Having previously explored the Therapeutic Working Alliance, today's post looks at Strains and Ruptures.
Strains and Ruptures
Strains or ruptures are often referred to in the broader psychotherapeutic literature as ‘resistance’, placing the responsibility for the breakdown in the relationship on the client. But in reference to the therapeutic working alliance they are breakdowns in the collaborative relationship between client and practitioner. Ruptures can be organised into two types, withdrawal and confrontation.
Withdrawal ruptures are characterised by the client withdrawing or partially disengaging from the therapeutic process, such as by providing minimal responses or shifting the topic away from what is being discussed.
Confrontation ruptures are characterised by the client expressing anger, resentment or dissatisfaction with the practitioner or the process of treatment.
Both types of rupture appear to focus on the client as the source of the problem although ruptures always contain elements from both client and practitioner. However, practitioners need to understand the mechanisms of therapeutic change well enough to respond to such impasses and ruptures in order to prevent clients from leaving treatment prematurely.
Although the use of the term ‘rupture’ may imply a dramatic breakdown in communication and in the relationship, this is not necessarily so and ruptures may just constitute minor tensions that only one party is aware of. In this instance, the phrase ‘strain’ might be more appropriate, with the recognition that if it is not responded to appropriately it may come to constitute a rupture. Positive resolution of ruptures is associated with better client ratings of the therapeutic alliance, better outcomes on measures of interpersonal functioning and better treatment retention. Importantly, successful resolution of ruptures is also related to the formation of stronger alliances than where no ruptures existed. However, failure to respond adequately to ruptures and to ‘heal’ them, either because they are too severe or they are not responded to appropriately, is commonly a contributing factor to treatment failure.
Practitioners often overestimate their abilities to establish and maintain strong therapeutic alliances and also their abilities to recognise and respond to ruptures. The problems of ruptures are often exacerbated by clients’ reluctance to confront practitioners regarding alliance issues, especially where they feel they are not involved collaboratively, leading them to resort to subtle defensive manoeuvres. Comfortable tolerance of client criticism by practitioners is essential to supporting the therapeutic relationship. It is therefore important that practitioners appreciate that strains and ruptures are a normal part of treatment and develop the appropriate skills to respond to them.
For further details of the practitioner training in therapeutic alliance fostering techniques and working alliance fostering approaches that Soma run, please click here. The training is particualrly suitable for drug and alcohol practitioners, social workers, probation officers and other criminal justice practitioners.