How does your therapist handle ruptures?

How does your therapist handle ruptures?

Explanations -- verbose or succinct -- much appreciated.

ETA: Thanks ATAT!

The first one is awful and has blamed me saying my sense of humor lead her to it. She never apologized for mocking me. I no longer tell her anything that would allow it to happen again and I remind her of her failure/incompetence when she tries to be funny or bond with me in any way and ask that she stop it.
The second one has had not real rupture - she can be more or less paying attention -but she is better at stepping aside from the potential rupture so it does not occur. She is better at both apologizing and at not getting into a clash. She is also usually better at reading me - so that probably helps.

No. 3, well.

No. 2, no ruptures. Yet.

No. 1, well (or so I thought at the time, I may be revising my opinion).

I have straight up asked once if it was a rupture and she did not respond. I don't think she sees them as a thing. It's hard to air something out when the other person does not appear to see the problem.

I had a boss who responded similarly when I would tell her that we weren't communicating well. She would say she didn't see a problem in the way we communicated. I would say I had a problem with it. Then she would proclaim it not a problem because she did not experience one. Meanwhile, our voices would rise and the rest of the office would go silent, people looking for a place to hide. A few times, my boss would blow up and slam the door on me. And still, she would insist there was no communication problem, that the problem was just me. But I digress.

I basically don't like having a rupture not acknowledged.

I said "well to awesome" because we had only one, but she handled it perfectly I thought. She did not contact me after, but when I did call her to apologize for my part in it, she owned her part and apologized for pushing me, and when I said I knew I had destroyed our relationship, she said very graciously "You didn't destroy it. It's damaged, but like any relationship, it can be repaired." And that's what we did. That was over 2 years ago now. I don't even remember exactly when it happened anymore. But I've never forgotten how terrible I felt those 3 days before I called her to apologize, and how gracious she was in accepting my apology and offering one of her own and working through it with me. eta: and oh yeah I forgot to add that she also thanked me for being brave enough to call her and apologize.

Awesomely. Sometimes I swear I try to make a rupture on purpose so t will get sick of me and dump me. It never happens. She always insists we work things out and does so with so much love and kindness. I don't quite get it. But I'm thankful for it.

I wish mine would respond like that, but if there's a rupture that gets addressed in any way, it's that she will ask me what it is I want her to say and, of course, have no idea and just say I was hoping she would know the options, being the therapist. Again, it goes back to acknowledging that there's a problem--if that doesn't happen, it just festers on my end until I give up.

Other I guess. We never really had ruptures. We handled things in the moment and things just never had the chance to develop into ruptures.

I've only had one rupture with my T, when she sent me to the hospital, and we worked it out and she handled it really well.

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Okay, a revision of sorts. Something just got worked out, only it wasn't called a rupture. It was more like what happened with my old boss, where I say there's a problem and she says what banana? and I say what do you mean banana? And then we go back and forth, only without the door slamming and swearing, and with a better ending. Eff me. I am a mess.

My t says quoting winnicott that ruptures are what a relationship is built on. For the therapy couple, the parent child dyad, okay how do I turn off spellcheck?? dyad is not a hard word, this phone is an idiot! BBL

awesome... he is open to criticism and not scared to apologize if he's in the wrong. for example, one session he was basically telling me abt my roommate (we have the same T) and how she has significant difficulties but is still optimistic (i am a huge pessimist). i told him it felt like he was comparing me to her and that i didnt measure up. i told him he hurt my feelings. he told me he is sorry for doing that many times and sorry for hurting my feelings. another example is when i saw him after a stay at my mom's where i was getting my drugs. i hadnt used the whole time there and was so happy to tell him abt it. then he started lecturing me abt how i should tell my mom to hide the drugs when im there, etc. i basically shut down and turned into a child and covered myself with a blanket laid down. he asked me what was going on adn i said i felt like he was lecturing me. he then said it seems like i came in there all excited to tell him how i am clean and he didnt acknowledge that and started the lecture . and that my inner child was hurt bc of this. i said yes!!! he said he is sorry that he just worries about me. that he is very proud of me for staying clean.

I'm going with "well" though it's ongoing so that could change. He's generally open to admitting his mistakes and hearing my feelings, so that's a good thing, but he has said some hurtful stuff here and there so I wouldn't go as far as awesome.

My therapist used to be very good at handling ruptures and helping me have a reparative and healing experience, but in the past year he's got worse at it. Now it's like he just wants to heal his hurt in the rupture - so he'll tell me if something I do bothers him and we absolutely have to discuss it, but we've had a huge rupture in February - March which has left me feeling so much worse than when I started therapy many years ago, and yet he seems to avoid discussing how I feel about it (or if we do he somehow ends up blaming me or denying the validity of my feelings and perceptions).

I think there's a problem in assuming that all therapists use the relationship as part of therapy. That type of therapist (who doesn't use the relationship in that way) can be easily wounded thinking that their professional skill is being criticized if a problem is brought to their attention, and a wounded therapist can be dangerous for someone in a vulnerable state.

For those therapists who do use the therapy relationship, talking about ruptures is clearly helpful.

The problem is in not knowing how a therapist operates until things get heated, so there's a lot of risk taking on the part of the person that can end badly. This is not to say that those who don't address ruptures are bad therapists--it's just that they don't follow that model, and it's a problem for the person who doesn't know how to proceed and doesn't want to risk making things worse.

I've never really had what I'd call a rupture. We've had misunderstandings, and sometimes one of us has said or done something that upset the other. However, those things are always discussed within a session or two. It never builds enough to be called a rupture. Typically, if it's something that upset me, I will email T and let her know and ask if we can talk about it. If it's something I've done that bothered T, she will bring it up at the next session. So, I guess she handles it awesomely. We just talk and work things out and so far there hasn't been an instance where we couldn't come to a resolution quickly.

My therapist responds well. I appreciate that he is not very defensive, even for a therapist he is very non defensive, and will readily apologize without blaming me.

The other question here is what is a rupture. We may not all be defining it the same. I had never heard the term until I came to PC. It isn't a term my therapist ever mentioned. After hearing people here talk about ruptures it still just isn't something I really associate as ever really happening in my own therapy. Most of the time here a rupture seems to be fairly dramatic disagreement or clients talking about feeling abandoned or betrayed or other really strong hurt or anger at/with their therapist -- sometimes to the point of questioning if they can even continue in therapy with that therapist. Other times people have given a milder definition of "rupture" so we may not all be on the same page about what we are discussing here maybe?

The word "rupture" brings images of oozing wounds or volcanic explosions in my head; definitely don't get that feel from my experience.

So I took a few minutes to find a therapy definition online, and I found this definition from a scholarly journal on the subject: "A rupture in the therapeutic alliance can be defined as a tension or breakdown in the collaborative relationship between patient and therapist (Safran & Muran, 2006). Although the term rupture may imply, to some, a dramatic breakdown in collaboration, ruptures vary in intensity from relatively minor tensions, which one or both of the participants may be only vaguely aware of, to major breakdowns
in collaboration, understanding, or communication."

So it seems that a rupture is about a breakdown in the collaborative relationship in therapy according to the literature. Again, in my therapy, we were fortunately always able to communicate and work through disagreements or misunderstandings before anything really "broke down"; thus, I really don't think an actual "rupture" ever occurred in my therapy. We definitely had a therapy relationship -- a really close and productive one -- but I'm not sure I ever felt my therapist "used" (as ruh roh mentioned) our relationship as a focus in my therapy. On the other hand, I would say he did model clear communication, honesty, self-advocacy, etc. in our relationship which I know I picked up on and applied in my life, so while the relationship never felt like the focus, it certainly influenced my progress and the effectiveness of my therapy experience.

I'm just kind of thinking out loud as I work through this idea of ruptures. Thanks ruh roh for your post. It was thought-provoking and insightful.

A quick search

http://www.commonlanguagepsychothera...ingrupture.pdf

http://supportingsafetherapy.org/the...iance-ruptures

Therapeutic alliance ruptures/tensions: description, frequency, causes & effects | Good Medicine

Patterns of Therapeutic Alliance: Rupture-Repair Episodes in Prolonged Exposure for Posttraumatic Stress Disorder.

http://www.antiochne.edu/dissertatio...psychotherapy/

http://file.scirp.org/pdf/PSYCH20121200006_16027411.pdf

Settings.

As for ruptures, No. 3 is the only one who has used the term. And the first one we had, she immediately called it a rupture. She had completely misconstrued something I said and I was upset, partly because of the subject matter and partly because misconstruing it the way she did required real mental gymnastics - when the simplest interpretation was obvious.

So to her at least a rupture can be immediate.

I can imagine in talk therapy ruptures are important, with the qualifier ruh roh mentions. Not so important in CBT or anything like that.

Okay. So the CBT thing has been mentioned a few times here and I was curious so I waded (as much as I could stand) through a scholarly article about ruptures comparing several different modalities, one of which was CBT.

Here is what I think I gathered (maybe):

It isn't that there aren't ruptures in CBT. The difference is that CBT therapists work from a very collaborative focus with a goal of working to find agreement whereas the other modalities they studied (more psychoanalytical but I can't remember exactly what they called them -- sorry) had a focus on analyzing disagreement/discord as a way to understanding. So, from what I gathered, ruptures in CBT were statistically reported less often but that with the caveat that the different modalities are approaching intentionally from different angles. The more psychoanalytical modalities "love" a good rupture (I'm heavily paraphrasing here so excuse my informality) as a starting point for the "work" while behavioral modalities approach from the angle of preventing ruptures in the first place through constant collaboration. It is a difference in the angle of approach to a great extent -- neither necessarily being better than the other -- simply being very different about the approach to and/or philosophy behind the therapeutic necessity and utilization of ruptures.

That was my quick and very dirty paraphrase of a very long and heavily statistically-laden scientific journal/study.

Oh, here is the link if you have the patience to try to wade through this: http://www.safranlab.net/uploads/7/6...t_al_20091.pdf

I have read a couple of articles (in journals linked through the university so I don't know how to ling them here because they are not open online) about how therapists rate the alliance higher and the occurrence of rupture lower than clients do when surveyed. A lot of these articles simply take the therapist's view into account and not that of the client.

Actually, I think this study noted that therapists actually report higher incidents of rupture than clients do statistically which has to do with therapists viewing the structure very much from their training about what the ideal session/relationship looks like. I think this is the one that also noticed less experienced therapists who tended to use techniques very by-the-book reported more ruptures than more experienced who were less likely to stick to the textbook and more likely to individualize.

On that note my brain is tired and I see a nap in my future.

It is not surprising that we found opposite results.

Both my old T and my new one handle ruptures well. They are both open to hearing about it and why its upsetting me and what I think they did wrong and what I did wrong. They both have corrected it and apologized for there part in it. I love how they took responsibility in there part of it.