Lack of progress in therapy, and what to do about it


There are a number of reasons clients may not progress as well as you had hoped. We're going to look at some of them here and also suggest a few things you can do to get things going again.

Often lack of progress is summarily dismissed as due to 'secondary gain' or 'resistance', or perhaps 'the client isn't ready to make the change'. But is that really the problem?


Why might therapy not be helping your client?


I'm not saying that the reasons mentioned above are always wrong, but as ethical therapists, it is surely in our own best interests - and our clients' - to look a bit further.  There are a number of reasons and Judith Pearson [1] suggests we need to consider if the problem could be related to:

  1. Competing goals: the client can have result A or result B but not both.
  2. Competing values: achieving the goal creates conflict between two equally significant personal values or beliefs.
  3. Wanting the goal, but not having the strategies to accomplish it.
  4. Wanting the goal, but not being prepared to put in the work required to achieve it.
  5. Wanting the goal, but not the problems or responsibilities that might come with it.
  6. Wanting the goal, but feeling blocked by limiting beliefs or fears rooted in past experiences.
You'll notice that all these are about the client, but if we are honest this is a two-person relationship and we need to consider our own input to the situation as well. This is where reflective practice comes in handy. Think about:  
  1. Are you really the right therapist to deal with this client?
  2. Could transference or countertransference be getting in the way?
  3. Are issues from your personal life interfering with your ability to offer therapy?
  4. Are there clear, measurable goals for the therapy, and a plan to reach them?
  5. Are you expecting too much of this client, or moving too fast?
  6. Are you failing to step outside your own comfort zone when you need to?
  7. Is your rapport with the client good enough that they are telling you everything you need to know to help them?
      

Steps to take when therapy isn't working


If we accept the NLP assertion that clients are not 'broken' but using imperfect coping strategies as best they can, then we can still seek to give them better ones no matter the reason of the lack of progress. So, what can you do to help get things moving again?

  1. Consider if it's in the client's best interests for you to refer them on.
  2. Reassess your approach - discussing things with your supervisor can be helpful here.
  3. Discuss the situation openly and honestly with the client - do they share your perceptions that things are not progressing? Why do they think that is?
  4. Consider if their goals need refining, reviewing or chunking (breaking into smaller steps).
  5. Consider if you need to think about stepping aside from the original goals to work directly with motivation, self-sabotage, secondary gain or other impediments to progress.
  6. Accept that some clients need longer to adapt to change than others.
      

Steps to avoid when therapy isn't working

  1. Don't simply write the client off as 'hopeless' or 'not ready'. If they are still coming to see you they want to change, and they still have faith in your help.
  2. Review your approach by all means, but don't swing randomly from one thing to another, hoping to find something that makes an impact.
  3. Don't take it personally if the client doesn't complete homework or makes the same unhelpful decision yet again. Explore the reasons and look for ways to deal with them.
  4. Don't be openly or covertly critical in your questions or blame the client, stay neutral.
  5. Don't force your own ideas or solutions on the client - it may take longer for them to find their own but they will be more effective.
       

[1] http://EzineArticles.com/459700


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Author: is an experienced hypnotherapist and hypnotherapy trainer. She is the author of Their Worlds, Your Words and has co-written the Hypnotherapy Handbook, both of which are available from Amazon.
Find out more about Debbie's services on
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Location: UK Selby district, Yorkshire, UK

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