Clinical Consensus Strategies to Repair Ruptures in the Therapeutic Alliance

• Published in: Journal of psychotherapy integration 2018-03, Vol.28 (1), p.60-76
• Main Authors: Eubanks, Catherine F, Burckell, Lisa A, Goldfried, Marvin R
• Format: Article
• Language: English
• Subjects: Female; Human; Male; Psychotherapeutic Processes; Psychotherapy; Test Construction; Therapeutic Alliance; Treatment Guidelines
• ISSN: 1053-0479; 1573-3696
• DOI: 10.1037/int0000097

The alliance been recognized as an essential common factor and robust predictor of outcome. The present study sought to further our knowledge of the alliance and to promote the integration of research and practice by assessing consensus among peer-nominated expert therapists of varying theoretical orientations on the effectiveness of clinical strategies to repair alliance ruptures. This study drew on the behavioral-analytic model (Goldfried & D'Zurilla, 1969) and the methodology of the Expert Consensus Guideline Series (Frances, Docherty, & Kahn, 1997). In Phase 1, 69 therapists submitted clinical situations describing alliance ruptures. In Phase 2, 177 therapists generated responses to the situations, and clinical strategies underlying the responses were identified. In Phase 3, 134 peer-nominated experts (a mean of 22.3 therapists per situation) rated the effectiveness of these clinical strategies. The experts reached consensus on the use of strategies that validated the client's experience and explored the rupture during the rupture session. Change-oriented interventions (e.g., changing interpersonal interactions; highlighting patterns of behavior, thought, or emotions) were generally rated as less effective to use during the rupture, but effective for use in future sessions. The findings are consistent with the growing literature on the value of using certain alliance-focused interventions during a rupture. The findings point to the importance of therapists' awareness of the state of the alliance so that they can identify when ruptures are occurring. Estrategias de consenso clínico para reparar rupturas en la alianza terapéutica Objetivo: la alianza ha sido reconocida como un factor común esencial y un fuerte predictor de resultados. El presente estudio buscó ampliar nuestro conocimiento de la alianza y promover la integración de la investigación y la práctica mediante la evaluación del consenso entre terapeutas expertos nominados por pares de diferentes orientaciones teóricas sobre la efectividad de las estrategias clínicas para reparar rupturas de alianzas. Método: Este estudio se basó en el modelo analítico-conductual (Goldfried & D'Zurilla, 1969) y la metodología de la serie de guías de consenso para expertos (Frances, Docherty y Kahn 1997). En la Fase I, 69 terapeutas presentaron situaciones clínicas que describen las rupturas de alianzas. En la Fase II, 177 terapeutas generaron respuestas a las situaciones y se identificaron las estrategias clínic