Five Strategies for When Therapy is Stuck

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 therapy goes wrong, it’s typically because we’ve entered our clients’ negativity 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?

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. 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.

The Judgment Trap

Are you or your clients distracted and distressed by judgments about their problems?

As if having bad feelings weren’t bad enough, many clients criticize their bad feelings, making them feel even worse. “You shouldn’t feel bad!” “You’re being a silly goose about this.” “Can’t you be a man and ‘suck it up’?” Any judgment adds yet another layer of trance, distancing clients even further from their problems and any possible solutions.

Whenever a client describes his or her feelings as “bad,” it can be useful to point out that these feelings are effectively good. Like pain or the trouble light on your dashboard, they signal that something needs attention. Clients who don’t have these feelings might fail to heed the underlying issue and suffer further consequences. People born without pain receptors continually damage their bodies because they lack vital feedback. Even just changing a description from “bad” to “unpleasant” can redirect attention from trying to eliminate the feeling—as addicts and many others do—to solving the problem that causes it.

Escaping the Tyranny of Language

Are your communications directed too much toward clients’ conscious, verbal understanding and too little toward their unconscious responses?

It’s easy to get caught up in consciously describing or discussing a problem, thinking mistakenly that this will help solve it. But if you direct your attention only or mainly toward clients’ words, you’re usually wasting your time, because the most relevant information is being communicated in voice tone, tempo, movements, facial expressions, posture, breathing, and other unconcious means. One of my teachers used to say, “Verbal report should be treated as unverified rumor, unless accompanied by nonverbal confirmation.”

It can be useful to approach therapy as a process similar to training an animal. You can still employ words, but only to use your own nonverbal behavior—voice tone, tempo, facial expressions, hand gestures, and so forth—to elicit new and different responses. If you want a dog to get excited, you must get excited yourself, speeding up the tempo and amplitude of your movements and raising the pitch of your voice. If you want the dog to calm down, you need to speak softly and slowly. People really aren’t that different. If you aren’t getting a useful response from a client, you can either wait for it to occur naturally—which could take a long time!—or you can vary your behavior until you succeed in eliciting it.

The Power of Presupposing and Implying

Are you offering explicit messages that would be more effective if you presupposed or implied them?

A skill too often ignored by therapists is the ability to use language in ways that unconsciously elicit nonverbal responses and create sudden shifts in feeling and attitude. For instance, read the following two sentences, and notice the difference in your response:

“You may find it easier to imagine this with your eyes closed.”

“You may find it harder to imagine this with your eyes open.”

Logically, those sentences are completely equivalent; however, the first one presupposes that the task will be easy and the second one presupposes that it’ll be hard. Most people don’t consciously notice the difference, but they’ll tend to respond to the first instruction with ease and the second with difficulty.

Therapy is widely described as “the talking cure,” yet clinicians are seldom taught even the rudiments of linguistics, the study of language itself, so they don’t learn how to detect and use presuppositions and implications in a directed way to elicit specific behavioral responses.

Is It Time for a Joke Break?

Have you and your client fallen into the grim trap of terminal seriousness?

Unhappy people, singlemindedly engrossed in their own misery, often regard themselves and their predicament with deadly seriousness. Jokes and humor have the power to surprise and unbalance people, popping them out of their negative mindset without threatening their comfort level. Humor is an unparalleled trance-breaker because, by its nature, it changes the perspective and alters attention.

A joke is one of the best, most enjoyable, ways to change a client’s (and your own) state to one that’s more playful and experimental. You can use almost any excuse to introduce one: “I heard a joke this morning, and it’s on my mind. If I don’t tell it to you, it’ll interfere with focusing on my work with you.”

Putting It Together

When you remember that the experiences that cause feelings are important—rather than the feelings themselves—that judgments are useless distractions, and that the mostly unconscious, nonverbal exchanges, presuppositions, and implications embedded in your communication are powerful means of promoting change, therapy can become a much more liberating experience for you and your clients. But even more important than that is the understanding that your clients, no less than you yourself, are hypnotists who weave a spell in the therapeutic hour. The difference between you is that the success of therapy typically hangs on your ability to demonstrate more skill and awareness in using the trancelike qualities of human communication to move beyond the tunnel vision that can stall therapy and prevent change and healing from taking place.

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