9, ALLIANCE RUPTURES: ait SUMMARY AND CONCLUSIONS In general, an alliance rupture is a particular conceptualization of a treat ment impasse or misalliance involving both patient and therapist contribu- tions in a complex interpersonal process. It includes features that are out- side of subjective awareness but visible to observers, and features that are exclusively the internal experiences of the patients and therapists in the room and only accessible by their self-descriptions. A rupture is also a pat- tern of relating and disengaging within the ebb and flow of the therapeutic relationship that captures the ways in which the participants negotiate the dialectically opposing, essential human needs they both have for related- ness and individuation. More specifically, ruptures are experienced as a kind of tension in the therapeutic relationship and are described by patients as a sense of feeling misunderstood, alone, and demoralized: They range in intensity from subtle to severe, in duration from isolated to protracted, and in frequency from few to several; they take on qualitatively different forms with different clusters of patient interpersonal behaviors marking different internal conflicts and expe- riences of distress; and they can occur within the context of an ongoing treat- ment and strong alliance or at the beginning of a therapy when the patient and therapist meet for the first time. Clinically, ruptures provide a unique op- portunity to explore and reconfigure a patient's relational schemas and maladaptive interpersonal experiences. A rupture is all of these things and as such, it is a challenge to define comprehensively yet succinctly. Our conceptualization of this important change event has been en- hanced by assessment methods that incorporate patient and therapist de- scriptions of their own rupture experiences and observer ratings of video- taped recordings: Patient and therapist subjective experiences provide information that cannot be witnessed by objective observers, but observ- ers pick up on behavior that is outside of the participants’ subjective aware- ness. Videotaped sessions are a critical part of the assessment process be- cause many of the rupture marker behaviors are nonverbal and could not be rated by audiotape or transcript alone. Increasing specificity regarding the components of a rupture episode—the misunderstanding event and rup- ture marker behaviors—have helped to further distinguish the breakdown in the alliance from stages of the resolution process. Additional features of withdrawal ruptures and two types of control ruptures (attacking and blam- ing and manipulative) have been identified through intensive observation and analysis of rupture episodes, deepening our understanding of these dis- tinct clinical phenomena. ‘The observer-rated Rupture Resolution Scale (Samstag et al., 2000) emerged out of our observational analyses and is in an early stage of devel- opment. Future research efforts will focus on the reliable assessment of cy-