Morgan Hagner, PsyD, Post-Doctoral Fellow

Part One of this series focused on the importance of understanding and conceptualizing protective strategies. These strategies are often used by clients in and out of session to cope with feelings of vulnerability, fear, or discomfort. Part Two expands on this concept by examining how to respond when a rupture occurs in the therapeutic relationship and how these moments can impact treatment outcomes.

In addition to identifying cognitive patterns, clinicians must also identify and attend to beliefs that interfere with the therapeutic process. These therapy-interfering beliefs – often rigid, unconscious assumptions clients hold about treatment, their therapist, and their future after therapy – can significantly hinder progress. Though rooted in self-protection, these beliefs can lead to resistance, emotional withdrawal, and relational problems. Clinicians are encouraged to explore these beliefs with curiosity and care, as doing so can foster deeper engagement and therapeutic change.

Why Ruptures Happen

Ruptures are inevitable, especially with clients who have complex relational histories. These situations often arise from misunderstandings, unmet expectations, or from the activation of deeply held core beliefs. Instead of viewing a rupture as a therapeutic or relational failure, they should be reframed as an opportunity for growth, trust-building, and deepening the therapeutic alliance. If left unaddressed, ruptures can erode trust, safety, and openness. Therefore, it’s important to focus on how to effectively repair the therapeutic relationship.

How to Repair a Rupture

Productive repair requires attunement, patience, and collaboration. The goal is not to just resolve immediate tension, but also to model a healthy relational process that clients can internalize and apply outside of therapy.

  1. Recognize the rupture: Carefully observe the client to enable you to notice a shift in mood, tone, engagement, or body language that may signal a disruption in the connection with them.
  2. Gently bring attention to the rupture: Approach with curiosity and compassion and ask the client how they are feeling or whether they are experiencing distress.
  3. Identify the client’s cognitions: Ask,“What was just going through your mind?” or “What did it mean to you when I said [blank]?”
  4. Validate and positively reinforce the client: Tell the client, “It’s good you told me that.”Doing so helps reduce defensiveness and foster safety.
  5. Collaborate on the repair:If you made a mistake (like suggesting an Action Plan assignment that was too difficult), model apologizing and discuss how you can avoid the problem in the future or how the client can let you know if you make a mistake in the future. If the client has incorrectly done mind-reading, gently express what you were actually thinking and feeling. When a different kind of problem arises, work together to understand what is needed to build or restore trust or solve the problem.
  6. Reinforce the relationship: Emphasize clients’ strengths, the importance of the therapeutic relationship, and the value of working through difficult moments; this helps deepen a client’s sense of security and resilience.
Case Example

A client with whom I’m working, “Doug,”* is a 68-year-old married man who specializes in a trade and is getting ready for retirement. He sought treatment for anger, help with the transition to retirement, and to improve his relationship with his wife and adult son. During an early session, I asked, “What are your goals for treatment?” Doug scoffed and replied, “Isn’t that your job?” Before I could answer, he became increasingly angry and shouted, “Shouldn’t you be the one telling me? You clearly don’t know what you’re doing! Are you even certified to do this work? What am I even doing here? What a waste!”

I calmly responded, “Gosh, Doug, I’m sorry. It’s good you told me that. It’s important to me for you to get something out of our work together, and certainly for it not to be a waste of your time. Would it be okay if I took a moment to explain why I asked that question?” He mumbled, “Fine.” I continued, “The reason I asked about your goals is to make sure that I understand what you want so we can work together efficiently and develop a plan that is useful to you, one that gives you the best chance to achieve what matters most to you.” I paused, to give him a moment to think. “What do you think about that?”

Doug replied in a quieter tone, “Well, it’s my understanding that as a doctor you should know what you’re doing.” I said, “Doug, that’s a fair point, but I don’t think it captures the whole picture. It is my job to learn about you, what you want your life to look like, teach you skills that can help you get there, and support you along the way. It’s certainly not my job, or within my ability, to decide what’s best for you or tell you what you should be doing.” I paused again. “What do you think about that? Is that reasonable?” Doug was agreeable and had noticeably calmed down.

I then said, “I am curious though, Doug. When I asked about your goals, I noticed your tone and body language change. What happened?” He replied, “I got pissed off. I’m one of the best at my trade. I’m not an idiot. You should just cut to the point and say what you’re doing.” I validated him, saying, “I’m really glad to know that! It’s helpful for me to learn more about you, especially the skills you have and the work that you do. Moving forward, I’ll make sure to give a rationale before asking new questions so we’re both on the same page. Is there anything else that would be good for me to know?” Doug then shared that the question also made him feel stupid which activated his anger and led him to question if therapy could even help him.

I responded, “I really appreciate your sharing that with me, and I’m sorry it made you feel that way. It’s never my intention to piss you off, but I recognize that I did today. Could we make a plan for how to handle things if you feel angry with me in a future session? And could we also discuss a way to assess whether therapy is helping you?”

Doug was receptive, and together we developed strategies for him to express anger more constructively, self-regulate when feeling overwhelmed, and clarify our therapeutic goals. We also agreed on methods to monitor his progress, including weekly measures and end-of-session feedback. This collaborative approach helped Doug feel respected, involved, and better prepared to navigate any future challenges in therapy.

Long-term Impact of Repair

Repairing a therapeutic rupture can have profound long-term benefits for clients – both within sessions and in their outside lives. Successfully navigating ruptures and mending the relationship can foster a deeper sense of safety, resilience, and authenticity in the therapeutic process. This was evident in my work with Doug. In later sessions, we identified his warning signs for anger, practiced communication and regulation strategies, and worked toward his therapeutic goals, which also led to improvements in his relationships outside of therapy.

Therapeutic relationships can serve as models of how to address conflict and misunderstanding in a constructive way. These interactions can strengthen a client’s capacity for emotional regulation, vulnerability, and self-advocacy inside and outside of therapy sessions. Rather than derailing progress, a well-repaired rupture can often become a turning point that accelerates treatment.

It’s also important to recognize that therapy-interfering beliefs and behaviors—such as rigid assumptions about the therapist, the process, or the client’s own worth—can significantly hinder progress. Addressing these beliefs through rupture and repair not only restores trust but also opens the door to growth.

*The client’s name and identifying details have been changed to protect confidentiality.

Reference:

Beck, J. S. (2005). Cognitive therapy for challenging problems: What to do when the basics don’t work. New York, NY: Guilford Press.