The therapeutic relationship: alliance, ruptures and repair

1On the exam (CRPO's words)

• CRPO's blueprint: the therapeutic relationship is at least 25 to 30% of the assessment, the largest domain (Resource Manual, Test Blueprint Specifications).
• CRPO's tip 4: when a question names a purpose, for example rebuilding alliance, select only the responses relevant to that purpose.
• CRPO does not publish how many points any one competency carries within the domain.

2What CRPO asks (4.2, 4.3)

• 4.2 Core conditions: empathy, respect and authenticity; rapport; a non-judgmental stance; theory in words the client understands; client autonomy; appropriate boundaries; physical and emotional safety; dependability.
• 4.3 Safe and effective use of self: awareness of your own subjective context and of power dynamics; keep your personal issues off the client; congruent communication; appropriate self-disclosure.

3The alliance

• Agreement on goals, collaboration on tasks, and the emotional bond: a rupture is a strain in any of the three (Eubanks et al., 2018, Psychotherapy 55(4):508-519).
• Across 295 studies and more than 30,000 patients, the alliance was linked to outcome (r = .278), whatever the approach (Flückiger et al., 2018, Psychotherapy 55(4):316-340).

4Notice a rupture

• Quieter: short answers, agreeing too fast, changing the subject, late or missed sessions.
• Pushing back: criticism of you or the work, doubt that therapy helps.
• Ask about the relationship itself, gently, rather than waiting for it to pass.

5Repair

1. Name it without defensiveness: what you noticed in the session.
2. Invite the client's view, and listen for what did not fit.
3. Own your part, plainly, without making the client look after you.
4. Adjust together: the goal, the task, the pace or the way you work.
5. Check back later that the change is helping.

6Why repair, and self-disclosure

• Resolving ruptures went with better outcomes (r = .29, 11 studies); training in rupture resolution did not show a significant effect (Eubanks et al., 2018).
• Self-disclosure and immediacy were most often followed by a stronger relationship and other gains (Hill et al., 2018, Psychotherapy 55(4):445-460).
• Disclose only for the client's benefit, briefly, and return the focus to them (4.3e).