One of the most challenging aspects of our work shows up when there are impasses, ruptures, and enactments. These are moments or periods in therapy when there is a strain or breakdown in the therapeutic alliance. Nevertheless, when we compassionately face these difficulties, we access one of the most impactful vehicles of change. Why? Because the therapeutic alliance is the foundation of our therapeutic efforts and one of the most powerful determinants of successful outcomes.
Regardless of our particular approach, the very basis of encouraging therapeutic intimacy rests on our ability to effectively repair ruptures. Ruptures can range in quality and intensity from distinct experiences during which clients lose trust in their therapists and leave treatment (emotionally or physically) to more subtle ruptures during which they have a vague sense that something is not right, and may avoid or ignore it.
When conflict arises in the clinical relationship, what we do to repair the break in trust serves as an important model for facing interpersonal challenges with integrity and compassion. It also sends a message that we value the connection enough to work through it. We are willing to engage in a process that demonstrates that the therapeutic relationship, and relationships in general, can survive conflicts and misunderstandings. On the other hand, if we do not address conflict, we run the risk of collusion and send an unspoken message that we privilege emotional safety over authentic presence. The rupture may, in this case, reinforce past experiences of disappointment and frustration that created disconnection in previous relationships and will likely serve to maintain maladaptive relational strategies.
This doesn’t mean we should avoid conflict or stress ourselves out by trying to prevent ruptures from happening. In order to properly address the ruptures that arise, however, we have to be aware they are happening and get clear about the most healing form of repair for the situation. Even with more experience clinicians, there are blindspots that can hinder skillful repair after a rupture in the therapeutic alliance. We will focus on three oversights that we feel are most powerful to become aware of.
Focusing on Content of Rupture, Rather than Emotional Impact
One of the most helpful things we can do for our clients is to become adept at listening from multiple angles and depths so we have a chance to hear, sense, and feel the unconscious relationship that is playing out. This is important because it is the unconscious relationship pattern from the past the client wants so badly to heal. These patterns are often projected onto the therapeutic relationship so the client can see them clearly and find another way to relate to them. By listening from multiple angles, we can sense into past and present as a parallel processes in the psyche and engage in a way that heals relational wounds.
When we discover that there has been a rupture in the therapeutic alliance, it may be tempting to focus on the content of what the client is sharing, rather than the emotional impact. While the information is important for understanding the relational dynamics during the rupture, the client is taking an emotional risk by letting you know about the disappointment they are having and this should be acknowledged and appreciated. In these moments it is important to remember that what is surfacing from the unconscious is not only the current pain of a break in trust, but likely the pain of past experiences with primary caregivers and/or frightening events that have been internalized as post-traumatic stress. It is not important that you did not intend to hurt them or disappoint them. What is important is that they experienced what you did or didn’t do, said or didn’t say, as a break in the trust and it is painful. To respectfully and compassionately address this pain is vital in advancing clinical work because you are helping them internalize a new relational experience and rewire their neural pathways for the better.
In this process, we should be mindful to distinguish between a healthy reparative process that focuses on emotional connection, integrity, and compassion, and a tendency to collude with avoidant strategies that masquerade as repair. In more challenging dynamics where unconscious enactments of power may be playing out, if we are not aware of how we are participating, we may reinforce maladaptive relational strategies and/or re-traumatize the very clients we are trying to help.
Overlooking the Importance of Early Experiences of Rupture and Repair
There are many ways a patient may signal that there has been a rupture in the relationship, yet some may not be able to express through a narrative. If an experience of abuse, neglect, or rejection happened in formative years, clients may not be able to explain the negative emotional and somatic experiences they are having. Hints from the unconscious such as nonverbal body memories, feeling flashbacks, and core beliefs that appear as images, sounds, smells, and unexplainable triggers can surface in unexpected ways. Because these expressions are signals from past experiences, we must take seriously the significance of the vulnerability the person is feeling when we notice ruptures in nonverbal communication, even if we generally know them to be at a high level of functioning or seemingly easy going.
Evidence from interpersonal neurobiology shows that implicit memories are held in the brain and nervous system as if they are happening in present time, forever cycling as reality until properly integrated as experiences in the past. This means that we consider our own early experiences of rupture and repair and how they might influence the relationship so we can confidently attune to the person sitting before us with compassion, nonjudgment, and interactions that promote the transformation of relational schemas. Becoming aware of how the experience in the room affects us and noticing how it lives in us, we can slowly separate our personal material from the relational dynamic playing out before us and come to clearly understand how to move toward reparative therapeutic actions.
Misinterpreting Rupture as Resistance to Therapy
When a rupture happens in the therapeutic alliance, it can be misinterpreted as resistance to therapy or the clinical relationship. While we do our best to clearly perceive signals that reveal our client’s internal world, we may misunderstand the true meaning behind these cues. Because of the nature of the unconscious, it is vital to observe the language of implicit signals to get a sense of the spiral of impact occurring between ourselves and our clients. We can focus our attention on eye contact, facial expression, tone of voice, breathing patterns, posture, gesture, and the timing and intensity of response. This way of tracking interactive nuances affords us the opportunity to more accurately determine whether a client is truly resistant to change or if something happened to break our client’s trust in their connection with us. This is particularly important with people who have insecure/traumatic attachment because rupture is more frequent and experienced more intensely than in other relational styles.
Because it is our role to help maintain and nurture connection to promote collaboration rather than a power struggle based on a conditioned domination model, consideration of past relational dynamics is especially significant during a repair process. More often than not, the resistance is showing up as a coping mechanism unique to the particular client to protect against perceived breaks in trust, such as being controlled, manipulated, or dismissed. It is important to compassionately and nondefensively name and honor these protective measures and the reasons it felt important for the client to engage in them with you. It is just as important to promote a collaborative effort in building trust by specifically enlisting their participation in fostering relational trust and welcoming constructive feedback whenever it arises.
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