Alliance rupture and repair processes in psychoanalytic psychotherapy: multimodal in-session shifts from momentary failure to repair

ABSTRACT

This exploratory single session-study presents a multimodal, mixed-method description of a session of psychoanalytic psychotherapy and illustrates an in-session “failure”, defined in terms of rupture in the therapeutic alliance and the process of its repair. It aims to enhance our understanding of the mechanisms implicated in therapeutic change. The research materialcomprises session’s video-recording, transcript, and measurements of participants’physiological arousal, as reflected in their heart rate in the session. The analysis consisted of an iterative, multi-layered process that combines observations from verbal and nonverbal modalities of interaction for the identification of significant in-session moments. We applied quantitative descriptive analysis on participants’ physiological arousal and synchronization, qualitative analysis of the clinical dialogue, and coded the in-session fluctuations in the therapeutic alliance,using the Rupture Resolution Rating System. The detailed analysis of specific interactive events in the session illustrates the shift from a “failure” in therapeutic collaboration to gradual repair; this shift entailed increased relatedness and physiological synchronization, and on a semantic level, co-created, reflective meanings in the here-and-now of the therapeutic interaction. The findings highlight ruptures as important in-session events and suggest that the therapist’s empathic oscillation between interpretative and metacommunication strategies can be mutative during moments of relational rupture.

Practical Implications

• Negotiation and resolution of in-session therapeutic ruptures may provide opportunities for therapeutic growth in terms of increased relatedness and reflectiveness.

• The therapist’s flexible shifts between using interpretative interventions and immediate collaborative explorations in the here-and-now, in the form of metacommunication, seem to facilitate the repair of alliance rupture.

• Multimodal methodologies and multi-layered analyses, integrating verbal and nonverbal, physiological data in the study of therapeutic interaction can shed light on significant in-session events and mechanisms of the change process.

KEYWORDS:

• Therapeutic failure
• alliance ruptures
• physiological arousal
• physiological synchronization
• therapy process

Acknowledgement

We gratefully thank Panos Vythoulkas, clinical psychologist, for contributing to the 3RS coding, and Panagiotis Kartsidis for developing the code to calculate Partial Directed Coherence, used to analyze ASV data.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. This is a pseudonym

2. Transcription notation: the symbol (.) denotes brief pauses of up to 4 seconds’ duration. Longer pauses are marked with the number of seconds in parentheses e.g. (8). Underlined text denotes emphasis. […] denotes omitted text

Additional information

Funding

This research is co-financed by Greece and the European Union (European Social Fund- ESF) through the Operational Programme «Human Resources Development, Education and Lifelong Learning» in the context of the project “Strengthening Human Resources Research Potential via Doctorate Research” (MIS-5000432), implemented by the State Scholarships Foundation (ΙΚΥ).

Notes on contributors

Anna Mylona

Anna Mylona is a Ph.D. candidate of Psychology at Aristotle University of Thessaloniki, Greece. Her doctoral research is focused on the therapeutic interaction (verbal and non-verbal) in psychodynamic therapy and more specifically on the therapeutic alliance process, as well psychotherapy change processes. She is working as a clinical psychologist in private practice.

Evrinomy Avdi

Evrinomy Avdi is associate professor in clinical psychology at the School of Psychology of the Aristotle University of Thessaloniki, Greece. She is a clinical psychologist, psychodynamic psychotherapist and dramatherapist. Her research interests lie in applying discursive and narrative research to the study of the process of psychotherapy, as well as the experience of serious illness. She is particularly interested in exploring the links between deconstructive research and actual clinical practice.

Evangelos Paraskevopoulos

Evangelos Paraskevopoulos is a lecturer in cognitive neuroscience at the department of psychology of the University of Cyprus. His research focuses on the reorganizational ability of cortical networks and brain connectivity induced by cognitive interventions and musical learning. His research tools include behavioral, neuropsychological, Magnetoencephalographic and Electroencephalographic measurements