Assessing ruptures and resolutions of therapeutic alliance in patients with and without personality disorders

This study presents the revised version of the Collaborative Interactions Scale (CISR; Colli, Gentile, Condino, & Lingiardi, 2017), an observer-rated measure for the assessment of therapeutic-alliance ruptures and resolutions. Aim: Our aim is to assess differences in the presence of alliance ruptures and resolutions in relation to patient’s diagnosis. Specifically, we hypothesize that the focus on the affects is different in the sessions of patients with and without personality disorders (PDs). Method: three raters conducted a blind evaluation of a sample of 130 sessions (390 segments; 7,214 narrative units) with 65 patients (33 had a PD diagnosis and 32 had a DSM–5 clinical syndrome diagnosis without a PD). Results: The ANOVA evidenced that the patients with PDs showed a greater number of alliance ruptures and a smaller number of collaborative processes than patients without PDs. Moreover, the non-PD patients are characterized by: (a) a major frequency of the patient’s communications focused on the affects (F = 4.002; sig. = .048) and (b) a higher number of therapists’ interventions on the affects (F = 4.116; sig. = .045) than PD patients. Conclusions: The application of the scale seems to confirm thatas evidenced by the former version (CIS; Colli & Lingiardi, 2009) also the CISR is a reliable rating system that is useful for both empirical research and clinical assessments.