Rupture and Repair of the Therapeutic Alliance in CBT with Young People

  • Sonia Marquardt

Student thesis: PsychD


Psychotherapy research has indicated that the therapeutic alliance is one of the most important components of the therapeutic  relationship. Nearly half of young people terminate therapy prematurely without an agreement with their therapist (de Haan, Boon, de Jong, Hoeve, & Vermeiren, 2013). Given that a poor alliance was found to be a key predictor of terminating therapy prematurely (de Haan et al., 2013), a better understanding of ruptures could contribute to improving the alliance. To understand ruptures better, this study aims to explore the challenges that therapists face in addressing ruptures with young people using CBT (Cognitive Behavioural Therapy), and to understand what kind of ruptures occur with young people and how, and to what extent, they are repaired. Semi-structured interviews were conducted in person and by telephone, and thematic analysis was used to analyse the data. Participants (N=11) included counselling psychologists, clinical psychologists and CBT therapists, in the NHS (National Health Service) and private practice. Five themes were found: cause of rupture, the system contributing to the rupture, therapist’s interpersonal actions in response to ruptures, positive alliance factors that underpin rupture resolution, and outcome of the rupture. Ruptures occurred mostly with young people with the following presentations: OCD (Obsessive Compulsive Disorder) , ASD (Autism Spectrum Disorder), trauma and BPD (Borderline Personality Disorder). Causes of rupture included the young person not wanting to attend therapy, not completing homework or in-between session tasks, the therapist disclosing an issue about risk, and the parents and young person having different goals/agendas. Rupture resolution involved therapists taking responsibility for the rupture and using empathy, validation, negotiation, among others, and giving the young person control. Recommendations for the application of clinical practice are made, and suggestions for repairing ruptures is given. Given that ruptures were common with young people who presented with OCD, ASD, trauma and BPD, future research could focus on these areas.
Date of Award19 Oct 2021
Original languageEnglish
Awarding Institution
  • University of Roehampton
SupervisorJohn Rae (Director of Studies) & George Georgiou (Co-Supervisor)


  • CBT
  • young people
  • Rupture
  • therapeutic alliance
  • repair

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