Exploring alliance ruptures through the lenses of therapeutic distance.

Abstract

Objective: To observe ruptures through clients' and therapists' experiences of closeness and distance in therapy. Method: Sixty-six clients and their 29 therapists underwent RAP interviews that were rated with the Therapeutic-Distance-Scale- observer version (TDS-O) and completed the Post-Session-Questionnaire (PSQ) three times along therapy (early, mid and late therapy). Using a dyadic model, we associated client and therapist self-report of ruptures with TDS-O observer ratings. Results: Clients' report of ruptures positively associated with clients' observed scores that the therapist was too distant, while therapists' report of ruptures related to their observed scores that the client was too close. Clients report that the rupture addressed related to their higher observed autonomy, but therapists report that the rupture addressed related to less client's autonomy. Resolution related to lower observed distance and higher observed engagement of both partners. In dyads in which the therapist was rated as experiencing distance, there was a higher level of resolution than in dyads in which the client observed as experiencing distance and the therapist did not. Clinical examples demonstrate how ruptures were manifested and understood through the therapeutic-distance prism. Conclusions: Observing the therapeutic-distance potentially improves therapists' ability to identify, negotiate, and resolve ruptures.