Therapists’ recognition of alliance ruptures as a moderator of change in alliance and symptoms

Roei Chen, Dana Atzil-Slonim, Eran Bar-Kalifa, Ilanit Hasson-Ohayon, Eshkol Refaeli

Research output: Contribution to journalArticlepeer-review

37 Scopus citations


Therapists’ awareness of ruptures in the alliance may determine whether such ruptures will prove beneficial or obstructive to the therapy process. Objective: This study investigated the associations between therapists’ recognition of these ruptures, and changes in clients’ alliance ratings and symptom reports, using time-series data in a naturalistic treatment setting. Method: Eighty-four clients treated by 56 therapists completed alliance measures after each session, and the clients also completed symptom measures at the beginning of each session. Results: Therapists’ recognition of alliance rupture in non-rupture sessions was positively associated with clients’ alliance ratings in the next session and this effect was significantly higher when rupture did occur. There was also a significant interaction effect for functioning ratings: Therapists’ recognition of alliance ruptures abolished the negative effect of ruptures on clients’ symptom ratings in the following session. Conclusion: These results highlight the importance of therapists’ recognition of deterioration in the alliance for a repair process to take place that may eventually lead to an improved relationship and outcome.

Original languageEnglish
Pages (from-to)560-570
Number of pages11
JournalPsychotherapy Research
Issue number4
StatePublished - 4 Jul 2018
Externally publishedYes


  • alliance
  • process-outcome research
  • rupture and repair
  • therapist processes

ASJC Scopus subject areas

  • Clinical Psychology


Dive into the research topics of 'Therapists’ recognition of alliance ruptures as a moderator of change in alliance and symptoms'. Together they form a unique fingerprint.

Cite this