Q: What should I do when the response to anything I suggest to a client is, "I've already tried that and it doesn't work"?

A: Those moments can feel like you're caught in Chinese handcuffs--the more suggestions you make, the more stuck you and the client feel. Sometimes, a therapist's suggestions aren't so hot--fair enough, we are human. And sometimes clients obstinately resent our attempts to move them out of their problems because they are resistant to change. But more often than not, when clients repeatedly respond to my suggestions with "I've already tried that and it doesn't work," what I hear them expressing is not resistance or criticism of me, but feelings of helplessness and hopelessness about the possibilities for change. Instead of trying to come up with more clever suggestions or getting into a power struggle over their "resistance," I respond to that subtext.

I recently saw a woman in her thirties, Martha, who had gone through a difficult divorce and was having a hard time feeling good about herself again. She came in one day distraught because her mother was planning a visit, and she worried that her dog, an excitable terrier, would misbehave, which would cause her mother to criticize her. I suggested, "Maybe you can try saying, 'Nanu, no barking' and then offer him a cookie as a bribe." Martha said, "I tried that. Nothing works." I said, "Maybe you can let your mother and Nanu work it out between…