When Therapy Stalls: The Questions to Ask

This Is Part II in a Series.

In a case consultation, therapist Radha admits she’s unsure how to engage Eddie, who started therapy six months after the death of his wife of 33 years. Eddie’s first couple of sessions focus on his tearful admission of how lost he feels. But as therapy continues, Eddie tends to report on his daily life without any mention of the grief.

In a different case consultation group, David brings up his sessions with Melissa, saying he’s unsure how to direct the conversation. Melissa complains about her partner and co-workers, asks David for advice on how to handle situations, and then doesn’t put the advice into practice. He feels stuck in a listening to her complain dynamic.

In both of these situations, clinical progress has stalled and the therapists are being challenged to find ways to re-engage and re-focus their clients. Radha worries that asking Eddie to focus on his grief will be too much; David is concerned that Melissa will leave therapy if he challenges her tendency to blame others.

How do we challenge ourselves as therapists in these moments? How do we face the internal tensions and hesitations that are part of inviting clients into truly uncomfortable moments? How do we make sure our hesitations don’t thwart the real depth a client might need to face? The dance of therapy includes moving between layers of intensive heart work and lighter conversation, a skillful blending of comfort with challenges. Keeping our eye on the depth of our sessions reinvigorates therapy when it seems stagnant.

In a previous post, I focused on dynamics from the client’s side that would contribute to the experience of stalling. When turning the lens around to consider dynamics from the therapist’s side of the process, there are patterns that contribute to a lack of progress or lack of depth on that side, too.

These questions might be a way to engage yourself when therapy stalls.

• Who is responsible for progress in therapy?

This is a great question to start with when sharpening your skills for engendering progress with clients. Do you think you are responsible, or do you see the client as responsible for their own progress? While you can’t take responsibility for the changes outside of sessions, do you hold yourself responsible for the changes that might happen during sessions? Do you think the responsibility is mostly theirs, mostly yours, or shared?

• Do you hold yourself responsible for the level of presence, attention, focus, and challenge you bring to sessions?

Regardless of who you see as responsible for progress, how do you think of the responsibility for your level of interacting with clients? Do you have ways to monitor this, evaluate it, and make changes? And do you have ways in which you sincerely attend to this layer of responsibility every session?

• Do you ever consider: what percentage of my clients improve?

What percentage stays about the same? What percentage leaves therapy without real change? It’s useful to keep our fingers on the pulse of our success or lack of success in helping clients change. I encourage therapists to move away from thinking in terms of good-bad judgments; they can simply take stock, over and over again, and know where they stand in terms of clinical effectiveness.

• Are you willing to tolerate discomfort in the service of asking pertinent questions or bringing up uncomfortable topics?

A client’s progress might be limited if you aren’t willing to face your own discomfort. How can you get more skilled in tolerating the tension that’s an inherent part of deeply challenging a client? Can you grasp that you are, literally, teaching them to tolerate their discomfort for the sake of growth in their hard emotional work?

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• What am I not saying?

When therapy begins to stall, there’s always something the therapist isn’t saying or asking. It might be helpful to simply ask yourself: What am I not saying to this client? What are you holding back from asking, observing, or inquiring about?

All of these questions point to the deep engagement on the therapist’s part, requiring the therapist to hold a certain amount of pressure on themselves; clinical progress requires therapists to be highly engaged, perceptive, and adept in each session so the client reaps the greatest growth and insight.

Engaging with any of these questions 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; in fact, they learned a thousand ways not to do it. But coming home inside themselves means they need to learn to access internal places and truths they might tend to avoid.

Think of “stalling” as showing you the precise place to dial into your hesitations more adeptly, to consider all that’s to be gained from bravely asking more of yourself as a therapist—breaking new ground and inviting your client into new territory within themselves.

This is Part II in a series.