by Megan Paterson, Licensed Marriage and Family Therapist in Roseville, California

5 Tips for Helping a Client When You’re Both Stuck

Ever had a client who keeps booking appointments and coming in faithfully, but you can’t figure out why? You know, the type of client that makes you wonder, “What are we even doing here?” All of your suggestions, re-directs, and reframes just seem to float in the room and out the window to Neverland. This client seems to be in the exact same stuck place week after week.

If you find this frustrating, you’re not alone. As a clinical supervisor, I often hear about how therapists feel “stuck;” as a therapist myself, I have been here as well. What do you do in this situation?

1. Go Back: What Do They Want?

Go back to the basics! What is the presenting problem? What brought this client into therapy in the first place? Every client who seeks therapy makes that initial call to you for a reason, seeking a change. Keep this reason in mind and bring it up in session. This sounds basic, but it’s so helpful to return to in treatment because it is how we measure progress. Ask questions to remind the client, why did he/she/they seek services in the first place? What is the change they are looking to experience?

2. Double-Check: Is the Diagnosis Right?

After re-visiting the “presenting problem,” you should double-check the diagnosis. Ask your client what symptoms they are experiencing, giving particular attention to what might validate or undermine your current diagnosis. Reconsider what treatment goals and methods you can develop and implement based on the diagnosis.

I have always found going back to “presenting problem” and “diagnosis” to be useful when I notice that “stuck in session” mode reoccurring. It helps me focus, and it allows clients to participate in their own wellness plan. It holds clients accountable for their work with you; you are not his/her/their “friend” and this is good boundary to always re-visit without having to straight out say it.

3. Consider: Mull Over These Questions

Once you’ve clarified the presenting problem and the diagnosis based on the client’s symptoms, here are few questions to ask yourself to help resolve this “stuckness” for both your client and yourself:

1. What conflicts could arise for this client when change occurs? Maybe the fear of “change” keeps this client stuck.
2. What does this client gain from being “stuck?” Maybe it’s attention or predictability.
3. How has this client experienced trust in their life? Explore “trust experiences” with your client. Trust is built in droplets, and if your client has a history of betrayal or lack of trust in relationships, this may be a reason for feeling “stuck.”  Address “trust” as a goal and use your relationship of building rapport and trust as an intervention and see if the feeling of “stuckness” reduces.
4. Am I providing containment for this client to feel heard? And maybe that in itself, right now, is working towards the goal?
5. Am I as the therapist talking too much in session? What would it change if I remained quiet a bit longer?

4. Ask: Is the Client Ready to “Graduate?”

Remember, if the client is not meeting a diagnosis, then they do not meet “medical necessity” for therapy. This is a good thing to communicate to your client. They might not need therapy! Termination is a good thing; celebrate this phase of therapy!

If they aren’t ready to finish their therapeutic work, but you come to realize that you can no longer help them, you have other options that further their interest! Don’t be afraid to refer out or provide “natural supports” options. Help them connect with friends, family, and community supports.

5. Stay Curious: Reconsider the Value You Bring

If your client pays you and books another session, something is probably working even when you mentally label a session as “stuck.” Therefore, pay attention what keeps this person coming back.

You are offering a service, meeting a need for this client, maybe even when you feel like you don’t. Creating space, modeling containment, hearing clients  — these are powerful services. The energy in a session can change, especially when it is clear to the client that they are heard and they are safe. Provide safety, build trust, say less, and you will see change in your “stuck” sessions and in your work with your clients. Let go of judgment, get curious about this “stuck” feeling in session, ask questions about “stuckness” — and see what unfolds. Sometimes, when you call the elephant out in the room, it gives you something to talk about.

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© Copyright 2021 GoodTherapy.org. All rights reserved. Permission to publish granted by Megan Paterson, LMFT in Roseville, California