Abstract
Objective: Although researchers have explored therapeutic alliance ruptures in individual therapy, little is known about how these processes unfold in group therapy. The goal of this study was to examine associations between alliance ruptures at multiple group interpersonal levels and outcomes. We hypothesized that alliance ruptures that occurred member-to-therapist (M–T), member-to-member, and member-to-group would be associated with poorer interpersonal distress outcomes posttreatment. We also conducted exploratory analyses to assess the relationship between change in alliance ruptures across group therapy and outcomes and whether rupture repairs moderated this relationship. Method: The study included 62 video-recorded therapy sessions from 21 groups. Raters coded alliance ruptures using the Group Rupture Resolution Rating System (Baldwin et al., 2025), an observation-based measure of ruptures and repairs in group therapy. To assess the study’s hypotheses, we ran multivariate hierarchical linear models. Results: Higher M–T ruptures in early treatment were significantly associated with worse-than-expected interpersonal distress, partially supporting the hypothesis. Therapist-to-member repairs did not significantly moderate this relationship. Member-to-group ruptures demonstrated a moderate but nonsignificant association with outcomes. Higher M–T ruptures late in treatment were significantly associated with better-than-expected outcomes. In exploratory analyses, decreases in M–T ruptures and member-to-group ruptures across stages of group therapy were associated with worse-than-expected outcomes. Conclusion: M–T ruptures early in group therapy may interfere with developing cohesion and set patients on a trajectory for poorer treatment outcomes. Therapist-to-member repairs did not reduce the negative impact of early M–T ruptures in these groups. (PsycInfo Database Record (c) 2026 APA, all rights reserved) (Source: journal abstract)