Why does it sometimes seem that therapy is not moving forward?

“I was like a fly hitting glass,” recalls 45-year-old Veronica. “Week after week, I again and again experienced anger at my mother, feeling at the same time complete insignificance.” She recalls the sympathetic look with which the therapist listened as she repeated the same thing, his nods: “Yes, yes, of course,” and even the cryptic phrase “Wait, wait …” when she said she wanted to stop the sessions. But what to expect? we ask ourselves, feeling that stagnation has come.

The 52-year-old Marina had the impression that therapy was no longer of any use, during the two cycles of psychoanalysis, which she went through in 10 years. “At the beginning of each cycle, I talked a lot,” she admits. “I was stimulated by the fact that they listened to me. But every time it all ended with me having nothing to say.” She left her second analyst three years later saying, «You can’t hear me, and I can’t hear you anymore.»

It is the irritating feeling of a “stuck record” in the session and the statement that everything in life remains the same, which leads the client to the idea that the therapy is not working. The therapist, for his part, also sees that the client is marking time. “Sometimes, from the client’s stories about what is happening to him, or about his dreams, from his drawings, you can conclude that there are no changes in his life,” says Elena Ulitova, a family therapist. “In addition, the psychotherapist’s own feelings become a signal for the psychotherapist: usually in such a situation you begin to feel annoyed or bored.” What does this drop in energy mean in psychotherapy?

«Blank» period

Psychoanalyst Valerie Blanco believes that such periods of slowdown are a full part of the treatment: “Psychoanalysis does not promise results in 15 days. To treat a person with his unique personality, with his history, and also to look at his unconscious — it takes time! she says. When a psychoanalyst offers his interpretations of a client’s story, it may take a long time for the client to internalize this discovery. As a result, there is a feeling that the therapy has frozen.

Similar processes occur in the work of psychotherapists in other areas. “Initial changes in a client often happen quite quickly, sometimes even in the first or second session,” explains Elena Ulitova. — It usually causes euphoria. Sometimes the client disappears at this stage: it seems to him that the desired result has already been achieved. And then there is a backlash, and the client may think that psychotherapy did not help. In fact, the first «wow effect» is not enough, the work must be continued.

Psychotherapy is a long process, because it involves profound changes. They may remain invisible for some time, but there is a cumulative effect at work here.” This stage can be compared to the pause we take while climbing stairs to catch our breath, says psychotherapist Rani Dupra, who specializes in working with addictions: “Such a pause most often allows the client to find a new position in order to continue moving on.”

Then, looking back, some patients perceive this «empty» period as one of the important points in psychotherapy. “In the end, I thought it was unusual,” recalls 40-year-old Veronica. Everywhere they try to satisfy you, to entertain you. And here some sessions are like a desert that needs to be crossed. But they lead to the spring of life, to another level of self-understanding.”

Who is to blame?

Sometimes the reason for “slippage” lies in an unsuccessful start, if a contract was incorrectly concluded (or not concluded at all) between the psychotherapist and the client.

“It happens that the psychotherapist rushes into work without agreeing “on the shore” about how the interaction will take place,” says Elena Ulitova. — And then at some point it turns out that the client does not understand who is responsible for what. After all, psychotherapy is a mutual responsibility. And the client sometimes thinks that he has come to a magician who will do everything for him and solve all his problems, but nothing depends on him. In fact, the effectiveness of work is only 50 percent or even less dependent on the psychotherapist.

The rest will have to be done by the client himself. If he does not make efforts to change, does not do his homework, does not apply in life what he agreed with the therapist, then you need to return to the contract and remind the client of his part of the responsibility.

This does not mean that «stagnation» is never associated with the incompetence or inexperience of the psychotherapist — this is also possible: «He, for example, can give advice to the client and at the same time proceed from his» map of the world «, from his life experience,» explains Elena Ulitova. — And this may not suit the client at all: he does not have the resources for this, he is not able to fulfill this advice. Or the psychotherapist offers the client inappropriate interpretations that are not related to reality and only irritate him. But a psychotherapist who is too distant is no better: he leaves the client to fend for himself in his repeated unsuccessful attempts to solve the problem in an inappropriate way.

It is during this period that the psychotherapist’s work on himself, in particular within the framework of supervision, becomes decisive. It helps to avoid dwelling on the «blind spots» in his own history that cause him to take an ineffective stance towards the patient.

Get out of the vicious circle

Action in psychotherapy most often comes down to talking. But the client in stagnation gradually ceases to open his mouth. This is the perfect time to confess to the therapist that you are tired and frustrated and ask questions about it. In general, turn your difficulties into a «topic for work.» “When I revealed to my psychoanalyst the most shameful thoughts that came to my mind,” Rani Dupra recalls about personal therapy, “the feeling of walking in a circle that tormented me immediately receded.” This is one way to thwart your own resistance to change.

But as a specialist, she believes that the therapist also needs to take an active position: «To dare to say to your client:» I do not feel what you are telling me now, «or» You are going in circles «- this is often decisive.» In some cases, the therapist has to apply some other methods, continues Elena Ulitova.

So, for example, it happens with excessive intellectualization: “The therapist and the client are talking, identifying the reasons for what is happening with the client. The client seems to understand everything — but no changes occur, because his experiences are not involved, the level of feelings is not involved. And change comes only through experience. Until he survives this, the desired changes do not occur. And then the task of the psychotherapist is to switch to working with feelings.

If attempts to revive the work fail, the therapist may refer the client to a colleague. Changing the type of psychotherapy and therapist is one way to work through problems on a different level. 35-year-old Olga, who could not survive the breakup, “slipped” for a long time in psychoanalytic therapy, and then went to a psychotherapist who practices eye movement desensitization and reprogramming (EMDR). “For three years of therapy, I did not dare to talk about the rape that I experienced as a teenager. Here, with a trauma specialist, the block was removed in a few weeks.”

There is another way out, to which those who think that their therapy is useless mentally return more than once — to stop it. But even this decision can become a topic for work and dialogue between the therapist and his patient: what are the motives? what will be the exit protocol? After all, those who leave therapy without warning or, on the contrary, drastically destroy the “building” that they managed to build, are threatened with a return of symptoms. It’s probably best to keep putting effort into the connection you’ve created with your therapist…even if it means rebuilding it entirely.