hardtherapeutic alliancerupturewithdrawalmetacommunicationalliance repairpsychotherapy process
A PMHNP has been providing psychotherapy to a 44-year-old man with persistent depressive disorder for three months. The patient previously engaged actively in sessions, completed homework assignments, and reported gradual improvement. Over the past two sessions, however, the patient has become noticeably more withdrawn, gives brief one-word answers, has not completed his thought records, and states that therapy 'probably isn't going to work for me anyway.' When the PMHNP asks what has changed, the patient shrugs and says, 'Nothing. Everything's fine.' Which of the following best describes what is occurring and the most appropriate therapeutic response?