10 Top Tips: How to help a ‘stuck’ client
We all know the feeling, our client is stuck, and we feel stuck along with them. It’s frustrating, we don’t know how to move things forward, and we feel deskilled and question our abilities. So how do we help improve the situation?
Obviously each client is different and will bring their own personality and struggles to the therapy room and each may want a different outcome so there is no ‘one size fits all’ solution, however there are many options to consider before we come to the end of the road.
3 questions to ask yourself:
‘am I trying to fix them?’ They’re stuck, we’re stuck, and we throw endless ideas and strategies at them and nothing seems to help. Is this what’s best for the client or are we trying to help ourselves feel better?!
‘why are they still coming?’ If the client feels the same way we do, what makes them turn up week after week? Are they waiting for a breakthrough or are they actually gaining something we’re not seeing? Perhaps they like watching us trying our best and failing?! We have to be careful we’re not feeding into the client’s attempts to prove that they can’t be helped.
‘am I offering control to the client?’ Are we taking on a caretaker role by ‘looking after’ the client in order to take away the potential challenge and emotional distress they may face in considering their own needs?
Tips to get things moving again:
First and foremost, check out with the client how they feel the therapy is going, ask them what specifically they are benefitting from and how. You may need to be quite challenging here, lots of clients will dodge this question and if they do, ask them again. And again. And again. It may generate an entire session of discussion about the work and offer you the opportunity to explore whether or not it’s actually therapy they’re needing at this point in time.
Re-visit their initial goals of therapy. Do they feel they’ve achieved their goals? If not, what is it they feel needs to change and how do they believe you can support them to reach their intended outcome?
Explain what therapy is and is not. Therapy should focus on progress, actions to be taken towards a healthier way of being. Has your client thought about it in those terms? What are they doing to get themselves to a better place. What actions are THEY going to take? Therapy should not be a ‘check in’ space to offload the last week’s ups and downs.
Bring the focus into the therapy room. It may well be that the client simply can’t affect change outside of the therapy room until they’ve practised new ways of thinking, feeling, and behaving in the sessions with you. Who are you to the client? What do they think your opinion is of them? Is transference at play in the sessions? Do they feel safe being open and honest with you? Are they being open and honest with you? What is your relationship with the client and what are they looking for from you? Is your relationship healthy and equal? Do they trust you? Are you the right therapist for them? Consider their presenting issues and whether this may be something to work on between the two of you.
Get back to basics, if strategies aren’t working, then do they simply need to talk? We should never underestimate the positive impact on another person’s wellbeing by simply offering them the opportunity to talk without judgement or interruption, to just listen and show understanding. Remember your person-centred base and offer them the basics for a while, empathy, unconditional positive regard, and congruence go a long way in connecting and re-connecting with your client.
Does the client feel they’ve come as far as they can go at this moment in time? Discussing the ‘stuckness’ you are both feeling (if indeed the client is also feeling stuck) may give the client the opportunity to reflect on how far they may already have come and whether this is enough for the time being.
Is the client relying too heavily on you? It’s okay to gently challenge the inequality in your relationship, you deserve to have your voice heard too. Raising your own feelings of stuckness with the client gives you permission to take a step back, you’ve been open and honest and told them you don’t know how to support them and that you now need some direction from them. It’s important to stick with this and not give into temptation to take back the control. The client NEEDS to take responsibility for their own progress, you’re simply an advocate to this. Keep throwing it back.
Consider the clients’ words and actions, do they make you feel uncomfortable? Are they using the sessions appropriately or do they have an alternative agenda? Trust your instincts. I find that being direct here usually means they don’t return, you’ve seen through their performance and the fun ends there.
Consider your own needs and difficulties. Do YOU need a break from this client’s therapy? Do you need more understanding of the presenting issue? Is countertransference at work? Is the work triggering something YOU don’t want to dig too deep into? Are you feeling uneasy? Do you need to build your own confidence in presenting appropriate strategies that you haven’t used very often before? Make the most of your supervision to explore these potential barriers.
What are they NOT talking about? As much as we understand that the client is the best judge of themselves and their needs, as qualified and experienced therapists, we should also trust our judgement about the work the client needs to undertake and direct the focus where appropriate. If the client will not engage in the work they evidently need to focus on, you have a problem, sometimes a client wants desperately to feel better but is simply not able to explore the root of the problem, it can sometimes be too much for them to consider opening themselves up to. If they can’t do the work, then there’s nothing you can offer them and as hard as it is to bring the therapy to an end, you’re doing them no favours in pressing on. In discussing these limitations, you are giving them an option. They can end the sessions with a full understanding of where their difficulties lie and how it will continue to impact them without exploration OR they can look to find it within themselves to begin the work with your full support. You can ensure they know they can return to therapy at any time when they feel ready to refocus and move forward.
Ending the sessions.
Bringing a client’s sessions to an end will never be an easy decision and may leave you feeling you’ve failed as a therapist. It’s important to remember just how hard you’ve tried to support your client and that your decision to end has been in their best interests. Making these difficult decisions and managing them appropriately displays confidence and professionalism, you’ve nothing to feel bad about if it’s been the right action to take with your client. We can only do our best with what we’re presented with. We have no magic wand.
Use your supervision to talk this through, make sure you’ve considered all angles and ending the sessions truly is in the best interests of the client. But watch out for countertransference here too, your supervisor may also feel stuck and uncomfortable in trying to help you and the decision you make together may be the best for the two of you!
