Tension and conflict between a patient and therapist need not be gratuitously disruptive to the process of therapy.

In fact, if handled skillfully, such episodes can shed light on the patient's negative beliefs and actions regarding interpersonal relationships (cf. Layden et al. 1993). This information, in turn, can be used to help the patient make important discoveries, and can inspire him or her to experiment with new adaptive behaviors.

An example:
a therapist noticed that the patient was looking glum, not making eye contact, and sounding a little sarcastic. To explore the meaning of this behavior, the therapist forthrightly said, "Things seem a little tense between you and me today. Did you notice that?" This led to the patient's becoming uncharacteristically silent; therefore the therapist knew that she had hit home. She added, "Can we talk about it? If something is wrong I'd like to try to work it out, if that's okay with you."

Upon further discussion, the patient stated that the group therapy leader (in another setting, though still part of the patient's treatment package) had said something that "he could only have known if he spoke to you." In other words, the patient thought that his individual therapist was saying things about him behind his back to the group therapy counselor. This, in fact, was not the case at all.

The therapist and patient discussed all the possible alternatives to his mistrustful point of view, including the possibility that the group counselor and individual therapist were independently reaching similar clinical judgments about the patient. The therapist added that she would certainly talk to the patient directly about the prospect of sharing information with the group counselor if the need arose.

Then she demonstrated empathy for the patient, stating, "It must have been difficult for you, thinking that I betrayed your trust. I can imagine how disillusioned you must have felt. I'm glad we can set the record straight, because I have enjoyed working with you, and things seemed to be going well until this misunderstanding."

Furthermore, this episode became grist for the mill in that it highlighted one of the patient's characteristic patterns, namely, to jump to conclusions about the ill motives of another person, and then to keep these suspicions to himself.

This would then prevent the possibility of talking things out and resolving or clarifying the matter with the other person and the relationship would deteriorate. It was little wonder that the patient felt he had so few friends, and believed that he could never depend on anyone.

Because the therapist succeeded in uncovering the nature of the rupture in the therapeutic relationship, the patient-therapist alliance was preserved, and an important aspect of the patient's dysfunction became a clinical topic for the session.