Therapist interventions and ruptures and resolutions of therapeutic alliance in anaclitic and introjective patients

This study explores the relationship between therapist’s interventions and ruptures and resolutions processes of therapeutic alliance in anaclitic and introjective patients. We also present the revised version of the Collaborative Interactions Scale Revised (CIS-R; Colli, Gentile, Condino, & Lingiardi, 2017), an observerrated measure for the assessment of therapeutic-alliance ruptures and resolutions. Our aim is to investigate the impact of the therapist’s techniques on the (a) ruptures markers and (b) collaborative processes in two groups of patients. Specifically, we hypothesize the effects of these therapist’s interventions: (a) The focus on the relationship and/or affects are predictive of the collaborative processes in anaclitic patients and of the indirect rupture markers in the introjective patients; (b) the intervention on insight and/or defenses and/or recurrent patterns are predictive of the collaborations in the introjective patients and on the direct rupture markers in the anaclitic patients. Method: three raters conducted a blind evaluation of a sample of 130 sessions (390 segments; 7,214 narrative units) with 65 patients (33 had an anaclitic orientation and 32 had a introjective orientation). Measures: Collaborative Interactions Scale Revised (CIS-R; Colli, et al., 2014, 2017) to evaluate the ruptures and collaborative processes in the session; Comparative Psychotherapy Process Scale (CPPS; Hilsenroth et al., 2005; Gentile & Tanzilli, 2015) to assess therapist’s interventions; Prototype Matching of Anaclitic–Introjective Personality Configuration (PMAI; Werbart & Levander, 2014, 2016) for the assessment of the anaclitic and introjective; Psychodynamic Functioning Scale (PFS; Høglend et al., 2000, 2006, 2008) for the evaluation of the patient’s level of functioning. Results: The linear regression evidenced that the focus on affects interventions are predictive of collaborative process in anaclitic patients only in presence of high level of functioning (b=.683, sig.=.001). The focus on the relationship are predictive of collaborative processes both in anaclitic (b=.472, sig.=.000) and introjective patients (b=.389, sig.=.05) in presence of low level of functioning. The interventions focused on insight (b=.541, sig.=.000) and defenses (b=.767, sig.=.005) are predictive of collaborative process in introjective patients with a high level of functioning. Conclusions: The application of the scale seems to confirm that¾as evidenced by the former version (Colli & Lingiardi, 2009)¾ also the CIS-R is a reliable rating system that is useful for both empirical research and clinical assessments. The data seem suggesting the differential impact of therapist techniques according patient’s characteristic and focusing the importance of the tailoring in order to promote patient’s collaboration in session. Clinical implications of these results will be discussed.