Formations, ruptures, rebounds, and repairs : an intensive investigation of changes in the therapeutic relationship

Abstract

This study examined client-reported changes in the therapeutic relationship across 29 sessions, spanning ten cases of short-term, Process-Experiential psychotherapy. Cases and sessions were empirically identified, based on clients' end-of-session ratings on the Working Alliance Inventory (WAI). This empirical selection strategy was intentionally broad and atheoretical, to encompass a variety of change scenarios. Therapist and client behaviors and interactions during selected sessions were explored using the Structural Analysis of Social Behavior (SASB) and the Hill Counselor and Client Verbal Response Modes (VRM) Systems. Both frequency and sequential analysis of category codes were conducted, followed by a session-by-session review of the ten cases. Observed therapist and client behaviors clearly reflected the Process-Experiential therapy model as well as therapist efforts to establish and maintain empathic attunement. No significant differences were found in the frequencies of SASB or VRM codes between strongest and weakest alliance sessions or between rupture and post-rupture sessions. This raises questions about the ability of these measures to differentiate between subtle in-session processes. The case reviews underscored the clients' independent and often-overlooked contributions to the formation and repair of the therapeutic relationship.