Abstract
Patients with personality disorders present with difficulties in interpersonal functioning that can impact the development of the therapeutic alliance. By closely attending to the emergence of alliance ruptures, therapists can develop an alliance-focused process formulation that helps them to understand their patients' relational wishes and fears, and to identify ways in which the therapeutic relationship could provide a corrective experience for the patient. This chapter explores how the Rupture Resolution Rating System (3RS: Eubanks, Muran, & Safran, 2018b) can serve as a useful tool for identifying both patient and therapist contributions to rupture and resolution processes in the session. The alliance-focused formulation method is applied to a case example of a patient diagnosed with narcissistic personality disorder.