"Picking up the pieces": Patients' retrospective reflections of rupture resolution episodes during treatment.

Objective: Although theorists and researchers have stressed the importance of rupture resolution episodes for successful treatment process and outcome, little is known about patients' retrospective reflections about rupture resolution. Aim: The overarching goal of the present study was to use a mixed-method approach to examine patients' retrospective reflections on the frequency, types, and consequences of rupture resolution episodes and the association between rupture resolution episodes and patients' attachment orientation and treatment outcome. Method: Thirty-eight patients diagnosed with major depressive disorder (MDD) were interviewed, on average three years after termination, about their experiences of ruptures in short-term dynamic psychotherapy. Results: Thirty patients reported having experienced at least one rupture, with patients who showed less improvement in depressive symptoms more likely to report having had a rupture. Ruptures were judged as having been successfully resolved for 13 of these patients; suggesting that patients with a high level of attachment anxiety were less likely to be judged as having had a successful resolution. Patients whose ruptures were successfully resolved with the therapist's help reported better treatment process and outcome than patients whose ruptures were not successfully resolved. Conclusion: Results highlight the importance of hearing patients' perspectives on ruptures, rupture resolution, and treatment outcome.