--- title: "PPRNet Clinical summary: Does a Therapist's Professional Self-Doubt Help or Hinder Alliance Rupture Resolution?" description: The director of the Psychotherapy Practice Research Network (PPRNet) is Dr. Giorgio Tasca. Dr. Tasca is an Associate Professor with the School of Psychology, in the Faculty of Social, University of Ottawa. His research focus is on psychotherapy process, mechanisms of change, and outcomes, as well as eating disorders. image: https://collabzium.com/hubfs/chub_backup/therapy-1.png --- [![FAC_SOCIAL_SCIENCE_HEADER_BAR](https://collabzium.com/hubfs/FAC_SOCIAL_SCIENCE_HEADER_BAR.svg "FAC_SOCIAL_SCIENCE_HEADER_BAR")](https://www.uottawa.ca/faculty-social-sciences/) [![Collabzium](https://collabzium.com/hubfs/CollabziumLogoEnglish(Name)-COLOUR.svg "Collabzium")](https://collabzium.com/) - Articles - [Collabzium Guide](https://collabzium.com/en/articles/author/collabzium-guide) - [All articles](https://collabzium.com/en/articles) - Research - [Chairs and Labs](https://collabzium.com/en/chair-and-labs) - [About](https://collabzium.com/collabcrew) [Subscribe](https://20500402.hubspotpagebuilder.com/subscribe-now) [Subscribe](https://20500402.hubspotpagebuilder.com/subscribe-now) [PPRNET](https://collabzium.com/en/articles/tag/pprnet) # PPRNet Clinical summary: Does a Therapist's Professional Self-Doubt Help or Hinder Alliance Rupture Resolution? [Dr. Giorgio Tasca](https://collabzium.com/en/articles/author/dr-giorgio-tasca) calendar icon Jan 07, 2026 · Reading time 2 min read [mailto:?subject=Check%20out%20https://collabzium.com/en/articles/pprnet-clinical-summary-does-a-therapists-professional-self-doubt-help-or-hinder-alliance-rupture-resolution&utm_medium=social&utm_source=email%20&body=Check%20out%20https://collabzium.com/en/articles/pprnet-clinical-summary-does-a-therapists-professional-self-doubt-help-or-hinder-alliance-rupture-resolution&utm_medium=social&utm_source=email](mailto:?subject=Check%20out%20https://collabzium.com/en/articles/pprnet-clinical-summary-does-a-therapists-professional-self-doubt-help-or-hinder-alliance-rupture-resolution&utm_medium=social&utm_source=email%20&body=Check%20out%20https://collabzium.com/en/articles/pprnet-clinical-summary-does-a-therapists-professional-self-doubt-help-or-hinder-alliance-rupture-resolution&utm_medium=social&utm_source=email) Maintaining a strong therapeutic alliance is key to patients achieving [good outcomes](https://trk.cp20.com/click/gs5t-300wo2-16w95c-l89bayk3/) from psychotherapy. However, the alliance is not static over time – it can deteriorate. Such deteriorations are called [alliance ruptures](https://trk.cp20.com/click/gs5t-300wo2-16w95d-l89bayk4/), characterized by a decrease in therapist or patient collaboration on therapy goals (what the patient wants to achieve), therapy tasks (how to conduct or proceed with therapy), or a strain in the relational bond between therapist and patient. Not repairing alliance ruptures is associated with poorer patient outcomes or [dropout](https://trk.cp20.com/click/gs5t-300wo2-16w95e-l89bayk5/) from therapy. Identifying factors that contribute to the repair of alliance ruptures may be helpful to therapists and patients. One factor that may affect the resolution of alliance ruptures is the therapist’s level of professional self-doubt (PSD), which refers to doubt about one’s professional capacity as a therapist. But PSD is complicated. For some therapists, self-doubt may foster heightened attunement to and realistic appraisal of patients’ emotional states, as well as greater humility. For other therapists, it may increase their professional insecurity, inadequacy, and vulnerability that limit their ability to recognize and repair alliance ruptures effectively. In this study, Igra and colleagues examined therapist PSD at varying levels and its effects on the resolution of alliance ruptures. The authors explored whether an alliance rupture during a session affected the relationship between a therapist’s PSD and the therapeutic alliance in the next session. The study had 53 psychologists who tended to integrate two or more therapeutic approaches, treating 533 adult patients with a wide range of problems. An alliance rupture in one session had a positive effect on alliance change in the next session (*B* = 0.21, SE = .05, *p* < .001), suggesting that therapists tended to repair ruptures in the alliance successfully. However, the interaction between rupture occurrence and PSD in predicting alliance change was not straightforward. Following a session with a rupture, alliance scores were lowest at both low and high levels of therapist PSD, and highest at moderate levels of therapist PSD. That is, *therapists with low levels of professional self-doubt* might be overconfident or defensive, which may impede their ability to recognize and address alliance ruptures. *Therapists with high levels of professional self-doubt* may feel overwhelmed and have difficulty coping with an alliance rupture, which may block their ability to attend to the patient’s needs during a rupture. *Therapists with a moderate level of professional self-doubt* may have the emotional and cognitive flexibility to adjust what they do in response to a rupture without being defensive or overwhelmed. Practice Implications  The results of this study suggest a “[Goldilocks](https://trk.cp20.com/click/gs5t-300wo2-16w95f-l89bayk6/)” effect of professional self-doubt (PSD). Lower PSD may reflect blinding overconfidence in the therapist, whereas higher PSD may reflect paralyzing insecurity. Both low and high levels of PSD may be more pronounced under the pressures and demands of an alliance rupture, especially if a therapist also has an underlying feeling of professional inadequacy. Moderate levels of PSD may reflect a therapist’s professional humility and indicate a balance between self-confidence and self-criticism that may be essential for rupture resolution. > Igra, L., Jacobsen, C.F., Lunn, S., Nielsen, J. & Poulsen, S. (2025): The effect of therapists’ trait-like and state-like professional self-doubt on rupture resolution, *Psychotherapy Research,* [https://doi.org/10.1080/10503307.2025.2584974](https://trk.cp20.com/click/gs5t-300wo2-16w95g-l89bayk7/).   calendar icon Jan 07, 2026 · Reading time 2 min read [mailto:?subject=Check%20out%20https://collabzium.com/en/articles/pprnet-clinical-summary-does-a-therapists-professional-self-doubt-help-or-hinder-alliance-rupture-resolution&utm_medium=social&utm_source=email%20&body=Check%20out%20https://collabzium.com/en/articles/pprnet-clinical-summary-does-a-therapists-professional-self-doubt-help-or-hinder-alliance-rupture-resolution&utm_medium=social&utm_source=email](mailto:?subject=Check%20out%20https://collabzium.com/en/articles/pprnet-clinical-summary-does-a-therapists-professional-self-doubt-help-or-hinder-alliance-rupture-resolution&utm_medium=social&utm_source=email%20&body=Check%20out%20https://collabzium.com/en/articles/pprnet-clinical-summary-does-a-therapists-professional-self-doubt-help-or-hinder-alliance-rupture-resolution&utm_medium=social&utm_source=email) --- ### [By Dr. Giorgio Tasca](https://collabzium.com/en/articles/author/dr-giorgio-tasca) The director of the Psychotherapy Practice Research Network (PPRNet) is Dr. Giorgio Tasca. Dr. Tasca is an Associate Professor with the School of Psychology, in the Faculty of Social Sciences at the University of Ottawa. His research is centered around psychotherapy process, mechanisms of change, and outcomes, as well as eating disorders. ## Also Read - [PPRNet Clinical summary: Long-Term Effects of Psychotherapies for Depression](https://collabzium.com/en/articles/pprnet-clinical-summary-long-term-effects-of-psychotherapies-for-depression) - [PPRNet Clinical summary: Self-Compassion as a Protective Factor Against Burnout in Psychologists](https://collabzium.com/en/articles/pprnet-clinical-summary-self-compassion-as-a-protective-factor-against-burnout-in-psychologists) - [PPRNet Clinical summary: The Therapeutic Alliance in Internet-Based Interventions](https://collabzium.com/en/articles/pprnet-clinical-summary-1.-the-therapeutic-alliance-in-internet-based-interventions) - [PPRNet Clinical summary: What Do Individuals With Borderline Personalities Want From Treatment?](https://collabzium.com/en/articles/pprnet-clinical-summary-what-do-individuals-with-borderline-personalities-want-from-treatment) #### RELATED NEWS ![PPRNet Clinical summary: Therapists’ Responsiveness Reduces Ruptures and Improves Resolutions](https://collabzium.com/hs-fs/hubfs/iStock-1206150255-1.jpg?width=600&name=iStock-1206150255-1.jpg) [PPRNET](https://collabzium.com/en/articles/tag/pprnet) ## [PPRNet Clinical summary: Therapists’ Responsiveness Reduces Ruptures and Improves Resolutions](https://collabzium.com/en/articles/clinical-summary-which-patients-benefit-most-from-being-matched-to-a-therapist-0-3-1-0-1-2-0-0-0-1-1-2-1) The [therapeutic alliance](https://psycnet.apa.org/fulltext/2018-23951-001.html?utm_source=hs_email&utm_medium=email&utm_content=2&_hsenc=p2ANqtz-_SozpHQlYnPHz02a6klYsQBHVfzHFlT6G32qlxIMbjqAnPWRVM5-qG-jqha5kXLJWwFIRtS_thnOapFAMRSBttr_J8OA&_hsmi=2) is recognized as a key therapeutic mechanism of change in psychotherapy... Feb 24, 2025Reading time 2 min read ![Clinical summary: Therapists and Patients Who Agree on Their Experience of the Therapeutic Alliance](https://collabzium.com/hs-fs/hubfs/George%20Tasca-2.jpg?width=600&name=George%20Tasca-2.jpg) [PPRNET](https://collabzium.com/en/articles/tag/pprnet) ## [Clinical summary: Therapists and Patients Who Agree on Their Experience of the Therapeutic Alliance](https://collabzium.com/en/articles/clinical-summary-which-patients-benefit-most-from-being-matched-to-a-therapist-0-3-1) The therapeutic alliance is the agreement between the psychotherapist and the patient on the tasks... Aug 07, 2024Reading time 2 min read ![PPRNet Clinical summary: Therapist Review of Client Symptoms Measures Before Each Session](https://collabzium.com/hs-fs/hubfs/chub_backup/therapy-1.png?width=600&name=therapy-1.png) [PPRNET](https://collabzium.com/en/articles/tag/pprnet) ## [PPRNet Clinical summary: Therapist Review of Client Symptoms Measures Before Each Session](https://collabzium.com/en/articles/pprnet-clinical-summary-therapist-review-of-client-symptoms-measures-before-each-session) Routine outcome monitoring ([ROM](https://trk.cp20.com/click/gs5t-2zqro3-921tl-l89bayk6/) ), also known as feedback-informed treatment or measurement-based... 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