Using the Rupture Resolution Rating System (3RS) for microanalysis of the psychotherapeutic dialogue. This article describes the use and function of this instrument in psychotherapy research.
The psychotherapeutic dialogue is the tangible aspect of the psychotherapeutic alliance. Within this alliance is the healing aspect of psychotherapy. An alliance rupture is defined in this manual as a deterioration in the alliance, in the sense that these occurrences are manifested by ab apparent lack of collaboration between patient and therapist on the task forward. While the concept of rupture may have like a “negative” connotation in other alliances, ruptures are essential parts of the psychotherapeutic alliance.
The absence of rupture and repair in a therapeutic session is a sign of confluence between therapist and client; whereby both parties give in to each other’s requests throughout the session, without question or challenge. These mainly confluent, rupture-less relationships in psychotherapy do not lead to healing at best, and at worst, may lead to the client being dependent on the therapy.
By rupture, the authors Eubanks-Carter et.al (2014) reiterate that it is not about lack of agreement, but lack of collaboration. The authors are also aware that agreement on the surface may actually be withdrawal, which is a kind of rupture.
“Note that a lack of ruptures is not necessarily the same as effective therapy. A patient and therapist could be in agreement and be working together very smoothly, but pursuing goals and tasks that are not the best choice for the patient’s situation. When coding ruptures, the focus is on the quality of the collaboration and bond between the patient and therapist—not the quality of the therapist’s case conceptualization, choice of treatment approach, or adherence or competence.” (p. 4)
Ruptures may be outside the consciousness of the therapist and client. In severe cases, ruptures can lead to dropout or failure of treatment.
2 subtypes of ruptures:
- withdrawal ruptures : moving away the therapist (avoiding questions, etc.) or moving towards the therapist in a way as to avoid experiences (being overtly appeasing, etc), avoiding the actual work of the therapy.
- confrontation ruptures : moving against the therapist, expressing anger, dissatisfaction by trying to pressure or control the therapist /therapy
- Both
Both therapist and client contribute to ruptures.
The coding system looks at the patient’s behaviors as markers of ruptures.
Resolution process is a process by which the rupture is repaired. This is a opportunity for rebinding the alliance, and reinstating new goals.
Resolution strategies are measures taken by the therapist to initiate the resolution process.
Signs of rupture (p. 5):
- Patient and therapist are not working together collaboratively and productively. They
- are “not on the same page.”
- There is strain, tension, or awkwardness between patient and therapist.
- Patient and therapist are misaligned or misattuned.
- Patient and therapist seem distant from each other.
- Patient and therapist are working at cross purposes.
- Patient and therapist are acting friendly, but you sense tension or disagreement beneath the surface, such that the friendliness seems to be a pseudo-alliance.
- Patient and therapist seem to be caught in a vicious cycle or enactment.
- You feel very bored while watching a session. This might be a sign that a withdrawal rupture is occurring
Bibliography
Eubanks-Carter, C. F., Muran, J. C., & Safran, J. D. (2014). Rupture resolution rating system (3RS): Manual.