Investigating how interpersonal defense theory can augment understanding of alliance ruptures and resolutions: A theory-building case study

Interpersonal defense theory is an interpersonal conceptualization of defense processes. It is especially helpful for addressing issues about the therapeutic relationship. This qualitative, theory-building case study investigated whether the theory offers a framework for augmenting our understanding of ruptureresolution phenomena. The case involved the successful treatment of a 28-year-old female patient with adjustment disorder. Alliance was assessed after each session. Two rupture-resolution sequences were identified and examined. Analyses, which were guided by a case formulation based on interpersonal defense theory, included a discourse-analytic method to identify coordination failures in the patient's behavior and turn-by-turn examination of therapist interventions. As predicted, coordination improved from rupture to resolution sessions. Also, examination of therapist interventions and the temporal patterning of patient and therapist behaviors suggested that, as hypothesized, certain kinds of interventions contributed to alliance ruptures, whereas others promoted resolutions. In particular, the analyses supported the prediction that therapist responses that realized the patient's central interpersonal wish in the therapy relationship contributed to resolutions. These results suggest a new approach to ruptures and their resolution that focuses on the interpersonal significance of therapist interventions. The study adds to the support for interpersonal defense theory provided by previous investigations because it suggests that we can extend the theory to a new set of phenomena (ruptures and resolutions).