{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T17:15:01Z","timestamp":1788542101119,"version":"build-2803163510"},"reference-count":25,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Clin Psychol"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Although two meta\u2010analyses have examined the relationship between rupture repair and treatment outcome, no meta\u2010analysis to date has investigated the association between alliance ruptures and treatment outcome. Numerous primary studies have explored this relationship; however, the methods used to assess ruptures vary considerably. These include direct measures, such as ratings of the occurrence, frequency, or intensity of ruptures by observers, patients, or therapists, and indirect measures, such as fluctuations in alliance ratings. This methodological heterogeneity may contribute to inconsistent findings across studies. The present meta\u2010analysis sought to clarify the association between alliance ruptures and treatment outcomes by including only studies that assessed ruptures using direct measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      After applying inclusion and exclusion criteria, four publications remained reporting 18 effect sizes of the associations between ruptures and outcomes. Those provided data from\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009301 clients undergoing psychotherapy. Multilevel models with a three\u2010level structure with restricted maximum likelihood to estimate the aggregated effect size of ruptures on outcome were conducted.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The results showed a significant aggregated effect size of\n                      <jats:italic>z<\/jats:italic>\n                      \u2009=\u2009\u22120.22,\n                      <jats:italic>SE<\/jats:italic>\n                      \u2009=\u20090.04, 95 CI [\u22120.303, \u22120.133];\n                      <jats:italic>t<\/jats:italic>\n                      (17)\u2009=\u2009\u22125.40,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001,\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.21, indicating that alliance ruptures were associated with poorer therapy outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A small but consistent negative association between alliance ruptures and treatment outcomes was found. An individual patient data meta\u2010analysis would be an important future endeavor in the field of alliance ruptures, by including more studies and a homogenous analytic approach to estimate rupture\u2013outcome associations and including rupture\u2013repair as a moderator.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jclp.70192","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T10:52:13Z","timestamp":1784285533000},"page":"1683-1691","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Alliance Ruptures and Psychotherapy Outcomes: A Multilevel Meta\u2010Analysis of Their Association"],"prefix":"10.1002","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9187-1025","authenticated-orcid":false,"given":"A.","family":"Babl","sequence":"first","affiliation":[{"name":"Leiden University Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7304-407X","authenticated-orcid":false,"given":"J. M.","family":"G\u00f3mez Penedo","sequence":"additional","affiliation":[{"name":"Free University of Brussels Ixelles Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Nimphy","sequence":"additional","affiliation":[{"name":"Leiden University Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Ke\u00dfel","sequence":"additional","affiliation":[{"name":"Leiden University Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Crainic","sequence":"additional","affiliation":[{"name":"Leiden University Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Boendermaker","sequence":"additional","affiliation":[{"name":"Leiden University Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0561-1607","authenticated-orcid":false,"given":"C. F.","family":"Eubanks","sequence":"additional","affiliation":[{"name":"Gordon F. Derner School of Psychology Adelphi University Garden City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1037\/pst0000362"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1037\/pst0000457"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1037\/ccp0000861"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1037\/h0085885"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.12"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.112.1.155"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0032171"},{"key":"e_1_2_7_9_1","unstructured":"Eubanks C. F. andJ. C.Muran.2022. \u201cRupture Resolution Rating System (3RS): Manual Version 2022\u201d.https:\/\/doi.org\/10.13140\/RG.2.2.29780.17282."},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1037\/pst0000185"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/10503307.2012.693772"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.3758\/s13428-020-01373-9"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1037\/pst0000172"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/papt.12097"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1186"},{"key":"e_1_2_7_16_1","unstructured":"Lin H. n.d. \u201cEffect Size Converter.\u201d Accessed July 13 2026.https:\/\/www.escal.site\/."},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0016085"},{"key":"e_1_2_7_18_1","volume-title":"Patient and Therapist Postsession Questionnaires\u201d, Version 1992","author":"Muran J. 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