Alliance Rupture Detection and Repair in Group Therapy: Using the Group Questionnaire--GQ.

The identification of relationship ruptures in group therapy coupled with repair efforts by the group leader are addressed from a measurement-based care (MBC) perspective. Several MBC systems are now recognized as evidence-based treatments, and these systems typically use self-report assessment of both outcome and relationship measures. After laying a brief foundation of alliance rupture and repair from an individual therapy perspective, the complexity of applying alliance and repair across the multiple therapeutic relationships and constructs found in the group treatment literature is considered. The Group Questionnaire (GQ) is an empirically derived measure designed to capture the multiple relationship structures (member-member, member-leader, and member-group) and constructs (alliance, cohesion, climate, and empathy) in group therapy. Similarities and differences between the GQ and alliance rupture and repair measures are considered, followed by algorithms used to identify rupture and repair in group therapy on the three GQ subscales-positive bond, positive work, and negative relationship. MBC clinical reports are used to illustrate how rupture is identified at both a group and individual member perspective along with information to support repair interventions. Finally, both clinical and empirical reasons for using the MBC approach are considered along with clinical observations.