Two reasons why therapists might be failing their clients

Hmm…how might we be failing our clients?

At first glance, it looks like there are many reasons why people don’t make progress in therapy. We think:

• They’re not ready to change.
• They are too fused with their thoughts.
• I’m not a good enough practitioner.
• We haven’t a strong enough therapeutic alliance.

ACT Therapists fuse too! Your mind gives you reasons to explain why clients aren’t improving. When you fuse, you’re more likely to react in unhelpful ways. For example, if I glue to the idea that they are not ready to change, I am more likely to end therapy.

I risk discharging my client before we have explored all the possibilities.

I’m sure you can think of many other possibilities.

What if all the reasons boiled down to the same one or two reasons?

Why do my clients stop making progress?

When my clients don’t seem to be improving in therapy, I tend to think it’s for one of two potential problems:

1. They aren’t doing the work.
2. Their current behavioural patterns serve other unknown functions.

When your clients aren’t doing the work

We all relish the easiest path of resistance:

• To be fitter without doing so much exercise.
• To be more confident without doing the scary stuff.
• To have more energy without getting moving.

It’s natural to want the rewards without taking the risk. However, as someone much wiser than me once said, discomfort precedes growth (thanks, Robyn!)

Many of your clients will harbour, if not say explicitly, that they want you to take away their pain and distress. The reality is that you can’t wave it away with a magic wand; they need to do the work. If their behaviour stays the same, then so too will their struggles.

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Their patterns serve unknown functions.

Sometimes, both you and your client cannot see the whole picture. They may tell you that they struggle with anxiety or depression, but they don’t know what other painful emotions sit somewhere in the background. 

Sometimes when a person procrastinates about or avoids homework, they’re under the control of rules that experiential avoidance helps them solve other problems. For example, take the single parent hiding in the bathroom to rehearse their compulsions. Preoccupied with thinking ‘bad’ thoughts, they rely on reassurance to alleviate their anxiety. 

However, when it comes to letting go of this habit and building up to something wiser and more workable, they continue to go to the bathroom. 

What if going to the bathroom has another function, such as giving themselves much-needed time alone? Unless you explore other possibilities for the persistent pattern, you may never discover that their behaviour makes sense from a self-care perspective.   Thus, you may need to explore ways the client can carve out time for themselves, which works better.

What can you do when your client is not making progress?

You’ve probably heard it before, but it’s valuable advice nonetheless. 

When nothing changes, it’s often helpful to leverage creative hopelessness interventions.

Creative Hopelessness is undermining control and avoidance as a way of approaching life. It’s powerful to start therapy, and I find that it helps us out time and time again. 

People may understand that what they do doesn’t work, but we will likely stay the same unless we feel uncomfortable. 

As another wise ACT Practitioner once said (Rikke K!), you need to re-arrange the consequences to help someone change their behaviour. In other words, if they’re stuck repeating an unhelpful pattern, then there is more you can do to put them in contact with the discomfort of doing nothing different!

The next time you’re in a session and notice that things aren’t changing in the client’s behaviour, bring Creative Hopelessness into their session. Please resist the urge to tell them it doesn’t work. Invite the pain closer. Here are a few steps to make it happen:

1. Invite the client to remember when they felt the urge to repeat the habit they want to change.
2. Go slow and encourage them to do the same.
3. Guide their attention to notice and describe what they feel in their body.
4. Gently go deeper by asking permission to explore what happens next.
5. Stay present to the pain of what they lose when they repeat this pattern, e.g. notice how you’re still alone, isolated, and struggling when you stay in the bathroom. Can you see how you continue to suffer when you go there?

I am mindful that visiting these places with your client can feel scary. Many of us want to help our clients feel better, but when we avoid discomfort, nothing new happens. 

It can be helpful to remember that our job is not to help our clients feel better but to help them be better at the feeling. As you hold that in mind, you open a bigger space for you and your client to walkabout. 

Not sure how to do creative Hopelessness?

Check out this workshop designed to help you increase the power of your creative hopelessness interventions.

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