Therapist’s interventions and ruptures and resolutions of therapeutic alliance in patients with and without personality disorders

This study explores the relationship between therapist’s interventions and ruptures and resolutions processes of the therapeutic alliance in patient with and without personality disorders. We also present the revised version of the Collaborative Interactions Scale Revised (CIS-R; Colli, Gentile, Condino, & Lingiardi, 2017), an observer-rated measure for the assessment of therapeuticalliance ruptures and resolutions. Our aim is to investigate the predictive effect of the therapist’s techniques on the patient’s collaborative processes in relation to session’s depth and patient’s insight. Specifically, we hypothesize that the effect of expressive interventions (focus on the affects, on the relational patterns, on the “here and now” of the relationship) on the patient’s collaboration is influenced by the level of depth and insight. 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). Measures: CIS-R (Colli, et al., 2014, 2017) to evaluate the ruptures and collaborative processes in the session; CPPS (Hilsenroth et al., 2005; Gentile & Tanzilli, 2015) to assess therapist’s interventions; SEQ-D (Stiles & Snow, 1984a) to describe the session’s depth of elaboration. Results: The linear regression evidenced that the expressive interventions are predictive of alliance ruptures in patients with PDs in presence of low level of insight and session’s depth. The expressive interventions are predictive of collaborative processes in patients without PDs in presence of good level of insight and session’s depth. Conclusions: The application of the scale seems to confirm that — as evidenced by the former version (Colli & Lingiardi, 2009) — also the CIS-R is a reliable rating system that is useful for both empirical research and clinical assessments. Clinical implications of these results will be discussed.