Ruptures in psychotherapy: Experiences of therapist trainees

Abstract

Trainees typically tried to repair the rupture by using immediacy or facilitating exploration about the conflict. Trainees typically reported both negative (e.g., strained therapeutic relationship) and positive consequences (e.g., therapeutic work became more productive). Trainees seemed to be less aware of withdrawal than confrontational ruptures. Implications are that trainees could benefit from learning more about ruptures including how to regulate negative emotions toward clients and acquiring more rupture-repair tools, as well as realizing that ruptures can have some positive as well as negative aspects.

The couple therapist’s emotional pain: Negative affect and the person of the therapist.

“…The “sources” category brings together a range of triggers identified in studies on variables that impact the therapist and the treatment in individual therapy, like seeing client distress or having a difficult client (Chui et al’s, 2016; Fleming, 2005), alliance ruptures (Kline et al, 2019), client hostility (Hill et al, 2003), or seeing oneself as a bad therapist (Chui et al, 2016). An elevated sense of responsibility (Kannan & Levitt, 2017), or wanting to help (Bernhardt et al, 2019) makes individual therapists more vulnerable too.…”

Therapeutic technique diversity is linked to quality of working alliance and client functioning following alliance ruptures.

“…One example of such an intervening factor may be the therapists' own emotional states. As previous studies suggest, when ruptures arise, they may lead therapists to feel wary of the ruptures' consequences (e.g., Coutinho, Ribeiro, Hill, & Safran, 2011;Kline et al, 2018). Thus, it may be that therapists who found it difficult to regulate their own emotional states when ruptures occurred were those who applied an overly wide range of therapeutic techniques.…”

“…However, the internal validity of such a design is limited. Specifically, we could not control for some potentially intervening factors such as clients' (e.g., Miller-Bottome, Talia, Eubanks, Safran, & Muran, 2019) or therapists' (e.g., Chen, Rafaeli, et al, 2018;Kline et al, 2018;Talbot, Ostiguy-Pion, Painchaud, Lafrance, & Descôteaux, 2019) characteristics that can be associated with rupture occurrences or that may have prompted the therapists to implement a certain variety of therapeutic techniques, independent of changes in the alliance. This document is copyrighted by the American Psychological Association or one of its allied publishers.…”

Revisión del concepto de autorreferencia en la formación de terapeutas sistémicos

“…En complemento, en la investigación de enfoque psicoanalítico de Kline et al (2018) se identificó que el manejo de las rupturas terapéuticas puede ser particularmente difícil para los terapeutas en formación; sin embargo, terapeutas más experimentados actúan ante estas haciendo conexiones entre lo que pasa dentro y fuera de la terapia, para ayudar al consultante a ganar conciencia sobre la ruptura; por ello, cuentan con mayor destreza para conceptualizar su contratransferencia y cómo reaccionan al conflicto en estos casos.…”

“…Lo que sí se puede afirmar es que en la literatura (Alvear et al, 2012;Bautista, 2014;Castellanos et al, 2017;Correal, 2018;Gómez, 2010;Huff et al, 2014;Kline et al, 2018;McMahon y Rodillas, 2018;Páez, 2019;Páez et al, 2018;Páez, Hernández et al, 2017;Pérez y Rábago, 2018;Polo, 2013;Polo et al, 2004;Viloria, 2012) se plantea la articulación de la formación y la supervisión, en la cual se evidencian los procesos auto y heterroferenciales que influyen en la consolidación del estilo terapéutico, especialmente en escenarios de supervisión. Ello resalta la participación de estos procesos en la construcción de relaciones generativas entre el aprendizaje y el ejercicio clínico.…”