8 Steps to Overcome Therapy Roadblocks
- Amanda Moses Psychology
- Jul 14, 2023
- 4 min read
Updated: May 7
When a client's progress stalls, here's what therapists can do.
Therapy is a dynamic and evolving process, and it’s not uncommon to encounter therapy roadblocks and setbacks along the way. As a provisional psychologist or early-career psychologist, recognising when progress stalls and taking proactive steps to address these challenges is essential for the therapeutic alliance.
When therapy isn’t progressing as expected, it’s essential to identify potential obstacles and adjust your approach. Here, we’ll explore eight key strategies to help you navigate common therapy roadblocks, enhance therapy effectiveness, and better support your clients’ journey toward healing and recovery.
1. Provide Psychoeducation and a Clear Rationale
Have you adequately explained the rationale behind your interventions? Clients need to understand why a particular therapy or technique is being used. When clients grasp the scientific basis and purpose behind interventions, they are more likely to engage, persist, and trust the process.
✔ Share why an intervention is used based on empirical evidence, not just personal preference.
✔ Clarify how it works and what results to expect.
✔ Instil hope and confidence in treatment by linking it to successful outcomes.
2. Set Realistic Expectations
Therapists and clients often expect rapid progress, but this isn’t always realistic. If therapy feels stalled, step back and reevaluate treatment timelines. Ask yourself:
✔ Am I setting goals that are achievable given this client’s circumstances?
✔ Is the client feeling discouraged due to unrealistic expectations?
✔ Do we need to adjust the pace or redefine progress?
Helping clients understand that therapy is a process—with ups and downs—can prevent frustration and disengagement.
3. Review the Pace of Therapy and Treatment Steps
Sometimes, therapists move too fast in an attempt to help a client, skipping essential groundwork. Consider:
✔ Have you overlooked early treatment steps?
✔ Are you moving forward before foundational skills are in place?
✔ Would breaking strategies into smaller, manageable steps increase engagement?
Slowing down and ensuring each step is solid before progressing can prevent roadblocks later.
4. Review and Refine Your Case Formulation
Feeling stuck? Revisiting your case formulation can provide clarity. Ask:
✔ Does the original case formulation still fit, or has new information emerged?
✔ Are we targeting symptoms rather than underlying mechanisms?
✔ Do we need to explore comorbid conditions or alternative explanations?
Many early-career psychologists struggle with case formulation, leading to misaligned treatment plans. If you’re looking to strengthen your case formulation skills, I cover this in both my therapy manuals and clinical training.
5. Address Trauma If Present
A history of trauma can significantly impact therapy engagement and progress. Clients may:
✔ Struggle with emotional regulation, making therapy overwhelming.
✔ Experience avoidance or dissociation, hindering treatment engagement.
✔ Need trauma-focused interventions first before other therapies are effective.
If trauma is unresolved, consider whether an approach like EMDR, CPT, or trauma-focused CBT should be incorporated before expecting progress in other areas.
6. Consider Neurodivergence
For neurodivergent clients, standard therapeutic approaches may need adaptation. Anxiety, for example, may not stem from cognitive distortions but from sensory overload, unpredictability, or masking exhaustion.
Additionally, some clients may be undiagnosed—particularly those with internalised presentations of ADHD or Autism. Clients who appear treatment-resistant or have a long history of misdiagnosed mental health conditions may require a different clinical approach.
✔ Assess for neurodivergence if clients seem unresponsive to traditional interventions.
✔ Modify therapy to align with their neurotype and specific needs. Ensure you take a neurodiversity-affirming approach.
✔ Collaborate with ND-affirming specialists where necessary.
7. Encourage Health Check-Ups & Consider Medication
If all psychological and therapeutic strategies have been explored with limited progress, it may be time to assess medical factors. Some conditions that mimic or exacerbate mental health symptoms include:
✔ Thyroid disorders – Can present as depression, fatigue, or anxiety.
✔ Iron or B12 deficiency – May contribute to cognitive fog and low energy.
✔ Medication side effects – Certain medications can worsen mood symptoms.
Additionally, collaborating with medical professionals on medication options may help clients stabilise enough to engage in therapy more productively.
8. Consider Alternative Psychological Therapies
If first-line treatments have not been effective, consider alternative evidence-based approaches.
✔ If a client feels stuck in CBT for depression, would psychodynamic therapy techniques be beneficial?
✔ If exposure therapy isn’t working for an anxiety disorder, would ACT or mindfulness-based strategies be a better fit?
✔ Have you assessed for personality factors that may require a different treatment style?
The key is to stay flexible while maintaining an evidence-based approach. If first-line treatment is ineffective, consider alternative methods within your scope of practice.
Final Thoughts: Therapy Roadblocks Are Opportunities for Growth
When therapy stalls, it’s a valuable opportunity to reassess and refine your approach. Therapy is a collaborative journey, and setbacks are not failures—they are moments for insight, adaptation, and progress.
✅ Keep refining your case formulations.
✅ Consider neurodivergence and trauma histories.
✅ Consider medical, psychological, and therapeutic adjustments.
✅ Stay open to alternative, evidence-based interventions when needed.
By continuously reflecting and adjusting, you can help clients move past roadblocks and reignite therapeutic momentum.
Want More Clinical Insights & Training?
If you’re looking to deepen your clinical knowledge and skills, I offer:
✔ Therapy Manuals – Structured guides covering case formulation, interventions, and evidence-based strategies.
✔ Clinical Training Workshops – CPD-accredited training designed for provisional and early-career psychologists.
