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

Abstract

In this introduction to this issue on Rupture–Repair in Practice, we present our understanding of alliance ruptures using common language to appeal to all theoretical orientations. Specifically, we define withdrawal movements away from another or oneself (efforts towards isolation or appeasement) and confrontation movements against another (efforts towards aggression or control). In addition to these interpersonal markers, we suggest that therapist emotional experiences can be considered as intrapersonal markers indicating rupture. We emphasize understanding ruptures as relational phenomena. Then we present various pathways toward rupture–repair, highlighting renegotiation of therapy tasks or goals and exploration of patient and therapist contributions and needs. We explain how these paths can be understood as critical change processes that can transform obstacles in treatment into opportunities. We finish with some mention of our alliance‐focused training for self‐development. This issue represents an important step towards demonstrating the transtheoretical and practical potential of rupture–repair.

Metacognitive reflection and insight therapy in an inpatient setting: Transforming messianism to a coherent mission

“…Hasson‐Ohayon et al (2017) suggest conceptualizing the therapeutic alliance as being created in an intersubjective space that allows for a unique shared narrative to emerge and continually be constructed, without necessarily adhering to the facts, but rather to the coherence of the story and its implications for recovery. Similar ideas have been explored in general psychotherapy literature beyond the setting of psychosis (Eubanks et al, 2021; Muran et al, 2021). The intersubjective framework was found to be particularly suitable and effective in adapting MERIT to treatment in a psychiatric acute ward.…”

Commentary: Rupture repair as a transtheoretical corrective experience

“…Furthermore, the fact that the patient is able to express concerns more explicitly via confrontation behaviors as opposed to more subtle withdrawal behaviors may indicate that the patient is starting to feel more secure in the alliance, to trust that the therapist is able to tolerate the patient's negative feelings. In addition, according to our stage-process model of rupture repair (Muran et al, 2021), the goal of addressing withdrawal ruptures is to help the patient move toward greater agency by more clearly asserting what they need from the therapist. Understandably, patients with limited experience with either practicing or witnessing healthy selfassertion may have some difficulty at first.…”

“…As we described in the introduction to this issue (Muran et al, 2021), rupture repairs can take the form of expressive interventions in which the therapist aims to facilitate an exploration of the rupture with the patient. We have emphasized the usefulness of therapeutic metacommunication, or communication about the communication process, in this exploration.…”

“…A corrective experience can also be facilitated by what we have termed an immediate repair strategy (Muran & Eubanks, 2020;Muran et al, 2021): a strategy that aims to immediately attend to the rupture and then get therapy "back on track" without extensive exploration. In prior work, we described immediate strategies as "surface" strategies (Safran & Muran, 2000), but we have intentionally moved away from that language because "surface" may suggest "superficial" or "shallow," and we believe this connotation fails to convey how useful, impactful, and responsive an immediate resolution strategy can be.…”

Incorporating narrative repair in the treatment of avoidant personality disorders: A case in point

“…Such repair can stimulate vital changes within the patient and between the patient and the therapist (e.g., Muran & Eubanks, 2020). Common, integrative, and transtheoretical principles involve the therapist noticing that the rupture has occurred (e.g., behavioral changes within the patient or the therapist) and then linking the rupture to a larger, interpersonal pattern within the patient (Eubanks et al 2021;Muran et al 2021).…”