My answer was twice. We were getting along fine for the first 6 months or so, then he did something that made me feel very hurt. (Actually, he didn't actually do anything, it was my perception, but that's another story.) The next session I was all upset and managed to tell him how I felt. As we discussed it, he said, "You've experienced a rupture in the therapeutic bond."

Now that it's happened twice, I define it as a break in the feeling of trust and safety between T and patient, the "therapeutic bond". It's hard for me to define in words, but I know it when I feel it. There was no bond between us for the first 6 months. He worked hard to build a bond and I accepted it .... very very slowly.

Obviously, if there is no bond, then there is nothing to rupture.