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Three Main Reasons Therapy Frequently Stalls After the First Few Sessions
What do you do when therapy stalls after the first few sessions? Here’s how to regroup when you lose momentum.
I often hear therapists say I am good at getting started with couples, but after 8-10 sessions I feel stuck. I seemed to make headway at the beginning, but now my sessions seem repetitive. What am I missing? The couple keeps bringing up the same old complaints. How do I make more progress in the middle stage of therapy?
If you sometimes feel this way, three cheers for recognizing that therapy is stalling!
This can be tough because the couple is not likely to tell you directly. They’re more likely to cancel an appointment or two and then simply quit.
Furthermore, who wants to admit uncertainty or even failure to themselves?
However, if you’ve been feeling this way, it means it’s time to step back, evaluate, and admit that you’ve lost momentum.
When therapy stalls, it is often the result of one of the three following problems: mushy or ambiguous goals, fight repetition, or risk aversion.
Here are some ideas to help you regroup.
- Mushy or ambiguous goals
You have lost track of the original goal, or the partners’ goals were mushy and never clearly self-focused. They bring you the problem of the week rather than creating an integrated thread to their therapy. This means it is time to set more specific goals. What do the partners want to
create in their relationship that is different from what they are doing now? What do they each want to stop doing, and specifically what do they each want to start doing?
- Fight Repetition
Frequently, couples report repeating fights. They trigger and re-trigger each other over and over in the same way. These fights illuminate partners’ hidden vulnerabilities, earlier trauma or developmental deficits. When their systemic interaction is so repetitive, you need to identify clearly what issues belong to each partner.
These repeating fights are often reenactments of old family patterns. When this is the case, successful resolution will require you to be able to work incisively with their internal conflicts and to know how to focus partners’ intrapsychic work.
- Fear of taking risks and being accountable
Many partners are afraid of stirring up conflict. Instead of being authentic with each other, they hide out and do nothing between sessions. The fear of active self-defining runs deep and stalls progress.
As you reflect on any of your own cases that may be stalled, ask yourself:
- What is repetitive in your clients’ fights? Is there a common underlying belief such as No matter what I do, it’s never enough?
- Where does each partner break down instead of initiating productive engagement? Do they collapse into helplessness or angry-victim behavior?
- Are you seeing them stretch themselves to develop new abilities both within and between sessions? Do you see them taking any risks to come out from behind their predictable defenses?
- Are you confronting their lack of follow through at home?
Focusing on these questions will allow you to target a more specific focus.
If your sessions continue to feel unproductive, ask each partner to tell you what is not working for them and then to write a summary of each session. Tell them you will start the next session by asking them to read their notes to each other. This will greatly facilitate the continuity of your work and help them
stay on track with their established goals.
And here are some personal questions for you.
- Do you know your own cutting edge of skill development as a couples therapist?
- Are you afraid of taking risks or stirring up conflict?
- Are you learning and pushing yourself?
- Is confrontation hard for you?
If you answered yes to any of these, consider joining my online training program. It takes a while to become a very skilled couples therapist. However, you don’t have to do it alone. I’d like to support you in learning exactly what you need to so your work becomes rich and satisfying.
The Developmental Model of Couples Therapy online training program helps you acquire tools and insights, and get immediate consultations on your stubborn or stalled couples.
Join me to master new skills while being part of a dynamic community that will support you as you risk new interventions that are initially uncomfortable. Doing this with support and guidance is the most effective way to become a true master. In training, you will focus on your development in a safe community of therapists who support your evolution to reach a higher level of expertise.
Training will be open for just four days, starting January 21, 2021. I hope this introductory series has demonstrated the depth and quality of the training because I’d love to have you join me. Hope to work with you soon,
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