Repairing Ruptures

“Repairing ruptures” is how neuropsychiatrist Dan Siegal describes the essential process of resolving conflict in partnerships. Working through conflict, we apply all our partnership skills.

The Role of Humility in Repairing Ruptures

You can only rebuild something that was built in the first place. Repairing ruptures, or fractures in the relationships, and restoring trust suggests you have already done the work to establish trust. When conflict arises or harm is done in the working relationship with families, we return to our humility by:

1. Acknowledging the rupture, your contributions, and the impact of your contributions — no matter the timeline
   • “It’s been on my mind, AJ, that in our last meeting with you and your husband, he did most of the talking about your behavioral health goals, and that is not ok.”

2. Apologizing with meaningful context and sincerity
   • “I apologize I didn’t interrupt this while it was happening. It was only when I looked at my notes that I realized the plan we mapped out was based mostly on your husband’s ideas.”

3. Making room for the family to share the impact on them
   • “I wonder if you feel frustrated with me and reserved about continuing to invite your husband to these meetings. How are you feeling?”

Moving Past Ruptures: Return to Commonalities

By the time the rupture or conflict arises in the partnership, you have likely identified commonalities in the partnership. After responding with humility, emphasize the commonalities — or common ground — to move past the rupture. Shared interests between individuals, families, and behavioral health providers typically include:

1. Wanting to share and apply expertise
   • “We all want to share our ideas to support you, AJ.”

2. Wanting the individual and family to recover
   • “You, AJ, and your recovery goals are central in this relationship.”

3. Wanting to maintain a positive, productive relationship
   • “It’s important this partnership is an effective support for you and you feel you’re making progress that’s yours.”

On Negotiating Attractive Options

‘Attractive options’ are potential, creative solutions that are appealing to all members of the partnership. Negotiating options involves:

1. Merging interests: combining priorities
   • “You are hopeful to start intensive outpatient (IOP) support in the near future, and your husband also hopes you’ll get effective support.”

2. Compromising interests: adjusting or shifting priorities
   • “You’re hopeful to start intensive treatment without any change to your work schedule; your husband is worried that might be too much, and I wonder if you might be worried about the time commitment, too.”

3. Changing perspectives/reframing: revising or reframing priorities
   • “Could we look at the time commitments for both to understand both perspectives?“

As you move forward negotiating options, it’s critical to make sure all members of the partnership are part of moving forward.

All Together: Humility, Commonality, & Attractive Options

Below are a provider’s words acknowledging the rupture and inviting a path forward in the behavioral health plan.

“It’s been on my mind, AJ, that in our last meeting with you and your husband, he did most of the talking about your behavioral health goals, and that is not ok. I apologize I didn’t interrupt this while it was happening. It was only when I looked at my notes that I realized the plan we mapped out was based mostly on your husband’s ideas. I wonder if you feel frustrated with me and reserved about continuing to invite your husband to these meetings. How are you feeling?

“We all want to share our ideas to support you, AJ. You, AJ, and your recovery goals are central to this partnership. It’s important this partnership is an effective support for you and you feel you’re making progress that’s yours. You are hopeful to start intensive outpatient (IOP) support in the near future, and your husband also hopes you’ll get effective support. You’re hopeful to start in intensive treatment without any change to your work schedule; your husband is worried that might be too much, and I wonder if you might be worried about the time commitment too. Could we look at the time commitments for both to understand both perspectives?”

Your 1-2-3 Summary:

1. Naming differences and commonalities strengthens partnerships.
2. Humility is central to resolving differences and fractures.
3. Negotiating options is a health-promoting pathway to common ground.