Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland.
Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.
Curr Psychiatry Rep. 2020 Dec 11;23(1):1. doi: 10.1007/s11920-020-01212-w.
This review provides an overview of the state of research on alliance ruptures and resolutions in the treatment of personality disorders (PDs). We discuss frequently used instruments to measure alliance ruptures and resolutions. We discuss the effectiveness of rupture resolution processes and highlight possible avenues for research to explore. Innovative assessments with the potential to reveal the link of ruptures and resolutions and mechanisms of psychotherapeutic change are discussed.
The assessment of alliance rupture and resolutions is heterogeneous. Instruments vary largely with respect to a direct or indirect assessment, the time resolution of assessment (integral therapy, phase, session, event), session sampling strategy and perspectives (patient, therapist, observer). The heterogeneity in the instruments and study designs impedes comparability and interpretation of the findings. Results support the hypothesis that ruptures are more frequent in PD. Results also point towards beneficial effects of rupture resolution patterns, early alliance quality, and resolution complexity. Few studies control findings for pretreatment factors. Evidence points to the direction that rupture resolution processes can be considered a general principle of change in the treatment of PD. The concept of alliance ruptures and resolutions provides a useful tool for the management of the therapeutic alliance and its moments of deteriorations throughout the treatment course. Dimensional pretreatment personality functioning is considered a key variable in future studies to highlight what works for whom.
目的综述：本文综述了人格障碍（PD）治疗中联盟破裂和修复的研究现状。我们讨论了常用于测量联盟破裂和修复的工具，讨论了破裂修复过程的有效性，并强调了探索可能的研究途径。本文还探讨了具有揭示破裂和修复联系以及心理治疗变化机制潜力的创新评估方法。
最新发现：对联盟破裂和修复的评估方法具有异质性。这些工具在直接或间接评估、评估的时间分辨率（整体治疗、阶段、疗程、事件）、疗程抽样策略和观点（患者、治疗师、观察者）等方面存在较大差异。工具和研究设计的异质性妨碍了研究结果的可比性和解释。研究结果支持这样一种假设，即破裂在 PD 中更为常见。研究结果还表明，破裂修复模式、早期联盟质量和修复复杂性具有有益影响。少数研究对治疗前因素的结果进行了控制。有证据表明，破裂修复过程可以被视为 PD 治疗中改变的一般原则。联盟破裂和修复的概念为治疗过程中治疗联盟及其恶化时刻的管理提供了有用的工具。在未来的研究中，维度预处理人格功能被认为是一个关键变量，以突出对谁有效。
