Search

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]

Objective: Clinical and theoretical considerations presume that patients with different personality disorder (PD) clusters will be associated with distinct alliance rupture profiles; however, there is scarce empirical literature examining this. The present study adopted a systematic framework for investigating profiles of alliance ruptures for individuals belonging to each of the three PD clusters. Method: The sample consisted of 94 patients from a randomized controlled trial for treatment of depression. PD cluster features were assessed at intake and ruptures were assessed across treatment. Three sets of multilevel analyses were conducted to test differences between the PD clusters in the general tendency to show a rupture profile, rupture development throughout the treatment, and timing of predicting ruptures by PD within sessions. Results: The three clusters were associated with distinct profiles of alliance ruptures. Clusters A and B were characterized by a general tendency to show more withdrawal and confrontation ruptures. Cluster A had a greater decrease in confrontation ruptures over the course of treatment, while cluster B had a greater decrease in withdrawal ruptures. Cluster C was characterized by a general tendency to show fewer withdrawal and confrontation ruptures, with a greater increase in both ruptures over the course of treatment. For withdrawal ruptures, the differences between clusters were evident from the beginning of sessions, whereas for confrontation ruptures, there was less of a difference between beginning and end of sessions. Conclusion: The distinct profiles of alliance ruptures for each PD cluster may contribute to progress towards tailoring treatment to individuals with PDs. [ABSTRACT FROM AUTHOR]

Contemporary theories and the empirical literature stress the importance of successful resolution of alliance ruptures for the process and outcome of treatment. Yet, little empirical work has examined what leads to successful resolutions. The aim of the present study was to examine which patients are more likely to achieve successful resolutions of ruptures and under which circumstances. Sixty-five patients completed measures assessing their trait-like pretreatment characteristics (alliance expectations and general attachment orientation), and state-like changes in treatment (working alliance, therapist serving as an attachment figure, and the implementation of common factor techniques). Successful resolutions were coded using observer behavioral coding at four time points. State-like changes, but not trait-like characteristics significantly contributed to successful resolution. Stronger working alliance and the therapist as an attachment figure, and the implementation of common factors techniques were found to contribute to successful resolutions. The current findings emphasize the importance of the process that occurs within treatment, and the therapeutic context in which the resolution process take place for the ability to achieve successful resolutions. [ABSTRACT FROM AUTHOR]

The therapeutic alliance is one of the most consistent predictors of therapeutic change, including symptom reduction and improvement in wellbeing and quality of life, across a variety of mental health interventions. Yet, little is known about its biological mechanisms. Oxytocin (OT) has been suggested as a biological mechanism by which bonds are formed and strengthened across species. This article is intended to demonstrate the potential of OT as a biomarker of therapeutic change in psychotherapy and counseling psychology, especially of the therapeutic alliance. We delineate three main potential paths of investigation based on the most recent research on OT in parent–child and romantic partner dyads. For each path, we provide a detailed explanation for whom, when, and how OT should be measured. Each path is illustrated using data collected in a randomized controlled trial of psychotherapy for major depressive disorder. These illustrations demonstrate the great potential of OT as a biomarker of (a) trait-like characteristics of the patients and the therapists, (b) the processes of therapeutic change, and (c) the dyadic synchrony between patients and their therapists. The potential clinical contribution of OT as a biomarker for each of these three paths is further demonstrated using a case study. Practical suggestions and directions for future research are discussed. Public Significance Statement: The article highlights the promising potential of OT as a biomarker in psychotherapy research, through the most recent research on the role of OT in parent–child and romantic relationships, as well as through data from a randomized controlled trial of psychotherapy for major depressive disorder. The article provides practical suggestions on how this potential may be realized. Interdisciplinary studies integrating the two fields of inquiry, psychotherapy and OT research, can create new important knowledge that has the potential to make a substantial contribution to clinical practice and complement existing approaches for measuring the process of therapeutic change. [ABSTRACT FROM AUTHOR]