Repairing alliance ruptures in psychotherapy with adults: a scoping review

Therapeutic alliance ruptures represent critical moments that, if properly addressed, may become opportunities for therapeutic change. Although various models and evidence exist regarding rupture repair, no prior scoping review has systematically mapped clinical recommendations using a replicable methodology. This review aimed to map clinical recommendations for repairing therapeutic alliance ruptures in psychotherapy with adults, focusing on therapist competencies, patient characteristics, and theoretical frameworks underpinning these recommendations. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, articles were retrieved from Web of Science, PsycINFO, and Scopus, supplemented by secondary searches. Conceptual and empirical publications addressing rupture repair in individual psychotherapy with adults were included (n=25). The review maps two complementary sets of recommendations. Empirical studies appear to converge on strategies organized around rupture recognition, expressive repair (focused on exploring the rupture experience), and immediate repair (focused on corrective task and goal adjustments). Theoretical and conceptual contributions highlight the influence of cultural, contextual, and trauma-related factors on rupture and repair processes, emphasizing the need for sensitivity to patient-specific, cultural, and contextual factors. Overall, the findings suggest that the literature on rupture repair is evolving toward greater contextual sensitivity, with personalization and responsiveness emerging from an integrative reading of the findings as central challenges for clinical practice and future research.