V-Episodes in the Alliance: A Single-Case Application of Multiple Methods to Identify Rupture Repair

The therapeutic alliance has been consistently found to be a robust predictor of therapeutic outcome across various modalities of psychotherapy. Alliance ruptures are thought to occur commonly within each therapeutic dyad and, if left unresolved, are associated with premature termination and worsened psychotherapy outcome. Research efforts have identified V-shaped shifts in the alliance, characterized by a high–low–high pattern of postsession alliance scores, as a meaningful method of operationalizing rupture–repair episodes, but these efforts rarely evaluate the within-session process of the identified sessions. As a result, it is often unclear whether these sessions identified by methods based on postsession alliance measures are reflective of clinically meaningful within-session rupture process. This article aims to further explore the V-episode operationalization of rupture–repair episodes by assessing for convergence between rupture process identified by between-session measures and the within-session observer-based Rupture Resolution Rating Scale (3RS) in a single patient–therapist dyad in a 30-session brief relational therapy. V-episodes were operationalized using various previously utilized methods to identify ruptures based on postsession measures of alliance. Results of this case study demonstrate that postsession patientrated V-episodes in the therapeutic alliance can be indicative of within-session rupture process, demonstrating convergence between within and between-session measures of alliance process. Implications of these results for methodological approaches for identifying alliance ruptures are discussed.