title: Therapists' and clients' experiences of alliance ruptures: a qualitative study.
abstract: OBJECTIVE
  We explored therapists' and clients' experiences of alliance rupture events for the first 15 sessions of each of eight cases; therapists were each paired with one client who had a personality disorder.
  
  
  METHODS
  All sessions were videotaped and rated with the Rupture Resolution Rating System. Approximately 1 week after a rupture, clients and therapists were individually interviewed about the causes of the rupture, how the rupture evolved, the impact of the rupture on the therapeutic process, and experiences during the event. The interviews were analyzed by five judges using consensual qualitative research (CQR; Hill, 2011).
  
  
  RESULTS
  Typically, rupture events involved a repetition of a previous rupture event, the rupture emerged when the client was not prepared to respond to the therapist's intervention, both therapists and clients felt confused and ambivalent, and confrontation events activated intense and negative feelings. We discuss the implications for practice, training, and research.
authors.affiliation: School of Psychology, University of Minho, 4710 Braga, Portugal. joanacoutinho@psi.uminho.pt
authors.forename: Joana
authors.initials: J
authors.lastname: Coutinho
authors.forename: Eugenia
authors.initials: E
authors.lastname: Ribeiro
authors.forename: Clara
authors.initials: C
authors.lastname: Hill
authors.forename: Jeremy
authors.initials: J
authors.lastname: Safran
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders / Q000523:psychology / Q000628:therapy*; D011369:Professional-Patient Relations; D013811:Psychotherapeutic Processes; D011613:Psychotherapy / Q000379:methods*; D036301:Qualitative Research; D000078329:Workforce; D055815:Young Adult