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Navigating Therapeutic Alliance Ruptures in Cognitive Therapy for Avoidant and Obsessive-Compulsive Personality Disorders and Comorbid Axis I Disorders

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Cluster C personality disorders are prevalent in outpatient samples, highly comorbid with Axis I disorders, and can worsen the course of Axis I pathology and treatment outcomes. Cognitive therapy for personality disorders (CT-PD) can be a potent treatment, but establishing and navigating the therapeutic alliance can be especially difficult with this population. Successful negotiation of alliance ruptures is important to prevent dropout, maintain patient engagement, and provide corrective feedback that can enhance treatment outcomes. We present examples of alliance ruptures from a clinical trial of CT-PD for Avoidant and Obsessive-Compulsive personality disorders, as well as strategies to address common challenges that therapists encounter. The issues highlighted also apply more broadly to cognitive therapy for other disorders.