CENTER FOR ALLIANCE-FOCUSED TRAINING
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Research evidence
Alliance ruptures have received increased research attention over the past 25 years, with growing evidence that they are common events (e.g., they are reported by patients in 20-45% of sessions, therapists in 40-55% of sessions, and third-party observers in 40-75% of sessions), and they predict (with a medium effect sizes) premature termination and negative treatment outcome.
A series of studies have found evidence consistent with a general model of rupture resolution. Our research suggests that resolution or productive process does not require progression through all the proposed pathways and patient states, especially within any given session, but instead that any exploration of a rupture or avoidance in and of itself can be experienced by patients as very meaningful. Several other studies have similarly demonstrated support for addressing ruptures directly and nondefensively, and a few studies have suggested the value of making links to situations or relationships outside of the therapeutic relationship.
There is also a growing body of research that has looked at training therapists to more effectively identify and repair ruptures. These have varied in the extent to which they emphasize didactic versus experiential components: The former has included psycho-education defining ruptures and repair strategies and videotape analysis of psychotherapy sessions; the latter has included mindfulness meditation and awareness exercises to develop the therapists' self-awareness and self-regulation skills in relation to their patients. A meta-analysis of studies that examined the impact of alliance-focused training on patient outcome found a large within-group effect size and a small between-group effect size –in both cases, a statistically significant effect. Adding to this is the research by Michael Lambert and colleagues demonstrating the benefit of providing therapists feedback with clinical support concerning alliance rupture and repair.
A good deal of the research on alliance ruptures comes from our own program that began in the late 1980s at the Clarke Institute for Psychiatry in Toronto and has been situated at Mount Sinai Beth Israel in New York since 1990. The program has been funded by several grant awards from the National Institute of Mental Health and other private foundations. It has also received significant support from the New School for Social Research and the Derner School of Psychology, Adelphi University. The program has primarily focused on the study of alliance ruptures, including the development of evidence-based models of intervention and training.
For research reports from the program, see the following links from ResearchGate:
J. Christopher Muran, Ph.D. ResearchGate link
Catherine Eubanks, Ph.D. ResearchGate link
A series of studies have found evidence consistent with a general model of rupture resolution. Our research suggests that resolution or productive process does not require progression through all the proposed pathways and patient states, especially within any given session, but instead that any exploration of a rupture or avoidance in and of itself can be experienced by patients as very meaningful. Several other studies have similarly demonstrated support for addressing ruptures directly and nondefensively, and a few studies have suggested the value of making links to situations or relationships outside of the therapeutic relationship.
There is also a growing body of research that has looked at training therapists to more effectively identify and repair ruptures. These have varied in the extent to which they emphasize didactic versus experiential components: The former has included psycho-education defining ruptures and repair strategies and videotape analysis of psychotherapy sessions; the latter has included mindfulness meditation and awareness exercises to develop the therapists' self-awareness and self-regulation skills in relation to their patients. A meta-analysis of studies that examined the impact of alliance-focused training on patient outcome found a large within-group effect size and a small between-group effect size –in both cases, a statistically significant effect. Adding to this is the research by Michael Lambert and colleagues demonstrating the benefit of providing therapists feedback with clinical support concerning alliance rupture and repair.
A good deal of the research on alliance ruptures comes from our own program that began in the late 1980s at the Clarke Institute for Psychiatry in Toronto and has been situated at Mount Sinai Beth Israel in New York since 1990. The program has been funded by several grant awards from the National Institute of Mental Health and other private foundations. It has also received significant support from the New School for Social Research and the Derner School of Psychology, Adelphi University. The program has primarily focused on the study of alliance ruptures, including the development of evidence-based models of intervention and training.
For research reports from the program, see the following links from ResearchGate:
J. Christopher Muran, Ph.D. ResearchGate link
Catherine Eubanks, Ph.D. ResearchGate link
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