Reactivity and stability in facial expressions as an indicator of therapeutic alliance strength.

Aspects of our emotional state are constantly being broadcast via our facial expressions. Psychotherapeutic theories highlight the importance of emotional dynamics between patients and therapists for an effective therapeutic relationship. Two emotional dynamics suggested by the literature are emotional reactivity (i.

"Picking up the pieces": Patients' retrospective reflections of rupture resolution episodes during treatment.

Although theorists and researchers have stressed the importance of rupture resolution episodes for successful treatment process and outcome, little is known about patients' retrospective reflections about rupture resolution. The overarching goal of the present study was to use a mixed-method approach to examine patients' retrospective reflections on the frequency, types, and consequences of rupture resolution episodes and the association between rupture resolution episodes and patients' attachment orientation and treatment outcome. Thirty-eight patients diagnosed with major depressive disorder (MDD) were interviewed, on average three years after termination, about their experiences of ruptures in short-term dynamic psychotherapy.

Is alliance therapeutic in itself? It depends.

The alliance has been a leading player in the long-running debate on whether therapeutic change is driven by factors common across distinct treatments or by treatment-specific factors. The present study disentangled between-patients differences in alliance strength from within-patient changes to investigate whether two treatments with identical goals but based on different roles of alliance differ in the within-patient effect of alliance on outcome. Both treatments are aimed at improving the patients' interpersonal abilities, but in the supportive treatment (ST) the alliance is the main specific factor, whereas in the supportive-expressive treatment (SET) it is conceptualized as a common factor.

A randomized controlled trial for identifying the most suitable treatment for depression based on patients' attachment orientation.

Objective: Many active treatments exist for major depressive disorder (MDD), but little is known about their differential effects for various subpopulations of patients to guide precision medicine. This is the first randomized controlled trial (RCT) designed to identify differential treatment effects based on patients' attachment orientations. We tested an a priori preregistered hypothesis of the potential moderating effect of patients' attachment orientation on the outcome of supportive therapy (ST) versus supportive-expressive therapy (SET).

Achieving successful resolution of alliance ruptures: for whom and when?

Contemporary theories and the empirical literature stress the importance of successful resolution of alliance ruptures for the process and outcome of treatment. Yet, little empirical work has examined what leads to successful resolutions. The aim of the present study was to examine which patients are more likely to achieve successful resolutions of ruptures and under which circumstances.

"We can work it out": Working through termination ruptures.

Supportive-expressive (SE) psychodynamic treatment is based on the identification of and working through the patient's signature core conflictual relationship theme. According to the SE framework, when termination is anticipated, separation conflict arises, and the actualization of the patient's interpersonal wish in the relationship with the therapist is no longer possible. The disactualization of the patient's wish in the relationship with the therapist may cause patients to regress to their maladaptive prototype responses (Nof, Leibovich, & Zilcha-Mano, 2017), which may manifest as a rupture in the therapeutic alliance.