Rupture and Repair: an opportunity
Rupture and repair is a topic that I love to explore and support in clinical supervision. In this article I will outline how I approach rupture and repair both in my own therapeutic work and as a clinical supervisor.
Rupture in the therapeutic setting reflects the humanness in the room. Ruptures include breaches, breakdowns, shifts in client body language (shut down/pull away responses), derailments, complaints, disagreements, projections, hurts, mis-attunements, a deterioration of the bond, etc.
Rupture in the therapeutic process can create panic, anxiety and uncertainty in the therapist. Let us first and foremost normalise ruptures in the therapeutic process. They will occur, it is only a matter of when. Part of reducing panic and anxiety when this occurs is feeling that we as therapists have a roadmap - a guideline for how to navigate a repair.
1. See the rupture as an opportunity
Whenever a client comes to me with something they were not happy with, a complaint, something that I said that hurt them or when I notice a shift in body language, a turning a way, a shut down, I know that it is time to slow down and determine what is occurring. I know I need not panic, if they have brought a concern to me, I feel so lucky that they felt safe enough to bring this to me.
A rupture can be a beautiful thing if it is navigated skillfully. Some clients may have never had the chance to engage in a difficult conversation with another around a disagreement or tension in a way that results in a reparative corrective experience. If you are able to repair, this may even strengthen your therapeutic alliance.
This experience is also a great model for the client for repairing interpersonal relationships outside of the therapeutic setting.
2. Hear the client
If the client was able to verbalise the rupture, thank them for feeling they could tell you - reiterate culture of openness and feedback that you value in your practice and relationship with them.
Embody a spirit of curiosity and give the client an opportunity to elaborate on their thoughts and feelings around what has occurred.
Reflect back + heavily validate client’s feelings.
3.Check in with yourself
Notice what comes up for you in your body, mind and heart when you gain awareness of this rupture. Are some of your parts/wounds being touched? Perhaps your “fixer” is quite strong or your “perfectionist” is coming up. We want to have awareness of these parts so that we do not respond from that place. Take a breath and come back to the present moment with the client.
We want to internally acknowledge the impact of this rupture on ourselves while acting and responding from a grounded place here and now in the room with the client.
4. Admit your mistakes
Research shows that fundamental to repairing ruptures is a spirit of humility. You are human and also make mistakes. If you feel you did make a mistake, be honest and even apologize.
5.Finding a way forward
Co-construct a repair. Inquire with your client about how they feel you may be able to move forward ? What would help them feel safe? What would help them re-gain trust? Do they feel satisfied with what you have offered in terms of repair so far?
Be honest about what you can and cannot do within your role. I once had a client who felt hurt that I could not confirm the diagnosis that they felt they were experiencing. They felt that in not confirming the diagnosis, I was not seeing them fully. This created a rupture. I had to be honest about what was within my scope of practice and my competencies, while also determining how I could ensure that they felt their experience was seen and heard.
I hope that this brief article gave you some simple steps to maintaining alliance with your clients and allowed you to know that you are not alone in moving through this part of your role as a therapist.
_________
Written by : Tara McRae MSW RSW, Registered Social Worker, Psychotherapist.
________
References
Muran & Eubanks, 2020
Castonguay & Hill, 2012
Rupture & Repair - The American Psychological Association