A critical‐cultural‐relational approach to rupture resolution: A case illustration with a cross‐racial dyad

Repairing Cultural Ruptures in Psychotherapy: Strategies to Enhance the Therapeutic Alliance

Ruptures to the therapeutic alliance are an inevitable part of therapy. The ability to repair these ruptures is an essential therapist skill. Racial, ethnic, and cultural differences between therapists and patients can increase the likelihood of rupture to the therapeutic alliance, potentially leading to unilateral treatment termination by patients. Therapists therefore need skills to work effectively with patients who have diverse, intersectional identities. In this article, the authors give therapists tools to help protect against ruptures and to repair ruptures when they occur by integrating three complementary models: taking a stance of cultural humility to decrease assumptions, identifying and directly broaching cultural topics, and implementing a six-stage cultural repair model. A case example is used to illustrate these tools and techniques in practice. These skills can improve collaboration and decrease the inherent power imbalance in the therapeutic relationship.

A Mixed Methods Study of Ethnic Identity and Mental Health Recovery Processes in Minoritized Young Adults

BACKGROUND/OBJECTIVES

Ethnic identity development is associated with positive mental health in young adults from ethnic minority groups. How a sense of belonging and attachment to one's ethnic culture is related to personal mental health recovery remains unexplained. This study examines the experiences of ethnic minority young adults in the U.S. to understand the aspects of culture and identity development that are relevant to their recovery processes.

METHODS

Young adults who were living with chronic mental disorders were recruited from four rehabilitation programs. Interviews produced quantitative and qualitative data. An explanatory sequential mixed methods design was used to integrate the qualitative findings from a sub-group of young adults (n = 44) with the results from the quantitative study. Directed content analysis was used to analyze the qualitative data, and the integrated data were analyzed in joint displays.

RESULTS

The prominent themes characterizing ethnic identity development in personal recovery were (a) cultural history, traditions, and values; (b) mental illness stigma within the ethnic community; and (c) bias and discrimination in mental health services. Young adults with high ethnic identity development reported having more support from family, but they also described experiences with stigma and racism.

CONCLUSIONS

The integrated results suggest that ethnic identity development promotes mental health recovery in minoritized young adults through social support and improved well-being and resilience. Experiences of intersectional stigma and structural racism associated with ethnic identity can interfere with self-determination and access to care among minoritized Hispanic/Latine, Black, and multiracial young adults in the U.S.

Commentary: Rupture repair as a transtheoretical corrective experience

This commentary highlights common principles shared across the diverse clinical case examples featured in this In Session issue on Rupture Repair in Practice. We discuss the importance of therapists recognizing subtle signs of rupture and responding to ruptures with curiosity and compassion. We also consider how therapists can use repair strategies responsively to facilitate a corrective experience for the patient. We explore the ways in which the specific resolution strategy of linking a rupture to larger interpersonal patterns can benefit the therapeutic process, and the ways in which it can constitute a form of avoidance. We conclude by noting promising future directions and celebrating the generosity evidenced by these insightful authors' willingness to share and explore challenging moments in therapy.

One more time with less jargon: An introduction to "Rupture Repair in Practice"

In this introduction to this issue on Rupture-Repair in Practice, we present our understanding of alliance ruptures using common language to appeal to all theoretical orientations. Specifically, we define withdrawal movements away from another or oneself (efforts towards isolation or appeasement) and confrontation movements against another (efforts towards aggression or control). In addition to these interpersonal markers, we suggest that therapist emotional experiences can be considered as intrapersonal markers indicating rupture. We emphasize understanding ruptures as relational phenomena. Then we present various pathways toward rupture-repair, highlighting renegotiation of therapy tasks or goals and exploration of patient and therapist contributions and needs. We explain how these paths can be understood as critical change processes that can transform obstacles in treatment into opportunities. We finish with some mention of our alliance-focused training for self-development. This issue represents an important step towards demonstrating the transtheoretical and practical potential of rupture-repair.