Therapeutic Alliance Tensions and Repair in Psychotherapy Practices

Therapeutic Alliance Tensions and Repair in Psychotherapy Practices: A Psychotherapy Practice Research Network (PPRNet) Study

This study evaluates a professional development program intended to improve the relationship or alliance between therapists and patients/clients who are receiving psychotherapy in the community. Half of the participating therapists will receive training to detect and improve alliance with new patients while half will not. The professional development training is expected to improve therapists effectiveness in identifying and correcting alliance tensions which will, in turn, improve therapeutic outcomes for patients/clients.

Study Overview

• Status: Completed
• Conditions: Psychotherapy; Therapeutic Alliance
• Intervention / Treatment: Other: Professional development program

Detailed Description

Psychotherapy is the treatment of choice for many mental disorders, yet there is a gap between research and practice. Research indicates that: the therapist-patient alliance is important to reduce patient symptoms, alliance tensions are detrimental to patients, and those therapists who identify and repair alliance tensions can improve patient outcomes. In this study we will use state of the art research to train community-based therapists in evidence-based interventions to identify and repair alliance tensions. Trained therapists and their patients will be compared to therapists who provide usual care to their patients. Improvement in therapists' skills in identifying and repairing alliance tensions and how this is associated with better patient mental health outcomes will be measured. Trained therapists will be interviewed to identify the best ways of improving the training and disseminating the findings to psychotherapists across Canada. Research to improve practicing therapists' ability to identify and repair therapeutic alliance tensions will result in better mental health outcomes for patients.

• Study Type: Interventional
• Enrollment (Actual): 84
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Ottawa, Ontario, Canada, K1N 6N5
      • University of Ottawa
    • Toronto, Ontario, Canada, M5G 1X5
      • Mt. Sinai Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Therapist

Inclusion Criteria:

• regulated health professional
• in good standing with a Canadian provincial regulatory college
• scope of practice includes psychotherapy
• ability to add 3 or more new, English speaking clients to caseload over 6 to 9 months
• ability to obtain timely permission to conduct research from therapist's employing institution or health group when applicable

Exclusion Criteria:

• none

Patient/Client

Inclusion Criteria:

• 18 years of age or older
• will participate in psychotherapy sessions in English
• will see the study-affiliated therapist for a minimum of 6 sessions in the next 6 months

Exclusion Criteria:

• already seeing another therapist
• diagnosed with a neurocognitive disorder
• diagnosed with a psychotic disorder
• expressed suicidal behaviour in the past six months as assessed by their participating therapist

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Professional Development Program; Therapists who participate in workshops and consultation sessions with study trainers during study-related therapy sessions and their participating patients/clients.	Other: Professional development program; Professional development program consists of training including workshops and consultation sessions to enhance therapists ability to detect and repair alliance ruptures in active community based psychotherapy.
No Intervention: Control; Therapists who did not participate in workshops and consultations sessions while engaging in study-related therapy sessions and their participating patients/clients.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean tension resolution rating scale	The Rupture Resolution Rating System (3RS) is an observer-based measure to identify alliance tensions and resolution processes. Independent blind reliable trained judges will rate video recordings of 6 psychotherapy session recorded with participating clients. A mean tension score will be assigned per client which will be the average of the 6 session scores. score ranges from 1 (withdrawal/confrontation rupture(s) did not occur; not significant for the alliance) to 5 (withdrawal/confrontation rupture(s) occurred; significant for the alliance).	6 therapy sessions over 6 weeks up to 6 months depending on the frequency of therapy

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Generalized Anxiety Disorder 7-item scale (GAD-7) change from baseline	Self-report measurement of severity of anxiety using the GAD-7 scale. A change in anxiety scores will be assess following 6 therapy session with data collected before therapy(baseline) and again after all 6 sessions of therapy have been completed. Scores range from 0 (low anxiety) to 27 (high anxiety) with scores over 10 being of clinical significance.	baseline and end of 6 therapy sessions, 6 weeks to 6 months depending on the frequency of therapy
Patient Health Questionnaire 9-item scale (PHQ-9) change from baseline	Self-report measurement of depression symptoms using the PHQ-9 scale. A change in depression symptom scores will be assess following 6 therapy session with data collected before therapy and again after all 6 sessions of therapy have been completed. Scores range from 0 (low) to 27 (high) with scores over 10 being of clinical significance.	baseline and end of 6 therapy sessions, 6 weeks to 6 months depending on the frequency of therapy

Collaborators and Investigators

• Sponsor: University of Ottawa
• Collaborators: Canadian Institutes of Health Research (CIHR)
• Investigators: Principal Investigator: Giorgio Tasca, Ph.D., University of Ottawa

Publications and helpful links

Helpful Links

• PPRNet website including study-related information and publications

Study record dates

Study Major Dates

• Study Start (Actual): February 1, 2018
• Primary Completion (Actual): May 14, 2021
• Study Completion (Actual): August 14, 2021

Study Registration Dates

• First Submitted: February 16, 2018
• First Submitted That Met QC Criteria: February 26, 2018
• First Posted (Actual): March 5, 2018

Study Record Updates

• Last Update Posted (Actual): May 1, 2026
• Last Update Submitted That Met QC Criteria: April 27, 2026
• Last Verified: June 1, 2022

More Information

Terms related to this study

• Keywords: Practice based research
• Other Study ID Numbers: 363733

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No