Operationalizing alliance rupture–repair events using control chart methods

This study aimed to determine how control charts—a form of time-series line graphs—can be implemented in psychotherapy research to indirectly identify probable rupture–repair episodes that are associated with psychotherapy outcome. There is no current standard in psychotherapy research with regard to how to use control charts to identify rupture–repair events. Control charts were generated for each patient (N = 73) using patient-rated Working Alliance Inventory (WAI) scores obtained at the end of every session in a 30-session therapy protocol of either brief relational therapy (BRT) or cognitive behavioural therapy (CBT). Empirically derived cut-off points were used to identify rupture and repair based on each dyad's control chart. Coded rupture–repair episodes were correlated with outcome measures to assess for their relationships. The results of these analyses provide preliminary support for the utility of control charts in psychotherapy research for the indirect identification of probable rupture repair events that are associated with psychotherapy outcome.