Therapy ruptures

No one likes therapy ruptures or at least I’m fairly sure no one enjoys them.

I think therapy ruptures are defined as a severe breakdown in the t and client relationship, patients often drop out at this stage.

I find them deeply destabilizing. I feel like I can’t go on living. They are scary to me and devastating. I think some people figure it will all work out. But for me in the middle of one it feels like nothing will ever be better ever again.

I go into therapy tomorrow night with a deep need for things to be on the mend. It may not go that way.

How do you pull out of a devastating rupture? What does t do to help you? What do you do for yourself? I’m scared for tomorrow.

I still don't know what a rupture is.

I've had negative transference. But there's never been a disagreement with T on a personal level. If Thsts what is meant by rupture.
Any disagreement I might hebe had hasn't been reacted to, but rather analysed and explained to me in historical terms.

My phone isn’t letting me copy and paste but a rupture is roughly the breakdown in the relationship between t and client. There are two types confrontation where a patient voices displeasure and withdrawal where a patient just drops out or skips sessions.

Displeasure in the therapist?

I've experienced a rupture with my T, and it feels astonishingly like a real life break up is in the offing, and it feels like it takes on a life of its own. I couldn't think about anything else- stress, distress, brokenhearted feeling. T's don't just talk about rupture though; they talk about rupture and repair. In the reparation is the best in therapy and the bond can strengthen. I hope Kashi focuses on repair, repair, repair.

Patient becomes very unhappy or uncomfortable with something the therapist said or did.

Hhhhmmm. Can't that just be discussed?

Sorry, I'm trying to understand this.

Sorry Mouse I’m sure I’m not explaining it well.

Ever have a misunderstanding with a t but discussing things only makes things worse and worse and leads to an even bigger misunderstanding or bigger breakdown in trust? That’s how I see the difference between a mild disagreement and a rupture.

In my case... “I need to feel loved in therapy to do the work”
T might say ....”that is a phrase I never use with patients”

In my case, finally telling the secret T implored me to put on the table, to trust

T, at the end of session , oh I will be out of town Friday( cancelling but giving no reason)

It dawned on me that my T is topnotch at his job, but when 50 minutes chimes, he is done being interpersonal. Getting Cinderella'd/ pumpkined, realizing he sees this doctor patient- that made me shift my paradigm that therapy is a special, touching , mysterious process to both me and my T. It hurt, and yet it is facing reality- not a bad skill for a daydreamer/dissociative. I am ambivalent now about my T instead of adoring.

So the rupture is a reaction to what the T said?
I guess I dint react in that way. I'd work with the T to understand why I need it so much and what can the T do that can help me feel secure within the relationship still.
If a T didn't use the word love (which I can understand) it's about working with that. That is the work of therapy.
Dysfunction in foo is where ruptures happened. Where one learnt to react if one didn't feel they were getting what they needed and the dysfunctional foo would either bend to that reaction or draw a harder red line. It was emotional blackmail.
Therapy is there to help find better ways to negotiate.
To work through.
That's if the T is knowledgeable. If they're not. Then all that's getting rehashed is old foo (family if origin) stuf and theres no way any growth can come from that.
I couldn't operate in an environment like that.

I had 2 in january, it was such a fun month LOL

i basically just told him i needed to see him a second time because i was feeling crappy, went in with notes, said what i needed, listened to him babble on about this or that and then we were fine again

Now I've created a potentially 3rd one on my own cuz of my stupidity, so we will see but if this is the case, I'm quitting, thats how I'm handling it lol

Yes, I would consider a rupture to be something that leads to a breakdown in trust. A T suddenly tightening or otherwise changing boundaries is something that has led to a rupture for me in a few cases (once with ex-T and twice with MC). A T saying something that feels really hurtful is another reason--like when ex-T said, in a harsh manner, "I can't be your mother or your friend!"

It's something that makes you doubt the relationship and/or changes your view of the T. It could be something that kind of rubs your face in the one-sidedness of the therapeutic relationship.

I think transference can make them much worse, because then the rupture often isn't just about the T, but also bringing to mind something from the past. I told MC recently that it felt like he had retraumatized me in suddenly telling me I had to reduce contact with him (partly in response to my saying I loved him). It brought to mind other times I'd been rejected for expressing my feelings. And it especially hurt because MC always would say that any feelings are OK, how we aren't in control of them. And he knows how sensitive I am to certain things. So for him to do what he did...then try to claim "Oh, I wasn't trying to push you away..." it seems much worse. (As compared to, say, a friend doing that.)

I think in some cases, working through ruptures can ultimately make the relationship stronger. But other times...I think they can shift things in a way that permanently changes the relationship--I feel that's what happened the most recent time with MC.

Sorry, I'm rambling now. Growly, I hope you're able to work this out with Kashi. I suspect much of it will come down to how he responds, whether he seems to understand what's upsetting you, whether he seems truly sorry, whether he owns his role in it, and what he does to repair it. At least, that's been the case for me.

I'm in the midst of one now.
I mostly gut through; I've been through enough ruptures now that I know that 1.) working through them will always bring me a deeper understanding of myself and 2.) my feelings change, always. Even if I feel like something needs to be decided or done "RIGHT THIS SECOND," that's not truly the case. Even if I feel like I will NEVER FEEL SOME OTHER WAY, a logical, rational, wise part of my brain knows that that isn't true: feelings change, always.

I have committed to working through things with this therapist, and that's going to mean having to sit with really awful "life-or-death" level feelings sometimes.

Therapists always think that their right and never say anything wrong. Therapist and client relationship is never a normal relationship, imo. My last therapist said I was making excuses for getting better which I wasn't. So I quit. My next to last therapist told me she couldn't help me after I told her I couldn't put myself back together so I quit. She was upset and told me she was using a technique. You can't get anymore blunt than "I can't help you".

I think it's fine and to be expected that ruptures can sometimes make or break a therapeutic relationship. When things blow up, that's when you really see what your T is made of. Can they stay with you, stay on your side, and deal with your feelings without losing their cool or getting sucked in? If they mess up (which they inevitably will), can they own their part of things and apologize? Not every T can do this kind of thing, and when they can't, therapy tends to go off the rails. But if they can work together with you to repair whatever the issue is, then the relationship will get stronger.

The whole thing can be incredibly confusing and painful, though, because if you're flooded with emotions (including emotions that relate to other things in your past), it can be difficult to figure out what is based in reality and what isn't.

Hi growly, from what you've shared, I don't think you have anything to be worried about tomorrow. Kashi will try to smooth things over by reeling you back in. I think the question is if that gets at your deeper issue in a more sustainable way? At the very least though, he seems the type to want you to leave feeling good about him.

I say this as someone whose therapist doesn't even acknowledge ruptures. She seems puzzled or confused whenever I suggest such a thing. The closest was her admitting that she'd lost her composure due to other stressors, although she wouldn't say what those were/are other than a tragedy for someone close to her, and a series of crises outside of work. Now she says it's other reasons, like workload, so who knows. The benefit is that it puts things into perspective for me about the relationship, and I can create distance to cope. I am guessing that's not going to help you, though.

I can relatively easily tolerate conflicts (in general, not just with Ts) given that everyone involved shows reasonable fairness and is willing to look at their contribution to it and we can arrive at a collaborative solution and then we all work on maintaining it. The "rupture without repair" with my first T was when we repeatedly ran into very similar types of nasty conflicts, but he only wanted to look at it from the point of view of my contribution and history and completely refused taking and voicing responsibility for his part. I allowed that to continue for a relatively short while twice, but refused turning my therapy around and making it all about "us" while originally I did not go there to work on relational stuff, I had more practical and discipline issues I wanted to improve. I was open and willing to expand my interest and investigate relational stuff to a certain extent but (as said before) I personally found that as huge distraction for me rather than useful work. Anyhow, I would have been interested in working on and resolving interpersonal conflicts with a T but only in case it was a mutual, a collaboration, and not just throwing all of it onto me. The "rupture without repair" occurred in my case when my T was consistently close to that and yet kept making the same errors that I could no longer tolerate and my original goal got totally lost in useless rounds of personality clashes and fights. Such things rarely happen in my everyday life so it wasn't even like therapy brought out something useful to investigate - it was simply a crappy T and a crappy client-T combination.

Just some info on ruptures:
Here's a less well known, but sobering statistic: clients report tensions or actual breakdowns in the therapeutic relationship in 19% to 42% of sessions. These figures rise to 41% to 100% of sessions when trained observers are used to identify “ruptures” between clients and therapists.
https://www.scottdmiller.com/i-was-w...psychotherapy/

So firstly, what do we mean by the term "alliance rupture"? In their excellent paper "Repairing alliance ruptures", Safran & colleagues helpfully define ruptures in the following way: "A rupture in the therapeutic alliance can be defined as a tension or breakdown in the collaborative relationship between patient and therapist." They go on to highlight "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." I personally find the label "alliance tension" rather more helpful than the often over-dramatic "alliance rupture". It helps alert me to the fairly hidden nature of probably most of these difficulties.
Therapeutic alliance ruptures/tensions: description, frequency, causes & effects | Good Medicine

The therapist repairs a rupture in the therapeutic alliance with the patient by using one or more different procedures. In confrontation ruptures the patient shows problems in the alliance by expressing hostility or criticism toward the therapist. In withdrawal ruptures the patient manifests alliance problems by withdrawing from the therapeutic process or by deferring or expressing negative feelings indirectly.
http://www.commonlanguagepsychothera...ingrupture.pdf

Ruptures used to be that way for me. It took many ruptures and many repairs for me to become secure that ruptures will be okay. It took a long time and my therapist had to prove himself for that to happen.

I hate them. They are so painful. I find them almost worse than a fight with a romantic partner because you have to wait a week or however long to work it out. They end up consuming all of my waking thoughts. I have trouble sleeping. It's horrible. And I'm only moderately attached to my therapist.

I just worked one out, and I feel like a million times better than I did last week. What I did to deal with it was to write out what I felt and also what I wanted him to differently. I spent a lot of time on it and I was extremely careful to avoid blaming language and to take responsibility for what I thought my part in it was. I did that because even though a therapist should be able to deal with criticism without getting defensive, I know they are only human and I wanted to feel like I was dealing with it in a healthy way.

He was very receptive and nice about it. He acknowledged his part in it and I noticed that he modified his style with me...more empathetic and less lecturing. So it worked.

But I did once have a huge therapy rupture that ended the relationship. I did try to talk to him about how triggering his style was to me, but he wouldn't modify anything or acknowledge that he had said/done anything wrong. Everything was all my fault according to him...and the thing is in any relationship problem, is anything ever all one person's fault? So I fired him. I called him up and told him how scary his style was to me, and quit. Then he was actually kind of nice. Maybe he thought I was going to make a complaint about it...still, I had decided to quit, and I did. Most healthy thing I ever did for myself.

I've had around 4 ruptures with my therapist and found that each one became more painful. Our longest lasted a 5 solid weeks. My current email thing has the potential to blow up into one.

I feel like they can only be repaired if the therapist is able to admit their own part in it and is willing to meet you half way.

I hope your session goes well Growly.

Thanks everyone. This is all helpful to me.

I have a therapy notebook I have not used in awhile. But last night I wrote a few pages

Things that t says or does that are helpful
Things that t says or does that are painful and destructive
Describing rupture pain and what it is like
And a page of odds and ends thoughts

I am hoping that this helps tonight. I’m worried to death

Good luck to you growlycat. I am sending strength your way. I remember someone speaking about warrior women strength and that's what I want to send your way as you try to straighten things out with your therapist.

I have never experienced a rupture, and I've been in therapy for more than a decade. I actually think my lack of ruptures indicates something (negative) about how I interact. It just doesn't seem right that it's never happened.

The notebook with those lists seems like a good idea. I hope tonight goes well.