Perceptions of Psychotherapy After Therapists Repair Ruptures With Immediate or Expressive Strategies

Abstract

Objective

Researchers have long recognised that disruptions in the psychotherapy relationship can lead to poorer treatment outcomes or dropout, with several strategies proposed to repair such therapeutic ruptures. The aim of the study was to compare two recommended repair strategies: (a) immediate repair, in which the therapist tries to resolve an obstacle by immediate problem-solving, or (b) expressive repair, in which the therapist addresses the disruption by focussing on emotional issues that may be the basis for the rupture. Each strategy was also compared with a condition consisting of minimal encouragers, representing no attempt at repair other than adopting a listening stance.

Method

In the study, participants watched two brief audiovisual recordings of stimuli presented as coming from two different psychotherapy cases in which a disruption had occurred. In one recording, the therapist uses either a repair strategy or the listening stance, and in the other recording, the therapist uses either the second repair strategy or the listening stance. For half the participants, therapist and client in the therapy recordings were male; for the other half, therapist and client were female. After each viewing, participants rated therapeutic bond and treatment credibility.

Results

Both repair strategies were superior to minimal encouragers for treatment credibility, and problem-solving was also superior to minimal encouragers for therapeutic bond. Problem solving was superior to emotion focussing for both types of perceptions. The effect of both strategies further depended on the race, sex and/or therapy experience of participants.

Conclusion

The findings suggest that therapists should attempt repair of a rupture rather than avoid it, with problem-solving appearing generally as a safer strategy than emotion focussing.