Resolution Process of Therapeutic Alliance Ruptures: A Review of the Literature


Adolescents living in youth centers often comply with therapeutic treatment against their will. We think that this forced environment ruptures the therapeutic alliance between adolescents and their therapists and, as such, influences the therapeutic results. It has been reported, however, that therapies evoking rupture of the alliance with its later restoration are more effective than therapies without rupture. We review the literature on models of therapeutic alliance rupture resolution. This review is limited to experimentally- tested models. Firstly, we define the concepts of therapeutic alliance and its rupture. Then, we explore experimental models that quantify therapeutic alliance rupture resolution, describing methods of experimental validation, the results of models applied for experimental validation, and analysis of the data thus obtained.

Share and Cite:

Baillargeon, P. , Coté, R. & Douville, L. (2012). Resolution Process of Therapeutic Alliance Ruptures: A Review of the Literature. Psychology, 3, 1049-1058. doi: 10.4236/psych.2012.312156.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Aspland, H., Lewelyn, S., Hardy, Gillian, G. E., Barkham, M., & Stiles, W. (2008). Alliance ruptures and rupture resolution in cogni tive-behavior therapy: A preliminary task analysis. Psychotherapy Research, 18, 699-710. doi:10.1080/10503300802291463
[2] Bakeman, R. (1983). Computing lag sequential statistics: The ELAG program. Behavior Research Methods and Instrumentation, 15, 530 535. doi:10.3758/BF03203700
[3] Barrett-Lennard, G. T. (1962). Dimension of therapist response as causal factors in therapeutic change. Psychological Monographs, 76, 1-36.
[4] Barrett-Lennard, G. T. (1978). The relationship inventory: Later development and adaptations (Nos. 8, 68). JSAS Catalog of Selected Documents in Psychology.
[5] Barrett-Lennard, G. T. (1986). The relationship inventory now: Issues and advances in theory, method, and, use. In L. S. Greenberg, & W. M. Pinsof (Eds.), The psychotherapeutic process: A research handbook. New York: Guilford Press.
[6] Benjamin, L. S. (1974). Structural analysis of social behavior. Psychological Review, 81, 392-425. doi:10.1037/h0037024
[7] Benjamin, L. S. (1979). Use of structural analysis of social behavior (SASB) and Markov chains to study dynamic interactions. Journal of Abnormal Psychology, 88, 303-319. doi:10.1037/0021-843X.88.3.303
[8] Benjamin, L. S. (1982). Use of structural analysis of social behavior (SASB) to guide intervention in psychotherapy. In J. C. Anchin & D. J. Kiesler (Eds.), Handbook of interpersonal psychotherapy (pp. 190-212). New York: Pergamon Press.
[9] Bordin, E. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research, and Practice, 16, 252-260. doi:10.1037/h0085885
[10] Brenner, C. (1979). Working alliance, therapeutic alliance, and trans ference. Journal of the American Psychoanalytic Association, 27, 136-158.
[11] Bennett, D., Parry, G., & Ryle, A. (2006). Resolving threats to the therapeutic alliance im cognitive analytic therapy of borderline personality disorder: A task analysis. Psychology and Psychotherapy: Theory, Research and practice, 79, 395-418. doi:10.1348/147608305X58355
[12] Curtis, H. C. (1979). The concept of therapeutic alliance: Implications for the “widening scope”. Journal of the American Psychoanalytic Association, 27, 159-192.
[13] Docherty, J. P (1989). The individual psychotherapies: Efficacy, syndrome-based treatments, and the therapeutic alliance. In A. Lazare (Ed.), Outpatient psychiatry: Diagnosis and treatment (2nd ed., pp. 624-644). Baltimore, MD: Williams & Wilkins Co.
[14] Florsheim, P., Shotorbani, S., Guest-Warnick, G., Barratt, T., & Hwang, W.-C. (2000). Role of the working alliance in the treatment of delinquent boys in community-based programs. Journal of Clinical Child Psychology, 29, 94-107. doi:10.1207/S15374424jccp2901_10
[15] Freud, S. (1913/1966). On beginning the treatment. In J. Strachey (Ed.), The standard edition of the complete psychological works of Sigmund Freud. London: Hogarth Press.
[16] Frieswyk, S. H., Allen, J. G., Colson, D. B., Coyne, L., Gabbard, G. O., Horowitz, L., & Newsom, G. (1986). Therapeutic alliance: Its place as a process and outcome variable dynamic psychotherapy research. Journal of Consulting and Clinical Psychology, 54, 32-38. doi:10.1037/0022-006X.54.1.32
[17] Gelso, C. J., & Carter, J. A. (1985). The relationship in counseling and psychotherapy: Components, consequences, and theoretical antecedents. The Counseling Psychologist, 13, 155-243. doi:10.1177/0011000085132001
[18] Greenberg, L. S. (1984). A task analysis of intrapersonal conflict resolution. In L. N. Rice, & L. S. Greenberg (Eds.), Patterns of change: Intensive analysis of psychotherapy process (pp. 67-123). New York: Guilford.
[19] Greenson, R. R. (1965). The working alliance and the transference neuroses. Psychotherapy Quarterly, 34, 155-181.
[20] Greenson, R. R. (1967/77). Technique et pratique de la psychanalyse. Paris: Presses Universitaires de France.
[21] Horvath, A. O. (1994). Empirical validation of Bordin’s pantheoretical model of the alliance: The Working Alliance Inventory perspective. In A. Horvath, & L. S. Greenberg (Eds.), The working alliance: Theory, research and practice (pp. 109-128). New York: Wiley.
[22] Horvath, A. O., & Greenberg, L. S. (1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36, 223-233. doi:10.1037/0022-0167.36.2.223
[23] Horvath, A. O., & Symonds, B. D. (1991). Relation between working alliance and outcome in psychotherapy: a meta-analysis. Journal of Counseling Psychology, 38, 139-149. doi:10.1037/0022-0167.38.2.139
[24] Inck, T. A. (1995). Resolving therapeutic alliance ruptures. Unpublished Doctoral Dissertation, New York: Adelphi University.
[25] Klein, M. H., Mathieu-Coughlan, P., & Kiesler, D. J. (1986). The experiencing scales. In L. S. Greenberg, & W. M. Pinsof (Eds.), The psychotherapeutic process: A research handbook (pp. 21-71). New York: Guilford.
[26] Le Blanc, M., Girard, S., Kaspi, N., Lanct?t, N., & Langelier, S. (1995). Les adolescents en difficulté des années 1990. Rapport no. 3 Adolescents protégés et jeunes contrevenants sous ordonnance de la chambre de la jeunesse de Montréal en 1992-1993. Montréal: école de psychoéducation, Groupe de recherche sur les adolescents en difficulté, Université de Montréal.
[27] Lessard, C. (2001). Indicateurs repères sur l’application de la loi sur la protection de la jeunesse 1993-1994 à 1999-2000. Québec: Service des indicateurs et mesure de la performance, Direction de la gestion des information, Ministère de la santé et des services sociaux.
[28] Luborsky, L., & Crits-Christoph, P. (1990). Understanding transference: The CCRT method. New York: Basic Books.
[29] Luborsky, L. (1976). Helping alliance in psychotherapy. In J. L. Cleghhorn (Ed.), Successful psychotherapy (pp. 92-116). New York: Brunner/Mazel.
[30] Martin, D. J., Garske, M. J., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-ana lytic review. Journal of Consulting and Clinical Psychology, 68, 438-450. doi:10.1037/0022-006X.68.3.438
[31] Mitchell, K. M., Bozarth, J. D., & Krauft, C. C. (1977). A reappraisal of the therapeutic effectiveness of accurate empathy, nonpossessive warmth, and genuineness. In A. S. Gurman, & A. M. Razin (Eds.), Effective psychotherapy: A handbook of research (pp. 544-565). New York: Pergamon.
[32] Moseley, D. C. (1983). The therapeutic relationship and its association with outcome. Unpublished Master’s Thesis, Vancouver: University of British Columbia.
[33] Orlinsky, D. E., Grawe, K., & Parks, B. K. (1994). Process and outcome in psychotherapy—Noch einmal. In A. Bergin, & J. S. Garfield (Eds.), Handbook of psychotherapy and behaviour change (4th edition, pp. 270-378). New York: Wiley.
[34] Pauzé, R., Toupin, J., Déry, M., & Mercier, H. (2000). Portrait des jeunes inscrits à la prise en charge des centres jeunesse du Québec et description des services re?us au cours des premiers mois. In D. R. Cloutier (Ed.), Synthèse du rapport: les soins aux jeunes en difficulté Qc-411 (pp. 1-8). Québec: Centre jeunesse de Québec.
[35] Pinsof, W. M., & Catherall, D. R. (1986). The integrative psychotherapy alliance: Family, couple and individual therapy scales. Journal of Marital and Family Therapy, 12, 137-151. doi:10.1111/j.1752-0606.1986.tb01631.x
[36] Pinsof, W. M. (1995). Integrative problem-centered therapy. New York: Basic Books.
[37] Rice, K. S., & Wagstaff, K. (1967). Client voice quality and expressive style as indexes of productive psychotherapy. Journal of Consulting Psychology, 31, 557-563. doi:10.1037/h0025164
[38] Rice, L. N., & Greenberg, L. S. (1984). Future research directions. In L. N. Rice, & L. S. Greenberg (Eds.), Patterns of change: Intensive analysis of psychotherapy process (pp. 289-308). New York: Guilford.
[39] Rice, L. N. & Kerr, G. P. (1986). Measures of client and therapist vocal quality. In L. S. Greenberg, & W. M. Pinsof (Eds.), The psycho therapeutic process: A research handbook (pp. 73-105). New York: Guilford.
[40] Rice, L. N. & Saperia, E. P. (1984). Task analysis of the resolution of problematic reaction. In L. N. Rice, & L. S. Greenberg (Eds.), Patterns of change: Intensive analysis of psychotherapy process (pp. 67-123). New York: Guilford.
[41] Rogers, C. R. (1957). The necessary and sufficient conditions of thera peutic personality change. Journal of Consulting Psychology, 21, 95-103. doi:10.1037/h0045357
[42] Safran, J. D. (1990). Towards a refinement of cognitive therapy in light of interpersonal theory: I. Theory. Clinical Psychology Review, 10, 87-105. doi:10.1016/0272-7358(90)90108-M
[43] Safran, J. D., & Muran, J. C. (1996). The resolution of ruptures in the therapeutic alliance. Journal of Counseling and Clinical Psychology, 64, 447-458. doi:10.1037/0022-006X.64.3.447
[44] Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic alliance: a relational treatment guide. New York: Guilford.
[45] Safran, J. D., Crocker, P., McMain, S., & Murray, P. (1990). Therapeutic alliance rupture as a therapy event for empirical investigation. Psychotherapy, 27, 154-165. doi:10.1037/0033-3204.27.2.154
[46] Safran, J. D., Greenberg, L. S., & Rice, L. N. (1988). Integrating psychotherapy research and practice: Modeling the change process. Psychotherapy, 25, 1-17. doi:10.1037/h0085305
[47] Safran, J. D., Muran, J. C., & Samstag, L. W. (1994). Resolving therapeutic alliance ruptures: A task analytic investigation. In A. O. Horvath & L. S. Greenberg (Eds.), The working alliance: Theory, research and practice (pp. 225-255). New York: Wiley.
[48] Safran, J. D., Segal, Z. V., Hill, C., & Whiffen, V. (1990). Refining strategies for research on self-representations in emotional disorders. Cognitive Therapy and Research, 14, 143-160. doi:10.1007/BF01176206
[49] Safran, J. D., Vallis, T. M., Segal, Z. V., & Shaw, B. F. (1986). Assessment of core cognitive processes in cognitive therapy. Cognitive Therapy and Research, 10, 509-526. doi:10.1007/BF01177815
[50] Sterba, R. (1934). The fate of the ego in analytic therapy. International Journal of Psychoanalysis, 15, 117-126.
[51] Zetzel, E. R. (1956). Current concepts of transference. International Journal of Psychoanalysis, 37, 369-376

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.