How do therapists deal therapeutic ruptures and client criticisms?

In fact, many therapeutic schools of thought suggest that therapeutic rupture’s are necessary aspects of treatment, because it’s one of the few things that can really shake someone from their core beliefs.

Let me share what I think is a useful example from very very early in my career as a therapist. At the time I was an intern, and my work focused on doing home visits for home-bound patients with mental health issues.

I had been seeing this particular client for a while, and it seemed we had a strong therapeutic alliance. This patient was particularly sensitive, and often felt others were against them. Having difficulty ambulating made them especially vulnerable.

On this particular morning, I came to the session sleep-deprived and most definitely not on my A game. The client was sharing with me the experience of an unusually happy weekend, during which they celebrated their birthday. As this client was usually depressed, I thought this might be an opportunity to explore what enabled them to feel so happy on this particular occasion.

With this in mind, I asked them, “How come you were so happy this weekend?” The problem was, because I was so exhausted, I did not modulate my voice appropriately, which made the question sound rather blunt.

Understandably, the client took it as me not thinking they had any reason to feel happy, and became tearful. I immediately realized what had happened, and tried to explain the misunderstanding.

More importantly, this provided an opportunity to explore how other situations might be misunderstood, when the lens that they looked through tended to make things appear negatively. I was only able to do this because our therapeutic alliance had been previously strong, and thus it did not make much sense that I would suddenly question their right to feel happy. While this did not result in an immediate and miraculous change of outlook, it did allow a seed to be planted, and might eventually result in deeper lasting changes.

As for direct criticism, I generally tell clients right at the start, that they should absolutely tell me when they disagree with something I say or don’t like in anyway. It’s very important that clients understand that the relationship can survive critique, and that they don’t have any responsibility or obligation to protect me. This can be very useful, as many people have had such roles throughout their life, and so they tend to take the blame for any rupture or misunderstanding, and do not feel entitled to speak their mind.

This is all to say, that therapeutic ruptures, and client criticisms, can be very beneficial in treatment. This does not mean they might not sting for a moment, but a well trained and prepared clinician understands their value, and generally where they’re coming from.