Alliance Ruptures and Resolutions in Personality Disorders
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PERSONALITY DISORDERS (K BERTSCH, EDITOR)
Alliance Ruptures and Resolutions in Personality Disorders Nathalie Schenk 1 & Lukas Fürer 1 & Ronan Zimmermann 1,2 & Martin Steppan 1 & Klaus Schmeck 1 Accepted: 17 November 2020 # The Author(s) 2020
Abstract Purpose of Review This review provides an overview of the state of research on alliance ruptures and resolutions in the treatment of personality disorders (PDs). We discuss frequently used instruments to measure alliance ruptures and resolutions. We discuss the effectiveness of rupture resolution processes and highlight possible avenues for research to explore. Innovative assessments with the potential to reveal the link of ruptures and resolutions and mechanisms of psychotherapeutic change are discussed. Recent Findings The assessment of alliance rupture and resolutions is heterogeneous. Instruments vary largely with respect to a direct or indirect assessment, the time resolution of assessment (integral therapy, phase, session, event), session sampling strategy and perspectives (patient, therapist, observer). The heterogeneity in the instruments and study designs impedes comparability and interpretation of the findings. Results support the hypothesis that ruptures are more frequent in PD. Results also point towards beneficial effects of rupture resolution patterns, early alliance quality, and resolution complexity. Few studies control findings for pretreatment factors. Summary Evidence points to the direction that rupture resolution processes can be considered a general principle of change in the treatment of PD. The concept of alliance ruptures and resolutions provides a useful tool for the management of the therapeutic alliance and its moments of deteriorations throughout the treatment course. Dimensional pretreatment personality functioning is considered a key variable in future studies to highlight what works for whom. Keywords Rupture resolution . Personality disorder . Alliance
Introduction It is argued that relationship factors are not only a byproduct of the psychotherapeutic encounter but also a vehicle of change per se (Task Force Division 29: [1, 2]). Building upon a relational approach [3••], alliance research concerned with personality disorders (PDs) investigates the assumption that the process of rupture resolution brings about change [4, 5]. The NICE guidelines recommend the building and management of the therapeutic alliance as a general principle of change in the treatment of PD [6]. However, patients with PD have general difficulties in forming interpersonal relationships, including Nathalie Schenk and Lukas Fürer contributed equally to this work. This article is part of the Topical collection on Personality Disorders * Klaus Schmeck [email protected] 1
Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland
2
Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
the therapeutic relationship, due to the
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