Understanding Alliance Discrepancies in Youth Therapy: A Case Study of Rupture and Repair in CBT.
Zhongze Ren, Tanya Lecchi, Antonella Cirasola
✦ AI-curated · Sources linked
Case in brief
A case study examined cognitive behavioral therapy for an adolescent with depression, using session recordings, alliance ratings, and post-therapy interviews with the adolescent and therapist. The adolescent consistently rated the therapeutic alliance more strongly than the therapist did. Review of sessions and interviews suggested that the adolescent’s high ratings reflected excessive compliance that obscured subtle withdrawal ruptures. The therapist recognized this dynamic and worked to address the ruptures; most were repaired. At the end of therapy, both described the relationship positively.
What made this case unusual
The adolescent’s consistently high alliance ratings masked a compliance-driven pseudo-alliance, while the therapist’s lower ratings reflected awareness of subtle withdrawal ruptures.
Diagnostic / clinical pearl
High alliance ratings from a young client do not necessarily rule out rupture: excessive compliance may conceal withdrawal, so ratings should be considered alongside observed interactions and the client’s account.