Alliance rupture profiles by personality disorder pathology in psychotherapy for depression: Tendencies, development, and timing

Clin Psychol Psychother. 2022 May;29(3):1125-1134. doi: 10.1002/cpp.2700. Epub 2021 Dec 12.


Objective: Clinical and theoretical considerations presume that patients with different personality disorder (PD) clusters will be associated with distinct alliance rupture profiles; however, there is scarce empirical literature examining this. The present study adopted a systematic framework for investigating profiles of alliance ruptures for individuals belonging to each of the three PD clusters.

Method: The sample consisted of 94 patients from a randomized controlled trial for treatment of depression. PD cluster features were assessed at intake and ruptures were assessed across treatment. Three sets of multilevel analyses were conducted to test differences between the PD clusters in the general tendency to show a rupture profile, rupture development throughout the treatment, and timing of predicting ruptures by PD within sessions.

Results: The three clusters were associated with distinct profiles of alliance ruptures. Clusters A and B were characterized by a general tendency to show more withdrawal and confrontation ruptures. Cluster A had a greater decrease in confrontation ruptures over the course of treatment, while cluster B had a greater decrease in withdrawal ruptures. Cluster C was characterized by a general tendency to show fewer withdrawal and confrontation ruptures, with a greater increase in both ruptures over the course of treatment. For withdrawal ruptures, the differences between clusters were evident from the beginning of sessions, whereas for confrontation ruptures, there was less of a difference between beginning and end of sessions.

Conclusion: The distinct profiles of alliance ruptures for each PD cluster may contribute to progress towards tailoring treatment to individuals with PDs.

Keywords: alliance; personality disorders; psychotherapy process; ruptures; supportive-expressive treatment.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Depression
  • Humans
  • Personality Disorders / therapy
  • Professional-Patient Relations
  • Psychotherapy
  • Therapeutic Alliance*