Rupture Patterns and Outcomes: The Moderating Role of Interpersonal Functioning

This study examined whether clients with more impaired interpersonal functioning benefit more from alliance rupture–repairs. Accordingly, we investigated if a client's level of interpersonal functioning moderates the relationship between alliance rupture patterns and psychotherapy outcomes. Data from 514 adults in outpatient psychotherapy were analysed. Treatments were classified into three rupture patterns: no rupture (57.8%), unrepaired rupture (32.8%) or repaired rupture (9.3%). Multilevel modelling examined the interaction between rupture patterns and interpersonal functioning in predicting the rate of symptom change. A significant interaction between the repaired rupture pattern and interpersonal functioning was found. Clients with more impaired interpersonal functioning showed steeper symptom improvement following repaired ruptures compared with clients with better interpersonal functioning. This effect persisted only in longer treatments (more than seven sessions). Clients with significant interpersonal difficulties benefit more from rupture–repair processes. Results contribute a step towards personalized treatment and validate the notion that different patterns of alliance development may benefit different clients.