J. Christopher Muran - Therapist performance under pressure negotiating emotions, difference, and rupture

Over the past 30 years or so, we have seen a marked shift in academia toward providing more autobiographical insight (see N. K. Miller, 1991, for an early call in this regard). Accordingly, here we would like to get personal and provide some context to our respective approaches to the subject that we address in this book.

For 3 decades, I have been studying ruptures in the therapeutic alliance. Ruptures are disagreements in the collaboration between patient and therapist, deteriorations in their emotional bond, and breakdowns in the negotiation of their respective needsas well as their respective identities (Muran, 2019; Safran & Muran, 2000). This focus was founded on the research demonstrating the predictive validity of the alliance (Flckiger, Del Re, Wampold, & Horvath, 2019), with the ultimate aim of providing more insight for the clinician on how the alliance functions, especially when things go awry, which we have demonstrated is quite often (Eubanks, Muran, & Safran, 2019). I began this professional journey in 1989, when Jeremy Safran hired me as his postdoctoral fellow at the Clarke Institute of Psychiatry, University of Toronto. A year later, I took on directorship of the Psychotherapy Research Program at Beth Israel Medical Center (now Mount Sinai Beth Israel) and invited Jeremy to be a principal consultant. Our collaboration flourished with numerous initiatives (supported in part by grants from the National Institute of Mental Health). Our work attempted to integrate principles from the psychoanalytic, cognitive-behavioral, and humanistic traditions, including findings from contemporary research on cognition and emotion. Arnold Winston and Lisa Samstag played critical roles in our efforts to study ruptures and their relevance for improving treatment success. Over the past 12 years, Catherine Eubanks (with her interest in therapist experience and development) became pivotal in helping us refine our approach to training therapists to resolve ruptures, and she helped me to further my thinking and focus on helping therapists negotiate difficult moments marked by rupture and manage their emotions under pressure.

During this time, my wife, Elisa, and I had a son, Andy, and I found myself spending every free moment with him, playing the role of fathercoach. By this, I mean beyond the usual responsibilities and challenges of being a father, I also tried to coach him in his various athletic pursuitssomething that is not typically recommended (and by and large, I would agree with this). I comanaged his Little League and travel soccer teams, and I coached him on the U.S. Squash junior circuit. Coaching him in squash was a unique challenge: In this individual sport, you can coach the player between games, and often Andy was facing a player coached by a paid professional who had a world ranking. My own background was that I captained varsity tennis and squash in college (a culmination of my junior years in competition), but whatever success I had was part of another era and modest by todays standards. Trying to help your son between games, in the heat of the moment, is no small feat: We had exchanges that no father and son should have; we also had brilliant moments (and Im happy, proud, and relieved to say that Andy was recruited by and became a highly ranked college athlete at Cornell Universityand most important, we have remained very close).

At some point, these father-and-son experiences struck me as remarkably comparable to experiences I had in training therapists to negotiate their emotions and skills in the face of rupture events. My reading of the developing literature on performance science only reinforced this recognition. My professional path intersected with my personal path. Some might wonder why it took me so long to realize this, why I kept them separate or thought they were. (The answer, like many things, is complicated.) This book is a product of this intersection.

When Chris invited me to join him on this book project, I accepted eagerly. I cannot lay claim to the kind of athletic career Chris hadthough mine did have enough of an impact on me that I still experience an anxious anticipation when I smell fresh-cut spring grass and can almost feel the high school track under my feet as I wait for the starter pistol to fire.

I began collaborating with Chris and Jeremy more than 12 years ago, and in that time I have developed a deep appreciation for their approach to understanding alliance ruptures. In many ways, it feels as if I fell into this work. Thanks to the wise and impactful teaching of my mentor, Marv Goldfried, I was introduced to Chris and Jeremys theoretical and empirical contributions to the psychotherapy literature during graduate school. I then had the opportunity of being supervised by Chris during my clinical internship at Beth Israel. I enjoyed working with Chris, so when he invited me to stay on in a postdoctoral fellowship, I agreed; I began collaborating with him and Jeremy on alliance research, and essentially never left.

Looking back, I hope that my path to a career as an alliance rupture researcher was not simply inertia on my part but rather that I found something that resonates with me. Chris and Jeremy approached alliance ruptures and therapist performance under pressure in a way that felt different and, dare I say, therapeutic for me. Befitting my upbringing as a young woman from the American South, I entered this research collaboration well acquainted with an idea of grace under pressure as the appearance of seamless perfection. Chris and Jeremy introduced me to something radically different: the idea that our clinical misfires have the potential to be transformational, that a therapy with ruptures might end up yielding a better outcome than a seamlessly smooth one, that we can admit and own our vulnerability with curiosity and compassion rather than being paralyzed by shame. This is a different way of thinking about grace under pressurenot grace as ladylike perfection but more akin to the kind of grace I hear about on Sunday mornings.