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Research on standard methods of therapist training has found mixed evidence to as to whether standard training methods are effective. This study investigated the impact of a novel, research-informed training protocol that integrated elements of alliance-focused training (AFT) and facilitative interpersonal skills (FIS). Beyond traditional training techniques of didactics and lecture, the AFT/FIS intervention incorporated empirically supported video simulations of therapy, which were reinforced by role plays and deliberate practice on key therapeutic interpersonal skills. Fifty-eight graduate-level therapy trainees and professional therapists from various helping fields were randomized to one of two brief trainings in a multi-site RCT: (i) the AFT/FIS workshop or (ii) a more traditional demonstration training (DT) workshop. Participants were assessed on critical, relational therapeutic skills before and after the training. After controlling for relevant covariates, participants in the AFT/FIS training saw a marginally higher post-intervention level of overall therapeutic skills. Subsequent exploratory analyses revealed AFT/FIS participants also had significantly higher levels of specifically targeted post-training therapist skills (i.e., empathy, alliance bond capacity, and alliance rupture-repair responsiveness) compared to participants in DT. Implications for future empirical investigations and training initiatives are discussed.

Objective: In this paper, we test the reliability and validity of two novel ways of assessing mentalizing in the therapy context: the Reflective Functioning scale (RF) applied to code psychotherapy transcripts (In-session RF), and the Exploring scale of the Patient Attachment Coding System (PACS), which measures in-session autonomy and is linked with secure attachment in psychotherapy. Method: Before treatment, 160 patients in different types of psychotherapy and from three different countries were administered the Adult Attachment Interview (AAI), which was rated with the RF scale. One early psychotherapy session for each patient was independently rated with the In-session RF scale and with the PACS Exploring scale. Results: Both scales were found to be reliable and to have concurrent validity with the RF scale rated on the AAI, with the PACS Exploring scale found to be a better predictor of RF on the AAI. Conclusions: These results suggest that the PACS Exploring scale might be a practical method for assessing RF in psychotherapy research and a way for researchers and clinicians to track patients' RF on an ongoing basis. These results also provide information regarding the ways in which differences in RF manifest during psychotherapy sessions. Clinical or methodological significance of this article Researchers and clinicians can assess patients' mentalizing based on any single psychotherapy transcript, in many therapeutic modalities The Exploring scale of the Patient Attachment Coding System can yield a reliable measure of reflective functioning based on any single psychotherapy transcript, in many therapeutic modalities Client differences in mentalizing manifest in part independently of the therapist's contributions.

The working alliance is one of the most consistent predictors of outcome. Yet, little empirical knowledge exists on how therapists can use this association to maximize the outcome of cognitive behavioral therapy (CBT) for individual clients. The present study aimed to examine pre-treatment client interpersonal characteristics that determine what function the alliance should fulfill in order to maximize its effect on outcome. We did so by identifying moderators of the within- and between-clients effects on outcome. Data of 185 clients receiving CBT treatment was disaggregated to study the effects of the within- and between-clients alliance on outcome. Findings suggest that for clients who described themselves as overly cold and were described by their therapists as low on intrusiveness, state-like strengthening of alliance predicted better outcome, and that for clients not overly cold but overly exploitable, the general tendency of the client to report stronger alliance was associated with better outcome.

Objective This study examines the validity of the Alliance Negotiation Scale (ANS) in a psychotherapy research program. Analyses were designed to evaluate the relationship between the ANS and psychotherapy process and outcome variables. Method Data were collected in a metropolitan psychotherapy research program. Participants completed 30 sessions of therapy, postsession assessments, and a battery of measures at intake and termination. Results Relationships were found between the ANS and session outcome, working alliance, and the presence of ruptures and their resolution. Relationships emerged between the ANS and treatment outcome on measures of psychiatric distress and interpersonal problems. Conclusions The ANS demonstrated relationships with several psychotherapy process and outcome variables. The ANS was the most differentiated from the working alliance on measures of interpersonal functioning and in discriminating personality disorder pathology. These results extend previous findings on the ANS’ psychometric integrity, and offer new data on the relationship between negotiation and treatment outcome.

Our aim was to examine the reliability and validity of the Rupture Resolution Rating System (3RS), an observer-based measure of alliance ruptures and resolution processes.We used the 3RS to rate early sessions from 42 cases of cognitive behavior therapy. We compared the 3RS to a simplified version of the Structural Analysis of Social Behavior (SASB), as well as patient and therapist self-reports of ruptures and the alliance.Coders achieved high rates of interrater reliability on the frequency of confrontation and withdrawal ruptures and resolution strategies (ICCs = .85 to .98), as well as ratings of the therapist's contribution to ruptures and the extent to which ruptures were resolved (ICC = .92). Predictive validity analyses found that confrontation markers (d = .74), successful resolution (d = .67), and ratings of the therapist's contribution to ruptures (d = .61) predicted dropout from therapy. Analyses of convergent validity with the SASB failed to meet predictions; however, we observed theoretically coherent relations between 3RS and SASB variables. Confrontation rupture markers were significantly associated with patient self-report of rupture (d = 1.54) and therapist self-reported alliance (r = -.50, p = .002).This study provides evidence that the 3RS is a reliable and useful tool for examining psychotherapy process and predicting dropout. Clinical or methodological significance of this article: This study provides evidence of the reliability and validity of the 3RS, an observer-based measure of alliance ruptures and resolution processes. The 3RS can be used to identify problems in the therapeutic relationship that are associated with premature dropout from therapy.

In this article, we examine how the different attachment patterns enable or hinder the resolution of ruptures in the therapeutic alliance. We try to show that secure and insecure patients alike may experience ruptures in the therapeutic alliance, but that their ability to participate in resolving such ruptures differ markedly. Recent findings with the Patient Attachment Coding System (PACS) show that attachment classifications manifest in psychotherapy as distinct ways of communicating about present internal experience. Secure patients disclose their present experience openly and invite attunement from the therapist, while insecure patients either minimize their contributions to the dialogue (avoidant) or the contributions of the therapist (preoccupied). Using examples from session transcripts, we demonstrate how secure patients are particularly responsive to resolution strategies that focus on here-and-now experience, while insecure patients' characteristic ways of communicating pose significant challenges to the resolution process.

In this article, we provide an overview of our research program on therapeutic impasses and alliance ruptures. Beginning in the mid-1980s at the University of Toronto, and continuing in New York at Beth Israel Medical Center since the early 1990s, we have focused our efforts on trying to illuminate the processes associated with resolving ruptures in the alliance and working through therapeutic impasses. Influenced both by the relational turn in psychoanalysis and findings emerging from our own research on the process of change, we have developed and evaluated an approach to short-term treatment that appears promising. We are also developing and evaluating the effectiveness of training methods for enhancing therapists’ capacities to work constructively with negative therapeutic process, regardless of the particular “brand” of treatment they are practicing. Finally, we summarize some preliminary findings regarding the impact of therapists’ capacity for mentalization on both treatment process and out...

There is currently little empirical evidence regarding how patients' attachment patterns manifest in individual psychotherapy. This study compared the in-session discourse of patients classified secure, dismissing, and preoccupied on the Adult Attachment Interview (AAI). Rather than focusing on content or form alone, this study analyzed how patients' discourse elicits and maintains emotional proximity with the therapist. The AAI was administered to 56 patients prior to treatment and one session for each patient was rated with the Patient Attachment Coding System (PACS) by four independent raters, blind to patients' AAI classification. Significant differences were found in the discourse of patients with different attachment patterns. Namely, secure and preoccupied patients showed more contact-seeking behavior than dismissing patients, who avoided emotional proximity more, while preoccupied patients resisted therapists' help more than did secure and dismissing patients. These results suggest that the different attachment patterns may have distinctive manifestations in the psychotherapy process that can be tracked by external observers.

This study examined the relationship of pre-treatment personality disorder diagnosis to the quality of early therapeutic alliance in 145 patients randomly assigned to either cognitive behavioral therapy or brief relational therapy. The pre-treatment diagnosis was established by DSM-IV (SCID) and Wisconsin Personality Inventory. Quality of the alliance was assessed by patient and therapist reports using the 12-item Working Alliance Inventory, Session Evaluation Questionnaire, and direct questions of ruptures. Results indicated that pre-treatment personality disorder as determined by SCID predicted no variables of early psychotherapy process. Factor scores yielded from a PCA of the WISPI indicated that high impulsivity, dysregulation, and lability were associated with lower patient and therapist ratings of session depth of exploration and higher patient ratings of rupture intensity.

Although numerous studies have investigated the relationship between the therapeutic alliance and dropout, most have focused on the relationship between alliance quality and psychotherapy outcomes. Objective: To compare sessions with therapeutic alliance ruptures and two sessions prior to treatment dropout (pre-dropout) in terms of rupture subtypes, psychotherapists’ behavior, attitudes, and session content. Method: We implemented quantitative methods to select the sessions and qualitative methods to analyze them. We analyzed 16 temporary rupture sessions from 12 therapist–patient dyads and 16 pre-dropout sessions from 8 different therapist–patient dyads. The sessions originate from clinical psychology Master’s or Doctoral students under supervision in either cognitive behavioral or schema therapy. Pre-dropout sessions were considered unrepaired rupture sessions while rupture sessions were subsequently repaired. Results: Results revealed apparent differences and similarities between the session types in positive and negative psychotherapist behaviors, content intensity, and the type and frequency of ruptures. We explored three new rupture subtypes: attributing positive developments to other sources, indirect speech, and sarcastic hostility. Conclusions: A striking implication is that the frequency of positive and negative psychotherapist behaviors, ruptures, and session content is more likely to decrease in the pre-dropout sessions than in the temporary rupture sessions. © 2016, © 2016 Society for Psychotherapy Research., Türkiye Bilimsel ve Teknolojik Araştirma Kurumu: SOBAG104K082, This work was supported by the Türkiye Bilimsel ve Teknolojik Arast irma Kurumu [TÜBITAK-· SOBAG104K082]. This study was awarded with the “Prof. Dr. Isı¸ k Savası¸ r Clinical Psychology Research Incentive Award” by the Turkish Psychological Association.

The present study investigated the association between therapist dispositional mindfulness and therapist self-affiliation, the therapeutic alliance, and treatment outcome. Total therapist mindfulness was associated with therapist self-affiliation, r=.413, p

[Clin Psychol Sci Prac 18: 357–371, 2011] This survey evaluated the impact of empirical research findings on the clinical practice of a sample of psychotherapists who are also actively engaged in the consumption, critical evaluation, and production of psychotherapy research. On the one hand, we found that even this sample of researcher–clinicians perceives empirical research to be less helpful to them as clinicians than a variety of other sources of information, including their ongoing experience working with clients. On the other, we found that they do value empirical research, but consider it as one source of information among others to be incorporated into the clinical decision-making process. Implications of the findings are discussed with respect to a number of dimensions, including the nature of professional expertise.

The concept of emotional intelligence (EI) describes a set of emotional skills that may comprise efficacious therapist variables. The present study is the first to investigate EI among psychotherapists. Based on conceptual overlaps between the EI model and psychotherapy models, as well as a review of empirical evidence from both literatures, we make several predictions of how therapist EI impacts treatment. In a small pilot study, we assessed psychotherapist EI to determine its relation to psychotherapy outcome and process. Therapists with higher ratings of EI achieved better therapist-rated outcome results and lower drop-out rates compared with therapists with lower ratings of EI. Though not hypothesized, higher therapist EI was significantly associated with increased patient assessment compliance. There was no relationship between early working alliance ratings and therapist EI. Findings offer preliminary support for the relevance of therapist EI to psychotherapy.

The aim of the study described in this paper was to develop a method for measuring the therapeutic alliance from an intersubjective perspective and to evaluate the efficacy of the measure in predicting psychotherapy outcome. We conducted the study using data from 22 patient-therapist dyads engaged in a 30-session protocol of a brief relational therapy. The alliance measure chosen for this purpose was the short form of the Working Alliance Inventory. We used the subjective patient and therapist versions of the measure and created a correlation index representing the intersubjective congruence between patients and therapists on their ratings of the alliance. We examined the relations among the measures, as well as their predictive relation to an outcome measure. The results showed significant intercorrelations among the three alliance measures, suggesting that all captured aspects of the therapeutic alliance. In addition, all three measures were significantly predictive of outcome, with the correlation index appearing more powerful.

The aim of this study was to investigate the interrelationships of three measures of the therapeutic relationship and their validity in predicting treatment outcome, including the early identification of two treatment-failure conditions. Forty-eight patient-therapist dyads, in 30-session therapies for personality-disordered patients, were classified as premature dropout (DO), poor outcome (PO), or good outcome (GO) cases. Poor and Good Outcomes were determined by a reliable change score. Dropout cases were terminated during the first third of treatment, and patients cited dissatisfaction with the therapy or therapist. Assessment of working alliance, interpersonal behavior and a new measure of narrative coherency in the first third of treatment revealed that DO dyads had significantly poorer alliances and less coherent narratives in early sessions, while PO dyads, who ultimately completed the 30-session treatment protocol, unexpectedly demonstrated the highest degree of hostile complementarity. Clinical implications of the results are discussed.

Psychoanalytic authors have traditionally been skeptical of nomothetic studies, in which group averages obscure the uniqueness of individual cases. Several relational psychoanalytic authors have expressed more pronounced skepticism, affirming, for example, that given the uniqueness of each therapist-patient dyad, systematic empirical research is particularly problematic. In this article we highlight the potential synergy between relational thinking and today's psychotherapy research, by exploring some of the ways in which the work of relational authors has influenced relational psychotherapy research, shifting the focus of study from validation of the models of treatment to the study of the clinical variables such as: countertransference, therapist empathy, self-disclosure, rupture and resolution in therapeutic alliance, intersubjective negotiation, and the patient-therapist attachment relationship. In conclusion, the aim of this article is to facilitate the dialogue between relational psychoanaly...

In this article, we provide a brief summary of our current thinking about the constructs of the therapeutic alliance and ruptures in the therapeutic alliance. We speculate about some of the factors that have led to sustained interest in these constructs by psychotherapy researchers and discuss some of the conceptual problems associated with them. We also consider the question of whether the therapeutic alliance continues to be a meaningful construct, and we delineate more and less promising avenues of research for the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

(2003). The Relational Turn, the Therapeutic Alliance, and Psychotherapy Research. Contemporary Psychoanalysis: Vol. 39, No. 3, pp. 449-475.

In this article I describe an approach to brief psychoanalytic treatment that is consistent with many of the key principles of the relational tradition. In this approach the treatment process is conceptualized as an ongoing cycle of therapeutic enactment, disembedding, and understanding, enactment and disembedding. Particular emphasis is placed on the use of countertransference disclosure for purposes of facilitating the collaborative exploration of relational scenarios that are being unwittingly enacted between patient and therapist. The influence of the brief time frame on the treatment process is explored and differences between the current approach and other approaches to brief psychoanalytic treatment are examined. A case is presented to illustrate the approach, and a number of questions are explored regarding the nature of change in short-versus long-term treatments.

Alliance ruptures, impasses, and transference-countertransference enactments are inevitable in therapy. A growing body of evidence suggests that repairing ruptures in the alliance is related to positive outcome (Safran, Muran, & Eubanks-Carter, 2011). Our research program has led to the development of training methods to enhance therapists' abilities to detect and work constructively with alliance ruptures and negative therapeutic process (Safran et al., 2014). This article outlines relevant theoretical underpinnings, intervention principles, and empirical findings.

Objective: In this article we present preliminary findings from a research program designed to investigate the value of alliance-focused training (AFT), a supervision approach designed to enhance therapists’ ability to work constructively with negative therapeutic process. Method: In the context of a multiple baseline design, all therapists began treating their patients using cognitive therapy and then joined AFT supervision groups at either session 8 or 16 of a 30 session protocol. Study I investigated the impact of AFT on patient and therapist interpersonal process as assessed through the Structural Analysis of Social Behavior (SASB). Study 2 investigated the impact of AFT on therapists’ tendency to reflect on their relationships with their patients in an experientially grounded fashion, as assessed via the Experiencing Scale (EXP). Since one of the goals of AFT is to train therapists to use their own emerging feelings as important clues regarding what may be taking place in the therapeutic relationship, we hypothesized that they would show increased levels of EXP after undergoing AFT. Results and Conclusion: The results of both studies 1 and 2 were for the most part consistent with hypotheses. Implications and future research directions are discussed.

This pilot study examined the relationship between interpersonal schemas (as measured by the Interpersonal Schema Questionnaire) and the therapeutic alliance (as measured early in treatment by a patient self-report version of the Working Alliance Inventory) in short-term cognitive therapy. Twenty-six (15 men, 11 women) patients participated in this study. Findings revealed that the complementarity of expected responses in submissive situations was positively associated with therapeutic alliance, whereas the complementarity of expected responses in dominant situations and the desirability of these responses were negatively related to therapeutic alliance. A number of cognitive theorists have emphasized the need for expansion of the theoretical and conceptual framework of cognitive therapy (Meichenbaum & Gilmore, 1984; Safran, 1990; Safran, 1998; Safran & Segal, 1990). Specifically, this challenge intensified the need for identification and adequate assessment of core cognitive structures. In this vein, Safran (1990) introduced the notion of the interpersonal schema that incorporates an understanding of cognitive structures within an interpersonal context. He defined the interpersonal schema as generalized representations of self-other relationships or programs for maintaining relatedness. Safran (1990) has proposed that interpersonal schemas maintain themselves using the principle of complementarity (Kiesler, 1983). This principle states that specific, interpersonal behaviors tend, predictably, to pull for other specific, interpersonal behaviors (Kiesler, 1983). It asserts that individuals exude a force field that drives others to respond to them with constricted classes of control and affiliation actions. Therefore, they pull from others complementary responses intended to affirm and validate their chosen style of living and being (Kiesler, 1996). The aforementioned developments regarding the expansion of the conceptual framework of cognitive therapy and refinement of assessment techniques have strong implications for the therapeutic relationship or therapeutic alliance in cognitive therapy (Safran & Segal, 1990). They have proposed that problems in the therapeutic relationship can be linked to the patient's fundamental beliefs about interpersonal relationships (interpersonal schemas), and have illuminated the integral link between modifying these beliefs and resolving difficulties in the therapeutic alliance. Safran (1993) exemplified this as follows: A client who experiences a therapist's silence as hindering may have a general tendency to perceive others as withholding or emotionally unavailable. A client who experiences a therapist's more active interventions as hindering may have a generalized tendency to perceive others as controlling or intrusive, (p. 13) This was based on the proposition that the exploration of the way in which the client is construing the therapist's action may potentially lead to the clarification of core-organizing principles that shape the meaning of interpersonal events for the client (Safran, 1993). We hypothesized that interpersonal schemas may predict an ability to form an alliance. Regarding cognitive interpersonal theory (Safran & Segal, 1990), we anticipated that complementarity of friendly and submissive situations would be associated with good alliance, whereas complementarity of hostile and dominant situations would be correlated with poor alliance. Accordingly, we designed a pilot study examining the relationship of interpersonal schemas to therapeutic alliance within the framework of short-term cognitive therapy. METHOD Participants Twenty-six (15 men, 11 women) patients participated in this pilot study. Their mean age was 37.19 years (SD = 8.95 years). Seven had never been married, 11 were married or remarried, and five were currently separated or divorced and one was widowed. Participants were diagnosed as having Axis I depression, anxiety and combined depression and anxiety disorders according to the DSM-III-R. …

The question of how interpretations take effect is among the most important in psychotherapy research. In a landmark study, Silberschatz, Fretter, and Curtis (1986) developed a method to assess the compatibility between an interpretation and a patient's psychology (the patient's unconscious plan), and demonstrated that this factor-plan compatibility-may contribute substantially to an interpretation's effect. However, they did not consider the following possibility: An interpretation might be plan compatible in terms of content, but incompatible in terms of process (e.g., an interpretation accurately identifying a patient's fear of acting independently may be delivered in a controlling way), or vice-versa. In a reanalysis of data provided by Silberschatz et al. (1986), we demonstrate that raters can reliably distinguish content from process in evaluating plan compatibility. We demonstrate, further, that a distinction between content and process plan compatibility may increase the amount of explained varian...

This article reviews and synthesizes the diverse contributions of the authors in this issue of In Session: Psychotherapy in Practice. It presents a schematization of direct and indirect interventions that therapists typically implement to address problems related to the tasks and goals of treatment, or the affective bond between therapist and client. We then present an additional perspective on the resolution of therapeutic alliance ruptures, emerging out of our own research program.

This article critiques major trends in the psychotherapy integration movement from the postmodern perspectives of contextualism and pluralism. A contextualist position asserts that psychotherapeutic concepts and interventions can be understood only within the linguistic, theoretical, and ideological frameworks in which they are embedded. Therefore, they take on new meanings when extracted from their original context and are incorporated into an eclectic therapy. Pluralism holds that there is no single theoretical, epistemological, or methodological approach that is preeminent and no one, correct integrative system toward which the field of psychotherapy is evolving. In light of this critique, we argue that the goal of the integration movement should be to maintain an ongoing dialogue among proponents of different theories and world views, thereby allowing for the clarification of differences as well as the judicious Integration of alternative perspectives and techniques. The article also spells out the implications of contextualism and pluralism for psychotherapy theory, practice, and research.

This article outlines some of the main features of a research program on ruptures in the therapeutic alliance and reports some of the major findings to date. A rupture in the therapeutic alliance is a deterioration in the quality of the relationship between patient and therapist; it is an interpersonal marker that indicates a critical opportunity for exploring and understanding the processes that maintain a maladaptive interpersonal schema. Following the task-analytic research paradigin, a preliminary model of the resolution process was developed and then tested and revised with 2 different data sets. A series of lag 1 sequential analyses were used to confirm the hypothesized sequences of events within resolution sessions and to demonstrate a difference between resolution and nonresolution sessions. This article describes the evolution of a model of rupture resolution and then discusses its implications for treatment development and evaluation.

Current measures of the working alliance tend to emphasize the degree of agreement or collaboration between patient and therapist about therapeutic tasks and goals. There are, however, both theoretical and empirical grounds to suggest that the degree to which patient and therapist are able to constructively negotiate disagreements about tasks and goals is another important dimension of the alliance. The present study outlines the preliminary development and evaluation of a measure to operationalize this dimension. This measure, the Alliance Negotiation Scale (ANS), is a 12-item patient self-report instrument. Exploratory factor analysis and expert ratings informed the development of the scale, which consists of two distinct factors that demonstrate good internal consistency. Correlations between these factors and the working alliance offer preliminary support for its construct validity. A working version of the ANS is presented and the need for further validation is discussed.

In this article, we review the existing empirical research on the topic of therapeutic alliance ruptures in psychotherapy. Ruptures in the therapeutic alliance are defined as episodes of tension or breakdown in the collaborative relationship between patient and therapist. Two meta-analyses were conducted. The first reviewed studies examining the relation between rupture-repair episodes and treatment outcome (r = .24, z = 3.06, 95% CI [.09, .39], p = .002, k = 3, N = 148). The second meta-analysis reviewed the research examining the impact on treatment outcome of training therapists in the use of alliance rupture intervention principles (prepost r = .65, z = 5.56, 95% CI [.46, .78], p < .001, k = 8, N = 376). Both meta-analyses provided promising evidence regarding the relevance of alliance rupture-repair processes to therapeutic outcome. The limitations of the research reviewed are discussed as well as practice implications for repairing the inevitable alliance ruptures in psychotherapy.

Aim: We explored therapists’ and clients’ experiences of alliance rupture events for the first 15 sessions of each of eight cases; therapists were each paired with one client who had a personality disorder. Method: All sessions were videotaped and rated with the Rupture Resolution Rating System. Approximately 1 week after a rupture, clients and therapists were individually interviewed about the causes of the rupture, how the rupture evolved, the impact of the rupture on the therapeutic process, and experiences during the event. The interviews were analyzed by five judges using consensual qualitative research (CQR; Hill, 2011). Results: Typically, rupture events involved a repetition of a previous rupture event, the rupture emerged when the client was not prepared to respond to the therapist’s intervention, both therapists and clients felt confused and ambivalent, and confrontation events activated intense and negative feelings. We discuss the implications for practice, training, and research., Fundação para a Ciência e a Tecnologia

This article explores a number of definitional and conceptual issues relevant to our understanding of problems or ruptures in the therapeutic alliance. In it, I argue that ruptures or strains in the therapeutic alliance are important transtheoretical phenomena, and that the conceptual and empirical elucidation of processes leading to both the development and resolution of these problems can play an important role in the development of an integrative body of knowledge about psychotherapy. Three common patterns leading to the development of problems in the therapeutic alliance are described. In addition, the question of whether patient expressions of anger or hostility toward the therapist which facilitate the therapeutic process should be considered ruptures in the alliance, is raised. As a way of resolving this question, a distinction is made between momentary fluctuations in the quality of the alliance and the meta-alliance, i.e., the underlying relationship context in which these fluctuations take place.

In the current study, the development and initial validation of the Suitability for Short-Term Cognitive Therapy (SSCT) interview procedure is reported. The SSCT is an interview and rating procedure designed to evaluate the potential appropriateness of patients for short-term cognitive therapy with an interpersonal focus. It consists of a 1-hour, semistructured interview, focused on eliciting information from the patient relevant to nine selection criteria. The procedures involved in the development of this scale are described in detail, and preliminary evidence suggesting that the selection criteria can be rated reliably is presented. In addition, data indicating that scores on the SSCT scale predict the outcome of short-term cognitive therapy on multiple dependent measures, including both therapist and patient perspectives, are reported. It is concluded that the SSCT is a potentially useful scale for identifying patients who may be suitable, or unsuitable, for the type of short-term cognitive therapy administered in the present study.

An alliance rupture consists of an impairment or fluctuation in the quality of the alliance between the therapist and client. Alliance ruptures vary in intensity, duration and frequency, depending on the particular therapist-client dyad. In more extreme cases, the client may overtly indicate negative sentiments to the therapist or even terminate therapy prematurely. At the other end of the continuum are minor fluctuations in the quality of the therapeutic alliance which may be extremely difficult for the outside observer or for even the skilled therapist to detect. While the features of alliance ruptures vary from case to case, most therapy cases, even the more successful ones, are characterized by at least one or more ruptures in the therapeutic alliance over the course of therapy. While much of what we will have to say in the course of our discussion will ring true to the reader, our intention is to "unpack" familiar concepts such as the therapeutic alliance in a fashion which leads to more differentiated understanding and research.

This article is the second of a two-part series on the refinement of cognitive behavioral theory and practice in light of interpersonal theory. Building upon the theoretical framework outlined in the first paper, a number of suggestions are provided for systematically integrating therapeutic concepts and intervention strategies derived from interpersonal theory with the practice of cognitive therapy. Similarities and differences between the current perspective and certain developments in contemporary interpersonal and psychodynamic thinking are discussed, and suggestions for future research are provided.

Publisher Summary This chapter focuses on therapeutic alliance and its theoretical perspective, and presents conceptualizations and strategies for cultivating and negotiating a healthy and strong relationship with patients. The therapeutic alliance is a prerequisite for change in all forms of psychotherapy. The alliance consists of three interdependent components: first, tasks—the specific covert and overt activities in which the patient must engage to get benefits from the treatment; second, goals—general objectives toward which the treatment is directed; and third, bonds—affective quality of the relationship between patient and therapist. The process of negotiation involves many tasks for the therapist. Therapists must be able to shift their attention between the process and the content of the session—not just what is being said, but how it is said. Awareness of the process keys the therapist into the interpersonal communication the patient is making about the relationship with the therapist. The interpersonal field should be monitored for levels of relatedness, connection, or disconnection at any given moment. Shifts in affective engagement are important clues to the patient's experience of the therapeutic material as well as the therapeutic relationship.

In this brief discussion I highlight some dimensions of Angus and Kagan's (2013); Olivera, Braun, Gomez Penedo, and Roussos (2013); and Jock, Bolger, Olivera, and Roussos (2013) articles that are of particular interest to me. Reading their articles has served as a catalyst for me to reflect at a more general level on the state of the art of qualitative methods in psychotherapy research, and to articulate some informal reflections about qualitative research.

he previous chapters provide a wide array of both common and unique perspectives on the conceptualization and management of the therapeutic alliance in short-term psychotherapy. In this chapter, we summarize some of the major principles emerging from our reading of these chapters. We then adapt a model emerging from our own research on resolving ruptures in the therapeutic alliance, for the purposes of further clarifying some of the principles involved in working through termination issues in shortterm psychotherapy. T

A compelling body of empirical evidence has established the therapeutic alliance as a core psychotherapy process that directly contributes to overall patient change across a range of theoretically diverse treatments (Horvath & Symonds, 1991; Martin, Garske, & Davis, 2000). There are numerous theoretical conceptualizations of the therapeutic alliance and several instruments have been developed to measure it. A common feature among them is a description of the general affective quality of the patient-therapist relationship, including the interaction of patient and therapist interpersonal characteristics (e.g., therapist’s capacity for empathy, patient’s degree of involvement in treatment) in their moment-to-moment collaboration toward agreed on treatment goals (Horvath & Greenberg, 1994).

In this chapter, we will outline and illustrate some of the central principles of the integrative approach to psychotherapy being developed by Safran and colleagues (Safran 1984a,b, 1990a,b; Safran, Crocker, McMain, & Murray 1990; Safran & Segal 1990). This approach draws heavily on the cognitive therapy tradition. For example, a central emphasis consists in helping clients to examine their perceptions and to treat them as hypotheses to be tested. The approach, however, is also strongly influenced by both experiential and interpersonal frameworks.

Introduction - Negotiating the Therapeutic Alliance in Brief Psychotherapy Therapeutic Alliance in Brief Psychoanalytic Psychotherapy - a Drive/Conflict Perspective Therapeutic Alliance in the Relational Models of Time Limited Dynamic Psychotherapy Functional Analytic Psychotherapy, the Therapeutic Alliance and Brief Psychotherapy The Therapeutic Relationship in Short-Term Cognitive Therapy The Therapeutic Alliance in Human and Experiential Therapies The Alliance in Time-Limited Group Psychotherapy The Therapeutic Alliance in Strategic Therapy The Therapeutic Alliance in Couples and Family Therapy Theory in Practice Common Ground and Shared Principles.

Emotion is viewed as a biologically adaptive system that presents people with information about their reactions to situations and that organises them for action. The emotion system integrates information across a variety of information-processing domains and, as such, is the most complex, integrative information-processing system humans possess, providing a constant readout of the person's current state. Emotions and feelings are therefore of central importance in psychotherapy. They need to be brought to awareness in therapy to help improve patients' orientation to the environment and to help them mobilize for action. The importance of affective assessment in therapy is stressed in order to provide the clinician with a framework for intervention and, more specifically, to guide the clinician concerning when to access, bypass, or modify particular emotions. Six therapeutic affective-change processes—acknowledging, creation of meaning, arousal, taking responsibility, modifying, and expression—are discussed as well as the role of emotion in anxiety and depression. The chapter includes a discussion of three types of change events in which a number of affective-change processes operate. In the allowing and accepting of emotion event, patients overcome the avoidance of painful feelings and acknowledge and take responsibility for their feelings. In events involving the completion of interrupted expression, emotion is aroused and expressed and the emotional network is restructured. In the third and final event, accessing core beliefs, emotion is aroused in order to access core organizing beliefs and make them amenable to change.