Larrea Eguiguren, Maria Soledad; (2022) Exploring ruptures in the therapeutic alliance in Short-Term Psychoanalytic Psychotherapy with adolescents with depression. Doctoral thesis (D.Psych), UCL (University College London).

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Abstract

This thesis explores therapeutic alliance ruptures in treatments with depressed adolescents. The first part is a literature review aiming to conceptualize the therapeutic alliance, looking for its history and how it has been researched with adolescents. Findings showed that despite the rich literature on the therapeutic alliance with adults, there is lack of research on this topic with adolescents, as well as lack of consensus on the concept, measures and methods to research the topic with adolescents. This subject needs to be further studied and requires a greater understanding, considering the difficulties in engaging adolescents in therapy. The second part is an exploratory mixed-methods two-case study aiming to explore and understand the emergence of alliance ruptures in two Short-Term Psychoanalytic Psychotherapy treatments for adolescents with depression. Data for the study was drawn from the IMPACT trial (Goodyer et al., 2016) and the IMPACT-ME study (Midgley et al., 2014). The emergence of ruptures was analysed from three perspectives: observers´, patients´ and therapists´. 22 audio-recorded sessions were coded using the Rupture and Resolution Rating System (Eubanks, Muran, & Safran, 2015) to identify and define rupture patterns through treatment phases. Additionally, two after-therapy interviews for each patient and one for each therapist were thematically analysed to deepen the understanding of the emergence of ruptures. Findings showed that there were ruptures in all coded sessions; withdrawal ruptures were more frequent and had a greater impact on the alliance, and the amount of ruptures changed through treatment phases. Patients found difficult the beginning and ending of therapy, as silences and transference interpretations, which might increase the amount of ruptures. Both therapists recognised patient´s ambivalent feelings regarding therapy and considered important to work on the therapeutic relationship. The third part reflects on the researcher´s ambivalent feelings towards the research process and the helpful and enriching aspects of this work.

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