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Editor Giorgio A. Tasca, PhD, provides a review of a special issue of Group Dynamics on group therapy alliance rupture and repair

The March 2021 issue of Group Dynamics, guest edited by Cheri Marmarosh (2021), is a landmark issue that features six articles focusing exclusively on alliance rupture and repair in group therapy.

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Society of Group Psychology and Group Psychotherapy. (2021, February 26). Editor Giorgio A. Tasca, PhD, provides a review of a special issue of Group Dynamics on group therapy alliance rupture and repair. http://www.apadivisions.org/division-49/publications/journal/alliance-rupture-repair

Editor Giorgio A. Tasca, PhD, provides a review of a special issue of Group Dynamics on group therapy alliance rupture and repair

The therapeutic alliance (agreement on tasks and goals of therapy, and the relational bond between client and therapist) is one of the most researched concepts in psychotherapy. Therapists’ capacity to develop and maintain an alliance is clearly related to client mental health outcomes (Fluckiger et al., 2018). More recently, clinicians and researchers have focused on therapeutic alliance ruptures, that is, disagreement on tasks and goals of therapy and problems in the relational bond. Research shows that alliance ruptures are related to poorer client outcomes, whereas repairing ruptures may be related to improved psychotherapy processes and to better client mental health outcomes (Eubanks et al., 2018). Rupture repairs involve renegotiating goals or tasks and healing strains in the relational bond. Despite the importance of alliance rupture and repair to psychotherapy, there was almost no research on this topic when it comes to group therapy until now. The March 2021 issue of Group Dynamics, guest edited by Cheri Marmarosh (2021), is a landmark issue that features six articles focusing exclusively on alliance rupture and repair in group therapy.

The first article by Alldredge, Burlingame, Yang, and Rosendahl (2021) is the first to perform a meta-analysis of the relationship between the alliance and outcomes in group therapy. Similar to findings in individual therapy, the authors found that a higher alliance is reliably associated with client outcomes in group treatment. The meta-analysis suggests that therapists must monitor the state of the alliance in group therapy. To do so, therapists must examine the complexity of the alliance as it occurs in groups. That is, the alliance may occur between client and therapist, between the client and other group members, or between the client and the group as a whole. Subsequent articles in the special issue take up this theme.

The second article by Burlingame and colleagues (2021) used the Group Questionnaire (GQ; Burlingame et al., 2017) to assess members’ perceptions of the bond, work, and relationships in the group. Burlingame and colleagues showed that the GQ can identify members who are struggling in the group by giving group leaders regular feedback on their clients’ GQ scores in order to detect deteriorations from session to session in their ratings of the group. Significant decreases in members’ reporting of the bond from one session to the next indicates to leaders that a rupture has occurred. The authors showed that it is important for leaders to receive this kind of feedback from group members after each session in order to detect and repair a rupture.

The third article by Lo Coco, Gullo, Kivlighan and colleagues (2021) moved the use of the GQ forward by incorporating group-level factors. That is, the authors not only looked at ruptures occurring within the individual member from one session to the next, but they also compared a member’s score to the average of the rest of the group on the GQ. A member’s bond score that is significantly lower than the rest of the group for a session could indicate an alliance rupture for that member. The authors found that if a member had lower scores during a session relative to their own average score across all sessions, and if the member’s score during the session was lower than the rest of the group, then the member experienced less engagement with the group. In other words that member was out of step with the rest of the group during that particular session thus indicating a rupture that reduced their intimate behaviors in the group.

The fourth article, by Urmanche, Minges, Eubanks, Gorman, and Muran (2021) examined the experiences of trainees who received alliance-focused training (AFT) group supervision and compared them to trainees receiving cognitive-behavioral therapy (CBT) group supervision. This is a unique study that applies the concepts of group alliance ruptures and repairs to group supervision contexts. The AFT focused trainees on the therapeutic alliance and its maintenance and repair, whereas those in CBT supervision presumably did not. The authors found that AFT fostered more engagement in supervision even if it was a more challenging for the trainees. AFT trainees worked in the here-and-now during supervision with raised some discomfort. Group supervision that focuses on the alliance appears to facilitate a deeper experiential understanding of ruptures and repairs.

The fifth article by Garceau and colleagues (2021) used one of the most important behavioral process coding systems to examine ruptures – the Rupture Resolution Rating Scale (3RS; Eubanks et al., 2019) in an Evidence-Based Case Study. Garceau and colleagues found similar ruptures occurring across different group relationship, that is, between members and leaders, members and members, and members and the group-as-a-whole. In a finding unique to group therapy, the authors reported that most of the ruptures in group occurred between members, and most of the repairs were initiated by the leader. Despite that, almost one third of repairs were initiated by another group member (not the therapist). The study demonstrates how complex the process of alliance rupture and repair is when one takes into account the multiple levels of interactions that occur in a group.

The sixth and final article is a Practice Review by Miles, Anders, Kivlighan, and Platt (2021) in which they discuss microaggressions in group therapy as instances of alliance ruptures. They review the research on how microaggressions impacts on clients’ mental health and the process and outcomes of psychotherapy. Miles and colleagues highlight how important it is to address microaggressions when they occur in group therapy, and they illustrate leader factors that influence repair processes, like multicultural competence, multicultural orientation, and comfort with difficult dialogues. What is particularly compelling about this article is the case example that illustrates instances of microaggression. The example shows how therapists can proactively prepare for microaggressions before they occur in a group and how to manage microaggressions when they occur in the here-and-now.

This special issue of Group Dynamics on therapeutic alliance rupture and repair in group therapy brings together world leaders on the topic as it relates to group therapy. These authors applied their research and knowledge to extend the concept of alliance rupture and repair to the complexities of group contexts. Some of these articles are the very first to research this important topic in group therapy. This special issue represents an important resource to researchers and clinicians that will inform clinical practice, group therapy theory, and group research.

References

Alldredge, C., Burlingame, G., Yang, C. & Rosendahl, J (2021). Alliance in group therapy: A meta-analysis. Group Dynamics.