What to Do When Therapy Isn’t Working: A Guide for Therapists

You take on clients feeling confident about helping them. So why does it sometimes turn out that therapy isn’t working, and what can you do about it?

There are a number of reasons clients may not improve as much as you’d 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 Therapy Doesn’t Work (Possible Causes)

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 therapy doesn’t progress, or stops progressing, and Judith Pearson (2006) 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. Worrying about the problems or responsibilities that might come with achieving the goal.
6. Wanting the goal, but feeling blocked by limiting beliefs or fears rooted in past experiences.

To that, I would add that latent learning might be in the mix.

You’ll notice that all these are about the client, but if we’re honest, this is a two-person relationship. 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 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? Or could your client be withholding information?
     

What to Do 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.
     

What to Avoid When Therapy Isn’t Working

1. Don’t simply write the client off as ‘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.
6. Discuss options within supervision: brainstorming may come up with ideas you wouldn’t think of on your own.
      

When progress feels limited, it can be frustrating, but it’s also an opportunity to step back and review what’s happening beneath the surface. With a little reflection and flexibility, therapy can often begin to move forward again.

References

Pearson, J.E. (2006). The weight, hypnotherapy and you : weight reduction program : an NLP and hypnotherapy practitioner’s manual. Carmarthen: Crown House.

Disclaimer
The information and ideas shared on this blog are based on the author’s professional experience, research, and training. They are intended for educational purposes and to support reflection and professional development. Therapists should always apply their own professional judgment and consider the needs of individual clients when using any techniques or suggestions discussed here.
While every effort is made to ensure the information is accurate and helpful, no responsibility can be accepted for any loss, damage, or difficulties arising from the use or misuse of material contained in these articles.