Repairing alliance ruptures

Increasingly, research on the therapeutic alliance has shifted its focus to clarifying the factors contributing to alliance development, including the processes involved in resolving alliance ruptures. This article provides a brief review of the empirical literature on ruptures in the alliance and their resolution or repair. In sum, the research is promising, indicating the relevance of ruptures and resolution to psychotherapy outcome. However, much of the research thus far consists of small samples or qualitative studies. In many respects, such research should be considered in the early stages of development. Provisional practice implications are presented, suggesting that therapists be more attentive to ruptures, explore patient negative feelings about therapy, and respond to those feelings in an open and nondefensive fashion.