The therapeutic alliance rupture as a transtheoretical phenomenon: Definitional and conceptual issues

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.