John Christopher Muran- Ph.D.
- Dean & Professor at Adelphi University
John Christopher Muran
- Ph.D.
- Dean & Professor at Adelphi University
About
246
Publications
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Introduction
J. Christopher Muran currently works at the Gordon F. Derner School of Psychology, Adelphi University and at Mount Sinai Beth Israel Brief Psychotherapy Research Program, Mount Sinai School of Medicine.
Current institution
Additional affiliations
October 2022 - January 2023
January 2022 - present
July 2016 - present
Education
September 1993 - June 1998
September 1989 - August 1990
Field of study
- Postdoctoral Fellowship in Cognitive Therapy, Clarke Institute of Psychiatry
September 1985 - December 1989
Publications
Publications (246)
Psychoanalysis is a generic term for both a set of psychological theories and a group of techniques, each of which emphasizes the unconscious as an essential factor in human adaptation and behavior. Sigmund Freud (1856–1939), an Austrian neurologist and psychiatrist, originally developed psychoanalysis as a treatment for emotional disorders. From t...
Introduction: Alliance ruptures constitute a high risk of premature treatment termination and poor psychotherapy outcome. The Alliance-Focused Training (AFT) is a promising transtheoretical approach to enhance therapists` skills in dealing with alliance ruptures.
Methods and analysis: To evaluate the effectiveness of Modified AFT with doubling (MAF...
To improve the provision of psychotherapy, many countries have now established clinical practice guidelines for the treatment of specific disorders and mental health concerns. These guidelines have typically been based on evidence from meta-analyses of randomized clinical trials with minimal consideration of findings from qualitative research desig...
Repairing alliance ruptures has the potential to serve as a powerful mechanism of change in psychotherapy. In this article, a transtheoretical individual-specific framework for repairing alliance ruptures is proposed. According to the proposed framework, at the intake session, the therapist evaluates the trait-like tendencies of individual patients...
The American Psychological Association Advisory Steering Committee for Development of Clinical Practice Guidelines created a working group to consider the feasibility of, and appropriate methods for, developing an APA clinical practice guideline for interventions that address a transdiagnostic change process, rather than a categorical disorder. Spe...
Over the past 40 years, we have witnessed various movements to challenge established (though not so strongly empirically supported) boundaries to
diagnosis and intervention; that is, challenges to definitions established by Diagnostic and Statistical Manual of Mental Disorders (DSM) or
International Classification of Diseases (ICD) taxonomies and b...
Alliance ruptures in youth psychotherapy can have a significant impact on treatment outcomes. However, there is currently limited guidance on how to effectively repair these ruptures with young people. This study aims to address this gap specifically in the context of psychodynamic psychotherapy with adolescents. The objectives of the study are (a)...
Manual for the Rupture Resolution Rating System (3RS) version 2022. This measure is a revision of the 2015 version of the 3RS.
This chapter discusses the supervisory alliance and its importance in the training of clinicians and ultimately in the outcomes for clients. While the supervisory alliance is considered to be transtheoretical in nature, we will define and discuss the alliance as it aligns with a cognitive behavioral model of supervision. Parallels between the clini...
The goal of supportive psychotherapy is to ameliorate symptoms and to maintain, restore, or improve self-esteem, adaptive skills, and psychological function (Pinsker and Rosenthal 1988, p. 1). These objectives often can be accomplished with specific and direct supportive techniques, delivered in a conversational style, that are responsive to the pa...
This mini review considers patient-provider relations with regard to some of the inherent challenges providers face in their choices and interactions. It draws on diverse literatures to highlight the potential for error in decision-making and affective discord in human relations, including systematic biases (as well as random noise), contextual com...
The therapeutic alliance has been consistently found to be a robust predictor of therapeutic outcome across various modalities of psychotherapy. Alliance ruptures are thought to occur commonly within each therapeutic dyad and, if left unresolved, are associated with premature termination and worsened psychotherapy outcome. Research efforts have ide...
Our practice-based research programme has devoted itself to the
study of how psychotherapy works for over 30 years. It has focused
on how to negotiate the therapeutic alliance: more specifically, on
rupture resolution as a critical change process in psychotherapy.
Rupture refers to moments in which the patient and therapist
experience a disagreemen...
Objective: The purpose of this study was to provide some definition of rupture repair in a cognitive-behavioral therapy (CBT) for personality disorders, specifically how treatment tasks or goals are renegotiated.
Method: Following a task analysis, a rational model was developed with the support of an expert panel. An empirical analysis was conducte...
Most research on alliance rupture-repair processes in psychotherapy has been carried out with adults and little is known about the alliance dynamics with adolescents, especially in psychodynamic treatments.
Objective: This study aimed to better understand the process of alliance rupture–resolution and its role in a good-outcome case of a depressed...
A brief review of the conceptual and empirical literature on the alliance construct from its analytic origins, through its integrative applications, and to its empirical investigations regarding its predictive and causal relation to psychotherapy outcome and including research on alliance ruptures and their repair.
About one in five clients drops out of treatment prematurely. Premature termination has been found to correlate with patient, therapist, and treatment factors, as well as complex interpersonal processes, including ruptures in the therapeutic alliance. This study examines the therapeutic alliance using a qualitative approach to patient-, therapist-,...
This study aimed to determine how control charts ‐ a form of time‐series line graphs ‐ can be implemented in psychotherapy research to indirectly identify probable rupture‐repair episodes that are associated with psychotherapy outcome. There is no current standard in psychotherapy research with regard to how to use control charts to identify ruptur...
Objective:
The aim of the current study is to explore experiences of trainees engaged in alliance-focused training (AFT), a group supervision modality with an explicit focus on awareness of ruptures and implementation of repair strategies. Using Cognitive Behavioral Therapy (CBT) group supervision as a point of comparison, the study examines super...
This commentary highlights common principles shared across the diverse clinical case examples featured in this In Session issue on Rupture Repair in Practice. We discuss the importance of therapists recognizing subtle signs of rupture and responding to ruptures with curiosity and compassion. We also consider how therapists can use repair strategies...
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...
In March of 2020, due to the COVID-19 pandemic, the mental health services at the Brief Psychotherapy Research Program at Mount Sinai Beth Israel were abruptly altered to be delivered exclusively via teletherapy. Many patient-therapist dyads who had begun working together in an on-site setting were asked to transition to remote work. We wondered wh...
Group supervision presents unique opportunities for psychotherapy trainees to deepen their understanding of alliance ruptures and repair strategies. Trainees can explore challenging clinical moments and benefit from diverse perspectives and support. Group supervision also provides trainees with multiple opportunities to experience ruptures and repa...
Objective:
Even though the early alliance has been shown to robustly predict posttreatment outcomes, the question whether alliance leads to symptom reduction or symptom reduction leads to a better alliance remains unresolved. To better understand the relation between alliance and symptoms early in therapy, we meta-analyzed the lagged session-by-se...
El terapeuta reactivo: el problema de la reactividad interpersonal en la terapia psicológica y el potencial de un programa basado en la atención plena centrado en las habilidades de la atención plena en las relaciones para los terapeutas
Este artículo destaca las reacciones interpersonales negativas sutiles por parte de los terapeutas que pueden se...
The empirical literature on therapist training paints a quite
complicated picture (Hill & Knox, 2013; Knox & Hill, in
press). In their important effort to advance the literature,
Frank, Becker-Haimes, and Kendall (2020) focused their attention
on training in evidence-based interventions (EBIs or
treatment techniques with empirical support) and revi...
Objective: The objective of the study was to provide a foundational understanding of mental and physical pre-performance routines of elite squash athletes.
Method: The sample included 18 squash professionals who were ranked in the top 10 in the world, balanced by gender, generation, and nationality. Each participated in a semi-structured interview...
Previous studies have shown that individuals with personality disorder (PD) suffer from significant interpersonal distress. Some PDs, such as avoidant personality disorder (AvPD), have been characterized with a clear homogeneous interpersonal profile. Other PDs, such as obsessive-compulsive personality disorder (OCPD), have shown significant hetero...
Background: To draw clinically meaningful evidence-supported implications about the alliance-outcome association, recent studies have investigated patient-therapist congruence on ruptures in alliance. The present study investigated patient-therapist congruence on ruptures and its consequences on subsequent session outcome in two types of treatments...
Patient and therapist interpersonal interactions and the negotiation of negative process, often referred to as rupture resolution, have been shown to be critical to the change process in psychotherapy. In this chapter, we will present an evidence-based stage process model of rupture resolution, demonstrating a progression from mutual recognition of...
Background: To draw clinically meaningful evidence-supported implications about the alliance-outcome association, recent studies have investigated patient-therapist congruence on ruptures in alliance. The present study investigated patient-therapist congruence on ruptures and its consequences on subsequent session outcome in two types of treatments...
The authors discuss the phenomena of “misattunements,” or ruptures, in the working alliance. They present a set of skills and tools that aim to help therapists recognize and identify when ruptures occur, and they introduce a model for managing these moments. Albeit difficult, ruptures in the working alliance are common, and research shows that a th...
Objectives: Literature on outcome assessment suggests that 35–40% of patients in randomized control trials terminate treatment with unchanged or higher levels of symptomatology. The goal of the present study was to shed light on this phenomenon and the factors accounting for it using a single case study design that investigates the process and outc...
A rupture is a deterioration in the therapeutic alliance, manifested by a disagreement between the patient and therapist on treatment goals, a lack of collaboration on therapeutic tasks, or a strain in their emotional bond. This chapter presents the most frequently used measures of alliance ruptures and clinical examples to illustrate their repair....
Objective: Two decades of empirical research suggest that changes in symptoms are not linear, and many patients gain much of their symptom reduction in one between-sessions interval. Theoretically, such gains are expected to be manifested in the working alliance as well, following a rupture session; however, no study to date has directly examined b...
Jeremy D. Safran’s contributions to our understanding of the complexities of the therapeutic relationship, and its role in the process of patient change in psychotherapy, have been profound. In this paper, we briefly summarize the evolution of his thinking about the alliance and highlight how his ambivalence about this construct contributed to his...
Ambivalence, resistance, and alliance ruptures are three terms commonly used in psychotherapy, across different theoretical approaches and modalities. However, it is still not clear how those terms are related and how the connection can be used to maintain a therapeutic alliance while addressing clients’ ambivalence. This paper aims to briefly desc...
The current study explored trainee therapists' experiences in alliance-focused training (AFT), a form of group supervision focused on training therapists to recognize and negotiate alliance ruptures. We analyzed interviews with 36 former trainees who received AFT during their predoctoral psychology internships. Findings centered on trainees' views...
Decades of work by Jeremy Safran and his colleagues have established that ruptures in the therapeutic alliance are not necessarily obstacles to the treatment, and that the process of repairing these events has the potential to deepen the therapeutic relationship and promote change. The field of alliance rupture research has largely focused on thera...
Grounded in a view of the therapeutic alliance as a process of intersubjective negotiation between patient and therapist, this study examines therapist reflective functioning (RF) as a predictor of process and outcome of psychotherapy in 43 cases of brief relational therapy. Psychotherapy process was measured with the Working Alliance Inventory, Se...
Present an obituary for Jeremy David Safran (1952-2018). In 1993, Safran became full professor and director of clinical training at the New School for Social Research. At the New School, he developed the program with an affiliation to Beth Israel Medical Center, where he was a principal consultant on a psychotherapy research program founded by Arno...
Objective:
Our aim was to examine the reliability and validity of the Rupture Resolution Rating System (3RS), an observer-based measure of alliance ruptures and resolution processes.
Method:
We used the 3RS to rate early sessions from 42 cases of cognitive behavior therapy. We compared the 3RS to a simplified version of the Structural Analysis o...
A rupture is a deterioration in the therapeutic alliance, manifested by a disagreement between the patient and therapist on treatment goals, a lack of collaboration on therapeutic tasks, or a strain in their emotional bond. We present the most frequently used measures of alliance ruptures and clinical examples to illustrate their repair. To examine...
Aim: One of the most prominent achievements attributable to psychotherapy probably stands in the vast body of literature demonstrating its efficacy for a variety of diagnoses. However, a close look at the literature shows that some foundational questions such as defining and assessing outcomes have not yielded extensive literature. This study inves...
Objective: Striking the balance between creating challenge through confrontation (drawing attention to discrepancies) to encourage change and offering support through the therapeutic relationship to ensure safety for patients represents a central issue for psychotherapists. The aim of the present study was to assess immediate effects of confrontati...
This article attempts to integrate the literature on emotion regulation (i.e., the trajectory of emotional experience) and on pre-performance routines (i.e., how performers prepare themselves in advance to maximize their performance). The authors propose that the development of preperformance routines can be advanced by careful consideration of con...
Client ambivalence toward change has been shown to be a central influence on outcomes in
psychotherapy, as higher levels of ambivalence can result in limited engagement in therapy.
Furthermore, research has consistently demonstrated the importance of the therapeutic alliance, which can be impacted by alliance ruptures, or moments of tension or mis...
This document includes scripts that elaborate on the therapeutic alliance interventions listed in the OQ Clinical Support Tools Manual – Brief (CST: Lambert et al., 2007).
The working alliance is one of the most consistent predictors of outcome. Yet, little empirical knowledge exists on how therapists can use this association to maximize the outcome of cognitive behavioral therapy (CBT) for individual clients. The present study aimed to examine pre-treatment client interpersonal characteristics that determine what fu...
Objective: It has been demonstrated that patient perspective on alliance can predict subsequent treatment outcome as reported by the therapist, but not the other way around. This study aimed to investigate the circumstances in which therapists can provide estimations of alliance capable of predicting patient perceptions of subsequent session outcom...
Objective: In order to improve success rates in psychotherapy, an alliance-focused training (AFT) protocol was developed and evaluated with regard to patient-therapist interpersonal behavior in a 30-session protocol of cognitive-behavioral therapy for outpatients comorbid with Axis I and II conditions conducted in a medical center setting.
Method:...
Objective: The study of alliance rupture has become quite prevalent since 1990 and especially in the past 10 years where we have seen a noticeable surge in empirical publications on the subject. This honorary paper attempts to provide a critical review of this literature from the perspective of someone who has contributed to it in his collaborative...
In this article, we examine how the different attachment patterns enable or hinder the
resolution of ruptures in the therapeutic alliance. We try to show that secure and
insecure patients alike may experience ruptures in the therapeutic alliance, but that
their abilities to participate in resolving such ruptures differ markedly. Recent findings...
Psicoterapia psicodinámica asimilativa: Una reconsideración de un caso de estudio crítico
El objetivo de este artículo es examinar un modelo integrativo de la psicoterapia, la psicoterapia psicodinámica asimilativa (assimilative psychodynamic psychotherapy; APP, por sus siglas en inglés) e ilustrarlo con un caso llevado a cabo por el primer autor....
Small, R. B., Muran, J. C., Safran, J. D., & Eubanks, C. (2016, June). The impact of Alliance-Focused Training on therapist self-expression, emotional involvement, and alliance perspective. Poster presented at the 47th International Annual Meeting of the Society for Psychotherapy Research, Jerusalem, Israel.
Objective:
This study examines the validity of the Alliance Negotiation Scale (ANS) in a psychotherapy research program. Analyses were designed to evaluate the relationship between the ANS and psychotherapy process and outcome variables.
Method:
Data were collected in a metropolitan psychotherapy research program. Participants completed 30 sessi...
Objective:
Better alliance is known to predict better psychotherapy outcomes, but the interdependent and interactive effects of both therapist- and patient-reported alliance levels have yet to be systematically investigated.
Method:
Using actor-partner interdependence model analysis the authors estimated actor, partner, and 2 types of interactiv...
Objective:
Notwithstanding consistent findings of significant relationships between the alliance and outcome, questions remain to be answered about the relatively small magnitude of those correlations, the mechanisms underlying the association, and how to conceptualize the alliance construct. We conducted a preliminary study of an approach to the...
Objectives: The Adult Attachment Interview (AAI) has been the gold standard of attachment assessment, but requires special training. The Relationship Scales Questionnaire (RSQ) is a widely used self-report measure. We investigate how each correlates with brain activity during appraisal of subjects’ mothers.
Methods: Twenty-eight women were scored o...
This book attempts to foster collaboration between clinicians and researchers by presenting the experiences of 11 groups of contributors who have conducted practice-oriented research (POR) in various countries and naturalistic settings. Each of these groups was asked to describe the context in which their collaborative initiatives took place, as we...
Despite the widespread use of audio or video recording in psychotherapy training and research, there has been surprisingly little exploration of patient reactions to the use of recordings in psychotherapy, and there is even less written about patient factors that influence their willingness to consent to recording practices or the impact of such a...
The conceptual and empirical literature on alliance ruptures and their resolution is a developing one that is receiving increasing attention, especially as clinicians and researchers continue to face the challenges of treatment resistance and failure across all treatment orientations. Alliance ruptures have been defined as negative patient communic...
This study investigates the utility and psychometric properties of a new measure of psychotherapy process, the Alliance Negotiation Scale (ANS; Doran, Safran, Waizmann, Bolger, & Muran, 2012). The ANS was designed to operationalize the theoretical construct of negotiation (Safran & Muran, 2000), and to extend our current understanding of the workin...
In two National Institute of Mental Health (NIMH)-funded studies, our program has developed alliance-focused treatment and training (AFT) protocols and has demonstrated their beneficial effect on treatment resistance and interpersonal process in psychotherapy. AFT is founded on relational principles derived from research on cognitive, affective, an...
This is the training protocol for the Beth Israel Fidelity Scale that is currently implemented to check for therapist adherence in the Mount Sinai Beth Israel Psychotherapy Research Program.
Questions
Questions (12)
I'm interested on research from any discipline on performance under pressure... any basic science or neuroscience... in any context, including education, athletics etc.
The notion of alliance rupture has been described in numerous ways over the years: from breaches (Safran, 1993) disturbances, disruptions and misalliances (Langs, 1976); empathic failures (Kohut, 1981), enactments (Safran & Muran, 2006; impasses (Safran & Muran, 2000; Stolorow et al., 1994); misattunement (Beebe & Lachman, 2002; The Boston Change Process Study Group, 2010); miscoordination (Westerman et al., 1995); ruptures (Safran et al., 1990; Safran, Muran, & Samstag, 1994; Safran & Muran, 1996; 2000, 2006); strains (Bordin, 1994); vicious circles (Wachtel, 1997, 2007); to weakenings (Lansford, 1986) to highlight a few. I'm interested in combing the literature on other like-minded concepts & terms.
