Why Therapy Clients Get Stuck (and What to Do About It)

Lisa Marie Bobby: It is the worst feeling, isn’t it? I’ve been there having a client on the other side of the room. You’re sitting on one therapy couch. They’re sitting on the other and there’s. Stuck. They know they’re stuck. They’re frustrated because they’re stuck. They’ve been talking about things for a long time, weeks, maybe months, possibly longer, and they really don’t wanna be stuck anymore, and they’re looking to you to help them figure out a way forward.

And in these moments it can be incredibly anxiety-provoking for us as therapists because we too want to see them progress and grow and move forward and sometimes have tried everything that we know how to do to help them get unstuck and on their way and for whatever reason, it’s not working. Our clients feel bad.

We feel bad and it happens pretty often, I would say. And that’s what we’re gonna be talking about on today’s show because for us therapists, I. This is a common experience. We’ve all been there. And I think that by addressing this and really diving into why clients get stuck and what we can do to help them start moving forward again.

Is really important. It’s important for our clients, but it’s also important for our own personal and professional wellbeing because it’s such a common pain point. I previously recorded episodes in this series around why you can’t stop thinking about your client after your therapy session ends.

And, I think that it’s our clients that get. Stuck and we’re not quite sure why we don’t know how to help them. Those are the clients that we wind up thinking about after the session ends because we’re still like trying to close the loop. We’re trying to solve that puzzle of what’s going on here, what can I do that I haven’t done?

What is there something else happening? And just trying to figure it out because our clients trust us to help them create change and we. Our caring people, we are here to serve. We chose this challenging, yet rewarding profession as therapists because we really do care and we want to help people. We have empathy for them, and I know we care so much about our clients as people, not just as our clients.

And so to be in this position and not really know where to go or how to keep moving forward is a painful place. And again. Virtually every therapist experiences this on the reg, unfortunately. And I know this in addition to being your host here on the Love, happiness, and Success for Therapist podcast, I’m the founder of Growing Self-Counseling and Coaching.

It’s a group private practice that I founded a long time ago. And over the course of that, I’ve served as our clinical director. I’m also a clinical. Supervisor, but I’m also a colleague. Most so many personal friends that are therapists, right? A part of a consultation group. And this is a subject that routinely comes up, can I talk about my client that’s stuck?

Yes, let’s do it. And so that’s what we’re talking about on today’s episode because this is probably a pain point for you too. And so I just wanted to talk through this and hopefully put some helpful ideas in front of you that can. Support your personal professional development and long-term career satisfaction as a therapist.

’cause that’s why we’re here. So let’s just dive in. As we said, this happens and I think what contributes to it is that. Therapy, it’s always a dance, right? We’re dancing with vulnerability and strength and this pursuit of self-acceptance, yet also a pursuit of self-development, and there can be a lot of tension in these.

Spaces, right? But it’s also needs to be a safe space where our clients are always opening up, feeling safe enough to really, unpeel the onion. They’re seeking transformation when they start with us and that’s always the hope. I think that fuels their journey. And like with any journey, there can be these.

These twists and turns, like we can start, we can go backwards, and that can contribute to these feelings of being stuck because growth isn’t linear and there is always this duality, this dance, this need for insight and for action, for going back before we can go forward. And depending where we are in this process, it can feel.

Slow for us and for our clients. And there are also other reasons why clients can experience feeling stuck and genuinely be stuck, that are important for us to have visibility into so that we can manage it for them and for ourselves so that it’s productive long term. So one of the things that we should talk about to understand where stuckness can come from is potentially I.

We have started working with a client that we aren’t really the right growth partner for, and this can be a difficult thing to wrestle with or to accept. Let’s have a little redo there. This can be a difficult thing to wrestle with and to accept because we want to do a good job. And I think it can tie into feelings of shame or perfectionism or not being good enough if we can’t be all the things to all the people. But, I’ve had this experience myself and even starting with the therapy client and it’s productive and we’re doing great work and then.

It shifts. Maybe they have a different circumstance in their life that they need help with that, that I’m not really well qualified to help them address. I. For example I have worked with clients in the past. My area of expertise is relational work divorce and breakup recovery. I also enjoy doing career coaching.

That’s fun for me too. And have engaged with clients who maybe I worked with them very successfully. Fully for one chapter. And then I’ve had people come back and want to work with me again and they have presenting issues in this new chapter that maybe I think I could help with. So for example, like a substance use.

Disorder. I know for a fact and I wouldn’t even try to do substance abuse counseling with somebody who had a very serious problem because I’m, I am not a licensed addictions counselor, and I don’t want to practice outside the scope of my expertise, so that would always be a referral. But, I have started working with clients of like more mild things that they wanna work on.

And have had that, they’re stuck not because of their willingness or desire to change or willingness to do the work but ’cause of my own, lack of expertise in the kinds of models and methods that would move them forward. I think there’s a space for healthy humility in this, and it can be a great idea to get consultation or even to do some journaling like what’s going on here, to get that self-awareness that can help you decide if, the reason why we’re stuck is because that’s a signal they.

They should be working with somebody else. If you wanna learn more about that or think more about that, I recorded a previous podcast on this topic on when to let clients go. That dives into many different elements of when sometimes it’s important and honestly ethical to redirect clients for various to various reasons.

So I hope that supports you there, but. In my experience also that is relatively rare as a cause of like really why clients are getting stuck. I think a very common, an important underlying cause of stuckness can actually be related to expectations. And this is a big word. This is carries a lot of weight, right?

But we may have expectations as therapists and our clients may come into this whole experience with different expectations about how this works, what should be happening, what we should be doing, what they should be doing. Then we do. And I think the reason why this is so hard, they may not be aware of their expectations.

We may not be aware that their understanding of how this works and what should be happening is different from ours unless we are having a overt conversations about it. I think that. We therapists are so intimately familiar with the art and craft and practice of what we do. It is baked into the bread.

You are probably a very strongly psychologically minded person before you decided to get your master’s degree because that’s why you did go get your master’s degree. Like you had that in you and. I think that because of that our professional experience, our training, like we understand this stuff inside and out, but also I think have such a natural a tendency and understanding in these areas.

I. Sometimes I think we miss the degree to which our clients do not understand this process or the things that for us can seem really obvious. So for example, it is very common to have a client, particularly if there’s their first time in therapy, who do not know how this process works. How therapy works, and that will contribute to their stuckness if they don’t know and we’re not talking about it.

And that is one of the easiest and most important things that we can always be doing as therapists, is to create a lot of clear communication around. How this works, what our role in this process is, and what their role in this process is. And really, I think accepting the valid responsibility that, that we are the process guides and it is our job to explain what therapy is.

What it isn’t, how it works, why it works, and to be having these open, honest conversations about our clients hopes and needs and goals and on a regular basis, revisiting these topics, not just in the beginning but throughout the therapeutic journey so that, they’re not just dropping in and talking to us and then like leave, leaving again.

It’s as that we. Be like, here’s a map, here’s where we are on the map, here’s where we’re going on the map. Here’s what’s gonna happen in between. Here’s my job, here’s your job. And then if we do these things, this is how things change. Don’t assume that people understand what you understand. So clarity is the key in therapy to keep your clients from getting stuck because they really do need to understand what’s happening, what their role is, what is required of them, if they want this to work.

And again, that in order for us to provide this clarity, we need to be clear. Our case conceptualization and have a solid understanding of what the problem is, how our theoretical orientation guides our understanding of, okay, now what has to happen in order to shift this. And also, being very clear in our guidance with our clients and clear in our expectations of them and of ourselves.

The probably second biggest reason that I have seen for therapists and clients experiencing stuckness in the work. The first being that clients don’t really understand what they’re supposed to be doing, and nobody’s talking about that out loud, is that. Therapists themselves are not clear. And I say this as a, consultation partner.

As a clinical supervisor, when I say, okay, this client is stuck, articulate your case conceptualization for me. What’s the problem through the filter of your theoretical orientation? Go, sometimes I get this deer in the headlights look because the clinician on the other side hasn’t really put.

The time and the energy and the thought into figuring that out for themselves. So not only does the client not have a map. The clinician does not have a map. And so as we all know, just talking about things doesn’t change anything for anybody. That’s why it’s so important to have a solid theoretical orientation that is evidence-based, that has, structure to it.

And also be making sure that we have a clear case conceptualization. And I’m not talking about a treatment plan. That’s the stuff that goes in the case file for the insurance companies. That’s not. Usually valuable to really creating the kind of clarity that we need to help people move forward.

So if you’re thinking about a client that’s stuck, that means that there is either not understanding on the client’s part or not understanding. On the therapist part, and I say this with love and as somebody who has been here many times, and this is why it is so important for us to be continually doing our own growth work, our own professional development work, continuing education, being in supportive practice environments that challenge us to be our best and also to provide us with opportunities to work through this.

To have trusted emotionally safe colleagues that you respect to be able to say, can I talk to you about this client that I’m feeling stuck with? And just like having the opportunity to talk through can help you create that clarity in your own mind or help you know your client, your colleagues’ perspective, crystallize that case conceptualization.

I bet that’s what it is, so that you can then continue thinking about that and construct a map that you and your client can begin following together. So that’s a really important part of this process. And if you don’t have that kind of professional community in your life, consider getting one because I think it’s so difficult to do this kind of work in isolation.

We all have blind spots and everybody, myself included, is very vulnerable to just coming to the limits of what we can see. And we really need to be supported and encouraged to, bring it together, get other people’s perspectives in order to create our own clarity. So consider that. Then when it comes to having clarity on both sides, um.

The therapeutic process, the way it works, as we know, it’s a partnership. It is a collaboration. We can’t do the work for clients. Of course, clients need to be actively involved. Nothing that we say or do is going to. Magically change something for them. And so clients also need to understand what’s required of them, both inside the therapy room and outside of the therapy room in terms of their active participation in that process.

And again, part of our responsibility is now that we have a map in hand, helping people understand what is actually required when it comes to doing the work. Another reason that I have seen clients and clinicians feel very stuck is because a clinician is with very good intentions using an approach that is not the most helpful approach for that particular client’s needs and goals.

Sometimes this can mean shifting into a different modality. So for example, I’m an MFT. I love doing couples counseling and my go-to is emotionally focused couples therapy. I love it. It makes so much sense to me, like a whole attachment thing, huge fan. And I get stuck sometimes with couples where I, and I try to assess this before jumping in, but.

Assuming that they’re going to benefit from EFCT and they don’t, they actually would benefit from a much more structured, direct, overt approach. For example, the Gottman method. I need to shift my approach in response to who this client is. Flexibly instead of continuing to do the same thing that doesn’t seem like it’s working.

And also acknowledging that with clients and just having that conversation. Different people need different things. There are so many different ways to do this work, and I think what we’ve been trying so far, the approach isn’t really getting you the results that you want. It doesn’t seem to be creating the outcomes.

What we’re looking for. So let’s try something different for a little while. Are you open to that? Because of course, I mean your clients, that’s what they want too. And so people are always receptive of this, but just be prepared to talk about your rationale. And so here’s what will be different going forward.

Here’s what we need to do to put these things into motion. But just again, a lot of clarity, a lot of guidance in these situations. It is also true, and I’ve seen this many times that, um. A therapist will be engaged with a client. Going back to expectations like with this expectation, what this client needs and wants is therapy.

So traditional talk. Therapy insight oriented. We’re connecting the dots, we’re peeling the onion, we’re like putting all the things together. When in fact a client does not really need or want that. But, a client coming in doesn’t know how to articulate specifically the modality that they want.

Right? That’s our job to help assess and then guide that. And this is particularly true for high functioning clients who are really here to figure out. What’s getting in the way of their being able to create better outcomes in different domains of life and if those are the goals. Coaching is a much more effective model because they don’t need to keep talking about stuff.

They really want to be having different experiences and getting momentum and having different outcomes. And therapy is not made for that. That is not what. What therapy is intended to do therapy is for the purpose of healing. It’s for mental health treatment. It is not for, creating a lot of change in people’s lives necessarily.

And so I again, have had many conversations with very well-meaning therapists who are very excited about doing therapy and it is what they know how to do. Um. And not really realizing that what they’re trying to do with clients is not the vehicle that will create change with these clients.

And so they need to change their approach, not just, between modalities, but from therapy into coaching in order to have a more productive outcome. And so that’s one of the reasons why I’m such an advocate for therapists becoming well versed and credentialed in high quality evidence-based coaching, psychology, and systems and methods.

Because when we apply a coaching framework to a client that has been stuck in therapy, they can oftentimes make a lot more progress than they could with just continuing to talk about it. Yeah. So if you have any clients that you’re thinking about right now where they have all the insight, but still nothing’s changing, that might be a clue that coaching would be a more appropriate model.

So that could be an opportunity to refer them to a therapist who practices coaching or. Consider, becoming certified as a coach yourself, you have such a strong foundation already in all of the core components of, coaching psychology is based on counseling psychology. It’s not a totally different thing, it’s just a different framework, a different way of applying what we already know how to do through a coaching.

Process that is just has different intentions that the purpose of coaching is just different than the purpose of therapy. So I think that’s something that’s really important to think about and to consider and to maybe have that conversation with your clients. Lastly, there is one more thing, and this is one that can really fly under the radar and be difficult to see, which is.

That we can also have especially long-term clients who engaged with us for therapy, for the purpose of creating change. And because of the relationship itself have developed an attachment to us. That they’re having a really important and significant relationship with us. We might be the only emotionally safe person in their lives, right?

And so if we’ve run out of road in therapy, or if they do all the growth work, make all the changes are. Whatever they came here to be, that would by definition mean the ending of the relationship because this is a professional relationship. It’s a real relationship, but an ethical therapy relationship means that we’re here for a reason.

They’re not paying us just to have conversations with them, right? We’re here. We’re here to support their. Therapy process and. The reality is that we may need to address that with certain clients. A client’s attachment to us and fear of losing us can create an obstacle to their progress in therapy. So one of the things we should always be talking about with our clients is that one of the goals I think of most comprehensive therapy particularly in these situations, is assisting our clients to develop.

Supportive and emotionally safe relationships with people outside the therapy room. And this goes back to ethics, to not be doing that and addressing this means that we are. Cultivating a level of dependence on us that is not good for people long term. But also even just in being able to have positive outcomes from therapy itself.

So to be having open conversations about this, helping clients create structural changes that can support their transference. So some of that emotional dependence from you to other people can then actually create more space for them to do the work that they need to do in therapy. So that can be a delicate topic, but of a very real and important one to broach.

We’ve covered a lot. We talked about ethical considerations. How to be asking ourselves if it’s okay to keep seeing a client if they’re not making progress. Different reasons why clients can get stuck. Their expectations. Our expectations. A lack of transparency. Sometimes a lack of clarity.

Sometimes, using a different approach than the one that would be most helpful and needing to shift, but also the relational factors that can create that. That gridlock, right? So I hope that just talking through these was helpful for you. And if you had any moments of recognition or if you have other thoughts to share things that you’ve become aware of in your work with clients around that stuckness issue, I would love to hear about them.

And I hope you join the conversation. You can come visit with me on Facebook, on Instagram, on LinkedIn. Be sure to look for the growing self Instagram, Facebook, and LinkedIn account. That’s where I’m keeping the stuff for us, for our therapist work. So that’s all available for you. You can also come to my website, growingself.com forward slash therapist.

I have all kinds of free articles, podcasts, playlists for you that I’ve made for you that go into different aspects of the things that we’re talking about today. And additionally put together an assessment quiz for you called how to Flourish and Thrive as a Therapist. And if you take this, you’ll get some visibility into your own growth opportunities and the things that would probably.

It’d be most beneficial for you to start working on first in order to reclaim your joy in our shared profession. So I’m so glad we spent this time together today, and I’ll be back in touch with you next week with another episode of Love, happiness, and Success for Therapists. Talk to you later.