title: Ambivalence and alliance ruptures in cognitive behavioral therapy for generalized anxiety.
abstract: Client ambivalence about change (or motivation) is regarded as central to outcomes in cognitive behavioral therapy (CBT). However, little research has been conducted to examine the impact of client ambivalence about change on therapy process variables such as the therapeutic alliance. Given the demonstrated limitations of self-report measures of key constructs such as ambivalence and motivation, the present study instead employed a newly adapted observational measure of client ambivalence. Client statements regarding change (change talk (CT) and counter-change talk (CCT)) were coded in early (session 1 or 2) therapy sessions of CBT for generalized anxiety disorder. The frequency of CT and CCT was then compared between clients who later experienced an alliance rupture with their therapist, and clients who did not. The results showed that clients in dyads who later experienced an alliance rupture expressed significantly more CCT at the outset of therapy than clients who did not later experience an alliance rupture. However, CT utterances did not significantly differ between alliance rupture and no-rupture groups. CCT may strain the alliance because clients expressing higher levels of CCT early in therapy may be less receptive to therapist direction in CBT. Consequently, it is recommended that clients and therapists work together to carefully address these key moments in therapy so as to prevent alliance rupture and preserve client engagement in therapy.
authors.affiliation: a Department of Psychology , York University , Toronto , Ontario , Canada.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Hunter
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Button
authors.forename: Henny A
authors.initials: HA
authors.lastname: Westra
mesh_terms: D000293:Adolescent; D000328:Adult; D000339:Affect; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D011369:Professional-Patient Relations; D016896:Treatment Outcome; D055815:Young Adult
keywords: alliance rupture; ambivalence; change talk; counter-change talk; observational measure