| This study examinedalliance rupture eventfrequency, how ruptures werelinked to next-session psychotherapy outcomes, and potential moderators of that link.Archival data from 12,711outpatient counseling clients were used.Using control chart methods, ruptures occurred for 29% of clients and in 9% of sessions.Experiencing more ruptures overall (i.e., between-client effects) was linked with worse outcomes,but experiencing an individual rupture event (i.e., within-client effects) was linked with better outcomes. After accounting for rupture resolution, clients with moreunresolved rupturesand fewer resolved ruptures overallreported worse outcomes. The within-client effects of unresolved and resolved ruptures were not linked with outcomes. Therapist experience, pre-treatment interpersonal functioning, sessions completed, and the alliance moderated the rupture-outcome link; number of presenting problems did not.Findings highlight the importance of examining the session-by-session rupture-outcome link, disaggregating the between-and within-client effectsof ruptures, accounting for rupture resolution, and examining moderators. Keywords: therapeutic alliance,ruptures, psychotherapy outcomes, control charts |