Collaborative working models of alliance rupture repair: A theory-building case study.

Objective: Although rupture repair is a core process in psychotherapy, its mechanisms remain insufficiently understood. In this theory-building case study, we used an explanatory sequential mixed-method design to examine dyadic processes underlying successful versus unsuccessful withdrawal rupture repair. Method: We observer-rated rupture and repair across N = 81 video-recorded sessions of a successful psychodynamic psychotherapy. We applied Exponentially Weighted Moving Average control charting to identify two treatment phases with above-average success in rupture repair, and one phase with below-average repair. Sessions from these phases were analyzed using grounded theory coding informed by sensitizing concepts derived from a clinical discussion group. Results: The analysis yielded the core category of a collaborative working model of rupture repair. During the high-repair phases, therapist and patient tacitly established a shared interactional framework and a case-specific way of intuitively negotiating emotional intensity through multiple parameters. In the lower-repair phase, this collaborative working model could no longer be applied effectively, coinciding with changes in the treatment context that altered the transference-countertransference dynamics. Conclusion: The findings suggest that developing and sustaining a collaborative working model of rupture repair may be crucial for navigating impasses and highlight the importance of understanding the alliance as an emergent, dyadic process.