Clinical consensus of therapy alliance rupture strategies

Efforts to identify empirically supported treatments (ESTs) called attention to the need for consensus on practices that are empirically based. In response, the APA Presidential Task Force on Evidence-Based Practice (2006) recommends the use of approaches to enhance the generalizability of clinical research. One suggested approach is to examine the practices of expert clinicians. This study draws on clinical expertise to identify strategies to resolve alliance ruptures, reflected in tensions or breaks in the collaborative relationship between clients and therapists. This study systematically collected, categorized, and identified clinician-generated strategies to address alliance ruptures. One hundred and eleven nominated expert clinicians rated the strategies to address the rupture both during the current session and in later sessions using a procedure based on the Expert Consensus Guideline Series (e.g., Frances, Docherty, & Kahn, 1997) and the behavioral-analytic model (Goldfried & D'Zurilla, 1969). These results suggest that during the rupture, therapists favor exploring and empathizing with the client's experience rather than the use of active interventions. Recommendations for the application of this methodology and these results to future research are considered.