Frequencies of rupture markers and use of repair strategies and their relationship to psychotherapy outcomes in naturalistic clinical settings: A comparative study of personality disorders and anxiety disorders

OBJECTIVE: Alliance rupture frequency and absence of repair are associated with poorer therapeutic outcomes. Prior research suggests different diagnoses may show distinct rupture patterns, with personality disorder (PD) treatments often displaying higher rupture rates compared to other diagnosis. Evidence, however, remains insufficient to inform clinical practice. This study aimed to expand knowledge on frequency of rupture markers and use of repair strategies across diagnoses and examine their relationship to outcome. METHOD: In a naturalistic setting, 392 video-recorded sessions from nine PD and seven anxiety disorder (AD) treatments were rated with the Rupture Resolution Rating System. Outcome was assessed with the Symptom Checklist (SCL-92), and mixed-effect models compared groups across timepoints. RESULTS: No statistically significant differences were revealed between the groups in the comparison of frequency of rupture markers and repair strategy use. A trend toward more patient-initiated confrontation rupture markers in PD was observed. Higher patient-initiated rupture marker frequency correlated with greater symptom severity on five SCL-92 subscales somatization, anxiety, phobia, paranoid ideation, and psychoticism but not with the global severity index. CONCLUSION: Findings indicate that patient-initiated rupture marker frequency is linked to treatment outcome. Frequency of rupture markers and repair strategy use might vary individually in naturalistic clinical settings, but the limited sample size warrant further study.