Physiological Regulation Processes Differentiate the Experience of Ruptures Between Patient and Therapist

Amit Tchizick, Johann Roland Kleinbub, Shahar Bittan, Tal Bitton, Sigal Zilcha-Mano

Research output: Contribution to journalArticlepeer-review

Abstract

The empirical and clinical literature emphasizes the importance of alliance ruptures, signaling therapeutic processes occurring within and between the partners of the therapeutic dyad. However, knowledge about the underlying regulatory processes that occur amid ruptures is scarce. Identifying the underlying physiological markers may shed light on these regulatory processes. The overarching goal of the present study was to explore physiological markers of withdrawal and confrontation ruptures, within the patient and the therapist. Given the little known on the subject, we used a single-case design (94 episodic segments) to explore biologically based regulatory processes in the face of a rupture, contrasting confrontation ruptures versus withdrawal ruptures versus control episodes (emotional and neutral episodes). Findings showed that the patient and the therapist had contrasting physiological responses to the ruptures, depending on the type. During withdrawal ruptures, the patient exhibited high regulation, while the therapist did not show a clear physiological reaction. During confrontation ruptures, the patient exhibited low regulation, while the therapist exhibited high regulation. The different physiological regulation processes at times of ruptures suggest that, in withdrawal, the patient relied on intrapersonal regulation, contrasting with the interpersonal regulation observed in confrontation ruptures. Findings remained robust after controlling for speech turns and 10,000 Monte Carlo permutations to assess chance-level results. These findings provide initial evidence for the link between arousal and behavior in ruptures, offering valuable psychoeducational material for therapists to improve their handling of these challenging moments.

Original languageEnglish
Pages (from-to)292-303
Number of pages12
JournalPsychotherapy
Volume61
Issue number4
Early online date24 Oct 2024
StatePublished - Dec 2024

Bibliographical note

Publisher Copyright:
© 2024 American Psychological Association

Keywords

  • alliance ruptures
  • arousal
  • heart rate variability
  • regulation process
  • therapeutic alliance

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

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