It’s common for clients to get stuck in therapy. Sometimes a client stops progressing. Other times a client starts backsliding.
Fortunately, clinicians have various effective ways of navigating stuck scenarios. In our monthly series therapists spill the specifics on helping clients move forward.
John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens, talks candidly with his clients about being stuck. Just having such conversations, he said, ignites change.
Over the course of 15 years in practice, I’ve tried a lot of different techniques when I get stuck with a client. Now, I have found a device that seems to shift the dynamic almost immediately. I make the issue overt, and meta-communicate with my client around the stagnation of the therapy.
Effectively, I express my feelings. I might say, “Lately, it feels to me like we’re stuck, and things are not changing, either for you, or in sessions.”
This type of statement alone tends to change the dynamic immediately. You are no longer ignoring the issue, but you moved directly toward it.
I find that stagnation in therapy matches stagnation in life outside the therapy room. So, starting a shift in the room effectively becomes the therapy. In my opinion, few interventions are more effective, and it’s a model a client can use when stuck in most any area of her life.
Deborah Serani, Psy.D, a clinical psychologist and author of the book Living with Depression, focuses on understanding why her clients are stuck. She views these stalemates as stepping stones on the path toward growth and progress.
I’m a psychoanalyst by training, so for me, analyzing why a client is stuck is a meaningful treatment tool.
In the field, this is known as resistance — and the experience becomes a stepping stone that enables us to delve into historical reasons why the client may be blocked, stuck or looping in an emotional holding pattern.
Understanding why resistance is happening leads to newfound insight, which always “unsticks” therapy!
It’s important for readers to know that analyzing resistance is a positive thing, so being stuck shouldn’t always be a red flag. I often tell my clients that being stuck allows us to roll up our sleeves and dig deeper to discover great things.
When he’s stuck with a client, Ryan Howes, Ph.D, a clinical psychologist in Pasadena, California, explores what’s going on between him and his client. Again, just bringing up the issue in session has tremendous benefits, as Howes noted.
The first line of defense against feeling stuck is a strong grasp on theory. Most theories present a way to understand and address the common obstacles that arise all the time. In fact some would say that’s why theories exist – to help therapists know “what should I do next?”
For example, a CBT therapist may return to the list of goals and treatment protocols when they feel stuck, while a dynamic therapist may start looking for the client’s unconscious defenses or their own countertransferrence as obstacles. Comprehensive theories almost always provide someplace else to go with the client.
As a relational psychodynamic therapist, I highly value authenticity, equality, and collaboration in the therapy office. When I feel stuck, I look at it as a relational issue and ask myself what’s happening between us that is bringing our progress to a halt.
Is there a misunderstanding that needs to be addressed? Are both of us here in the room, or are our thoughts elsewhere? On some occasions I’ve simply told the client I feel stuck and invite them to solve the problem with me.
If I’m stuck, we’re probably both stuck, and this gives us an opportunity to tackle the stuckness together. I’ve actually found this strengthens the working alliance, helps the client feel more empowered and invested in the work, and demystifies the therapeutic process.
Jeffrey Sumber, MA, a therapist, author and professor, also considers how he might be stalling progress and creatively examines the effectiveness of his treatment.
When I feel stuck with a client, I rely on C.G. Jung’s premise that a client can only move beyond the places in therapy that their therapist has moved themselves, in their personal work.
First and foremost, I ask myself if there is something I am doing to hold the process back … Am I afraid of any emotion in the room? Am I excited about the client’s journey as I used to be? Am I feeling any underlying resentment toward the client?
Then I begin to look at the treatment from new angles, asking new questions to myself and to the client. I often ask the client how they feel our process is going and what is working and what might not be moving as smoothly as they would like. Sometimes I will ask the client to switch seats with me and role-play client and therapist from our new vantages.
Similarly, Christina G. Hibbert, Psy.D, a clinical psychologist and expert in postpartum mental health, carefully analyzes how both she and the client might be contributing to the stagnation in session.
I always try to pay close attention to how I feel when I’m working with a client. What I’ve learned over the years is that when therapy’s working well it’s a smooth, give-and-take process between client and psychologist. It’s when I start to feel like I’m working harder than my client that I know we have a problem. That’s how I know we’re “stuck.”
Of course, each client is unique and therefore each situation requires a unique approach, but in general, when I feel stuck with a client I first take a “step back” to give myself some perspective.
I try to imagine what might be going on with the client and I question myself to make sure there’s nothing going on with me that is getting in the way of the treatment.
Then, I bring it up to the client. I tell her, “Lately things haven’t been working as smoothly as before. Do you feel it too? I thought we should spend some time today discussing why this might be.”
Discussing it directly allows the client to share insights about her emotions, her experience in therapy, and her experience with me. This helps me understand what the client thinks about being “stuck,” gives me insight into any part I might play in the “stuck-ness,” and almost always helps clear things up one way or another. By confronting the “elephant in the room,” we’re able to get “unstuck” and keep the therapeutic process moving forward.
Joyce Marter, a psychotherapist and owner of Urban Balance, considers how her own concerns are affecting therapy with all her clients. Then, like the other clinicians, she talks directly with her client and raises specific key questions.
First, I will consider my countertransference responses to my client by reflecting on my feelings about the client, on other times I have felt similarly, and recognizing if any of my own issues are getting triggered.
I also consider if other clients of mine are also stuck, in which case I am the common denominator and becoming “unstuck” may need to start with me. I bring any discoveries to my clinical consultant and/or personal therapist to address so that I am best able to help my client.
If I am simply frustrated by the client’s “stuckness” and no other issues of mine are being triggered, I will refer to the teachings of Al-Anon to practice detachment with love, or the ability to stay present with my client without taking on any feelings of powerlessness.
Secondly, I will ask my client how he or she is feeling about therapy, our relationship, the process and his or her progress. I also ask if he or she has ever felt this way or had this experience before, as a way of identifying if this is [a] pattern being unconsciously recreated.
Marter shared how these kinds of conversations in session can spark great insights for clients.
I often find that this process sheds new light on the situation and provides an opportunity to take the therapy to a deeper level by exploring dynamics in the therapeutic relationship. Frequently, this increases the client’s consciousness and he or she is able to experience the therapeutic relationship as a corrective experience.
This was the case with a 45-year-old adult male client who, despite being extremely intelligent and educated at the graduate level, had never established a satisfying career. After we worked through issues related to depression and self-esteem, he seemed to be stuck in therapy.
As we explored this impasse in our relationship, he realized that his family (thinking they were being loving) enabled him to not work by making him a trust fund baby and never pushing him to be independent, which he took to mean he was incapable.
The therapeutic relationship proved to be a corrective experience for him, because we pushed beyond where others had stopped and he was made accountable and responded extremely well to that experience. His confidence soared and his career became more defined, vital and prosperous.
Sometimes, it’s the client’s defense mechanisms that trigger the paralysis, according to Marter. When that’s the case, she uses several techniques.
If the lack of progress in therapy seems related to the client’s defense mechanisms, I will consider using a different therapeutic technique as appropriate. For example, I may use a body-centered approach such as EMDR or a technique that is very collaborative and non-threatening, such as the Internal Family Systems Model.
Alternately, I find the use of CBT to address thoughts that are keeping the client stuck to be extremely helpful in moving through them and establishing new belief systems that encourage positive growth and change.
When a client stops making progress or takes a few steps back, clinicians contemplate their role in the stagnation. They have an honest conversation with their clients to pinpoint the problem. And they work on getting unstuck together.
** Thanks so much to KC, a substance abuse counselor, for suggesting this topic. If you’d like to see a specific topic in this series, email me at mtartakovsky at gmail dot com with your suggestion.