Even the very best of therapists have situations when therapy clients are stuck. For some therapists, there might be a pattern of clients not improving.
Before you jump to questioning whether you chose the wrong profession or start thinking you’re a bad therapist, there are a few things to assess first.
To assist you, I have some strategies you can use when you notice that your therapy clients are stuck and not improving. Hopefully this prevents this pattern from repeating in your practice.
Clients Stuck? It Might Not Be You!
We’ve all had at least some scenarios when our therapy clients are stuck, even if they’re committed and continuing to come to therapy.
It can be really easy to jump to believing that either we’re not competent as a therapist. Or sometimes we blame our clients.
But I’ve found that, most of the time, it is a bit more nuanced than that. I dealt with this quite often early in my career, but this issue rarely comes up for me at this point.
I don’t believe that the primary explanation for this change is that my clinical skills have improved such that the therapy helps clients improve better and faster.
But the fact is, my clients do improve better and faster. There are a few things I believe I could have easily implemented earlier on to minimize how often I found myself stuck seeing clients week after week with minimal improvement.
4 Strategies To Prevent Having Stuck Clients
1) Know your Wheelhouse (and your limits)
- Rather than taking on any client who is willing to work with you, select clients who fit in your niche. You are going to be more excited and equipped to work with clients who are in your wheelhouse (and they’re more likely to enjoy working with you more too!).
2) Communicate That Work Is Involved
- I used to make the mistake of making it sound like I would help make it easy for potential clients. This puts clients in a passive mindset while they wait for us to “fix” things. They grow disappointed and resentful of the therapy process because it doesn’t work. And we just wind up burning out as we work far harder than our clients while getting no results.
- Clearly communicate to potential clients that the hard work of therapy comes from them, and we are their guide walking alongside them.
- I like to think of our work as similar to that of sherpas. Just as sherpas guide climbers up a mountain, we as therapists can support our clients by setting them up for success, helping them decide what routes make sense, and serving as a companion on their journey. But ultimately, we don’t carry our clients up Everest. They have to do the actual hard work on their own.
Okay, so those tips may help minimize the chances of having a therapy client that is stuck, but what do you do if you’re already in this situation with your client right now – you’ve been meeting for some time and they are just.not.improving?
3) Ask Yourself: When Did Something Feel Off?
- Ask yourself if there was a point in the therapy process when you noticed things just didn’t seem to be working. Oftentimes, it dates back to the initial contact or phone screening. We just get that “vibe” that something is not quite right.
- Sometimes our clients’ needs shift over time and after we’ve helped them through their initial goals, things don’t seem to be improving on secondary goals. Try to pinpoint where you noticed that happening with your client.
- Making a mental note of when things got off track can help you do things differently the next time you find yourself in a similar situation with a client. Remember to stay in your wheelhouse and stick by your gut.
4) Observe Aloud To Your Client
- You can take an approach that aligns with your treatment style, but you want to acknowledge the lack of improvement in some form, and invite your client to problem-solve with you.
Example Of How to Name the Problem Out Loud:
| Client | Therapist: Dr. Marie Fang (me!) |
| Therapy client is stuck | “We’ve been meeting for a few sessions and I know when we first met you asked for help with [fill in the blank]. I’m wondering how you feel things are going with that goal?” |
| Client seems oblivious to the pattern of no change | I might gently state what I’ve observed and take a collaborative approach to problem solving. For example: “When we first met, I recall you wanted to reduce how many panic attacks you experienced during meetings at work. It sounds like, overall, you’re still experiencing just as many panic attacks as you did before. Does this sound right to you?” Then: “I wonder if there’s something we might like to change about our approach in order to be more helpful to you?” You can invite them to give direct feedback about what they thought therapy would be like, what they might have expected from you, and any potential roadblocks they’ve come across. |
| Client acknowledges therapy is harder than they realized | I would have a conversation about what kind of work therapy entails and whether they want to reconsider if therapy is something they want to invest their time, energy, and money into right now. If my clients go this route, I validate just how challenging therapy is. I like to tell clients that I assume for every person who has made the effort of reaching out to me and arriving in my office, there are dozens of others who are too uncomfortable to even acknowledge that they need help. And that what they’ve done already is huge. |
Don’t Stop There
There are other tools you might consider using, such as motivational interviewing and other evidence-based tools.
I do suggest that you seek consultation when you find your clients aren’t progressing, as a fellow professional or two should help you see the situation more clearly and offer solutions you may not have thought of.
And most importantly, the fact that your client isn’t improving does not mean you’re a bad therapist. And it doesn’t mean your client is a bad client. But it is an important item to address right away as soon as you see it come up.
To aid you further, I have a video where I dive deeper into the top tool for helping clients who are stuck.
Until next time, from one therapist to another: I wish you well!
-Marie
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