Experiences of Alliance Ruptures

The main goal of this study was to investigate the therapists' and clients' experiences of alliance rupture, which is defined as "moments of tension or breakdown in the alliance between the therapist and the client." There are two kinds of ruptures: withdrawal ruptures, in which a client tries to avoid or deny talking about their experiences, and confrontation ruptures, in which the client expresses dissatisfaction or attempts to pressure the therapist. Eight therapist-client pairs participated in the study; nine judges coded the therapy sessions using the Rupture Resolution Rating System, and about one week after a rupture, the client and therapist were interviewed separately about the event. The researchers found that the following characteristics were typically common among rupture events: events had occurred in a previous therapy session, events came about from the client's unpreparedness concerning a therapist's intervention, therapists and clients alike experienced confusion, and ambivalence, and confrontation ruptures caused the therapist and client to have intensely negative feelings.


Citation: Coutinho, J., Ribeiro, E., Hill, C. E., & Safran, J. (2011). Therapists' and clients' experiences
of alliance ruptures: A qualitative study. Psychotherapy Research, 21:5, 525-540.