Capturing both sides of the therapeutic dyad: A validation study of the revised rupture resolution rating system...

This study examined the interrater reliability (IRR) and convergent validity of the revised Rupture Resolution Rating System (3RS v2022). The revision addresses prior limitations by incorporating a dyadic assessment of rupture-repair episodes and the Working-Together-Subscale (WT) as an alliance measure.

We applied the 3RS v2022 to 213 audio-recorded therapy sessions from 67 patients in long-term treatment. We examined convergence with therapist-rated session quality and patients' emotional experiencing.

Raters achieved substantial-almost perfect IRR at the segment-level. Session-level IRR was moderate-substantial for rupture markers and fair for repair effectiveness. Supporting convergent validity, WT and repair effectiveness were positively associated with session quality, while WT predicted higher experiencing at session and segment levels, and patient withdrawal predicted lower experiencing at the session level. Crucially, withdrawal and confrontation ruptures interacted with repair effectiveness: when repairs were effective, they buffered or even reversed the otherwise negative impact of ruptures on patients' experiencing.

This study provides evidence that the 3RS v2022 is a reliable and valid measure of rupture-repair processes. Its applicability to audio-recorded sessions broadens utility for psychotherapy research. Findings support the assumption that rupture-repair episodes are common, co-constructed phenomena, underscoring the usefulness of the 3RS v2022's dyadic assessment.