Evaluation of therapeutic alliance in the first 10 sessions in patients with depression and anxiety disorder treated with schema therapy and examination of the moments of rupture in therapeutic alliance with qualitative analysis

In this study, it was aimed to evaluate the therapy relationship in terms of the client and therapist in clients with depression and anxiety diagnosed with schema therapy, the course of the therapeutic alliance, the detection of the sessions that may occur ruptures in the therapeutic alliance with the case-sensitive idiographic method, monitoring the alliance with control graphics, thematic analysis of the contents of the sessions with ruptures, evaluation of the significance of the clinical results of the therapy with pretest, posttest and follow-up, and evaluation of the findings in terms of schema therapy and therapy outcomes. The relationship between the therapy relationship and treatment outcome was determined as a positive and strong relationship (Flückiger et al., 2018). It is known that a weakened therapy relationship is associated with early dropout and unsuccessful treatment outcome (Safran et al., 2011). It has been reported that if the ruptures in the therapeutic alliance are not recognized and resolved in therapy, they may weaken the therapeutic alliance and negatively effect treatment outcomes (Eubanks et al., 2018).In our study, we monitored the therapeutic alliance session by session with scales and identified possible rupture sessions with the ideographic method. When we examined these rupture sessions with thematic analysis, we found possible rupture patterns. We found that the therapist may cause rupturess due to reasons such as anxiety about controlling the session, excessive focus on therapeutic techniques, conflict with the client, causing the client to withdraw by making constant explanations to the client,while the client may have an impact on ruptures due to reasons such as avoidance, denial, short answers, telling stories about other issues, abstract speech, causing the therapist to withdraw by constantly rejecting the therapist, direct conflict with the therapist. We interpreted that intense conflicts in the therapy process may be related to negative treatment outcome and that conflicts may be related to the schemas of the client and the therapist. In particular, it was interpreted that the therapist's high standards schema may cause the therapist to constantly dominate the therapy, the clients withdraw by submitting to the therapist in these processes, and the client's schema of entitlement / grandiosity, punitiveness and dependence may lead to direct conflict with the therapist.