Release time: 2023-07-25 16:48
What to Do When Therapy Stalls
How to address a lack of progress with clients.
KEY POINTS
Therapists need to adeptly address the lack of progress in therapy when it occurs.
There are specific ways you can re-engage yourself and your client when therapy stalls.
Learning to deepen the therapeutic process and get clients engaged helps move therapy forward.
A recent conversation with colleagues left me pondering all the ways the therapeutic process can “stall,” or reach a time when there’s no real progress being made and the interactions sink into directionless exchanges.
Four Ways Therapy Can Stall
The client covers the same material in their sessions, without developing new insight or depth. Devika keeps circling back to recounting how awful her ex-husband was to her, repeating her list of grievances and bolstering her case against him.
The client "reports" on their week, offering stories or details without relevance to a deeper process. Spencer began therapy wanting to learn how to have a successful relationship and tends to start his sessions with a review of his week’s activities: “So, I got together with my buddies, Randy and Arsenio. We did some climbing and then I got home late, so I called Joey...” (There’s nothing inherently wrong with details, but when a client focuses solely on details and stories, there might be little therapeutic progress.)
The client says they want things to be different, but they continue to make the same choices. Marisol states she wants to be more independent from her parents, but consistently accommodates their needs by putting her plans on hold.
The client ignores their contribution to the issue, focusing on the other person(s) and seeing them as the problem. LaTisha wants her husband to help more around the house, but she’s not noticing how her need to control and critique his efforts contributes to his lack of participation.
As therapists, we play a pivotal role in our client’s skill development, and directly addressing the “stall” when it happens is crucial, regardless of how uncomfortable or challenging it might be. Most of us notice when progress stalls. It can be awkward and leave us uncertain about how to handle it. But ethical practice requires us to address the underlying patterns and unconscious avoidance that might be driving the lack of progress. As soon as we notice that therapy feels stalled, we want to get re-engaged and anchored more deeply in whatever it will take to shift things, so our clients benefit and progress.
The primary antidote to therapeutic stall is to focus on deepening the process. This deepening can happen in many different ways, but when therapy stalls, I immediately start to focus on where I’ve let the process and the client (and myself!) become less engaged.
Ways to Respond to the Therapeutic Stall
Bring a much more direct challenge or confrontation to the conversation, rather than simply supporting or "understanding" the client’s process. For instance, instead of "understanding" Devika’s need to repeat how awful her ex-husband was, I might deftly direct her attention to how she saw herself contributing to the marriage’s demise and challenge her to get curious about what she would want to do differently in future relationships.
Speak about the truth that's not being spoken. While it’s easier and more comfortable to keep talking about his week, you could help Spencer squarely face his initial concern: “I’m really lonely for a relationship, and I’m afraid I don’t know how to do it.”
Help the client face the two-choice dilemma they're in. (Perhaps they’re stalling and hoping they can find a third choice). Marisol’s two-choice dilemma: She can stay enmeshed with her parents and face the cost of that enmeshment or stand up for her independence and face their disapproval or disappointment. It’s likely there’s no “third choice” where Marisol claims her independence and her parents react positively.
Enlarge the context of the issue at hand. LaTisha has the opportunity to face the larger context of her patterns, such as how her need to control and critique shows up in other areas of her life, and what its unconscious value might be for her.
Any of these will intensify and deepen the level of the therapeutic process. Other options for addressing the stall might include a change in focus or a different therapeutic modality. And most clients (to be honest) are aching for someone to help them process more deeply. Often, clients simply don't know how to do this; they learned a thousand ways not to do it. They have their own resistance to it because it’s scary to forge into new emotional/psychological territory.
And yet, one of us has to have the courage to say, "Let’s talk about what you're up against a little differently."
The point is that in order to stay therapeutically engaged, we have to find a way to address the stall—if we ignore it, the client loses the opportunity to truly change their lives by addressing habitual patterns of avoidance. As we help them engage more deeply, the client has the opportunity to learn how to challenge themselves more deeply, and that’s an emotional skill that will serve them for a lifetime.
Elizabeth Heaney, MA, LPC, maintains a private practice in Asheville, NC, working with individuals and couples. Drawing on four decades of clinical experience, Elizabeth also provides case consultation and clinical training for therapists.
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