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.