Why People Get Stuck in Therapy

(And How They Get Better)

Some people improve in therapy in a short amount of time. Others stay in treatment for years without seeing any significant progress. What’s the difference? Psychologists have been trying to answer this question ever since people started getting into therapy. And after decades and decades of research and progress, not only have we discovered why some people get stuck (and others don’t), we also developed the methods and tools to provide people with the most effective care psychology has to offer.

The Tough Reality of Following Through

There is a disconnect between therapy and real life. In therapy, clients can open up in a safe environment, helping them explore difficult topics and gain valuable insights. In real life, however, these same insights are quickly forgotten amidst the chaos of urgent to-do lists and messy relationships. The rent needs to be paid, a deadline needs to be reached, groceries bought, children taken to karate class, and on and on and on. It’s easy to see how tasks and exercises from therapy slip down on the priority list (or become overlooked altogether). 

Additionally, many clients don’t have the luxury of a supportive social network. Rather than being surrounded by attentive, encouraging people, they are often stuck in dismissive – abusive even – relationships, which facilitate bad habits and discourage genuine self-care. In such an environment, it can be challenging to follow through with even simple exercises, thereby preventing any meaningful growth. What may seem simple and straightforward in therapy, often becomes complex and confusing in real life.

It’s no surprise that one of the biggest obstacles in therapy is getting clients to take action outside of it. Instead of following through, clients often procrastinate, forget, become demotivated, or lose faith that things could ever be better. And unfortunately, people cannot get better unless they start changing their behavior in their own life. This is not to blame the clients. Instead, both the therapist and their clients need to work together to find a way towards meaningful growth and progress. In a way, it’s very much like making music.

The Conductor’s Challenge: Creating a Symphony

Suppose you are the leader of an orchestra, and all the instruments within it are the parts of your life. There is the saxophone, depicting your relationship with your spouse. There is the piano of your physical health, the oboe of your occupation, the harp of your hobbies, the flute of your finances, and so on. Every aspect of your life that affects your personal well-being – directly or indirectly – is part of the orchestra. And your task as a conductor is to create a symphony where all the instruments get to play together. 

This is easy with some instruments, because you are particularly good at them, or because you really enjoy playing them (sometimes even both). For instance, if you frequently attend to your relationship with your spouse, the saxophone is playing loud and clear. With other instruments, it can be more challenging. For example, if you struggle with self-doubts and worries, the trumpet of your thoughts may seemingly play off key or out of rhythm. Some instruments, such as your memories, may play sounds so discordant, such as memories of a severely critical parent, that you think there is no possible way that not can enter into the symphony of your life. Still, whether you like it or not, each instrument is a part of your journey. How can you include them?

If you’ve ever played around with music you may sense what to do. When a note seems odd, sometimes there is a more complex chord to be created by adding notes. Sometimes when a harsh or discordant sound occurs in a piece, it actually adds richness to the next musical phrase as it gradually resolves and is included. The same is true in your life. For example, suppose that the discordant note of a critical parent links you powerfully to your own values and needs, such as for kindness, safety, love, and trust. You may see the need for those notes not only in your life but in the lives of others. As you work with yourself and others to help create those new notes, parental criticism is transformed. Yes it can hold you back – but it can also drive you forward just as a harsh note might drive the music forward. And seeing that, you may reach out to others, or may be more willing to receive the support of loving others if that is available – allow this “new music” of kindness to spread.

Your challenge is to find the right rhythm for you, and to create a melody and harmony with what you have been given. And there are many ways in which you can do this. You can amplify the notes of your life from a given area or “instrument” by attending to them and building them out into other strands. Instead of stopping the entire orchestra when an odd note is played, you can lower their volume indirectly by including them and by gently amplifying other instruments. An orchestra is a large team and you do not control all the players so the composition works better not through removal, but by addition. Even an odd instrument can be transformed into part of a richer tapestry of sound. Real life is not simple, composed of a few obviously melodic notes. It’s not like playing “twinkle, twinkle little star” on a toy piano. Integrating the many elements of your life socially, physically, and psychological is a lifelong challenge of how to turn these elements into a complex but ultimately harmonious musical masterpiece.

The Power of the Process-Based Vision

People can get better. They can be empowered to take effective steps that improve their quality of life – by finding the rhythm and composition that works for them, given their goals, needs, and individual circumstances. Getting better is thus a matter of taking action, of learning about important factors, and of intervening in just the right way. This often involves some experimentation and the social support of others. None of us were trained “life conductors” when we were born. Learning what to do often means applying a therapist’s advice, learning how it has worked, and using the feedback to make adjustments and improvements.

The therapeutic process in a nutshell

This is a continuous journey, and it requires some time to find out what’s working. We can, however, accelerate the process by using evidence-based tools and techniques that have shown to be most effective. For instance, the change processes in the psychological flexibility model have proven to be among the most important skill-set in all of mental health (as was shown in a recent meta analysis of nearly 55.000 clinical studies). Furthermore, we now have the technology to uncover people’s hidden processes – quicker and more accurately than ever before – and to support clients even outside of session in their own lives (for more on this, check out PsychFlex).

We are entering a new era of psychological intervention. An era that is more individualized, more adjusted to the needs and goals of individual people, and therefore more effective than traditional psychotherapy could ever hope to be. People get stuck because they are not helped in ways that fit their unique circumstances. This is not to blame the therapist, because effective care requires the collaboration of both client and clinician. Together, with the right tools, they can identify the factors that matter, express them in the right ways, and create a masterpiece of meaningful change.

References

Hayes, S. C., Ciarrochi, J., Hofmann, S. G., Chin, F., & Sahdra, B. (2022). Evolving an idiographic approach to processes of change: Towards a unified personalized science of human improvement. Behaviour Research and Therapy, 156, 104155. https://doi.org/10.1016/j.brat.2022.104155.

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