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This practice-oriented volume helps clinicians recognize, address, and repair ruptures in the therapeutic alliance in CBT. Alliance breakdowns often prompt clients to drop out of treatment, while a strong alliance paves the way for improved outcomes. Although CBT is known for its structured, evidence-based methods, its collaborative nature and relational frame have received comparatively less attention. This book fills that gap by bridging research and practice. Each chapter focuses on a specific clinical population or challenge, weaving together the latest research findings with case examples, therapist-client dialogues, and practical tools in a clear, reader-friendly format.
List of contents
Part 1: General Considerations.- Ch 1: Tracking Tensions in the Therapeutic Relationship.- Ch 2: Time factors in rupture-repair in CBT.- Ch 3: Using confrontation in CBT: how and why to talk about the elephant in the room.- Ch 4: Integrating Motivational Interviewing into Cognitive Behavioral Therapy to Address Patient Resistance.- Ch 5: Immediate and Expressive Rupture Repair Strategies.- Ch 6: Responsively Navigating Breaks in Therapeutic Collaboration.- Ch 7: Rupture Repair and Mindfulness.- Ch 8: Cultural Considerations for Navigating Alliance Ruptures in CBT.- Part 2: Special Considerations.- Ch 9: Therapeutic alliance and rupture repair with children in CBT: Creating better clinical chemistry and catalyzing curiosity.- Ch 10: Alliance Ruptures and Resolutions when Working with Adolescents in Cognitive Behavioral Therapy.- Ch 11: Building Alliance and Repairing Ruptures with Couples and Families: Individual and Systemic Strategies.- Ch 12: Navigating alliance ruptures in group CBT.- Ch 13: Alliance Rupture and Repair in Personality Disorders Characterized by Emotion Dysregulation.- Ch 14: Alliance Repair in Treating Patients Characterized by Overcontrolled Behaviors and Emotions.- Ch 15: Navigating Rupture and Repair with Autistic Clients in Cognitive Behavioral Therapy.
About the author
Dr. Annika Okamoto works as the Clinical Director at Oceanside Clinics in Santa Barbara, California, which is also designated as the regional clinic for the National Social Anxiety Center. She teaches courses in therapy interventions, cultural processes, and community mental health in the Clinical Psychology Master’s program at Antioch University, Santa Barbara. Dr. Okamoto serves as the Past President of the Santa Barbara County Psychological Association for 2025. Her experience includes working in various community mental health clinics such as UCLA-Semel and Harbor-UCLA Medical Center, and working with unhoused, frequently incarcerated, and involuntarily hospitalized populations. Dr. Okamoto brings a relational and trauma-informed lens to her editorial work, grounded in a deep understanding of how emotions, cultural issues, and power dynamics shape therapy and the therapeutic alliance. She is a strong advocate for approaches that are both depathologizing and empowering. Before her career in the United States, Dr. Okamoto led the psychology department at Viljandi Hospital in Estonia. She has worked in mental health settings for over 25 years as a therapist, supervisor, researcher, trainer, and mentor.
In collaboration with the Cognitive Behavior Therapy Research Unit, Dr. Okamoto has published several papers on the therapeutic relationship, alliance, and rupture repair in CBT (e.g., Okamoto et al., 2019, 2021; Impala et al., 2023) and the 2019 article received the APA Top Downloaded Paper Award across all 89 APA journals, out of more than 4,500 articles.
Summary
This practice-oriented volume helps clinicians recognize, address, and repair ruptures in the therapeutic alliance in CBT. Alliance breakdowns often prompt clients to drop out of treatment, while a strong alliance paves the way for improved outcomes. Although CBT is known for its structured, evidence-based methods, its collaborative nature and relational frame have received comparatively less attention. This book fills that gap by bridging research and practice. Each chapter focuses on a specific clinical population or challenge, weaving together the latest research findings with case examples, therapist-client dialogues, and practical tools in a clear, reader-friendly format.
