Applying The Rupture Resolution Rating System (3rs) To Group Therapy: An Evidence-Based Case Study

Objective: Despite the known association between therapeutic alliance ruptures and outcomes in individual therapy, there is almost no research on the topic in group therapy. Group therapy is inherently more complex such that interactions occur at multiple relational levels, including member-to-member, member-to-therapist, and member-to-group. Ruptures may occur at any of these levels, and therapists or group members may initiate repair strategies. We used an evidence-based case study to evaluate the utility and feasibility of using the Rupture Resolution Rating System (3RS) in group therapy. Method: Participants were 8 members with perfectionism and 2 therapists in a middle session of group therapy. We coded ruptures and repairs with the 3RS, the relational level of the group's interactions, and the actor and target of rupture or repair behaviors. Perfectionism outcomes were assessed pre- and posttreatment. Results: Members' perfectionism showed clinically meaningful improvement. The group therapy session had both withdrawal and confrontation ruptures at each relational level of the group, with half of all ruptures occurring between members. Therapists initiated most of the repair strategies, but members initiated about one third of repairs. Conclusions: The 3RS may be useful to code ruptures and repairs in a group therapy context. Modifications were necessary so that the relational level of group interactions and the target of the behavior (member, therapist, group) were concurrently coded. This concurrent coding strategy makes use of the richness of 3RS coding, accounts for the complexity of group therapy interactions, and may be useful to inform clinical practice and research.