A Portfolio on the Therapeutic Relationship, Therapeutic Ruptures and Repairs, and Counselling Psychology
The role and impact of a positive therapeutic alliance on psychotherapy outcome has been vastly documented. However, ruptures in the therapeutic alliance are a common phenomenon posing marked challenges on the work of therapists. Although outcome research indicates that rupture-repair processes contribute to an enhancement of the therapeutic relationship, as well as positive treatment outcome, there is a relative lack of qualitative research on the topic. The aim of the current research project was to address this gap by exploring the ways therapists experience, make sense of and repair therapeutic ruptures. Ten semi-structured interviews with counselling psychologists of various therapeutic orientations were conducted, and subsequently analysed using Interpretative Phenomenological Analysis. Four superordinate themes emerged from the data: ‘The Threat’, ‘The Struggle’, ‘The Meaning-Making’, and ‘The Resolution’. Ruptures were perceived as threatening to the therapeutic endeavour, and experienced in the form of withdrawal, breakage or misattunement. Participants’ accounts also revealed experiences of heightened struggles in the form of power and control issues, personal and professional dilemmas, as well as negative emotionality. Participating counselling psychologists appeared to make sense of ruptures in relation to intense intrapsychic and interpersonal dynamics, personal vulnerabilities, as well as pacing of therapeutic interventions. Unique and idiosyncratic ways of processing ruptures were employed, whilst successful resolution was ultimately experienced as transformational for the therapeutic relationship and outcome, and was perceived as a valuable learning experience for both therapists and clients. Overall, therapeutic ruptures and repairs were conceptualised as fundamentally relational, intersubjective acts, co-created and co-experienced by both members of the therapeutic dyad. The emerged findings are examined in relation to existing literature and, the implications for the research, training, and practice of Counselling Psychology are discussed.