Developing a Method for Training Clinical Psychologists to Recognize and Repair Alliance Ruptures: A Pilot Study

Abstract

Abstract Background Research in psychotherapy has underscored the importance of therapeutic relationships, especially alliances between therapists and clients, in predicting therapeutic outcomes. A strong alliance not only enhances outcomes, but also reduces client dropout rates. Ensuring therapists' self-awareness, emotional regulation, and insightful analysis of their interactions with clients are pivotal for maintaining this alliance and addressing potential ruptures. Methods A training program was formulated with three primary components: 1) observation of one's thoughts, feelings, and intentional behavioral control; 2) mindfulness training; and 3) consideration and categorization of the triadic adjacencies of interactions during therapy sessions. To assess the program's effectiveness, a pilot study was conducted with graduate students. Results Content analysis post training showed a notable reduction in respondents who felt "hooked" (Pre1 65%, Pre2 50%, Post 17%) and a significant increase in those who felt "involved well" (Pre1 22%, Pre2 36%, Post 83%). Post-training feedback revealed that the most frequent positive responses were "noticing captivity objectively" (24%), "relating with intention" (21%), and "not being upset" (14%). Although the first two components of the program were deemed effective, the third component concerning triadic adjacencies requires further refinement. Conclusion The training program showed promise for promoting therapist awareness and preventing alliance ruptures. However, refinements are necessary, particularly for the triadic adjacency component. The study's limitations include not objectively measuring awareness frequency and the potential influence of social desirability bias in participants' feedback.