Ruptures, Disagreements, and Misunderstandings in Therapy

Ruptures (lines drawn with frayed ends), disagreements (lines drawn with ends that divert from one another), and misunderstandings (lines that are squiggly and interwoven) are normal in therapy. It's a place to see, practice, and participate in conflict resolution in real time.

This simple illustration represents something that can be hard to understand about therapy: It’s okay to not see eye to eye with your therapist.

Ruptures are natural to experience in any relationship.

Many of us begin therapy as clients expecting the therapist to be the expert. We expect they’ll gently speak or help us find some magic words that must be uttered for us to heal. We don’t necessarily expect intense discussions that engage conflict.

Good therapy is quite the opposite.

It’s okay if a significant portion of therapy is spent engaging in ruptures and repairing miscommunications, disagreements, and misunderstandings.

Why? Because one way that good therapy works is by helping us understand and change problematic relational patterns. How we respond to being misunderstood or challenged by our therapist may reflect the same dynamic in our personal relationships. This could make it challenging to maintain fulfilling relationships with friends and partners.

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Therapy can help us increase our social support (connected to decreased mental health symptoms long-term). One way is by allowing us to experiment with new methods of relating with others and getting our needs met. Unfortunately, this change doesn’t come through simply educating ourselves. Otherwise, we could just read books and listen to podcasts instead of going to therapy!

This type of profound relational change comes through practicing rupture and repair in therapy. This practice is often emotionally loaded and sometimes very painful. If we run away at the point that therapy is painful, we may miss the exact opportunities we need. Opportunities to develop our capacity to engage in deep, healthy, differentiated ways that build fulfilling relationships.

Allan Schore, a leading researcher at the intersection of psychology and neurobiology, says these moments of rupture repeat and reenact emotional scenarios from both a client’s and a therapist’s own lives. These moments allow clients to rework an old story, pattern, or default response and then emotionally experience a new ending.

According to Schore, the most important experiences of therapeutic rupture occur near the boundary of our tolerance to handle them. In other words, “it’s when therapy feels worst that it’s doing its best work” (Wylie & Turner).

Click Here for more content on healthy conflict as a route to more fulfilling relationships.

Sketchnote on a pink background about how good conflict grows intimacy. A white ghost is drawn in the middle of the sketch note. Around it says, "For many of us, conflict is terrifying. We fear losing connection, intimacy, or trust, but that's exactly what avoiding conflict brings. Good conflict is a learned skill and you can improve your conflict skills like anything you'd like to get good at: books, podcasts, youtube, practice, training, and therapy. Avoiding conflict to 'keep the peace' prevents us from being fully present and makes us ghosts in our own relationships. Over time, avoiding conflict creates in us: loneliness, bitterness, anger, and contempt. It creates in partners: confusion, isolation, frustration, and disengagement. Good conflict is how two or more people exist in relationship as separate people."

Experiencing and repairing miscommunications, disagreements, and ruptures is vital to how good therapy works.

How we respond to relational conflict is a story uniquely wired into each of our brains.

If we always do what we’ve always done, that wiring gets stronger. Strengthening it is a problem if that story makes it hard for us to form supportive, satisfying relationships.

Good relational therapy makes room for emotionally-charged conflict. It makes it safe for us to stay, engage, and experiment with handling conflict differently. Doing so can change our brains by giving us vivid, emotional experiences that help rewrite old stories with new endings in a way that just learning about relationship skills can’t. This creates a greater capacity to form and maintain fulfilling relationships beyond therapy.

The image is a hand-drawn doodle of two people. The person on the left has short, dark hair and dark-toned skin. They have an open, warm look on their face, and their arm extended toward the person on the right, with their hand on their shoulder. The person on the right, with long, dark-colored hair and dark-toned skin, is turned away. They have a frustrated expression on their face. There is a gold banner on the bottom of the image that reads, "Rupture is inevitable. Repair takes work." Image was created by Lindsay Braman.

Image Description:

The main image for this article is a simple black-and-white doodle that illustrates how conflict can be a part of good psychotherapy.

At the top of the image, a header reads “ruptures,” below that header is a broken line, on either side of the break, the line shows an asterisk, indicating a conflict that has separated the connection between two people.

Next, the header states “disagreements,” below that two lines are shown moving away from each other in different directions, indicating two people trying to move towards each other aren’t able to connect.

The third illustrated line shows two convoluted lines with loops, curves, turns, and intersections that meet and then depart from one another. These lines indicate the confusion of trying to connect with another person despite misunderstandings.

A handwritten font at the bottom of the image reads, “[these things] are normal in therapy. It’s a place to see, practice, and participate in conflict resolution in real-time.

Does lots of conflict with a therapist mean therapy isn’t working?

Conflict isn’t a problem in therapy. However, that doesn’t mean there isn’t a problem with how a particular therapist handles conflict and how that therapist’s relational style is entering their client’s sessions. Suppose a therapist can’t engage authentically, be curious about others’ experiences, and remain willing to consider their own potential errors. In that case, it may be a red flag that the therapist is not personally at a point where they can engage in interpersonal work in a therapeutic relationship. They may still have a lot to offer in other ways but may need help to help clients through the dynamic reshaping of their relational patterns.

How do I bring up an issue with a therapist to a therapist?

I sometimes invite my clients to talk about “what it would be like to talk about” something before they name what that something is. Talking about “talking about” something is a way to experiment, test safety, and get help from someone else to “go there” without immediately “going there.”

Some people find it helpful to drop a therapist a brief email (i.e., “In Tuesday’s session, I want to talk about ____, but it will be difficult for me to bring up, can you help me get there?”). This is so you both enter the session with the same goal.