American Academy of Clinical Psychology

Cheri Marmarosh sheds light on a topic that is often overlooked.

By Cheri L. Marmarosh

I will never forget the words of wisdom Jack Corazzini passed onto me: “It is not what you do; it is what you do about what you do.” In other words, no matter what you say or what happens in the group, it is more important to address the impact of what follows after. You may think your intervention is on point, but you fail to realize it offends a group member. You may think that you are being empathic when you make a group-as-a-whole intervention, only to find out you disappointed someone who felt differently in the group. You may think you are reaching out to connect to someone in the group, but your words convey a microaggression. The truth is, we never know how our interventions in group will land. We hope for the best when we take risks and inevitably, we find ourselves tangled in ruptures.

The individual psychotherapy literature has emphasized the importance of these ruptures in the alliance and their repair (Safran & Muran, 2000), and meta-analyses have revealed that repairing ruptures relates to positive outcomes in individual psychotherapy (Eubanks, Muran, & Safran, 2018). There are models addressing alliance ruptures, and clinical researchers have developed measures to assess ruptures and repairs through self-report and observer coding (Eubanks, Muran, & Safran, 2015).

Interestingly, the importance of rupture and repair has not received as much attention in group work, although I imagine the number of ruptures and the importance of their repairs are significant in group therapy. Lo Coco and colleagues (2019) reviewed the literature and found only one study that examined patterns of alliance ruptures in group treatment (Watson, Thomas & Daffern, 2017) and no study that examined the repaired-rupture event as a predictor of treatment outcome in group therapies. Watson et al. (2017) explored the ruptures in the alliance in group therapy for sexual offenders in a structured group treatment program. Thirty group members (55.6 percent) reported a rupture in the alliance, and half of them reported that the ruptures were repaired. Interestingly, group members who perceived a non-repaired rupture reported less working alliance. This is an important study that links ruptures in group therapy to other curative factors in group treatment and encourages us to continue to explore ruptures in group therapy.

Lo Coco et al. (2019) did a wonderful job reviewing the literature and giving examples of different types of ruptures in group therapy based on the work of Safran and Muran (2000). They describe two different types of ruptures: withdrawal ruptures, where members pull back and disengage after experiencing a rupture, and confrontation ruptures, where members directly express their anger or disappointment after experiencing a rupture. In addition to providing clinical vignettes of these ruptures, they describe what it looks like when the rupture is not resolved and when it is resolved. Reading the case examples is helpful, and it illuminates how critical it is for us to pay more attention to withdrawal ruptures that can be more subtle, especially in a group where there are many people interacting.

When it comes to research, the authors suggest that research on alliance rupture-repair in group treatment is important and the area is wide open. We need studies to validate self-report and observer ratings of ruptures in group therapy. We also need studies that link ruptures and repairs to group process and outcome. Understanding individual differences regarding the types of ruptures and openness to repair is important as is researchers that examine leader effects. In addition, the authors suggest that we should address the complexity of group therapy, and we should rely on sophisticated statistical analyses in order to tease apart individual and group variability in alliance and outcome.

Because ruptures and repairs are so important in group therapy, I am editing special editions devoted to this topic to further research and theory to help guide us. Thus, there has been calls for papers in The International Journal of Group Psychotherapy, the journal for the American Group Psychotherapy Association (AGPA) and Group Dynamics, the journal for Div, 49, for this special edition, and the deadline for submissions is Nov. 26, 2019, for both journals.

For Group Dynamics, the special issue is for empirical studies (PDF, 83.6KB), papers that describe statistical methods specific to group research, manuscripts that illustrate psychometric assessment particular to group contexts and evidence-based case studies that meet the journal’s guidelines. Authors are encouraged to contact myself, Cheri Marmarosh, or the journal editor, Giorgio A. Tasca, to discuss the suitability of a potential topic for submission.

For the International Journal of Group Psychotherapy, we are interested in theoretical and clinical papers that explore how ruptures and repairs in group therapy relate to trauma work, macroaggressions, reflective functioning, subgroups, leadership, attachments, and group process and outcome. Authors are encouraged to contact myself, Cheri Marmarosh, or the journal editor, Jill Paquin, to discuss suitability of a potential topic for submission. We hope you will consider submitting your work.

References

Eubanks, C. F., Muran, J. C., & Safran, J. D. (2015). Rupture Resolution Rating System (3RS): Manual. Unpublished manuscript, Mount Sinai- Beth Israel Medical Center, New York.

Eubanks, C. F., Muran, J. C., & Safran, J. D. (2018). Alliance Rupture Repair: A Meta-Analysis. Psychotherapy, 55, 508519. doi: 10.1037/pst000018

Lo Coco, G., Tasca, G. A., Hewitt, P. L., Mikail, S.F., & Kivlighan, D . M. (2019). Ruptures and repairs in group therapy alliance: An untold story in psychotherapy research. Research in Psychotherapy: Psychopathology, Process, and Outcome, 22, 58-70.

Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic alliance: A relational treatment guide. New York, NY: Guilford Press.

https://www.apadivisions.org/division-49/publications/newsletter/group-psychologist/2019/07/ruptures?_ga=2.240650251.900611814.1569254001-424535628.1569254001