8 Steps to Overcome Roadblocks in Therapy
When a client's progress stalls, here's what therapists can do.
Therapy is a dynamic process that can have roadblocks and setbacks along the way. As a provisional psychologist, or early-career psychologist, it is important to recognise when progress seems to stall and take proactive steps to address these challenges. In this post, we will explore several factors to consider when therapy is not progressing as expected. By identifying potential obstacles and making necessary adjustments, you can enhance the effectiveness of your interventions and better support your clients' journey toward healing and recovery.
1. Provide psychoeducation and rationale.
One key aspect to evaluate is whether you have adequately provided psychoeducation and explained the rationale behind the interventions you are using. Clients need to understand the scientific basis and purpose of the techniques employed in therapy. By sharing this information, you can instill hope, increase their confidence in the interventions, and reinforce the idea that recovery is possible. Interventions should be chosen based on empirical evidence rather than personal preference.
2. Set realistic expectations.
It is important to assess whether you have set the bar too high in terms of expectations for treatment progress. Sometimes psychologists and clients alike may anticipate faster results than what is realistically achievable. Take a step back and reevaluate the timeline for progress, making sure it aligns with the individual's unique circumstances and challenges.
3. Review the pace of therapy and essential treatment steps.
Consider whether you might be going too fast in an attempt to help your client. Rushing through or overlooking earlier, essential treatment steps can hinder progress. Take the time to assess if there are foundational elements that require attention before moving forward. Breaking down strategies into smaller, manageable steps can also make them more manageable for your clients.
4. Review your case formulation.
Regularly reviewing and updating your case formulation is crucial, especially when you feel stuck in therapy. This process allows you to examine the therapeutic goals, interventions, and progress made so far. Adjustments may be necessary based on new insights or developments in the client's situation.
Case formulations is a point I see many provisional psychologists get stuck in treatment. I address case formulations in both my therapy manuals and my clinical training.
5. Address trauma.
It is essential to explore whether there is an underlying history of trauma that needs attention. Trauma can significantly impact a person's ability to engage in therapy effectively. Consider incorporating evidence-based interventions like eye movement desensitization and reprocessing (EMDR) or other trauma-focused approaches to address and process the trauma before expecting progress in other areas.
6. Consider neurodivergence.
For clients who are neurodivergent, it's important to recognize that their experiences and needs may differ from those of neurotypical individuals. Anxiety, for example, may stem from factors unique to their neurotype, such as their sensory processing differences. Ensure that your interventions are tailored to target the root causes of their challenges and adapt your therapy accordingly. Collaboration with neurodivergent specialists can provide valuable insights and strategies.
Clients may also be undiagnosed due to having highly internalised presentations. It is important to consider clients that appear treatment-resistant, or who have a long history of psychological problems, may have undiagnosed autism or ADHD.
7. Encourage health check-ups and consider medication.
If you have exhausted problem-solving approaches without seeing progress, it may be worth recommending a health check-up for your client. Underlying medical conditions can contribute to or exacerbate psychological symptoms, hindering progress in therapy. Additionally, medication may be warranted to alleviate the client's distress enough for therapy to become more productive. Collaborate with medical professionals to explore these options.
8. Consider alternative psychological therapies.
If first-line treatments have not yielded desired results, it might be necessary to consider alternative therapeutic modalities. Always prioritise evidence-based interventions, ensuring that any treatments you utilise have proven efficacy. Exploring other first-line or second-line treatment options can open new avenues for progress and help break through therapy roadblocks. For example, if the client is feeling stuck in cognitive behavioural therapy for depression, you could incorporate some psychodynamic therapy techniques, if you are trained to do so.
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Navigating roadblocks in therapy requires introspection, flexibility, and a willingness to adapt. Remember: Therapy is a collaborative journey, and it's important to regularly reassess and adjust your approach to meet your clients' evolving needs. Overcoming roadblocks in therapy requires patience and a commitment to continuous learning. Therapy is not a linear process, and setbacks are a natural part of the journey. Embrace these challenges as opportunities for growth and resilience, and keep supporting your clients with empathy, understanding, and an unwavering commitment to their well-being. This piece was also published on my blog at Psychology Today. You can see that here.