Read the case transcript provided below and demonstrate

where, what and how any ruptures in the therapeutic

alliance are being negotiated. Identify the learnt techniques
in the case provided. How could you have used the
techniques learnt differently?

Lata is a 32-year-old woman who sought treatment because of a

general lack of direction in her life, and a difficulty maintaining a
long-term relationship. At the start of the fifth session she announces
that her work schedule is in flux and it will be difficult for her to
schedule regular appointments. Lata is somewhat equivocal about
her intentions regarding whether she can or will stay in treatment.
L: I don’t know if I will be able to come for another session… the time
doesn’t work for me… Could you suggest any names of therapists
who might be able to accommodate my schedule better?
(Withdrawal)
T: I can probably come up with one or two.
L: I hope it’s okay, and you don’t mind?
T: It is completely alright, and you can choose any therapist with
whom you are comfortable. I would want you to do whatever works
best for you. But I guess I’m a little curious and kind of taken by
surprise. Because when we started you were aware that you were
going to be starting a new job.
L: Yeah, but I didn’t know exactly what my schedule would be.
T: Anything else going on for you?
L: No, that’s about it. What would you do if you were in my
situation?
T: I’m not sure, to be frank.
L: Well, I’m only doing what’s right… right for me, anyway.
T: I’m wondering what’s going on for you inside.
L: I’m wondering what you’re thinking.
T: I guess, I’m aware of feeling like I’m being kind of withholding with
you. Does that fit with your experience at all? (Confrontation)
L: Yeah, I guess, a little.
T: Can you say anymore?
L: Well, I’m not sure if you’re really giving me what I need. Maybe
that was true last session as well.
T: I'm glad you're able to tell me that. Would you want to
explain what happened?
L: I don’t know… it’s just that I am feeling frustrated in the therapy…
and that makes me question myself, wondering if I am really giving
things a chance…
T: Alright. Right now, today also, is there a feeling of frustration?
L: At the moment? Yes, I am a little frustrated… but maybe I’m being
demanding.
T: Are you open to exploring your frustration a little more?
L: I don’t know.
T: Any sense of what your reservations are?
L: Well, I wouldn’t want to say something that you took the wrong
way.
T: What might happen if I took it the wrong way?
L: I don’t know… you might take it personally.
T: And what if I took it personally?
L: I might hurt your feelings (long pause and the patient looks
pensive). (silence)
T: Any sense of what you’re experiencing right now?
L: … maybe a little angry.
T: Uh-huh, can you put some of your feelings into words?
L: Why should I have to worry about your feelings? I don’t see any
progress. I guess I want to know what’s going to make me function
better. Like I want you to tell me what it is about me that stops me
from being a functioning person. Why is it that I’m always getting
into these predicaments? I guess I want you to tell me what to do.
T: Okay. So, I’m going to see if I’m understanding what you’re saying.
L: Okay.
T: You can tell me whether or not I’ve got it. You’re saying, ‘‘I want to
know what’s going on… what’s blocking me from doing what I want
to do, or from being happier and more contented.” (Paraphrasing)
L: Yeah
T: And sort of, “I want you to tell me or show me in a way’’…
something like that. Can you say a little more?
L: Basically, I want to hear what you have to say. I mean I’ve given
you the facts, and I guess you know what my insights are. I guess I
want you to wrap it and tell me what you think. (At this point, Lata
makes an emphatic gesture with her hand.)
T: (The therapist mirrors the gesture) When you make that gesture,
what kind of feeling goes with it?
L: I don’t know. It’s like… it’s your show or something.
T: It’s your show?
L: Yeah...you know...the ball’s in your court.
T: Okay... ‘‘the ball’s in your court.” It sounds like it feels like I keep
putting the ball back in your court rather than really taking
responsibility for helping you.
L: Yeah . . . I guess that’s it.