Therapeutic alliance's ruptures and resolutions and patient's reflective functioning

Introduction: The process of intersubjective negotiation that is involved in therapeutic alliance ruptures and resolutions probably play a central role in relation to in-sessions and across sessions changes in patient's reflective functioning. Aims: This study aims at investigating the relationship between therapeutic alliance and patient's RF at session level. Our objective are to: 1) evaluate whether low levels of RF will be related to therapeutic alliance rupture processes; 2) verify whether high level of RF will be related to collaborative processes; 3) verify if an increase of RF at session level is predicted by collaborative interactions or rupture's resolutions; 4) verify whether decreases of RF are predicted by therapeutic alliance rupture's. Method: From a database of transcripts of psychotherapy sessions we extracted a random sample of 10 patients who had completed psychotherapy and for each patient selected 8 transcripts of different treatment phases. Two assessment measures were applied to the transcripts: Collaborative Interactions Scale (Colli, Lingiardi, 2009), for the assessment of alliance's ruptures and resolution processes; 2) Reflective Functioning Scale (Fonagy et al., 1998) for the assessment of patient's RF. Each transcript was rated by three independent and trained raters for each measures (CIS and RFS). Results: Results suggest that low RF are associated with patients' alliance ruptures and high RF level with patients' collaborative processes. Ruptures resolutions predict an increase of reflective functioning during sessions. Results will be discussed in terms of clinical and theoretical implications.