OBJECTIVE Ruptures and repairs in alliance and their association with treatment outcome have been studied widely. Many of these studies have used indirect methods, focused on decreases in alliance across sessions while measuring alliance at postsession. However, this approach does not establish whether observed decreases occur within (as insinuated by most theories) or between sessions. In the current study, we examined decreases of alliance measured both pre- and postsession in 3 clinical trials and explored the phenomenology and interpretation of these decreases. Additionally, we investigated the effects of rupture magnitude and the interpretation of repairs on treatment outcome, examining whether the "repairs benefit" or the "unrepaired ruptures damage" theories were supported by the data. METHOD Presession and postsession therapeutic alliance and outcome measures were examined from patients who participated in 1 of 3 studies: cognitive-behavioral therapy (CBT) for social anxiety disorder (N = 29), CBT for panic disorder (N = 31), or short-term psychodynamic psychotherapy for depression (N = 44). Patterns of change in alliance are described. Ruptures and repairs are examined according to several criteria and are used to predict outcome using longitudinal multilevel modeling. RESULTS In all samples, alliance systematically decreased between sessions and increased within them. Decreases in alliance as measured by traditional postsession to postsession were unreliable predictors of within-session decreases in alliance and of outcomes. CONCLUSIONS Decreases in alliance across sessions are not valid measures of ruptures as defined by most theories. Instead, we suggest that they are indicative of an ebb-and-flow model for the development of alliance. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

中文翻译：

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重新评估联盟中的破裂和修复：认知行为疗法和短期心理动力心理疗法的疗程间和疗程内过程。

目的联盟中的破裂和修复及其与治疗结果的关系已得到广泛研究。这些研究中的许多都使用了间接方法，侧重于跨会话减少联盟，同时在会话后测量联盟。但是，这种方法无法确定观察到的减少是否发生在会议期间（大多数理论所暗示的）或会议之间。在本研究中，我们在3个临床试验中检查了会前和会后测得的联盟减少，并探讨了这些减少的现象学和解释。此外，我们调查了破裂强度的影响以及修复对治疗结果的解释，检查了数据是否支持“修复收益”或“未修复破裂损伤”理论。方法从参加三项研究中的一项的患者中检查了会前和会后的治疗联盟和结局指标：社交焦虑症的认知行为疗法（CBT）（N = 29），恐慌症的CBT（N = 31）或短期抑郁症的长期心理动力学心理治疗（N = 44）。描述了联盟变化的模式。根据几种标准检查破裂和修复情况，并使用纵向多级建模来预测结果。结果在所有样本中，联盟在会议之间有系统地减少，而在会议内部则有所增加。按照传统的会后到会后衡量，结盟减少是结局和结局减少的可靠预测指标。结论在大多数会议中，跨会期联盟减少并不是有效的破裂量度。相反，我们建议它们是联盟发展的潮起潮落模型的指示。（PsycInfo数据库记录（c）2020 APA，保留所有权利）。