Re-establishing contact: A qualitative exploration of how therapists work with alliance ruptures in adolescent psychotherapy

Abstract

What challenges do therapists face when they experience ruptures in the working alliance in psychotherapy with adolescent clients; and what are their most typical strategies when they try to re-establish contact? These issues were explored through qualitative interviews with nine psychotherapists from outpatient child and adolescent psychiatric clinics in Bergen, Norway. A descriptive and hermeneutically informed phenomenological approach was used to analyse the interview transcripts. Most therapists/participants described that they would explore the reason for the rupture from the adolescent's point of view, and all participants often understood ruptures in light of the adolescents’ need for autonomy. However, the participants differed strongly in how much they would focus on the relationship per se, on intrapsychic factors, or on the adolescent's life outside therapy. For the therapists who regarded the relationship as something to be explored, client ambivalence to treatment was seen as something that could be confirmed and validated. If not, ambivalence seemed more likely to be handled as a choice situation. Therapists who explored ambivalence also tried to develop ways to talk about fluctuations in the adolescent's motivation and distress, and often interpreted ‘not wanting therapy’ as a way of communicating difficulties with the relationship.

Keywords:

• Therapeutic alliance
• ruptures
• adolescence
• psychotherapy