A critical‐cultural‐relational approach to rupture resolution: A case illustration with a cross‐racial dyad

Abstract

Ruptures are common in any therapeutic relationship and their successful resolution is associated with positive outcomes. However, therapist and client differences with regard to power, privilege, identity, and culture increase social and cultural distance, contributing to alliance ruptures and complicating the repair process. Informed by critical race theories, cultural psychological perspectives, and relational principles, we highlight how power, privilege, identity, and culture shape the development of ruptures and thus, how analyses of these dynamics should inform the process of repair. We present an expanded critical‐cultural‐relational approach to rupture resolution that emphasizes essential skills of critical self‐awareness, wise affect, and anti‐oppressive interpersonal engagement, and extends Safran and Muran's (2000) general rupture resolution model to emphasize a critical analysis of the rupture and repair processes. We illustrate our approach through a case presentation involving a rupture in a cross‐racial dyad with themes of racism and classism.

One more time with less jargon: An introduction to “Rupture Repair in Practice”

“… Chang et al (2021) focus on the impact of a crucial therapist and patient differences regarding power, privilege, identity, and culture and the ways in which these differences shape alliance ruptures and repair processes. Their critical–cultural–relational approach to rupture resolution emphasizes therapist skills of what they call critical self‐awareness, wise affect, and antioppressive interpersonal engagement. Kazantzis and Okamoto (2021) examine the therapeutic relationship within cognitive behavioral therapy (CBT).…”

Commentary: Rupture repair as a transtheoretical corrective experience

“…The articles in this issue presented promising ideas that we hope will inspire more theoretical and empirical attention. Examples of these contributions include but are not limited to: the value of considering all ruptures to be inherently cultural (Chang et al, 2021); the value of emphasizing active collaboration between patient and therapist in rupture repair (Kazantzis & Okamoto, 2021); the value of attending to how the patient's internal conflicts may manifest in the alliance (Abbass & Town, 2021); the value of distinguishing between early alliance formation versus later alliance difficulties (Elliott & MacDonald, 2021); the value of focusing on the function of the patient's and the therapist's behaviors (Walser & O'Connell, 2021); and the value of integrating rupture repair responses with one's case formulation (Boritz et al, 2021). These articles add to the growing literature on ways to attend to alliance ruptures in and across different orientations (e.g., Dimaggio et al, 2020;Kazantzis et al, 2017;Tishby & Wiseman, 2018).…”

“…In several of the case examples in this special issue, therapists initially had difficulty tuning into their own experience, and only after self‐reflection or consultation with a colleague or supervisor were they able to recognize their own emotional responses and identify how their efforts to avoid difficult emotions were interfering with their ability to detect ruptures. For example, in the critical‐cultural‐relational case example (Chang et al, 2021), the authors described a clear confrontation rupture during a phone call: when the therapist asked the patient how her inconsistent therapy attendance would impact her case with child protective serves, the patient said she wanted a new therapist and hung up the phone. However, this moment of confrontation was preceded by multiple moments of patient withdrawal, when the patient missed several sessions and offered only vague reasons for her absences.…”

“…Of course, taken too far, this can lead the therapist to become more engaged in trying to solve the puzzle than in being empathically attuned to the patient, but in moments when the therapist is very frustrated or very anxious, holding on to that curiosity can help them remain present and engaged with the patient (Muran & Eubanks, 2020). In the critical‐cultural‐relational case example (Chang et al, 2021), the therapist recognized links between how he interacted with the patient and her negative experiences with other authority figures. Reflecting on these links in the context of his patient's past experiences of oppression, as well as his position of power and privilege relative to his patient, helped the therapist reconnect with his own curiosity about and empathy for his patient's point of view.…”

“You Didn’t Cause Racism, and You Have to Solve it Anyways”: Antiracist Adaptations to Dialectical Behavior Therapy (DBT) for White Therapists

“…DBT skills and additional activities are therefore suggested as strategies for fostering growth in specific antiracist AKSA competencies, as outlined in Table 2. These recommendations were informed by research findings from four studies (Berg & Simon, 2013;Chang et al, 2021;Malott et al, 2019; that offer guidance for White antiracist practices in clinical psychology. In addition, two basic tenets of a CRP analysis are reflected in these suggested strategies: the assumption that racial equality necessitates interest convergence, and that White identity is a profitable, possessive investment.…”