy outcomes. K E Y W O R D S alliance ruptures and repairs, measurement, observer-based alliance measure, psychotherapy process, test development, therapeutic alliance, therapeutic relationship J. Clin. Psychol. 2019;75:404-417. wileyonlinelibrary.com/journal/jclp 404 |

Clients’ influence on psychotherapists and the treatment they provide.

“…Therapists need to be intentional in soliciting client input, and they need to do so on an ongoing basis if they are to be prepared to minimize or address fluctuations in alliance strength and quality (Eubanks et al, 2018;Larsson et al, 2019). The importance of this is underscored by the data on how poorly therapists are able to judge when clients are at risk of treatment failure or are deteriorating (Hannan et al, 2005;Hatfield et al, 2010) or to identify what clients perceive to have been the most effective in a particular session (Bedi & Hayes, 2019).…”

“…From this framework, strong alliances are characterized by collaboration or mutuality, manifest as complementarity in client-therapist interactions, which Larsson et al (2019) identified as one of the bond elements in an alliance. In fact, research has supported this link between alliance and complementarity (e.g., Friedlander, 1993;Kiesler & Watkins, 1989;Svartberg & Stiles, 1992).…”