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Rupture Resolution Strategies

Rupture resolution principles fall into two major categories: 1) immediate, and 2) exploratory. Immediate repair strategies, such as providing the patient with an explanation or rationale for a specific treatment task or goal, changing a task or goal to something more agreeable to the patient, and clarifying a misunderstanding with patient: These are common interventions that clinicians frequently employ to immediately correct and re-establish collaboration.  There is a study that provides empirical support for the value of a changing a task to work on something more salient to the patient’s issues.

Exploratory resolution strategies, which involve exploring core relational themes that underlie a rupture: These typically lead to clarifications of patient beliefs and action patterns around the rupture.  They also require significant attention to the therapist experience and behavior.  The essential technical principle for such explorations is therapeutic metacommunication, which involves any form of communication about the communication process.  The critical tasks for the therapists are to recognize and invite a collaborative inquiry about the rupture event, to empathize and remain nondefensive with regard to patients’ negative sentiments, and to take responsibility for their part.

Various models of this exploratory process have been proposed.  Safran and Muran proposed two specific resolution models for withdrawal and confrontation ruptures: In the former, the common progression consists of moving through increasingly clearer articulations of discontent to self-assertion, in which the need for agency is realized. The progression in the resolution of confrontation ruptures consists of moving through feelings of anger, to feelings of disappointment and hurt over having been failed by the therapist, to contacting vulnerability and the wish to be nurtured.  Throughout such progressions, there are often shifts, regardless of rupture type, avoidant movements that reflect anxieties resulting from the fear of being too aggressive or too vulnerable associated with the expectation of retaliation or rejection by the therapist.  The therapist should explore these shifts when they emerge.

 

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