Abstract
Given the predictive validity of the therapeutic alliance for psychotherapy outcome, there has been a significant increase in empirical attention toward alliance ruptures and their implications for psychotherapy process, outcomes, and premature or unilateral termination. Although alliance ruptures have been well-established as phenomena that merit further empirical investigation, conceptual, and methodological challenges remain. The present review provides a primer of methodologies used to identify alliance ruptures in the literature. Included in this review are studies that illustrate the implementation of various methods of alliance rupture identification using both qualitative and quantitative criteria. A search of Google Scholar and American Psychological Association PsycInfo for articles that identified ruptures in adult, in-person, individual psychotherapy yielded the following four categories of rupture identification methods were identified across the literature: direct report measures, patient–therapist congruence, criterion-based and idiographic formulae applied to self-report measures, and observer-based measures. The strengths and weaknesses of each method are discussed, and guidelines for method selection of rupture identification are provided. No singular rupture identification algorithm has been shown to capture rupture events from all perspectives (e.g., therapist, patient, observer), indicating the need for multiple approaches to capture the complexity of this dyadic phenomenon. (PsycInfo Database Record (c) 2026 APA, all rights reserved) (Source: journal abstract)