Workshop: Complex Problems and Therapeutic Ruptures

Understanding a client’s difficulties is particularly challenging when, for example, there is more than one diagnosis, or a personality disorder is evident and/or problems are wide-ranging, long-standing and chronic. In such instances it is often difficult to maintain a coherent focus and a consistent approach and it can feel as though we are not able to use CBT skills and knowledge to the client’s best advantage. When we also face therapeutic ruptures in our working alliance, then the challenge is even greater.
Using a case study for illustration, Helen will explain how complex problems can be understood and formulated, and how CBT can be used creatively and productively and how therapeutic ruptures can be resolved. She will draw on the cognitive model to provide a framework for understanding and treating those with complex difficulties and will emphasise that problems are easier to resolve when therapists make use of collaborative formulations, and when they understand how to work with inflexible beliefs and behaviours. Helen will also draw on the work of Safran and Segal (1990), who developed a framework for managing interpersonal ruptures within CBT.
This workshop will build your confidence in understanding clients with complex problems by enhancing your knowledge of:
– Formulating complex problems
– Recognising inflexible beliefs and behaviours

– Deciding where to start and how to get the most out of your CBT skills
– Developing a coherent and consistent approach despite shifting problems
– Addressing difficulties in the therapeutic alliance: resolving ruptures


Safran,J.D., & Segal, Z.V. (1990/1996). Interpersonal processes in Cognitive Therapy. New York:

Basic Books. (2nd ed. Northvale, NJ: Aronson)

Helen has worked in the NHS for over 25 years and in that time gained much experience working with clients with complex problems, particularly those with developmental trauma and relapsing difficulties. She will be using clinical material to illustrate teaching points, and participants will be invited to ask questions and become involved in discussion.