When therapy
gets it wrong.
The repair mattered more than the mistake.
Ruptures in therapy, how they happen in disability-informed trauma work, and what repair involves beyond an apology.
What this is: a guide to ruptures, accountability and repair.
Why it matters: in trauma work, a therapist’s mistake can echo earlier harm.
The sharpest reframe: withdrawal is often the first sign of a rupture, not disengagement.
One thing to take away: an apology without change can feel like a repeat.
The short version
Therapists get things wrong: a technique that doesn’t fit, an interpretation that lands as blame, an access request forgotten, a letter written about someone without them. In trauma work, mistakes can echo earlier harm. Psychotherapy research describes these moments as ruptures in the working alliance, and finds that repairing them is associated with better outcomes. A trauma-informed repair goes beyond an apology: it acknowledges the impact, takes responsibility without defensiveness, and changes something. And it accepts that sometimes repair isn’t possible, and the right outcome is a good ending and a referral.
You might recognise this
Illustrative statementsDrawn together from common experiences. They are not quotes from individual people.
Ruptures and repair
Established theoryJeremy Safran, Christopher Muran and colleagues describe ruptures as breakdowns in the collaborative relationship between client and therapist. They distinguish withdrawal ruptures, where the client moves away, goes quiet, agrees too readily or stops coming, from confrontation ruptures, where the client expresses anger or dissatisfaction directly.
Research finding In a 2011 meta-analysis, Safran, Muran and Eubanks-Carter found that rupture-repair episodes were associated with better outcomes, in a small number of studies (three studies, 148 clients). Training therapists in rupture resolution showed a small advantage over control conditions. Recommended practice includes noticing signs of rupture, inviting clients to voice negative feelings, responding non-defensively, and taking responsibility for one’s own contribution.
How ruptures happen in disability-informed trauma work
Our frameworkAccess forgotten
The room, lights, interpreter or session length agreed last time, not provided this time.
The body misread
An impairment interpreted as trauma, or a technique that assumes a body the person doesn’t have.
Pressure
Being pushed towards memories, exposure or a pace the person didn’t choose.
Records and letters
Something written about the person, or shared, without their knowledge.
Rules applied without thought
A cancellation fee during a flare, an attendance policy that ignores fluctuating health.
Withdrawal mistaken for disengagement
Missing sessions or going quiet read as lack of motivation, rather than a sign something went wrong.
Proinsias is 29 and autistic. He asked his therapist to turn off the overhead lights; she forgot the next week, and he left halfway through. Her letter to his GP said he had “disengaged from treatment”. He saw it in his records months later. He stopped going without saying why.
Proinsias is a fictional teaching example, not a real person.
What repair involves
Our framework- Notice. Withdrawal is often the first sign. Missed sessions and quiet agreement deserve curiosity.
- Invite. Make it easy to say what went wrong, including in writing or through someone else.
- Acknowledge the impact, before explaining the intention.
- Take responsibility for your part, without defensiveness.
- Change something, visibly: practice, records, policy. An apology without change can feel like a repeat.
- Accept the person’s decision, including ending. A good ending, with a referral if wanted, is a form of repair.
What it might sound like
(by email, after Proinsias stops coming) I think I let you down. I forgot the lights, and I described you as disengaged in a letter, when the problem was the room. I’m sorry. If you’d like to tell me how that was, in any way, I’d like to hear it. If you’d rather stop, I’ll correct the letter either way.
(by email, a week later) Correct the letter. I might come back. The lights need to be off before I arrive, not after.
I’ve written to your GP correcting it, and I’ve copied you in. I’ve put the lights in your notes as a standing arrangement. Would you like to try one session?
What changes: the GP letter is corrected, and the therapist changes how she writes letters: drafts now go to clients before they are sent. Proinsias thanks her for the correction and decides not to come back. He asks for a referral to someone else, and she makes it. He says the corrected letter mattered more than the apology. The therapist doesn’t treat his leaving as a failure of the repair: the repair was for him, not a way to keep him.
When repair isn’t possible
Our frameworkSometimes the harm is too great, or trust can’t be rebuilt. Then the trauma-informed response is to accept that, offer a referral, make any records accurate, and make complaints routes clear and accessible. Clients shouldn’t have to manage the therapist’s feelings about the ending.
What needs attention here?
The client goes quiet or stops coming
Possible focus: the possibility of a rupture
Watch for: reading it as disengagement
The client says something went wrong
Possible focus: the impact first, then responsibility
Watch for: explaining the intention first
An apology has been made
Possible focus: what will change
Watch for: treating the apology as enough
The client wants to end
Possible focus: a good ending and accurate records
Watch for: persuading them to stay
Possible starting points, agreed with the person, not rules.
How you’d know it helped
- The client could say what went wrong, in their own way.
- Something concrete changed.
- Records are accurate and the client knows what they say.
Words you can use
For clientsQuestions worth carrying, as a therapist
Therapist Reflection- Have I mistaken withdrawal for disengagement?
- When I apologise, what do I change?
- Would this client know how to tell me I got something wrong?
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
The disability-related sources of rupture and the repair steps are this site’s synthesis.
Proinsias and the emails are constructed for learning. He is not a real person.
We have not located research on alliance ruptures over access needs in therapy with disabled clients.
Last reviewed: October 2026.
How to cite this page: Donaghey, C. (2026). When Therapy Gets It Wrong. Disability in Psychotherapy. Available at: https://disabilityinpsychotherapy.online/what-is-psychotherapy/trauma-informed-approaches/when-therapy-gets-it-wrong/ (Accessed: [date]).