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alliance study the processes involved in repairing ruptures as they occur. Theories and
research on ruptures are reviewed next, with a particular focus on writings on rupture
resolution.
Ruptures in the Therapeutic Alliance
Safran and Muran (1996) define ruptures as "deteriorations in the relationship
between therapist and patient" (p. 447). Safran and Segal (1990) explain that ruptures are
inevitable and that "most therapy cases are characterized by at least one or more ruptures
over the course of therapy" (p. 154). Furthermore, Safran and Muran (1996) assert that
ruptures may vary in intensity, duration, and frequency, depending.on the uniqueness of
the patient-therapist dyad. In addition, Safran and Muran characterize ruptures as patient
behaviors or communications that can be identified as interpersonal markers, indicating
critical points in therapy for further exploration. These findings underscore the
importance of investigating factors involved in recognizing and repairing alliance strains.
The practice of resolving ruptures in the alliance can be difficult for both
clinicians and patients. For example, Rennie (1994) conducted a qualitative analysis of
patients' interactions to their therapists during ruptures. Rennie's findings suggest that
patients avoid expressing negative feelings towards their therapy and/or therapist because
they believe that protecting their therapists' feelings keeps the relationship in tact.
Regan and Hill (1992) asked patients and therapists to discuss thoughts or feelings
they had difficulty expressing in treatment. They found for both patients and therapists,
negative thoughts and feelings were often left unsaid. In addition, they discovered
therapists were only aware 17% of the time of their patients' holding back.