Understanding Therapeutic Stagnation

For a client, the most soul fulfilling part of a therapy process in seeing how close they are to achieving their goals. Usually, the process is that the client first works with the therapist to understand their thought and behavioural patterns. Gain insight to change their behaviour, implement changes, sit with and process emotions and experience relief. Ultimately the client is made to be equipped to manage life on their own using the coping skills they have acquired through sessions. But some clients seem to reach a point when they experience therapeutic stagnation.

This means that the client in therapy is not progressing in any meaningful way. It is essential for the therapist to understand why this occurs, how to address it with the client, how to resolve it, and to ensure effective support for their client.

Who is Responsible for Progress in Therapy?

An important question for therapists to reflect on is: Who is responsible for progress in therapy? Is it the therapist or the client?

A therapist has to bring active attention and presence to the therapy sessions. While the client is challenged within the sessions and is expected to engage in some level of introspection outside of the therapy space as well.

Another question that the therapist can reflect on is: What does this progress look like? Is it my idea or the client’s?

An example that comes to my mind is of this client that I have been seeing for about 10 months, and in the past five to six sessions, we have been discussing her anger towards her parents. As a therapist, I felt we were stuck in this loop of discussing the same things over and again. I took a session with my supervisor, and she asked me:

“This need to see progress is it your need or the clients?”

It got me thinking that I have unconsciously been imposing my idea and pace of progress on my client and this is an unfair expectation to have. Maybe in those sessions my client really needed a space within therapy to just let it all out.

Signs That a Client is Stuck or Experiencing Therapeutic Stagnation

Therapeutic stagnation can manifest itself in numerous ways. It could be behavioural, emotional, cognitive or relational. Since being stuck can also be subjective, it is important that a therapist has knowledge of the types and the signs. When clients feel “stuck” in therapy, it can manifest as a plateau in progress of the client’s concerns. It can leave both the client and therapist feeling uncertain about the next steps.

Below are some key behavioural, emotional, cognitive, and relational indicators that can signal therapeutic stagnation in therapy.

Behavioural Signs

• Client’s Engagement

How much a client is engaging with the therapy sessions can be starting point to understand if and any underlying issues that might be present. particularly, that which prevents them from engaging in therapy. The client may avoid keeping eye contact, respond to most of the queries posed to them in sessions with little or no enthusiasm, and demonstrate complete disinterest in the sessions themselves. If a client is stuck in a loop where there is no progress in the client’s sessions, it may be indicative that they are not integrating the therapeutic work. At this point the therapist and the client can pause to reflect on what is going on in the sessions to resolve the stagnation.

• Homework

One clear sign of stagnation is lack of willingness to accept and/or complete the new strategies or homework exercises given by the therapist. Clients may avoid practicing and making use of the techniques they learn during therapy sessions. Such barriers obstruct progress and signify feelings of helplessness or skepticism amongst the clients when it comes to the suggested set of activities.

• Missing Sessions

Regular cancellations, arriving late or no show to therapy session speaks great volumes, as it showcases a sense of avoidance and deep dissatisfaction with therapy, which often stems from feeling stuck in a situation. These behaviours might indicate a gap between the client’s needs and what they are receiving currently in the therapy session. This can lead to a rupture in the therapeutic alliance and must be addressed compassionately by the therapist. I want to highlight that missing or re-scheduling sessions can also come from the therapists side. If this is something that happens with you with a particular client, sit with it, reflect and try to make meaning out of it.

Emotional Signs

• Feeling Overwhelming Emotions

Emotionally, clients who are stuck in therapy often experience heightened frustration, discouragement, or hopelessness. These types of clients usually question their ability to overcome their ability to overcome the hurdles in their life despite coming to therapy from a long time. This emotional exhaustion can obstruct their motivation to continue therapy which can lead to them questioning the value of the process. A client of mine usually tends to utilise the first 30 minutes of our session to let out the “content” part of therapy where she also expresses her apprehension that nothing is working for her and that she thinks there is no way out of this. It has been a delicate journey to work with her as any sort of feedback or confrontation can be perceived as a criticism. However, I notice that the client is stuck in the sessions.

• Feeling Numbness

Some clients may show emotional numbness, detachment, or a lack of emotional responsiveness. They may seem disconnected from their emotions or resistant to exploring deeper emotional layers. Whenever I asked one of my clients about her feelings associated with a certain event, she would always say “okay”. Introducing the emotional wheel at this point can psycho-educate the client about the intricacies of emotions. This emotional wall can be a defence mechanism to avoid the discomfort of confronting unmet needs or unresolved issues, particularly when progress feels stagnant.

• Falling into old patterns

This type of therapeutic stagnation is about going back to the previous emotional states, such as relapsing into unhealthy old patterns. For example, increased anxiety, depression, or emotional instability, is another indicator that a client is stuck. This regression can feel demoralising and lead to a drop in the motivation levels of the client and signal a need to adjust the therapeutic approach or re-examine the root causes of their challenges.

Cognitive Signs

• Cognitive Rigidity – Expecting Negative Outcomes

Cognitive rigidity is about holding strong negative beliefs even in the face of an opposing positive evidence. This strong tendency of clients ends up obstructing their capacity to acquire fresh understandings or shift viewpoints which remains crucial for therapeutic advancement.

• Lack of Behavioural Change

Clients often face difficulties in translating new thoughts and beliefs into real world applications because there exists a gap in their intellectual comprehension and practical execution. Individuals often understand therapeutic concepts yet struggle to implement them into tangible behavioural shifts or altered perspectives. For example, a client might understand the hurdles they face in quitting smoking however stopping this habit in real life might take significantly more time.

• Negative Self Talk as a Barrier

If a client constantly engages in negative self-talk, even the positive feedback received will not be interpreted optimistically. Clients often struggle to acknowledge their strengths and achievements while fixating on perceived weaknesses which creates ongoing stagnation.

Relational Signs

• Plummeting trust

Signs of a client feeling ‘stuck’ in the therapeutic process is something that not always presents itself at the start of a relationship. A deterioration of trust or communication between a therapist and a client may indicate an obstacle in the therapeutic process. These may present in the form of increased relational tension, a sense of emotional distance between the client and the therapist, making it difficult to move forward.

• Over Dependence

Another indication of a client being stuck in therapy is unhealthy degree of dependence on the therapist and the relationship. It is normal to seek help, however, being overly dependent on the therapist for reassurance, guidance, or decision-making often create unfavourable conditions for a client to become independent and more robust. It defeats one of the goals of therapy – which is to make the client independent.

• Avoiding Discussion

Another sign of stagnation from the client could be – avoiding discussions related to progress itself. It could mean a client is disengaged or dissatisfied with their progress and hence refrains from talking about the process of therapy. Conversations directed towards the therapeutic process are necessary to curb any dissatisfaction that might exist, as well as to make adjustments to the existing approach.

In conclusion, being aware of these indicators of stagnation and addressing them in the session along with the client can help curb further stagnation. It could be used as an opportunity to re-engage the client and to gain some momentum back in the therapy sessions.

Addressing the Therapeutic Plateaus

Upon detecting stagnation in therapy, therapists have numerous methods to re-engage clients and restore developmental momentum.

Reframing the Meaning of Therapeutic Stagnation

Stagnation does not indicate failure of therapy. It is how a therapist interprets it and utilises this piece of information that serves as a potential opportunity to discuss with the clients the hurdles in the process of therapy. Therapeutic stagnation must not be perceived as a termination point but as a chance to investigate alternative approaches and therapeutic methods.

Have an Authentic Conversation

Transparency is the key. A simple acknowledgment from the therapist, such as;

“I’ve noticed we have had similar conversations for the past several sessions. Have you noticed that, too?”

This can open a dialogue about the therapy’s effectiveness. It is also a good way to check in with the client to see if you both are on the same page. This conversation may reveal that a certain approach isn’t resonating with the client or that external factors are impeding their progress.

However, If the client does not feel the same then it might be an opportunity for the therapy to self-reflect and understand if it is the therapist’s need to bring about some change/progress. Supervision at this point will serve an important purpose.

Modifying the Treatment Plan

It is always useful to have flexibility in the therapeutic intervention plan, guided by a primary school of thought and at the same time picking up techniques and strategies from other school of thoughts to best suit the needs of the client –

• For example, there might be a need to combine cognitive behavioural therapy components with emotions focused therapy elements and mindfulness techniques to meet the ever changing needs in a therapeutic setting. The idea being that the therapist is using modalities in a way that best suits the client.
• Altering the number of sessions per time period.
• The implementation of creative interventions including art therapy and/or movement-based strategies.
• The process of examining and adjusting therapy objectives to maintain their applicability.

Understanding Existential Therapy’s Approach to Stagnation

Existential therapy focuses on the relational nature of therapy. A client’s “stagnation” in life is often a reflection of therapeutic stagnation. Therapists who are attuned to this stagnation in the therapy room and talk about it openly can help clients become aware of it and shift habitual patterns of behaviour. Instead of suggesting behavioural changes, existential therapy invites clients to explore and understand their discomfort, deepen self-awareness, and take accountability regarding the need to change.

Encouraging the Clients to Tolerate Discomfort

Have you ever noticed how progress usually means we have to face discomfort? When a therapist is reluctant to take the client out of their box, the client will stay in their comfort zone. Therapists need to model emotional resilience — we talk about hard things, and we help our clients practice emotional tolerance, so they can learn to hold discomfort for their own growth.

What Am I Not Saying?

When therapy stalls, there’s usually something that the therapist is afraid to say or ask. Unexpressed thoughts or questions that may lead you into a deeper investigation will be revealed through self-reflection. It can offer important information about what has to be fixed. Self-reflection and supervision are tools that will facilitate the process for the therapist.

For example, in one of my therapy sessions with a young adult male, I could see that I found it difficult to reflect the client’s pattern to them. With the help of peer supervision, I understood this might be from my fear of disappointing the other person.

Consider a Referral if Need Be

Even if after several attempts to reinvigorate therapy with the client fails, it may be time to refer the client to someone else. Therapeutic stagnation is not a reflection of the therapists inadequacy, sometimes it could be that the therapist and client dynamic is not the best fit. It might be difficult to recongize this but though self-reflection and supervision a therapist can try to notice a misfit. The therapist must continue keeping the client’s best interest in mind above everything els. Sometimes the best thing a therapist can do is refer the client to a therapist with an alternative approach.

When the Therapist Feels Stuck With a Client

• Prioritise the Therapeutic Relationship

Change happens within the client-therapist relationship, not just through applying techniques. Therapy is an experiential process, where growth emerges from relational dynamics.

• Use the stagnation as an opportunity for change

Clients are in an internal struggle between staying the same and changing and this tension is natural. Feeling “stuck” often signals that a breakthrough might be approaching.

• Embrace Rupture and Enactments

Disruptions in the therapy process (ruptures) are sometimes necessary for deeper healing. Clients will project past wounds onto the therapist – engaging with these enactments, rather than avoiding them, fosters transformation.

Conclusion

Therapeutic stagnation can feel like being lost in a maze, but it is not an indication of failure, it’s rather a chance to reassess, alter and move forward. By staying flexible, open-minded, compassionate, honest and aware, the therapist can help steer their client through these delicate moments and lead to breakthroughs and new motivation within the client. Let us normalise these therapeutic plateaus, with awareness and agency, they can become crescendos that pave the way for deeper growth and discernment.

Lastly, as a therapist, I would like to recommend a podcast on Spotify related to stagnation.

Listening to this podcast has helped me understand my needs versus the client’s needs, helped me reflect in the right direction and gave me a deeper understanding of what stagnation is in a session.