| The therapeutic alliance is a key predictor of psychotherapy outcomes, yet traditional
session-level assessment methods often fail to fully capture its dynamic nature. This study
employed a microprocess methodology to investigate within-session fluctuations in the
therapeutic alliance from both client and therapist perspectives. Using a second-by-second rating
system while viewing recorded sessions, five client-therapist dyads provided continuous alliance
ratings. The study had three primary aims: (1) to examine within-session variability in alliance
ratings, (2) to assess the congruence between client- and therapist-rated alliance within session,
and (3) to explore qualitative accounts of alliance ruptures and repairs. Results indicated
meaningful within-session variability in alliance ratings for both clients and therapists,
supporting conceptualizations of the alliance as a dynamic, evolving construct. Client and
therapist ratings demonstrated low temporal congruence, suggesting therapists may often be
unattuned to clients’ experiences of the alliance within session. Moreover, congruence was found
to be moderated by the number of sessions completed together, with higher congruence seen in
dyads that spent more session together. Qualitative analysis revealed common rupture themes,
including confusion and misalignment on tasks and goals, as well as repair themes such as
therapist compassion, client insight, and mutual collaboration. These findings contribute to a
growing body of microprocess research and underscore the importance of real-time alliance
monitoring. Implications for research and clinical practice include the need for increased
therapist attunement, ongoing alliance assessment, and the integration of client feedback
mechanisms.
Keywords: therapeutic alliance, psychotherapy process, microprocess research, alliance ruptures,
alliance repairs |