Ambivalence, resistance, and alliance ruptures in psychotherapy: It’s complicated.

Abstract

Ambivalence, resistance, and alliance ruptures are three terms commonly used in psychotherapy, across different theoretical approaches and modalities. However, it is still not clear how those terms are related and how the connection can be used to maintain a therapeutic alliance while addressing clients’ ambivalence. This paper aims to briefly describe ambivalence and resistance, describing their impact on psychotherapy process; reintroduce the theory of resistance as a manifestation of ambivalence (Engle & Arkowitz, 2006); and relate it to the concept of alliance ruptures. An original study is presented to further demonstrate this interaction between process and content in psychotherapy sessions. Moreover, this paper will discuss the implications of this relationship, offering directions for psychotherapists in addressing both ambivalence and ruptures in their work.

The alliance in psychotherapy—Papers in honor of Jeremy D. Safran.

“…Three of these articles are written by close colleagues and former mentees of Safran's, who bring his mentorship full circle by writing with their own students. Adelya A. Urmanche, a student of Muran's and writing with colleagues, evaluates the impact of client ambivalence on ruptures in the therapeutic alliance (Urmanche, Oliveira, Gonçalves, Eubanks, & Muran, 2019). Lisa Samstag, writing with her student Kara Norlander, takes inspiration from Safran's task analytic work to evaluate therapeutic process in trainee clinicians (Samstag & Norlander, 2019).…”

Patient experience of lasting negative effects of psychological interventions for anxiety and depression in secondary mental health care services: a national cross-sectional study

“…However, unlike the previous study, all those who took part in this new study had completed their therapy when they completed the survey. Some patients have both positive and negative experiences during therapy, and working through difficult experiences can be part of the therapeutic process [33] Further investigation is required as to whether those who report lasting harm from their therapy also found it helpful. Our survey questions were developed through in-depth interviews with patients and a person with lived experience of anxiety and depression helped to select items for inclusion in this analysis.…”

Trans-affirmative narrative exposure therapy (TA-NET): A therapeutic approach for targeting minority stress, internalized stigma, and trauma reactions among gender diverse adults.

“…Reservations with trust can present as lack of investment in the treatment process if not appropriately conceptualized in the context of minority stressors. Addressing ambivalence toward the therapeutic process acknowledges the difficulty of change while providing an opportunity to refocus on the alliance prior to a relationship rupture (Urmanche, Oliveira, Gonçalves, Eubanks, & Muran, 2019).…”