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Ruptures in the alliance have a potential to either undermine the treatment, leading to its premature termination, or to enhance it, leading to its success. Detecting ruptures is a critical step in therapy, especially concerning withdrawal ruptures that often go unnoticed because of the indirect expression of negative emotions. The present study explored whether acoustic data of a particular patient can serve as markers for ruptures, particularly withdrawal ruptures. Given the pioneering nature of the study, an exploratory approach based on a case study was chosen. The case-study showed that acoustic data can serve as markers of withdrawal ruptures (characterized by higher F0-span, pause proportion, and shimmer, and lower articulation rate than neutral speech) and of confrontation ruptures (characterized by higher F0-span and pause proportion than neutral speech). The limitations of a case study design are discussed. These findings add to previous knowledge and help to open the door to using feedback to assist clinicians in identifying the occurrence of ruptures and prevent deterioration in alliance and dropout. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic shifted many traditional face-to-face treatments to telepsychotherapy, forcing many therapists worldwide to adapt effective techniques developed in face-to-face treatment to telepsychotherapy. These include supportive techniques that may be particularly important at a time of rising anxiety, loneliness, helplessness, and depression. The present paper provides detailed guidelines for therapists on how supportive techniques developed in traditional face-to-face treatment can be effectively used in telepsychotherapy to resolve alliance ruptures. To this end, we used the conceptual framework of the core conflictual relationship theme (CCRT) formulation, making adjustments for identifying and resolving ruptures in the therapeutic alliance in telepsychotherapy. We demonstrated the proposed techniques for identifying and repairing ruptures with a case study of a patient participating in an ongoing RCT, whose treatment shifted in mid-therapy to telepsychotherapy because of the COVID-19 pandemic. The techniques presented and illustrated in this article may be used in the transition to remote therapy for a range of reasons, including patient or therapist relocation and more. [ABSTRACT FROM AUTHOR]