Rupture and Repair in Therapy

I chose the image above because I like the idea that a gap in something can be a window to something else. I think this can be true with therapeutic ruptures – a gap in understanding can illuminate areas which had been outside of awareness both for the therapist and the client, as well as in the relational dynamic.

When I think of ruptures in the therapeutic relationship, I am thinking of any point during the therapeutic process when the client and therapist encounter difficulties in their working alliance, whether it by through a miscommunication, therapist error, an incongruence between client expectations and therapist boundaries, or whatever else.

Such occurrence in therapy can be a source of great anxiety for client and therapist alike. Sometimes a rupture will be unresolved, and the client will choose to leave the relationship, sometimes there will be an unsuccessful attempt to repair the relationship, and very often ruptures can be worked through and resolved successfully.

I know from experience that repairing a rupture in the therapeutic alliance can actually have a strengthening effect on the relationship, and I think this is probably particularly true where the client’s previous experience of conflict has been scary, dangerous or unresolvable. When approached with acceptance and care, there can often be potential for growth and healing.

If we accept as an inevitability that ruptures may occur in the therapeutic relationship, we need to think carefully about what comes next. Obviously a lot will depend on the nature of the rupture, but I think some broad notions are worth keeping in awareness:

  • The client’s feelings are valid – No matter whether the therapist agrees with the client’s perspective about what has happened, it’s really important not to lose sight that the client is still entitled to it. I know it sounds obvious, but it is possible to become focused on our own frame of reference when our work is challenged. It’s a human response and we are all vulnerable to becoming defensive when we feel attacked. A defensive response towards the client is unlikely to have a therapeutic outcome.
  • It is a part of the work – From my relational perspective of psychotherapy, ruptures are a part of the work. As a client, they have taught me new ways to be ‘in relationship’ and the confidence I have gained in expressing my needs is helpful for all my relationships. Equally, the trust I have gained in my therapist allows for greater relational depth in the work. It’s a part of my process, and something would have been lost, I think, if my therapist and I had not worked together to resolve issues when they arose.
  • Boundaries are important – Issues around boundaries are sometimes a catalyst for ruptures in the therapeutic relationship, and they can also be instrumental in resolving them. It is important to have clear boundaries which create a sense of safety in the relationship, and being clear about where those boundaries lie may make boundary-related ruptures less likely. When ruptures do occur, therapeutic boundaries provide the frame and the space to resolve whatever issues are occurring. I would argue that while the alliance is fragile, altering therapeutic boundaries could cause additional strains or difficulties in the work.

Sometimes ruptures do go unresolved, and I think it’s important to retain perspective when this happens. It goes without saying that the therapist has an ethical responsibility to examine what has happened, and whether anything might have been done differently, – supervision provides a space for this important work. There will be occasions when ruptures arise due to the nature of the work (such as in the emergence of transference) and the client will leave before there has been any opportunity to work with the emerging material. It is so important in those instances, in my view, for the therapist to treat themselves kindly, and also to value client autonomy and trust them as the holders of their own process.

To me, ruptures are not about ascribing blame, but they are about taking responsibility – the willingness and ability to work non-defensively and reflexively are hugely important. I believe that modelling this way of being as a practitioner gives the best possible opportunity for positive therapeutic outcomes.

5 thoughts on “Rupture and Repair in Therapy”

  1. Very well written and informative. I’ve actually been wondering at what point the client might decide it’s time to move on, that working to repair the rupture just isn’t working.

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  2. I think this is very true. Working through a rupture and breaking the pattern of how conflict has been handled in the past is very important. I’ve many different experiences of this – with my current T I’ve lost count of how many times over the years I’ve been mad at him or given up on him, quit and come back, and I’ve always been able to repair the relationship although on on occasion that did actually involve having to go and work with a different therapist for a while, which helped me to see and value more the positive aspects of working with that first T; with two others, they were good therapists and under different circumstances we might have been able to work things through but the limitations of their practice meant that they really couldn’t offer the level of support necessary to create a long term, secure relationship and I left without resolving anything; and one who was a terrible therapist and it was never going to work.

    If I can weigh in on KD’s question, I’ve always found that if repair is going to happen you’ll get a sense of that fairly quickly (weeks?), although the actual work can take much longer. I’ve found that it’s no different from relationships outside therapy – when it’s bad you hang on and hang on and it never gets better, and when you finally leave and can see it from the outside you wonder what took you so long. And I personally think that a really good therapist will be willing to take the client back at any point (barring abusive behaviour on the part of the client of course), so if you change your mind after leaving and decide it was the wrong decision, you have a second chance at repairing the relationship.

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  3. For me it was game over talking to therapist and then starting in her group. Every attempt to leave undermined. I drowned there. After a year of intense stress and loss of all hope or capacity to function I left. Analyse “I don’t know what’s happening. I want to leave.”


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