中華心理衛生協會

Background: This case study presents a 26-year-old single male who began experiencing symptoms of social phobia 4 years ago, following a sudden ”change-of-heart” by a female with whom a brief romantic relationship took place. Over the course of the long-term therapy, the client gradually overcame his fears of associating with anyone by slowly allowing himself to process about his inner thoughts and feelings with the female therapist. While the therapeutic alliance may be characterized as well-established, the therapist became increasingly aware of the problematic nature of the alliance. Over time, the client appeared to be progressively more dependent on the therapist--the first female who seemed to accept him since his heart was broken. Intervention: The therapeutic task of discussing the boundary issues led to a rupture in therapeutic alliance: The client subjectively experienced rejection by the therapist and responded with withdrawal. The case study illustrates the resolution of the alliance rupture via metacommunication, based on the 5-stage Rupture-Resolution-Model proposed by Safran and Muran (2000). Outcome: The rupture in therapeutic alliance was successfully resolved. Conclusion: The clinical utility of the resolution model requires further examination, however, the present case report offers preliminary support for its use in the resolution of therapeutic alliance ruptures. Treatment recommendations are provided.