An in-session exploration of ruptures in working alliance and their associations with clients’ core conflictual relationship themes, alliance-related discourse, and clients’ postsession evaluations

Abstract

This exploratory study examined (a) the relationship among the occurrence of ruptures in the working alliance, the emergence of client's core conflictual relationship themes (CCRT), and focus of discourse within therapeutic sessions and (b) the relationship between ruptures in the working alliance and client's postsession evaluations of session's smoothness and depth. The authors included 151 sessions from five therapies conducted in a student counseling center. Sessions were content analyzed by independent raters, and a self-report questionnaire was given to clients after each session. Ruptures were positively related to the emergence of clients’ CCRT during the session, but only when the therapist was addressed as the “other.” Sessions with ruptures were characterized by heightened discussion of working alliance components and were evaluated as less smooth than sessions without ruptures. Findings are discussed, and the importance of ruptures in working alliance for therapeutic change is emphasized.

Keywords:

• alliance
• ruptures in the working alliance

Acknowledgements

This study was supported by The Israeli Foundation Trustees. We thank the staff of the Student Counseling Center at Bar-Ilan University for their assistance in this study.

Notes

1. The specific contents of each client's Ws, ROs, and RSs are available upon request from Eliane Sommerfeld.

2. The various manuals used for the analyses of a client's speech units are available upon request from Eliane Sommerfeld.

3. We also computed the percentage of speech units in which appeared either a confrontational or withdrawal rupture marker from the total number of speech units in a given session. Statistical analyses performed on these percentages revealed effects identical to those reported in the Results section.

4. HLM analyses, including the six CCRT scores as simultaneous predictors of the occurrence of confrontational or withdrawal ruptures in a given session, revealed in-session effects identical to those reported in Table I.

5. We also conducted HLM analyses in which the interaction between confrontational ruptures and withdrawal ruptures was included as an additional predictor. However, this interactive effect made no significant contribution to any of the working alliance components and markers as well as client's appraisal of the session.

6. We also conducted similar HLM analyses predicting percentages of the three working alliance components, percentages of the nine working alliance markers, and clients’ appraisal of session smoothness. However, these analyses revealed no significant interaction effect between clients’ identification of a working alliance rupture and raters’ identification of such a rupture.