Rupture and repair in psychotherapy: A critical process for change.

Abstract

"Rupture" has become a marker for the messiness in the patient–therapist relationship or alliance. It has been described in numerous ways over the years: from breaches, breakdowns, challenges, derailments, deteriorations, dissociations, disturbances, disruptions, dysfluencies, failures, impasses, misalliances, misattunements, miscoordinations, misunderstandings, negations, pulls, resistances, splits, strains, and threats to weakenings. Rupture also has been associated to such concepts as enactments, negative process, projective identification, transference-countertransference, and vicious circles or cycles. As a result, there is a good deal of latitude and too much confusion regarding what is meant by rupture. Like ruptures, repairs are coconstructed. It takes two. It is important to recognize that neither patient nor therapist should take full responsibility for the rupture and its repair. The conception of this book was born out of the second generation of alliance research—the proliferation of research on rupture repair and consideration of its importance as a change process across various theoretical orientations. It invites experts from across the spectrum of psychotherapy traditions and approaches. Each chapter includes at least one case example depicting a rupture and a repair and illustrating how the process of rupture resolution unfolds according to the perspective of the authors. The book presents realistic clinical material that shows how therapists struggle with ruptures and how initial attempts at repair do not always succeed. It represents clinical challenges that resonate with readers' own clinical experiences and provides examples of strategies and principles therapists can readily integrate into their work to help them navigate these challenges more successfully. (PsycInfo Database Record (c) 2022 APA, all rights reserved)