Part 7 of 8: Three main reasons therapy frequently stalls after the first few sessions

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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.

  1. 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?
  2. 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.
  3. 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,

Ellyn

Take Action Now

This is the last post in our series. We welcome your feedback. Please share anything that stood out to you below. We are committed to supporting you and to providing tools to advance your skills. We learn from your feedback and knowing which concepts or tools will stay with you.

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Judith
Judith
5 days ago

Thank you so much for this wonderful series introducing the Developmental Model of Therapy. I was surprised at how quickly I could see my own clients in these short modules. I absolutely want to dive in deeper and get the benefits of learning this method in depth for my clients, my work, and myself. Thank you, again!

Alexandru
Alexandru
5 days ago

Hello Ellyn, thank you for your generosity and contribution to the field of couple’s therapy.
Lately I’ve been reading your book “In quest of the mythical mate”. It is very informative. I would like to ask you a couple of questions:
Do you take into consideration the attachment styles? Do you look at the couples through this lens?
How do you (would you) integrate them with the stages of the relationship?
How do you approach attachment in your sessions?
Thank you very much!

ellyn bader
5 days ago
Reply to  Alexandru

Alexandru-I appreciate your questions. Yes I take into account attachment styles as i plan interventions. Your other 2 questions are excellent, but would require long answers that i teach about in the training program. I don't know how to answer them other than to say that anxious attachment leads to partners trying to maintain symbiosis and being afraid of differentiation. Avoidant attachment can masquerade as individuation while the avoidant partner is not able to support healthy differentiation in a committed partnership. I hope this helps a little.

Connie
Connie
5 days ago

Ellyn and Pete,
Thanks so much for sharing your wisdom with us. I used to live in CA, and took many of your courses, but these reviews are helpful for me!

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