Therapist-Trainee Attempts of Alliance Rupture Repair in Time-limited Dynamic Psychotherapy

Megan Phillips (2009)

This study examined how therapist-trainees and clients handled ruptures in the therapeutic alliance within time-limited dynamic psychotherapy (TLDP) training sessions. The purpose of the analysis was to determine whether therapist-trainees were making use of rupture repair processes as outlined in the stage-process model of rupture repair (Samstag, Safran, & Muran, 2006), and any association that this may have had with session outcome. Observers rated 42 TLDP training sessions containing noticeable rupture markers using the Rupture Resolution Scale (RRS; Samstag, Safran, & Muran, 2006). The intention of the study was to help inform therapist training in the TLDP model through the integration of the transtheoretical psychotherapeutic factor of rupture resolution and to add to the growing body of literature examining the process and effects of rupture resolution. The study found that therapeutic alliance ruptures were common among training sessions and that the most frequent type of rupture, Walling Off and Avoiding, is a subtle phenomenon that may often be overlooked by therapist-trainees. It was found that TLDP therapist-trainees made use of rupture resolution behaviors, though on a relatively superficial level that made less use of here-and-now interpersonal process than might be expected. Results of the study also suggested that the use of rupture resolution behaviors is not necessarily associated with improvement in client perception of therapeutic process. There was no significant positive relationship between the use of rupture resolution behaviors and session outcome, measured as client ratings of aspects of the therapeutic alliance and therapist-trainee and client emotional reactions to sessions, though several aspects of the rupture resolution process were negatively associated with session outcome. Overall, the results of the study suggest that the rupture resolution process is a complex endeavor that both therapist-trainees and clients may find somewhat disruptive and uncomfortable. Implications of the findings for training in TLDP and therapeutic alliance rupture resolution are offered. In addition, comparisons of the findings to earlier research using the RRS are discussed, as well as limitations of the study and suggestions for further research.