7 Questions to Ask When Therapy is Stuck
By Steve Andreas
When therapy goes wrong, it’s typically because we’ve entered our clients’ trance, joining them in their myopic misery. Once there, our job is to break the spell, broaden the vision, and open ourselves to possibilities outside the tunnel.
We’ve all had moments, sometimes entire cases, when the therapy seems stuck, our wheels spinning in the mud, unable to get any traction. Nothing we say breaks through the client’s dogged negativity, convinces her to take even a small step forward, or gets her to look more directly at her own self-destructive behavior. At these times, the tightness in our bodies can lead to thoughts like “Is this why I went through years of graduate school? Maybe I should get a job as a Walmart greeter!”
When clients get immersed in their problem, they often suffer from a kind of tunnel vision, focused on a small range of experiences, with their bad feelings taking center stage. It’s a state that resembles a hypnotic trance: a limited, intense, internal focus of attention. When therapy gets stuck, one way of moving it forward can be to think of clients as being in a troublesome trance induced by parents, caregivers, and difficult life experiences. They’re trapped in what Buddhists call maya, the world of illusion.
When therapy goes wrong, it’s typically because we’ve entered our clients’ trances with them, joining them in their myopic misery. In this mutually reinforcing state, neither client nor therapist can see beyond the small, cramped space of the stalled interaction. Focused entirely on the bad feelings generated by the problem at hand, we lose our capacity to use our skills to expand life’s horizons, oblivious to other possibilities for change—other ways of thinking and responding.
Once caught in such a trance, we need to break the spell, broaden our vision, and open ourselves to possibilities outside it. These goals may present a formidable challenge, but meeting it can be easier than you think, particularly with practice. To determine whether you are, in fact, in a trance when treatment has stalled, ask yourself the following questions, and consider the added suggestions for mobilizing your—and, more importantly, your client’s—capacity for more creative thinking.
The Feelings Trap
Are you focusing too much on the client’s feelings and too little on the triggers that elicit them?
Your client comes in, depressed as usual and totally miserable. She’s in a time warp: as far as she’s concerned, she’s always been depressed, will always be depressed, and, much of the time, feels herself to be depression incarnate. Or your client is angry much of the time, walks into every session with a chip on his shoulder and a show-me attitude. Session after session of this can wear you down: feelings are contagious, and it’s easy to catch the bug your client is carrying. When a client is in thrall to anxiety, sadness, fear, anger, or self-loathing, it can be hard for either of you to focus on anything else.
Many of us have been taught to focus on exploring clients’ feelings. That’s what therapists do, isn’t it? Of course, it’s important to know what the pertinent feelings are, validate them, and, if clients are puzzled about them, dissect their distinctive meanings. However, rather than continuing to circle around the bottomless drain of feelings, it’s usually useful to find out what’s causing the feelings and intervene there.
So the first principle of moving stuck therapy along is to recognize that feelings aren’t an ultimate reality, but just important signals, much like the warning lights on a car’s dashboard. What’s important isn’t the light itself, but what causes the light to go on. If the oil light in your car refuses to go off, there’s no point in studying the light; you need to put oil in the engine and see whether the light goes off. Clients’ feelings are useful signals offering you instant feedback about the effectiveness of therapy, but your interventions themselves need to be directed elsewhere.
One woman I saw had been in therapy for more than a year exploring her unhappiness with nearly every aspect of her life. When she walked into my office for the first time, her tense and pained face, her shallow breathing, and her slumped shoulders announced her misery before she’d said a word. After sincerely acknowledging her quite obvious distress, I took a more objective “scientific” attitude of curiosity. How did it happen that she was dissatisfied about everything? I asked. Was she a perfectionist with such high standards that the real world couldn’t meet them? Or had she just been having incredibly bad luck?
A little exploration revealed that she had a terrible way of making decisions. Even a decision about what to order for lunch in a restaurant became an ordeal in which an anxious internal voice said, “What are other people having?” countered immediately by another voice, saying in an annoyed, critical tone, “No, think for yourself!” followed by unpleasant feelings of frustration and self-dislike. These voices continued to argue until, when she felt bad enough, a third voice would say, “Choose anything; it’ll be better than this!”—leading her to choose at random to end the agony of indecision. Since random choices almost never fit her real preferences or values, she was usually unhappy with them.
I first taught her a more effective way of making decisions that were in alignment with her preferences. I rehearsed her in imagining picking out a meal, a dress, and a movie that would satisfy her tastes and give her pleasure, emphasizing an internal voice asking, “What would I like?” She was still unhappy with many of the decisions she’d made previously, but now she had an effective way to review them and extricate herself from them and the bad feelings associated with them.