Rupture of Therapeutic Relationship
Roamers Therapy | March 2024
In many areas, several psychotherapeutic modalities conflict with each other in theory. However, they all have one factor in common: the healing aspect of the therapeutic alliance between therapist and client. Research by Norcross and colleagues in 2011 found that in various types of psychotherapy, at least 12% of the psychotherapy treatments that worked well for clients were due to a strong therapeutic alliance. Even according to Rogers’ person-centered therapy, the therapeutic alliance is a necessary and sufficient factor for positive change in the client. Then, what is the therapeutic alliance? Therapeutic alliance or relationship means the connection between the client and the therapist. This connection includes many elements. First and foremost, there should be a mutual agreement to work together for the well-being of the client. The therapist and client should be on the same page about the therapy process. Other elements are a shared sense of mission, cooperation, trust in each other, and hope. The therapeutic process is dynamic, and the initial mutual agreement may be disrupted over time. This disruption is called a rupture. In this article, we will discuss how to address the rupture.
Why is the therapeutic alliance crucial?
The therapeutic alliance between a therapist and client is a critical component of what contributes to creating a positive therapy experience. This therapeutic partnership lays a foundation for building a safe and trusting environment for clients to feel comfortable expressing themselves authentically. This unique relationship can help the clients better understand themselves and improve their interpersonal skills with relationships in their lives. Therapy is meant to be a designated space to focus on addressing personal goals, and the ability for a client to feel like they can be vulnerable is critical. Building a solid therapeutic relationship takes effort from the clinician and the client. By working together, the therapist can stand as a thought partner to help explore and navigate stressors to reach personal goals. Like any relationship that is constantly developing and evolving, there is the possibility of disagreements arising.
Why does the therapeutic alliance rupture?
A rupture in the alliance is when there are ebbs and flows or ruptures in the quality of the relationship between therapist and client. The intensity, persistence, and frequency of the rupture in the alliance depends on the nature of the relationship between therapist and patient. A rupture in a therapeutic relationship is an instance of negative miscommunication or behavior that can damage the trust and connection between a clinician and client. At one extreme, there is the overt expression of negative feelings towards the therapist and withdrawal from therapy, while at the other extreme, there are subtle ebbs and flows in the alliance. Ruptures can be mainly caused by the following;
- Over-structuring sessions, inappropriate self-disclosure, critical tone or content, aggressive criticism, and sarcasm undermine the therapeutic alliance.
- The client may lose trust in the therapy if the intervention’s rationale is unclear or the proposed techniques do not seem rational.
- The rupture can occur when a client feels judged, misunderstood, or unheard.
- The client may see the therapist as incompetent or indifferent if they feel that the therapist is insensitive to their cultural values.
- The rupture may occur when the therapist’s behavior supports the patient’s dysfunctional interpersonal schemas and beliefs.
How to Address the Ruptures?
Although conflict can feel uncomfortable, a rupture offers an opportunity for growth and a better understanding of one another. Efforts to better understand and improve behaviors in the future are known as ” repairs.” Repairs are critical for opportunities for growth and a more profound connection with one another to avoid the repetition of the rupture in the future. Ruptures are not a dynamic that should be ignored but can be opportunities to practice assertive communication to work through conflict. Working through ruptures in therapy ensures a beneficial therapy experience and helps practice healthier ways of communicating when in disagreement. Assertive communication is an effective communication style that promotes respectfully articulating personal needs. Practicing these skills in a safe environment can teach the client that repairs are possible in relationships outside therapy. Repairing a rupture can be done by discussing what happened, understanding each perspective, and finding a solution to move forward together. This is a crucial part of the future success of the treatment because when a client feels heard and validated, they are more likely to feel safe and vulnerable.
It is important that the therapist is sensitive to clues about the breakdown in the alliance. The therapist needs to be aware of their feelings and constantly use them to gauge the relationship’s quality. What the therapist should do after recognizing the clues will be the following: the therapist should see their own role in the rupture of the alliance and accept their responsibility, facilitate the patient’s expression of negative emotions by approaching the rupture of the alliance with empathy, understand the pattern and not support the alliance by breaking this cycle with corrective experiences.
Are ruptures unusual?
Therapy is a personal space to explore and practice personal barriers and goals. The relationship between a client and their therapist is crucial to a safe environment where clients can truly express themselves. But even in the most successful therapy processes, the therapeutic alliance can break down several times. How the therapist deals with these fractures will influence the relational dynamic going forward. If left unrepaired, a moment of discomfort, miscommunication, or disconnection in relationships can break trust and intimacy. However, turning this disadvantage into an advantage is one of the natural processes of therapy, just like experiencing this break. This break offers an opportunity for better understanding and identifying positive unmet needs between therapist and client in order to achieve further growth in the relationship.
While our physical offices are located in South Loop and Lakeview neighborhoods in Chicago, Illinois for in-person sessions, we also welcome and serve clients for online therapy from anywhere in Illinois and Washington, D.C. Clients from the Chicagoland area may choose in-office or online therapy and usually commute from surrounding areas such as River North, West Loop, Gold Coast, Old Town, Lincoln Park, Lake View, Rogers Park, Logan Square, Pilsen, Bridgeport, Little Village, Bronzeville, South Shore, Hyde Park, Back of the Yards, Wicker Park, Bucktown and many more.
This page is also part of the Roamers Therapy Glossary; a collection of mental-health related definitions that are written by our therapists.
While our offices are currently located at the South Loop neighborhood of Downtown Chicago, Illinois, we also welcome and serve clients for online therapy from anywhere in Illinois and Washington, D.C. Clients from the Chicagoland area may choose in-office or online therapy and usually commute from surrounding areas such as River North, West Loop, Gold Coast, Old Town, Lincoln Park, Lake View, Rogers Park, Logan Square, Pilsen, Bridgeport, Little Village, Bronzeville, South Shore, Hyde Park, Back of the Yards, Wicker Park, Bucktown and many more. You can visit our contact page to access detailed information on our office location.