Therapists' recognition of alliance ruptures as a moderator of change in alliance and symptoms.
Therapists' awareness of ruptures in the alliance may determine whether such ruptures will prove beneficial or obstructive to the therapy process.



This study investigated the associations between therapists' recognition of these ruptures, and changes in clients' alliance ratings and symptom reports, using time-series data in a naturalistic treatment setting.



Eighty-four clients treated by 56 therapists completed alliance measures after each session, and the clients also completed symptom measures at the beginning of each session.



Therapists' recognition of alliance rupture in non-rupture sessions was positively associated with clients' alliance ratings in the next session and this effect was significantly higher when rupture did occur. There was also a significant interaction effect for functioning ratings: Therapists' recognition of alliance ruptures abolished the negative effect of ruptures on clients' symptom ratings in the following session.



These results highlight the importance of therapists' recognition of deterioration in the alliance for a repair process to take place that may eventually lead to an improved relationship and outcome.
a Department of Psychology , Bar-Ilan University , Ramat-Gan , Israel.
Roei
R
Chen
a Department of Psychology , Bar-Ilan University , Ramat-Gan , Israel.
Dana
D
Atzil-Slonim
a Department of Psychology , Bar-Ilan University , Ramat-Gan , Israel.
Eran
E
Bar-Kalifa
a Department of Psychology , Bar-Ilan University , Ramat-Gan , Israel.
Ilanit
I
Hasson-Ohayon
a Department of Psychology , Bar-Ilan University , Ramat-Gan , Israel.
Eshkol
E
Refaeli
D000328:Adult; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D011613:Psychotherapy / Q000592:standards*; D000078462:Therapeutic Alliance
alliance; process-outcome research; rupture and repair; therapist processes