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When Therapy Is Going Nowhere - Page 3

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Rather than escalate my efforts to break through with this couple, I did my “let’s evaluate our work” protocol, which led to a consensus about how therapy had progressed. We agreed that they’d learned to work as a parental team, with their son functioning better for it, and our sessions had given them insight into their marital issues, but without much change on that front occurring at home. I said that a plateau in therapy after good initial work is common, and that it gives us a chance to decide what to do next, including ending our work for now. They seemed relieved that I didn’t expect them to manufacture energy for changing their marriage. Earlier in my career, I might have increased my efforts to avoid failure and, as a result, bestowed a sense of failure on them. Instead, after one more session, we finished up with our heads held high.

These “Where are we now?” conversations don’t always mean an end to treatment. Sometimes they lead to reinvigorated therapy, as was the case with a woman who’d come to see me in crisis after a divorce. In the beginning of our work, she’d learned how to cope with her ex-husband and kids and to avoid some of the land mines in the divorce process. Gradually, however, I began to get the sense that I was serving more as a trusted confidant than a therapist. She mostly wanted to talk about the ups and downs of her week, along with routine complaints about her ex-husband. After we reflected on her progress and the plateau in our work together, she said she had more issues to focus on and wanted to continue our therapy to work on them. I then asked her the questions I put to all clients who say they want to continue: “What are your priorities for the next phase of our work? What do you feel a sense of urgency about?”

With these questions, I signal that I want a new contract if I’m going to sign on for another phase of therapy. In this case, since she’d reentered the dating world, the new contract was to work on finding a way for her to have both connections and boundaries in close relationships, and I was able to help her avoid her tendency to overinvest and then cut and run.

Of course, these conversations don’t always go this smoothly. Sometimes clients’ fears of abandonment and worries about making it on their own will surface. Fortunately, the emergence of these emotions can allow real therapy work to begin again, providing a new focus on issues of loss and autonomy.

Other times when trying to move from a plateau, it takes a while for the conversation to play out and a conclusion to be reached. In the case of a multiyear therapeutic relationship, for example, I may introduce the conversation, but suggest that we reflect on it over time by saying, “I’m not looking for any quick conclusion on this, but it’s good for us to keep track of where you are with what you came here to work on, and where we seem to be going now.” The idea here is to broach the subject while signaling that there’ll be no lurches or quick unilateral decisions. If the conversation is moving in the direction of ending therapy, I always indicate that we’re deciding on “stopping for now,” explaining that the door is open if clients want to come back for more work in the future.

My attitude is like that of a music instructor whose client has learned the basic scales and a few songs and is satisfied with that progress for the time being. I celebrate the gains and fully accept the client’s decision to put his or her energies elsewhere. We both know that there’s room for improvement, perhaps the potential to master Rachmaninoff, but that now isn’t the time. There’s no harm, no foul in taking a time out, even a permanent one.

This approach relates to Andy Christensen’s Integrated Acceptance model of couples therapy, which includes two phases: one geared toward helping couples change, and one geared toward helping couples accept what’s not likely to change. As psychiatrist David Burns points out in his recent Networker webcast “Motivating the Anxious Client” and his other work on motivation, when a therapist and client agree that not much is changing in therapy and the therapist accepts this reality and the reasons for it without trying to “sell” more change, the client is often paradoxically remotivated to change.

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