Interpersonal Problems and Their Impact on Alliance Ruptures in Psychotherapy

Alliance ruptures are frequent occurrences in psychotherapy. Understanding the factors that contribute to these ruptures is important for optimizing therapeutic outcomes. From the perspective of interpersonal theory, the experience of interpersonal problems may play a significant role in the occurrence of alliance ruptures, as maladaptive relational patterns can trigger momentary interpersonal misattunements. This study aimed to investigate how specific interpersonal problems predict the frequency of alliance ruptures in the first three sessions of cognitive-behavioural therapy.

Sixty-four patients completed the Inventory of Interpersonal Problems (32 items) (IIP-32) as part of their routine outcome monitoring in an outpatient clinic. Subsequently, the first three regular therapy sessions were coded using the Rupture and Resolution Rating System (3RS). Multilevel Bayesian hurdle models were estimated, simultaneously modelling (1) the likelihood of experiencing at least one rupture and (2) the frequency of rupture occurrences among patients who had at least one.

Withdrawal ruptures were more frequent than confrontation ruptures. Higher affiliation and friendly-submissive tendencies were associated with fewer withdrawal ruptures but increased the likelihood of experiencing at least one withdrawal rupture. In contrast, hostile-submissive tendencies predicted more frequent withdrawal ruptures but were associated with a lower probability of at least one occurrence. For confrontation ruptures, the overall level of dysfunction and self-sacrificing tendencies predicted fewer confrontation ruptures.

These findings suggest that specific interpersonal problems can provide therapists with crucial insights into subtle rupture occurrences. By understanding these dynamics, therapists can better recognize and address ruptures, ultimately enhancing the therapeutic process.