Persons with dependent personality disorder (DPD) have difficulties describing their inner world, and in realizing their negative ideas about the self, such as being weak, unworthy or powerless are just ideas. As a consequence, they tend to over-rely on others and may lose control over their emotions. Treating these persons can gain benefits from including body-focused techniques as they can promote a) awareness of internal states, b) better emotion regulation, c) the capacity to consider their negative ideas about themselves as not necessarily true, and d) gain power of and agency. We will describe the therapist used body-focused techniques in the context of Metacognitive Interpersonal Therapy when treating Lia, a 40-year-old woman suffering from DPD who also suffered from generalized anxiety disorder and had difficulties in making autonomous choices. She had a romantic relationship with a man she described as distant and judgmental so she felt lonely and not entitled to express her discomfort or capable to break up. The therapist used body-focused techniques, together with behavioural exposure, mindfulness and guided imagery, to let Lia be more aware of her thoughts and feelings, and then to regulate affects and realize she had previously capacities. At therapy termination anxiety diminished and she could break up with the partner and start a new one where she felt free to express herself. We suggest how bodily-focused techniques can be used to enhance therapy effectiveness in DPD.

Experiential techniques can be used to address maladaptive interpersonal patterns in patients with personality disorders (PDs) as long as they are delivered minding about the therapeutic relationship. We present the case study of Laura, a 38-year-old woman presenting with covert narcissism, generalized anxiety disorder, depression, and complicated grief treated with metacognitive interpersonal therapy. Laura initially refused to engage in any experiential work out of fear of being judged and abandoned by her therapist. To navigate this therapeutic obstacle, the therapist focused on exploring and eventually repairing early alliance ruptures. Thereafter, Laura engaged in experiential work, which helped her address her narcissistic interpersonal patterns. After 2 years, Laura\'s symptoms and narcissistic problematic behaviors decreased. This case study can help us understand how experiential techniques can be successfully used in PD psychotherapy as long as attention to the therapy relationship is paid.

In undertaking the complex process of being an emotion-focused therapist, one needs to strike a careful balance between providing a safe relational environment, while navigating with clients through their emotional world. In response to in-session verbal and non-verbal indicators, they invite clients to engage in chair work tasks designed to facilitate emotional exploration and deepening with a goal of emotional transformation. Therapists may be daunted by the prospect of introducing chair work tasks, and concerned about the impact on the relational bond. However, chair work tasks can deepen emotional exploration and shifts, and streamline the process of change. The case of Emma* will illustrate how therapists navigate the interplay between striking an empathic relationship and facilitating chair work tasks. The case will demonstrate how the therapist addresses hesitation or reluctance expressed by the client, while strengthening the bond and deepening emotional processing (*Pseudonym).

The therapeutic relationship is crucial to the ethical and effective practice of any psychotherapy. In Cognitive Behavior Therapy (CBT) as formulated by Aaron T. Beck, the generic elements of the relationship including expressed empathy, expressions of positive regard, agreement on goals, and agreement on tasks within a therapeutic bond were considered a necessary condition for change. Alliance ruptures can therefore have a detrimental effect on therapy if left unrepaired. This article contributes to the In-Session issue on rupture repairs by outlining the role of the alliance as a component of the therapeutic relationship in CBT and illustrates how ruptures can be identified and effectively resolved through detailed case examples. Given the central importance of using collaborative empiricism and Socratic dialogue for the therapeutic relationship in CBT, we demonstrate the distinctive role of these elements in repairing ruptures.

In this introduction to this issue on Rupture-Repair in Practice, we present our understanding of alliance ruptures using common language to appeal to all theoretical orientations. Specifically, we define withdrawal movements away from another or oneself (efforts towards isolation or appeasement) and confrontation movements against another (efforts towards aggression or control). In addition to these interpersonal markers, we suggest that therapist emotional experiences can be considered as intrapersonal markers indicating rupture. We emphasize understanding ruptures as relational phenomena. Then we present various pathways toward rupture-repair, highlighting renegotiation of therapy tasks or goals and exploration of patient and therapist contributions and needs. We explain how these paths can be understood as critical change processes that can transform obstacles in treatment into opportunities. We finish with some mention of our alliance-focused training for self-development. This issue represents an important step towards demonstrating the transtheoretical and practical potential of rupture-repair.

Emotional and interpersonal instability are core features of borderline personality disorder (BPD) and can pose a challenge for the therapeutic relationship. In dialectical behavior therapy (DBT) for BPD, ruptures in the therapeutic alliance are considered through a behavioral lens that examines the client\'s relational learning history, the function and context of the rupture, as well as the patterns of emotional processing difficulties that underlie interpersonal conflict. In this article, we use the case of Rachel to illustrate how alliance-focused approach can be integrated with DBT case formulation to enhance treatment planning and the successful negotiation of alliance ruptures.

Quantitative research on meaning in life in the context of psychotherapy is relatively limited. The current study aims to investigate the profiles of the meaning of clients and their perception of the working alliance and initial symptomatology at the start of therapy.
In a sample of 145 clients (62.1% female; mean age, 34.77) who started person-centered psychotherapy, the relationship between meaning, search for meaning, symptomatology, and the working alliance was analyzed. The assessment took place after the second session.
Cluster analysis revealed four profiles: Low Presence High Search, High Presence Low Search, High Presence High Search, and Low Presence Low Search. These meaning profiles are distinguished in terms of symptomatology but not in terms of the working alliance perception. However, the experience of meaning is significantly associated with the working alliance.
Results show the relevance of meaning-related questions for certain groups of clients at the start of therapy.

OBJECTIVE: Previous reviews have found equivocal evidence of an association between therapists\' internalized relational models and the therapeutic relationship and have neglected empirical literature based on Sullivan\'s notion of introject. This review expanded upon previous reviews to examine the effect of therapist internalized relational models on a broader conceptualization of the therapeutic relationship.
METHODS: Systematic search processes identified 22 papers measuring therapist attachment and/or introject and therapeutic relationship: 19 on therapist attachment, 5 on introject with 2 overlapping.
RESULTS: Overall, despite heterogeneity in design and variable methodological quality, evidence suggests that therapist attachment affects therapeutic relationship quality, observed in client-rated evaluation, therapist negative countertransference, empathy, and problems in therapy. Interaction effects between client and therapist attachment style were also found. Evidence suggesting that therapist introject also affects therapeutic relationship quality, including therapists\' manner and feelings toward their clients, was stronger.
CONCLUSIONS: Evidence clearly shows that therapists\' internalized relational models affect the therapeutic relationship. More research is necessary to clarify exactly how therapist and client internalized relational models interact and translate these findings into clinical practice.

OBJECTIVE: The aim of this study was to test a 3-path mediation model, in which the effect of treatment expectations on outcome is mediated first by the alliance and then by session positivity.
METHODS: Archival process and outcome data were used for this investigation. These data had been collected from 116 clients (70% female, 81% White, mean age = 24.1 years), who sought psychotherapy for a variety of reasons at a university-based clinic.
RESULTS: Correlation analyses established that clients\' treatment expectations, the therapeutic alliance, session positivity, and outcome were significantly related to each other. A bootstrap (data resampling) procedure was employed to test the hypothesized 3-path mediated effect. The results of this analysis were consistent with the hypothesis that high treatment expectations enhance the therapeutic alliance, which contributes to clients feeling positive at the end of sessions and in turn facilitates improvements in symptoms and functioning.
CONCLUSIONS: The current research is the first to provide evidence for this particular model, and thus helps to shed light on the intricacies and underlying dynamics of psychotherapy.