Demystifying Psychotherapy: What Are Ruptures in Psychotherapy and How to Deal with Them?

The client-therapist relationship ideally offers a sense of safety, allows for vulnerability, and creates space for exploration. Your relationship with your therapist is unique and evolving because, just as in all relationships, human beings bring both tangible and intangible qualities to every interaction.

Some people’s chemistry meshes better than others. Sometimes you find someone who just “gets” you. When you’ve found a therapist who really feels like the right fit, it might be scary the first time you feel annoyed at them or – gasp! – even angry. In this article, I will discuss ruptures in psychotherapy and how to deal with them.

Such an experience in psychotherapy is referred to as a “rupture,” meaning a breach in a previously harmonious relationship. As uncomfortable as conflict might be, it is important to know just how normal this is. Even though you might feel like running for the door (or ending the zoom call and never logging back on), you can work through it together. In fact, working through a rupture has the potential to make your relationship with your therapist even stronger and to give you the skills to do this important repair work in your relationships with friends and family.

What might cause a rupture in the client-therapist relationship? Therapeutic ruptures often occur when your therapist said something, or did NOT say something, in a session.

One time, a client let me know that several sessions back I had encouraged her to see her mother’s perspective on a disagreement they had had. She let me know she felt blamed for ever being angry at her mom. She was certain I thought she was being short-sighted and selfish.

This was a big “oof” moment for me. I had never intended to add to her suffering. In fact, I was trying to offer validation of her anger. I meant to ease some of the sharpness of her pain with empathy. Clearly, I missed the mark.

I was, and still am, grateful that she was brave enough to tell me how I had inadvertently hurt her. If she had not, the damage to our relationship might have been permanent and led to us parting ways without resolving what was really going on. Because she leaned into the discomfort of honesty, we were able to process the miscommunication, validate the wound and examine just how tricky it can be to hold anger and acceptance at the same time.

Other ruptures occur because of a therapist enforcing a boundary that does not seem fair or does not initially make sense. Policies, rules and regulation all guide the clinical profession. As in all settings, rules do not always feel fair in every situation. When your therapist enforces a policy that is intended to maintain fair practices but does not feel like it should apply to you, or feels like an obstacle to seeking psychotherapy, it makes perfect sense that you might feel angry or confused.

For example, some therapists choose not to respond to communication between sessions, while others have a practice in which skills-coaching in times of crisis is part of their work. If you email your therapist in a time of need and do not hear back for over 48 hours, it could feel terrible if you do not know the off-hours communication policies.

Ideally, therapists let clients know ahead of time where they stand on this issue. In reality, therapists sometimes make mistakes; they might have forgotten to respond, not had adequate time or were not clear enough when they reviewed the guidelines. Even if the guidelines were communicated clearly and in a timely manner, it is possible that their policies can feel harsh.

After all, when they are first set, boundaries can feel like rejection or abandonment. When they are set consistently, compassionately and clearly, we begin to see that they are just the opposite. Healthy boundaries help us know what is and is not acceptable in a relationship. That way, we can show up and be fully present without worrying if an unspoken line is being crossed.

Of course, something else might occurs and shift the dynamic between you and your therapist. A scheduling error may force a therapist to cancel your session with little notice or to show up late. If you see the therapist at your favorite store, you may worry you live in the same neighborhood, which could feel awkward. Or you might have gotten the feeling that the therapist was not getting what you were saying. Instead of correcting them, you let it slide and now feel lonely and misunderstood.

Therapists are by no means immune to human error because, well, we are human. In theory, we all know this. And in the moment of a rupture, it can be a brutal reality to face. Before discussing repair, we should address why working through these moments can be so hard.

If a rupture occurs, you might find yourself having the urge to avoid talking about it altogether. As in any relationship, conflict is difficult. It is natural to avoid discomfort and hope that it just gets better – or to find another therapist.

While finding a therapist who is a better fit for you is always an option you can explore, the problem with searching for a different therapist because a rupture has occurred with your current one is that it is not likely to solve the problem in the long run. All relationships experience rupture, and all relationships that endure do so thanks to effective repair. Even though you might not want to hurt your therapist’s feelings or are afraid of coming across as “mean,” therapy is just the place to practice difficult conversations. Your therapist can be there to help navigate this rocky terrain.

If you find yourself noticing a rupture before your therapist seems to have caught on, see if you can be honest and direct. Alternatively, if your therapist broaches the topic and catches you off-guard, see if it is possible to remain open and present in the conversation. It is likely that your therapist has guided you in managing difficult emotions and using effective communication skills in other situations.

The good news is that this is all the stuff of repairs. When repairing a rupture, it can be helpful to stick to some basic tenets of healthy communication: use “I statements,” speak in descriptive, non-judgmental language, and clearly state your needs. For example, “When you came to session late, I felt like our time together didn’t matter and I was undervalued. In the future, it’s important to me that you email me if you know you are running late and do your best to start our sessions on time. I can commit to doing the same for you.” The hopeful part about repair work is that it will get easier over time. The powerful part about it is that it will make your relationship stronger.

Because the relationship with your therapist is a real one, it is inevitably flawed, vulnerable and complex. Showing up authentically might mean getting it “wrong,” and that is absolutely okay. In fact, that is part of the process.

You might find that it is less threatening to work through repairs with your therapist than your parent, spouse, or best friend. Fantastic! In those cases, therapy can act like the gym, getting your repair muscles stronger for the moments that really test you. It might feel equally hard to work through these moments within therapy, and that also makes sense. In those cases, I hope you can trust that you and your relationship will grow from the honesty and courage of repair work.