Rupture and Repair in the Working Alliance : Relation to Psychotherapy Outcome and Within-Session Interaction

• Ruptures and repairs are processes related to shifts in the collaborative relationship Cthe working allianceJ between patient and therapist in psychotherapy. Ta study ruptures and repairs is one way ta disentangle mechanisms that might underlie the association between the working alliance and psychotherapy outcome. The overarching aim af this thesis was ta analyze the clinical relevance af the rupture and repair concepts at different process levels. The same three alliance patterns were investigated in the three empirical studies: the rupture pattern, the repair pattern, and the no-rupture/stable pattern. The analyses af the alliance patterns moved fromwhole treatments ta session segments. In Study I ruptures were found ta be associated with worse outcomes than treatments without ruptures. Repairs were, in longer therapies, shown ta be related ta better outcomes than norupture treatments. In Study Il it was found that the three alliance patterns could be discerned within sessions. Ruptures and repairs within sessions were found ta be associated with patient-ratings af the working alliance. In Study 111 the alliance patterns were found ta be related ta different  interaction patterns within sessions. In these analyses, importont patient contributions ta repairs af ruptures were found.

• Alliansbrott och reparationer är processer relaterade till förändringar i samarbetet och relationen mellan patient och terapeut i psykoterapi. Att studera alliansbrott och reparationer av dem kan utveckla kunskapen om sambandet mellan arbetsallians och psykoterapiutfall. Avhandlingens övergripande syfte var att pröva den kliniska relevansen av begreppen alliansbrott och reparationer på olika processnivåer. Samma tre alliansmönster undersöktes i de tre empiriska studierna: alliansbrottsmönstret, reparationsmönstret och icke-alliansbrott/stabila mönstret. Analyserna av alliansmönstren gick från hela behandlingar till sessionssegment. Studie I visade att alliansbrott hade samband med sämre utfall än behandlingar med mönstret icke-alliansbrott. Reparationer visade sig, för längre terapier, vara relaterade till bättre resultat än mönstret ickealliansbrott I Studie Il befanns de tre alliansmönstren vara urskiljbara inom sessioner. Alliansbrott och reparationer inom sessionerna visade sig vara associerade med patientskattad arbetsallians. I studie 111 befanns alliansmönstren vara relaterade till olika interaktionsmönster inom sessionerna. Det visade sig att patienterna bidrog på viktiga sätt till reparationer av alliansbrott.

Subject headings

SAMHÄLLSVETENSKAP  -- Psykologi (hsv//swe)

SOCIAL SCIENCES  -- Psychology (hsv//eng)

Keyword

Rupture and repair

working alliance

interpersonal interaction

psychotherapy outcome

Alliansbrott och reparation

arbetsallians

interpersonell interaktion

utfall av psykologisk behandling

Publication and Content Type

vet (subject category)

dok (subject category)