The therapeutic alliance predicts dropout from psychological therapy, and ruptures in the therapeutic alliance may also predict dropout, yet there is a dearth of research with adolescents. This study investigated whether markers of rupture-repair in the alliance were indicative of different types of treatment ending in adolescents receiving psychological treatment for depression. Data were from the IMPACT study, a trial investigating the effectiveness of therapies for adolescent depression. Participants were randomly allocated to receive a brief psychosocial intervention, cognitive-behavioral therapy, or short-term psychoanalytic psychotherapy. The sample (N = 35) comprised adolescents who had either completed their treatment (n = 14) or dropped out (n = 21) according to their therapist. Dropout cases were further classified as dissatisfied (n = 14) or got-what-they-needed (n = 7) based on posttherapy interviews with the adolescent and therapist. Selected recordings of therapy sessions were rated using the Rupture Resolution Rating System and Working Alliance Inventory (observer version). Therapeutic alliance and rupture-repair during therapy were similar for completers and got-what-they-needed dropouts, whereas dissatisfied dropouts had poorer therapeutic alliance, more ruptures, ruptures that were frequently unresolved, and greater therapist contribution to ruptures. Qualitative analysis of sessions led to the construction of three categories of therapist contribution to ruptures: therapist minimal response, persisting with a therapeutic activity, and focus on risk. Results suggest that ruptures, especially when unresolved, could be warning signs of disengagement and dropout from therapy. Future research should investigate how ruptures may be effectively identified and resolved in treatment with adolescents. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

中文翻译：

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当青少年停止心理治疗时：破裂-治疗联盟中的修复以及与治疗结束的关联。

治疗联盟预测心理治疗会辍学，治疗联盟破裂也可能预测辍学，但青少年研究不足。这项研究调查了联盟中破裂修复的标志物是否表明接受抑郁症心理治疗的青少年治疗的不同类型。数据来自IMPACT研究，该研究旨在研究治疗青少年抑郁症的有效性。参与者被随机分配接受简短的社会心理干预，认知行为治疗或短期心理分析心理治疗。样本（N = 35）由根据治疗师完成治疗（n = 14）或辍学（n = 21）的青少年组成。根据对青少年和治疗师的访谈后，辍学病例进一步分为不满意（n = 14）或需要什么（n = 7）。使用破裂分辨率评估系统和工作联盟清单（观察员版本）对选定的治疗记录进行评估。对于完成者和需要什么退出者，治疗联盟和治疗期间的破裂修复相似，而对于退出者，不满意的退出者具有较差的治疗联盟，更多的破裂，经常无法解决的破裂以及治疗师对破裂的更大贡献。会议的定性分析导致治疗师对破裂的贡献可分为三类：治疗师的反应最小，坚持治疗活动并关注风险。结果表明破裂，尤其是未解决时，可能是脱离治疗和退出治疗的警告信号。未来的研究应该调查如何在青少年治疗中有效地识别和解决破裂。（PsycINFO数据库记录（c）2020 APA，保留所有权利）。