Resolving therapist-client tensions may promote recovery.

Amalgamation of research findings commissioned by the American Psychological Association raises the intriguing possibility that experiencing the resolution of breakdowns or tensions (‘ruptures’) in the therapist–client relationship promotes client welfare even more than relationships with no ruptures. Evidence-based tips are given to help therapists resolve ruptures. Key points from summary and commentary • Commissioned by a task force of the American Psychological Association, this review amalgamated findings relating psychotherapy outcomes to tensions in the working relationship between client and therapist (‘alliance ruptures’) and restorations of this relationship (‘repairs’). • Breakdowns of the therapist–client relationship followed by its restoration were associated fairly strongly with better client outcomes compared to unresolved ruptures or no ruptures. Training therapists to restore ruptures was associated with improved outcomes but not to a statistically significant degree, possible due to the paucity of research. • Links between rupture-repair episodes and outcomes may or may not be causal. Nevertheless, the safest stance is for therapists to assume they are, and to remain alert to ruptures including subtle withdrawals from the therapeutic process and to seek to resolve them