Group Therapeutic Relationship Change: Using Routine Outcome Monitoring to Detect the Effect of Single Versus Multiple Ruptures

Routine outcome monitoring (ROM) is an evidence-based practice shown to improve psychotherapy outcomes. Assessments of the therapeutic relationship are included in ROM systems with research supporting their value-added benefit. The Group Questionnaire (GQ) is a self-report instrument that assesses the therapeutic relationship perceptions of group members. It was designed for ROM administration to identify relationship deterioration and ruptures in group therapy. Burlingame et al. (2018, p. 116) showed that GQ feedback could identify ruptures and that group leaders could use this feedback to repair ruptures on two GQ subscales. We examined whether multiple, simultaneous ruptures in a single session reduced the effect of feedback. A three-level, multistep variable captured the number of rupture alerts in the same session: one, two, or three or more. We replicated Burlingame et al.'s statistical analysis to determine if the number of simultaneous GQ alerts might better explain the effect of GQ feedback using 374 members (56% female; mean age = 23.5 years) in 58 psychotherapy groups. No effect for the number of simultaneous alerts was found on GQ feedback. A higher number of co-occurring relationship deterioration and rupture alerts does not change Burlingame et al.'s findings. Implications are discussed.