Working across the Clinical Spectrum with Enactments, Ruptures, and Repairs
Date: Saturday, February 10, 2024: 10am - 3pm (1 hour lunch break)
Credits: 4 CEUs/CMEs
Meeting Location: both online via Zoom and in-person at The Center for Integrative Counseling and Psychology, 4305 MacArthur Ave., Dallas, TX 75209
Presenter: Nancy McWilliams, Ph.D. & Michael Garrett, M.D.
Dr. McWilliams will review empirical data supporting the critical importance of the therapeutic alliance to therapy outcome. Although almost all research on the alliance has been done with nonpsychotic patients, and such patients will comprise the main group about which she talks, she will attempt to infer general principles of therapy process relevant to the rupture-repair cycle in all psychotherapy patients. She will give examples from her own experience of enactments and efforts at repair of ruptures of the therapeutic alliance.
Dr. Garrett will note research evidence that chronic psychosis diagnosed as “schizophrenia” would be better considered a bio-psycho-social stress-related disorder that requires psychotherapy than as a genetically determined brain disease treatable primarily with medication. Given the high incidence of childhood adversity (abuse and neglect) in people who develop psychotic disorders, he will describe how in abused children, insecure attachments to primary caregivers lead to implicit relational models of others that are internalized as dissociated, split-off, unintegrated mental representations of the self in relation to grandiose and persecutory psychological objects which, when projected into the individual’s interpersonal world, become manifest as delusions. He will outline how at times, in the psychotherapy of psychotic adults, early self- and object representations emerge in a psychotic transference. He will describe the treatment of three patients with varying intensities of psychotic transference amendable to varying degrees of repair in psychotherapy and offer suggestions for how to avoid and repair disturbances in the therapeutic alliance with patients suffering from psychosis.
Learning Objectives:
Apply research findings on the role of the therapeutic alliance to their clinical work.
Name two factors that account for most of the variance in psychotherapy outcomes.
Describe three ways of repairing ruptures of the alliance that apply to all patients.
Describe research evidence that what is conventionally diagnosed as “schizophrenia” is better regarded as a complex bio-psycho-social stress-related disorder.
State how insecure attachments can lead to dissociated internal objects.
List two aspects of technique in psychotherapy for psychosis that may help minimize therapeutic ruptures.
References:
Eubanks, C. F., Muran, J. C., Safran, J. D. (2018). Alliance rupture repair: A meta-analysis. Psychotherapy, 55(4), 508–519. https://doi.org/10.1037/pst0000185
Eubanks, C. F., Sergi, J. Muran, J. C. (2021). Responsiveness to ruptures and repairs in psychotherapy. In J. C. Watson; H. Wiseman (Eds.), The responsive psychotherapist: Attuning to clients in the moment (pp. 83–103). American Psychological Association. https://doi.org/10.1037/0000240-005
Friedlander, M. L. (2015). Use of relational strategies to repair alliance ruptures: How responsive supervisors train responsive psychotherapists. Psychotherapy, 52(2), 174–179. https://doi.org/10.1037/a0037044
Garrett, M. (2019) Psychotherapy for Psychosis: Integrating Cognitive Behavioral and Psychodynamic Treatment. New York: Guilford Press.
Muller, T. (2004). On psychotic transference and countertransference. Psychoanalytic Quarterly, 73(2), 415-452.
Muran, J. C., Eubanks, C. F., Samstag, L. W. (2021). One more time with less jargon: An introduction to “Rupture Repair in Practice.” Journal of Clinical Psychology, 77(2), 361–368. https://doi.org/10.1002/jclp.23105
Tasca, G. A., & Marmarosh, C. (2023). Alliance rupture and repair in group psychotherapy. In C. F. Eubanks, L. W. Samstag, J. C. Muran (Eds.), Rupture and repair in psychotherapy: A critical process for change (pp. 53–71). American Psychological Association. https://doi.org/10.1037/0000306-003
Yeo, E., & Torres-Harding, S. R. (2021). Rupture resolution strategies and the impact of rupture on the working alliance after racial microaggressions in therapy. Psychotherapy, 58(4), 460–471. https://doi.org/10.1037/pst0000372
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