Is Getting Stuck the Beginning or the End?
Your clients come to you with high hopes to eliminate or at least reduce the deficit from which they are suffering. So what do you do when a client stops making progress in therapy and it seems like your sessions are going nowhere? While it’s a common problem, understanding and support, while welcome, just won’t do it. You need effective strategies to get things back on track.
The first thing to remember is that It’s important to be able to talk candidly to your clients or their parents about diminished progress. While you may find these conversations to be awkward, being able to do so is definitely a skill that becomes sharper the more you practice it. And your clients will ultimately appreciate that you’re in tune with their needs and wishes. Fortunately, clinicians have several ways of navigating stuck scenarios.
The 5 Keys
1. Staring at the Elephant in the Room
John Duffy, Ph.D., a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens, talks quite openly with his clients about feeling 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 almost any area of her life.”
2. Defang the Fears of Change
While clients seek therapy with the intent of making changes in their lives, actually making those changes can often seem scary or daunting. But the relief will only come from confronting the fear that appears to be an obstacle. This confrontation often becomes the catalyst to more substantive change and progress.
Therapy usually stalls because there is some internal conflict regarding confronting whatever that is or realizing the goal. As a therapist, you need to acknowledge to the client that you recognize things are stalled, and inquire as to what seems to be causing the problem. If the client seems apprehensive, offer reassurance that this is normal and create the necessary comfort for the client to voice those fears.
3. Explore the Deeper Roots of the Problem
Therapists concur that those internal conflicts that stand in the way of change are oftentimes rooted in a prior emotional trauma of the client. However, it is unlikely that the client will connect that prior experience to the current problem.
Many people, even when they know that a certain belief, behavior, or relationship pattern is irrational, nonetheless will continue with well-worn patterns that seemed to have worked thus far despite recognizing that they aren’t working. The therapist must understand that the impasse in therapy may have nothing to do with the therapy being delivered but is rather a wall constructed by the client’s current emotional reality.
4. Rededicate yourselves to your Shared Goals
For example, a Cognitive Behavioral Therapist (CBT) often finds that returning to the list of goals and treatment protocols when forward movement is halted will be helpful. By accentuating the fundamental objectives laid out at the beginning of the therapy, therapists can often reignite the process itself. The agenda of the therapist and client need to “sync” together again.
When sessions move away from this baseline, it isn’t always so obvious or explicit that the client and therapist may be traveling down different paths. However, oftentimes the client’s nonverbal cues will let the therapist know that the appealing initial goal has been touched upon and that his/her motivation has been triggered once again.
Don’t wait for the client to give voice to the deviation from goals. Clients often feel awkward criticizing the therapist, who is perceived to be the expert. And so, they look to their therapist to set the agenda for any particular session and may not feel comfortable voicing their hesitation about moving forward. What’s more, clients sometimes blame themselves for the lack of motivation to follow or for falling short of their goals.
You can cut right through this by reading the client’s body language after restating a goal; it will be immediately revealed that you have hit on a goal that is really motivating. When you’ve moved into the zone of an appealing goal, the client will become more animated, the facial expressions will broaden, and you will have a client who is participating with more vigor and enthusiasm.
5. Engaging and Transforming Resistance
Deborah Serani, Psy.D, a clinical psychologist and author of the book Living with Depression, focuses on understanding why her clients are stuck. Rather than seeing these “stalemates” as hurdles, she sees them as “stepping stones” along the path toward growth and progress. As she puts it, “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”!
In essence, she flips the “problem” of being stuck on its head. As Serani sees it, “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.”