If you believe that breaking is possible, believe also that fixing is possible: a framework for ruptures and repairs in child psychotherapy

Abstract

Safran and Muran’s classic theoretical framework of alliance rupture and repair suggests effective techniques for repairing alliance ruptures. Accumulating empirical evidence suggests that successful processes of rupture and repair result in better therapeutic outcome and reduced dropout rates. Although ruptures in the alliance in child psychotherapy are frequent, little is known about how to repair them. The present paper proposes a model for identifying and repairing ruptures in child psychotherapy based on Safran and Muran. It consists of four phases: i) identifying the rupture and understanding its underlying communication message, ii) indicating the presence of the rupture, iii) accepting responsibility over the therapists’ part in the rupture and emphasizing the children’s active role as communicators of their distress, and iv) resolving the rupture using change strategies and meta-communication by constructing a narrative story. The theoretical rationale of each phase is explained in detail, and practical clinical guidelines are provided. Empirical studies are needed to examine the effectiveness of the proposed framework.

Repairing alliance ruptures in psychodynamic psychotherapy with young people: The development of a rational–empirical model to support youth therapists.

“…Moreover, unresolved ruptures early in treatment have been linked to treatment dropout among youths (O’Keeffe et al, 2020). Despite these findings, compared to adult psychotherapy, there is a dearth of research and guidance on how to address alliance ruptures in psychotherapy with young people (Cirasola & Midgley, 2023; DiGiuseppe et al, 1996; Nof et al, 2019).…”

Alliance rupture and repair in adolescent psychotherapy: What clinicians can learn from research.

“…For example, Daly et al (2010) Safran and Muran's (2000) rupture-repair model for child psychotherapy, resulting in the "child alliance-focused approach". In addition, for adolescents aged 12-16 and older, Safran and Muran's original rupture model is recommended (Nof et al, 2019). In contrast, Cirasola et al (2022; specifically developed a model for resolving ruptures in short-term psychoanalytic psychotherapy, integrating research, and theory through task analysis.…”

The alliance with young people: Where have we been, where are we going?

“…Daly et al (2010) validated for use with adolescents Bennett et al (2006) model of repairing rupture with adults in cognitive analytic therapy. More recently, Nof et al (2019) adapted Safran and Muran’s (2000) original rupture–repair model for child and adolescent psychotherapy and developed the “child alliance focused approach,” which has not been empirically validated yet. Given the lack of guidance on how to handle ruptures with young people, it is not surprising that a few qualitative studies have found that youth therapists often feel vulnerable, even wary in relation to ruptures (Binder, Holgersen, Høstmark Nielsen, 2008; Binder, Holgersen, Nielsen, 2008; Morán et al, 2019).…”