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The therapeutic alliance, based on mutually shared assumptions, goals, and trust, constitutes a keystone of successful treatment in all psychotherapeutic modalities. During the course of psychotherapy, this alliance can be ruptured by misunderstandings, distorted perceptions in transference or countertransference reactions, and other missteps. Investigators examined ruptures and repaired ruptures of therapeutic alliance in relation to outcomes during a 10-week, prolonged-exposure therapy study involving 116 patients with chronic post-traumatic stress disorder (PTSD), who were recruited through clinical referral and community advertising (mean age, 37; 76% women; 66% white).
The study excluded patients with psychosis, current substance abuse,…