Embodied Head-Movement Patterns Differentiate Confrontation and Withdrawal in Therapeutic Alliance Ruptures

This is an Open Science Foundation site complementary to the paper titled "Embodied Head-Movement Patterns Differentiate Confrontation and Withdrawal in Therapeutic Alliance Ruptures." Therapeutic alliance ruptures-moments of strain or disconnection between patients and therapists-are central to psychotherapy process and outcome. Rupture theory distinguishes between confrontation ruptures, characterized by overt disagreement or protest, and withdrawal ruptures, characterized by disengagement and emotional constriction. Although prior work suggests that rupture types differ in their physiological and interpersonal signatures, little is known about their moment-to-moment embodied expression or how such nonverbal processes evolve across therapy. The present study examined whether head-movement dynamics function as quantifiable nonverbal markers of alliance rupture type and longitudinal change. Video recordings from 104 patient–therapist dyads (562 psychotherapy sessions) were segmented and coded using the Rupture Resolution Rating System (3RS), yielding 4,721 rupture and non-rupture segments. Head movements were extracted using automated kinematic analysis and analyzed with multilevel longitudinal models. Across patients and therapists, confrontation ruptures were consistently characterized by greater head-movement magnitude, velocity, and acceleration than withdrawal ruptures, which showed attenuated movement. Patients exhibited higher overall movement levels than therapists across rupture types. Therapists’ head-movement patterns during ruptures changed systematically across sessions, consistent with increasing differentiation and regulation of nonverbal responses over the course of treatment. Gesture-level analyses further revealed distinct patterns of nodding and shaking associated with rupture type. These findings identify head-movement dynamics as embodied, nonverbal markers of alliance rupture processes and highlight their relevance for psychotherapy process research, therapist training, and the detection of rupture states in clinical practice.