Danielle Bertini, LPC

Evidence suggests that the therapeutic alliance is the strongest predictor of outcome in psychotherapy (Alexander & Luborsky, 1986). However, what happens when the therapeutic relationship falters? Does this mean there is no hope? Actually, research has shown that when the therapeutic alliance falters and is then fixed, therapy can continue to flourish. This process of experiencing, discussing, and solving problems in the therapeutic relationship provides a unique opportunity for learning and behavior change (Goldsmith, 2012).

Like any relationship, there can occasionally be ruptures. The relationship between the client and therapist is no different. These can sometimes be simple misunderstandings or miscommunication issues. Other times ruptures can be the result of a phenomenon called transference. Transference happens when a client relates to the therapist as if they were some other important person in their life, such as a family member, friend, partner or even someone who caused them significant trauma. When this process happens, the therapist then becomes a type of mirror in which the client can project feelings, thoughts, fantasies, and defenses onto the therapist that are more so meant for the person the therapist resembles. It is important to note that this is mostly done on an unconscious level.

And guess what? This is totally normal! This is something that we all do in everyday life. Have you ever felt a really strong reaction to someone, whether it be positive or negative, out of the blue? Or with just having met the person? Perhaps it was something about the person’s mannerisms, appearance, or even words that reminded you of someone else in your life.

Transference is a normal and fundamental part of therapy. Chances are that you know very little about your therapist’s life outside of sessions, so they are essentially a stranger. Because of this, a lot of things can get projected onto them. The unique thing about therapy is that it is the place for relational patterns to get repeated and then talked about, hopefully leading to great insights and transformative action. Processing emotions and thoughts about the relationship between the therapist and client that are happening in the moment are encouraged and welcome. As mentioned earlier, the rupture and repair of the relationship has been shown to make the relationship stronger and can also bring change for the client as they then apply these new tools to outside relationships.

However, this probably sounds easier said than done. Talking about the therapeutic relationship can feel awkward at first, especially if you are not someone with a particularly confrontational personality. Here are some tips for clients in resolving these issues (McDaniel, 2018):

⦁ Bring up the issue. Clients often feel anxiety about confronting their therapist with an angry feeling or concern. However, bringing up these issues is a welcomed and encouraged conversation for most therapists. This opens up space for a new path in the therapeutic process.
⦁ Express anger in an appropriate way. Violence, name-calling, verbal abuse, and raising your voice are not okay in any setting (Tony Soprano, anyone?). Instead, talk about why you feel angry and what you need from your therapist. Often times there is a deeper feeling underneath the feelings of hurt or fear, try to tap into those.
⦁ Understand the difference between validating feelings vs. validating thoughts. While your feelings of anger, hurt, fear, insecurity, etc. are always valid, sometimes the thoughts that led to these feelings might not be rational. Your therapist can help you explore and even challenge some of these irrational thoughts. This doesn’t mean that your therapist is saying your feelings don’t matter, but rather that they want to help you understand the source of those feelings.
⦁ Be open to making connections with previous relationships and experiences. This process can help normalize the reaction and possibly find better ways to cope. We are all shaped by our experiences.
⦁ Be willing to work with the therapist to develop understanding, find a solution, and restore the relationship.

It is important to note that issues with the therapeutic relationship are not only the responsibility of the client, but also equally the responsibility of the therapist. Here are some takeaways from this discussion:

⦁ Ruptures within the therapeutic relationship are normal and do not mean that the relationship must be terminated.
⦁ Talking about issues within the therapeutic relationship can be awkward at first, but being open and honest about your feelings (in an appropriate way) is key.
⦁ And lastly, the benefits of working through relational issues with your therapist can be worth the discomfort. Not only will the therapeutic relationship become stronger, but the insight gained can also positively impact outside relationships.

References

Alexander, L. B . & Luborsky, L. (1986). The Penn helping alliance scales. In L. S. Greenberg  and W. M. Pinsof (Eds.), The psychotherapeutic process: a research handbook. New  York: Guilford.
Goldsmith, J. (2012). Rupture-repair events in couple therapy: An exploration of the  prevalence of sudden drops in couple therapy alliance, and their impacts on therapy progress. (Unpublished dissertation). Miami University, Oxford OH.
McDaniel, R. (2018, October 08). What to Do When You’re Mad at Your Therapist. Retrieved from https://psychcentral.com/lib/what-to-do-when-youre-mad-at-your-therapist/