Assessing alliance ruptures and resolutions in patients with personality disorders

The frequency of therapeutic alliance ruptures greatly vary in relation to patient pathology. Clinical and empirical literature suggests that patients with personality disorders (PDs) tend to manifest greater problems in the maintenance of the therapeutic alliance than patients characterized by lower levels of personality pathology (Bender, 2005; Lingiardi, Filippucci, & Baiocco, 2005; Smith, Hilsenroth, Fiori, & Bornstein, 2014). Moreover, empirical evidence suggests that patients with PDs, characterized by inflexible patterns of emotional and interpersonal difficulties that could lead to dramatic in-session fluctuations of mental states, invariably pose great challenges to psychotherapists, especially with regard to the negotiation of the therapeutic alliance (Benjamin & Karpiak, 2002; Levy, Beeney, Wasserman, & Clarkin, 2010). The aims of the study was to describe the scale-revision process, to evaluate interrater reliability and scale validity comparing sessions of patients with and without personality disorders (PDs). Hypothesis; Patients with PDs will show a greater number of alliance ruptures and a smaller number of collaborative processes than patients without PD. Method: Three raters evaluated blind a sample of 60 sessions (180 segments; 3,607 narrative units) with 30 patients (15 had a PD diagnosis and 15 had a DSM-5 clinical syndrome diagnosis without PDs). Results: Interrater reliability results ranged from acceptable to excellent and were comparable with the former version. Patients with PDs showed a greater number of alliance ruptures and a smaller number of collaborative processes than patients without PDs. Moreover, therapists presented more negative interventions with the PD sample than in the non-PD group. Conclusions: The results indicate that the CIS–R is a reliable rating system and is useful in both empirical research and clinical assessments.