When we disagree
or get it wrong.
She said I was resisting. The taxi was late.
Disagreement, ruptures, repair and referral in pluralistic therapy, and the mistakes therapists commonly make with disabled clients.
What this is: a guide to disagreement and repair in therapy.
Why it matters: repairing ruptures is linked to better outcomes.
The sharpest reframe: check access before reading lateness as resistance.
One thing to take away: apologise briefly, and change something.
The short version
Therapists and clients disagree, and therapists get things wrong. In pluralistic therapy, that isn’t a failure of the approach. Disagreements are part of working out what helps, and ruptures in the relationship can be repaired. Research suggests that repairing ruptures is linked to better outcomes. For disabled clients, common mistakes include misreading access problems as psychological ones, and pushing a method that doesn’t fit. This page looks at how to disagree well, how to repair, and when referral is the right answer.
You might recognise this
Illustrative statementsDrawn together from common experiences. They are not quotes from individual people.
Disagreement is part of the work
Established guidancePluralism doesn’t mean doing whatever the client asks. Pluralistic guidance is clear that therapists can, and should, offer their own expertise. That means there will be times when therapist and client see things differently: about a goal, a method, or what is happening.
Our frameworkDisagreement handled well can be useful. It can show the client that they can push back without losing the relationship, and it can stop the therapist from quietly overriding them. The key is that it happens in the open, and that the client’s view carries real weight.
Ruptures and repair
Research findingA rupture is a strain or breakdown in the collaboration between therapist and client. It can be open, such as a complaint, or quiet, such as going along with things, missing sessions or saying less. Safran, Muran and Eubanks-Carter (2011) reviewed research on repairing ruptures. Across three studies, rupture-repair episodes were associated with better outcomes (r = .24). A later meta-analysis by Eubanks, Muran and Safran (2018), covering 11 studies and 1,314 patients, found a moderate association between repairing ruptures and better outcomes (r = .29). Evidence that training therapists in rupture repair improves outcomes is less clear. These are associations: they don’t prove that repair itself causes the improvement.
Éanna is 29 and uses a wheelchair. He arrived late to three sessions in a row. His therapist wondered aloud whether the lateness meant something about his feelings towards therapy. Éanna went quiet, and cancelled the next session.
When he came back, the therapist asked what had happened. Éanna said the accessible taxi company gave him a two-hour pickup window, and he’d left early every time. He had felt accused. The therapist apologised clearly, without explaining themselves at length. They agreed that on days when transport was unreliable, sessions would move online. If Éanna arrived late in person, they would use the time left, and the therapist would say at the start what that was, because another client followed at the hour.
Éanna is a fictional teaching example, not a real person.
Common ways therapists get it wrong
Our frameworkMisreading access as psychology
Lateness, missed sessions, fatigue or silence read as resistance or avoidance.
Persisting with a method
Explaining why it’s good, instead of hearing that it doesn’t fit.
Over-focusing on disability
Making everything about it, when the person came about something else.
Under-focusing on disability
Ignoring barriers, pain or discrimination that really matter.
Being too accommodating
Avoiding a disagreement that needed to happen.
Not every quiet is a rupture
Going quiet, missing sessions or seeming flat can signal a rupture. It can also be fatigue, pain, illness, medication, a bad week, or an access problem. Ask, without assuming either way.
How to repair
Our frameworkNotice
Look out for quiet signs: less talk, more agreement, missed sessions, lower energy. Remember these can have other causes too.
Ask
“I wonder if something I said didn’t sit right. Would you tell me?” Offer other routes, such as writing.
Take responsibility
Apologise clearly for your part, without a long explanation that puts the focus back on you.
Change something
Repair that changes nothing is just words. Sometimes the right change is helping the person move to another therapist, and doing that well is a repair too.
Check later
Ask again in a few sessions whether things feel different.
When referral is the right answer
Established guidanceNo therapist can offer every method. Pluralistic guidance says that knowing what you can and can’t offer, discussing it openly, and referring on when a client wants something outside your resources, is part of good practice.
Our frameworkReferral should be explained, planned with the client, and never used to end a difficult relationship without saying so. For disabled clients, check that the place you refer to is accessible.
What it might sound like
Last time, I suggested your lateness might mean something. I think I got that wrong. What happened?
The taxi gives me a two-hour window. I leave early every time.
I’m sorry. I made an assumption, and it wasn’t fair. What would make this easier?
Online when the taxi’s a mess. And don’t make it about me.
Agreed, both.
What changes: transport stops being a source of tension, and Éanna later says it was the apology that made him come back.
What needs attention here?
A client goes quiet
Possible focus: asking whether something went wrong
Watch for: carrying on as normal
Lateness or missed sessions
Possible focus: asking about access first
Watch for: interpreting it as resistance
You made a mistake
Possible focus: a clear, brief apology and a change
Watch for: a long explanation
The client needs something you can’t offer
Possible focus: an explained, planned referral
Watch for: stretching beyond your competence
Possible starting points, agreed with the person, not rules.
How you’d know it helped
Two different questions: whether the work is going well, and whether it is actually helping.
Is the work collaborative and accessible?
- Disagreement happens openly.
- Mistakes are named and something changes.
- Referrals or endings are explained, planned and accessible.
Is it helping with what matters?
- The person gets help that suits them, here or elsewhere.
- A rupture doesn’t leave lasting harm.
Words you can use
For clientsQuestions worth carrying, as a therapist
Therapist Reflection- What do I assume when a disabled client is late or absent?
- How do I respond when a client disagrees?
- Am I too accommodating to disagree when I should?
- Do I know where to refer, and is it accessible?
Evidence & sources
Sources checked in October 2026, using targeted searches rather than a systematic review. “We have not located” means our searches did not find it.
Safran, J. D., Muran, J. C. & Eubanks-Carter, C. (2011), “Repairing alliance ruptures”, Psychotherapy, 48(1), 80–87. doi:10.1037/a0022140.
Eubanks, C. F., Muran, J. C. & Safran, J. D. (2018), “Alliance rupture repair: A meta-analysis”, Psychotherapy, 55(4), 508–519. doi:10.1037/pst0000185.
On offering expertise, not doing whatever the client asks, and referring on: “Frequently asked questions on the pluralistic approach”, pluralisticpractice.com.
Cooper, M. & McLeod, J. (2011), Pluralistic Counselling and Psychotherapy. London: Sage.
The common mistakes, the repair steps and the guidance on referral for disabled clients are this site’s synthesis.
Éanna and the dialogue are constructed for learning. He is not a real person.
Bowie, C., McLeod, J. & McLeod, J. (2016), “‘It was almost like the opposite of what I needed’: A qualitative exploration of client experiences of unhelpful therapy”, Counselling and Psychotherapy Research, 16(2), 79–87. doi:10.1002/capr.12066. Unhelpful episodes were marked by an absence of negotiation, collaboration and care.
Our targeted searches did not find studies of ruptures and repair designed around disability, or reporting results by disability.
Last reviewed: October 2026.
How to cite this page: Donaghey, C. (2026). When We Disagree or Get It Wrong. Disability in Psychotherapy. Available at: https://disabilityinpsychotherapy.online/what-is-psychotherapy/pluralistic-psychotherapy/when-we-disagree-or-get-it-wrong/ (Accessed: [date]).
Shared under CC BY-NC 4.0, with an extra permission to teach from it on fee-paying courses. Credit the site. See Reusing This Material.