The subjective experience of psychotherapists during moments of rupture in psychotherapy with adolescents

Abstract

The study of the ruptures of the therapeutic alliance has impacted research in psychotherapy by highlighting the relational nature of this phenomenon. Despite ruptures are frequent and relevant during adolescent psychotherapy, most of the empirical evidence in this field has been carried out with adults. Understanding the subjective experience of the therapist during ruptures while working with adolescent is proposed as a starting point for the study of this type of interactional scenarios. The study examined the meanings that emerge from the therapists’ experience in terms of their explanations about the causes and effects of ruptures with adolescents. Eight psychotherapists were interviewed about their experiences during ruptures with young patients. The data was qualitatively analyzed through the Interpretive Phenomenological Analysis method. Four categories emerged: the failure to recognize the adolescent’s experience, the intensity of the affective experience of adolescents in psychotherapy, therapeutic boundaries as an articulator of the therapeutic purpose and, the obstacles that family generates during the therapeutic process. This study concurs with the literature on the need to make explicit with the family about the meaning, roles and limits of the therapy, and to prevent the exercise of control from an adultcentered position. It is concluded that in order to avoid and repair ruptures with adolescents in psychotherapy, an approach that integrates a sensitive attitude, an ecological point of view and mentalizing about the origin of the rupture is needed.

Comprensión del cambio psicoterapéutico en adolescentes: voces de pacientes y terapeutas

“…Esto permite entender la hipersensibilidad de los adolescentes a los menores signos de distanciamiento por parte de los terapeutas, lo que les genera desconfianza en el espacio terapéutico. En esta línea, Morán et al (2019), en un estudio con terapeutas de adolescentes acerca de rupturas de la alianza terapéutica (Safran & Muran, 2006), plantean que éstas se relacionan con la baja consideración del terapeuta de la experiencia inmediata del adolescente (el terapeuta llega con su propia agenda a la sesión) y con una alta reactividad y sensibilidad a los errores del terapeuta por parte del adolescente. Así, los terapeutas deben estar en constante alerta a los efectos interaccionales de sus intervenciones.…”

“…De manera particular, se ha encontrado que los adolescentes tienden a presentar eventos de ruptura en la psicoterapia, especialmente en los momentos iniciales y finales (Schenk et al, 2019); estos eventos se asocian a momentos Existe evidencia consistente sobre la efectividad de la psicoterapia con adolescentes, tanto en la disminución de la sintomatología de diferentes trastornos, el aumento del nivel de adaptación y bienestar como en la recuperación del curso normal del desa rrollo (Kazdin, 2004;Goodyer et al, 2011;Weisz & Kazdin, 2010;Weisz, Sandler, Dur lak, & Anton, 2005). en los que el adolescente siente distanciamiento atencional y emocional de parte de los terapeutas (Morán, Díaz, Martínez, Varas, & Sepúlveda, 2019), y su manejo es clave para el proceso terapéutico, en términos de adherencia y de resultados (Daly, Llewelyn, McDougall, & Chanen, 2010).…”

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

“…Research also suggests that unresolved ruptures are associated with premature dropout from therapy with adolescents (Eubanks et al, 2018; O’Keeffe et al, 2020). While more should be learnt on this, the following therapists’ behaviors have been identified as associated with alliance ruptures and poor resolution: (a) therapists failing to recognize the young person’s emotional experience in psychotherapy, (b) therapists being passive, unresponsive, or silent for long periods of time, (c) therapists persisting with a therapeutic activity, which the young person had rejected or not engaging in, and (d) therapists focusing on risk issues and a potential need to break confidentiality (Morán et al, 2019; O’Keeffe et al, 2020). These findings show how the knowledge of what helps and what hinders the alliance is relevant to clinical practice since it can guide therapists’ interventions.…”

“…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). Ruptures pose great emotional and interpersonal challenges to the therapeutic work and cause pressure on therapists, who need to be able to withstand such pressure while managing to repair them and continue the work of therapy (Muran & Eubanks, 2020).…”

The legacy of Jeremy Safran

“…29-33), Carrying Jeremy Safran into sessions: relying on internal representations of researchers to facilitate emotion regulation, clinical intervention, and self-efficacy underlines Safran’s influence on therapists’ training and evidences the importance of internalizing the technical strategies to manage the ruptures in the session and to focus on the emotions in the here and now of the relationship. The qualitative research by Morán, Martínez, Varas, and Parra Sepulveda ( 2019 pp. 34-44), The subjective experience of psychotherapists during moments of rupture in psychotherapy with adolescents , depicts the therapist’s perspective when rupture episodes occur in adolescents’ treatment.…”