Abstract : Everyone experiences “being stuck” with clients at one time or another. This article stresses the importance of dialogue as one of the key ways to move through this type of therapeutic impasse. The author highlights strategies that may assist helping professionals when they encounter stuck points in their work with clients.
Evaluating our “mistakes” in therapy can be one of the richest resources we have for learning, yet it appears to be one the most underutilized tools we have at our disposal. We all know we make mistakes or struggle in therapeutic situations with our clients, so let’s talk about it!!
“When the teacher is ready the student will appear.”
I believe that it is our clients who will bring us to the place of openness. It seems that the severity of cases that are coming through our doors is the impetus for the necessity of dialogue. We need the collective wisdom gleaned from our personal and professional experiences. We require “all hands on deck” to facilitate safe passage as we navigate the uncharted waters of the complexity of our cases. Now, more than ever, it is important for us to “check our egos at the door” and seek support and supervision from our colleagues.
Recently, I was one of several clinicians gathered to have a round table discussion about the experience of feeling stuck or being stuck in therapy. Most of us were comfortable sharing our successes amongst our esteemed peers. What made this discussion so significant and pivotal was our willingness to risk and be vulnerable with one another and expose our perceived incompetence.
The level of experience ranged from those who were recent master’s level graduates to those with 30 years of clinical experience. Most of us were familiar with each other, yet we were embarking on a new frontier “having a conversation about being “stuck in therapy” in a group setting amongst our peers. After reinforcing the importance of group guidelines to achieve our goal of having a supportive discussion without judgment, we proceeded.
–Getting stuck” happens
We all get stuck sometimes. Even seasoned CYC’s and therapists! Newer staff members expressed relief because they thought their “stuckness” was related to inexperience. Actually, “stuckness” seemed less related to inexperience or having or using the right therapeutic knowledge, tools or technique. It appeared to reflect more about the therapeutic relationship or the isomorphic nature of the therapist, treatment team, or client’s life. Oftentimes, feeling stuck reflected our hope for the family and our wish for their situation to improve, whereas clients seemed satisfied with where they were at. At other times, it was an indicator that it was time for the client to move on and that therapy was drawing to a close. Occasionally, therapists experienced pressure to be as productive as possible within constraining timelines. This appeared to impact the time required to adequately process therapeutic impasses.
Self-awareness is the key
Most important in dealing with “stuckness” is the helping professional’s self-awareness. It is essential to take the time to reflect upon one’s reactions: to clients, the content of therapy and one’s physical responses and attitudes. Often we can be stuck in therapy because we may be frustrated with a client or exasperated with the lack of progress. Perhaps we might be bored and feeling a lack of stimulation. We may even be angry with a client. “Stuckness” may also indicate that we need to pay attention to a blind spot or a pattern of therapeutic behaviour that continues to lead us into the stuck place we find ourselves in.
Give permission to feel
We need to give ourselves and each other permission to feel our “stuckness”. Sometimes, even though we are in this helping profession, we resist feeling our “stuckness” or our helplessness. Some of us may attempt to “keep it all together” when we are flailing and need assistance. We may rarely ask for help, perhaps living the fallacy that being strong means we can do it on our own. We keep telling ourselves, “that we ought to know what to do!”...that “if we asked for help we would really appear incompetent.”
Talk about it
We need the opportunity to express both our competence and our areas of growth with one another. If this opportunity does not exist I propose that we will not be doing the excellent work with clients that we are capable of. In fact, we may end up doing harm to our clients and to ourselves. Our collegial and supervisory relationships need to include being able to talk about our feelings, especially our shame about being stuck. If we do not have a supportive supervisory or collegial relationship I would suggest seeking someone out. It would also be important to highlight this issue with managers of the organization as they might be assuming that supervisory relationships are satisfactory to staff members.
Try something different
If we keep doing the same thing, we can expect the same results! The idea is to interrupt the cycle. It is important to take risks and do something different. It is up to us to take initiative in our workplace. If we are feeling stuck, request a reflective team or time with colleagues to present a case. We can seek assistance from our supervisor or a trusted co-worker to get a fresh perspective. Videotaping our work and reviewing it with our peers, asking for feedback can be helpful. It might be a useful exercise to create a “how to get unstuck list” with our colleagues. It may be essential to journal about our reactions to a client. We can “draw our frustrations” using crayons and pastels or “finger paint our “stuckness”. Sometimes, shutting the door and doing some yoga or deep breathing can help ground us.
Go back to the basics
Sometimes our “stuckness” is a symptom that we need to review the original goals we have collaboratively developed with a client. They are the compass for us when we feel lost or stuck. We can talk with our clients about what we are experiencing in our therapeutic relationship. Respecting the wisdom and choices that a client may make, even if it is not what we would perceive as the “right” choice is essential. We can pay attention to our self-importance and when we take ourselves too seriously. We can continue to cultivate our sense of humour. “Being with” our clients, knowing that bearing witness to their pain and validating their ability to survive, is indeed a measure of success.
The round table discussion came to a close but not before several people noted how energized and lively the discussion had been. There was great enthusiasm for when our next courageous conversation could occur. We had crossed the threshold of our fear of being judged into the reality that we were not alone in our “stuckness”. Instead, we found understanding, compassion and encouragement. We were hungry for more!
Each of us wants excellence in our work. It is our personal and ethical responsibility to ensure that our clients get the highest quality of care that they deserve. We need to trust the therapeutic process, knowing that “stuckness turbulence” is normal. Establishing a community of practice may help us achieve this goal.
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Stream, Dr. Herbert S. (1988). Behind the Couch- Revelations of a Psychoanalyst. Toronto: John Wiley and Sons.
Patricia Vanderheyden, M.T.S., RMFT is a Team Leader at Vanier Children's Services, a children's mental health agency in London Ontario. She provides therapeutic support, clinical supervision and program development within a residential treatment program. Patricia maintains an active private practice in Individual, Couple and Family Therapy in London, Ontario.