Megan Paterson is a licensed Marriage and Family Therapist in Roseville.
Ever had a client who keeps booking appointments and coming in faithfully, but you can’t figure out why? You know, the type of client that makes you wonder, “What are we even doing here?” All of your suggestions, re-directs, and reframes just seem to float in the room and out the window to Neverland. This client seems to be stuck in the same place every week.
If you find this frustrating, you’re not alone. As a clinical supervisor, I often hear about how therapists feel “stuck;” as a therapist myself, I have been here as well. What can you do in such a situation?
1. Go Back: What Do They Want to Have?
Revert to the basics What is the problem? What brought the client to therapy in the first instance? Every client who seeks treatment makes that initial call to you asking for a reason. Keep this in mind when you are in therapy and bring it up. This sounds basic, but it’s so helpful to return to in treatment because it is how we measure progress. Ask the client questions to remind them why they sought services. What are their goals for the future?
2. Double-check: Is the diagnosis correct?
After re-visiting the “presenting problem,” you should double-check the diagnosis. Ask your client about their symptoms, paying particular attention to any that might support or contradict your current diagnosis. Based on the diagnosis, consider what treatment goals and methods are possible.
I have always found going back to “presenting problem” and “diagnosis” to be useful when I notice that “stuck in session” mode reoccurring. It helps me to focus and allows clients to take part in their own wellness plans. It holds clients accountable for their work with you; you are not his/her/their “friend” and this is good boundary to always re-visit without having to straight out say it.
3. Take a look at these questions
Once you’ve clarified the presenting problem and the diagnosis based on the client’s symptoms, here are few questions to ask yourself to help resolve this “stuckness” for both your client and yourself:
- What potential conflicts could this client face if there are changes? Maybe the fear of “change” keeps this client stuck.
- What does this client gain from being “stuck?” Maybe it’s attention or predictability.
- How does this client have trust in their own lives? Explore “trust experiences” with your client. Trust is built in droplets, and if your client has a history of betrayal or lack of trust in relationships, this may be a reason for feeling “stuck.” Address “trust” as a goal and use your relationship of building rapport and trust as an intervention and see if the feeling of “stuckness” reduces.
- Do I offer any containment to allow this client to feel heard?Maybe that is enough to work towards the goal right now.
- Are you, therapist, talking too much in sessions?What would it look and feel if I were to remain silent for a little longer?
4. Ask: Is the Client Ready to “Graduate?”
Remember, if the client is not meeting a diagnosis, then they do not meet “medical necessity” for therapy. This is a good thing for you to communicate to your clients. They might not require therapy! Termination is a good sign; celebrate this phase!
If they aren’t ready to finish their therapeutic work, but you come to realize that you can no longer help them, you have other options that further their interest! Don’t be afraid to refer out or provide “natural supports” options. You can help them connect with their family, friends, or community supports.
5. Keep curious: Consider the value you bring
If your client pays you and books another session, something is probably working even when you mentally label a session as “stuck.” Therefore, pay attention what keeps this person coming back.
You are offering a service, meeting a need for this client, maybe even when you feel like you don’t. Creating space, modeling containment, hearing clients — these are powerful services. A session can have a positive impact on the energy, especially if it is clear that the client is heard and feels safe. Provide safety, build trust, say less, and you will see change in your “stuck” sessions and in your work with your clients. Let go of judgment, get curious about this “stuck” feeling in session, ask questions about “stuckness” — and see what unfolds. Sometimes, if you call the elephant out, it gives you something you can talk about.
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© Copyright 2021 GoodTherapy.org. All rights reserved. Megan Paterson, LMFT, Roseville, California granted permission to publish
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