How Psychologists Restart Stalled Progress in Therapy

Hi,

I'm Shebna N. Osanmoh I, a board-certified Psychiatric Mental Health Nurse Practitioner at Savant Care. Here are my thoughts.

How do you raise a stall without making the client feel blamed or discouraged?

I try to treat a stall as something we're looking at together, not something the client is doing wrong. A lull can mean the approach needs adjusting, the goals have shifted, life is getting in the way, or the work has reached something harder to talk about. I'd rather name it openly and with curiosity than let it sit, because unspoken frustration can quietly weigh on both of us. I also try to say what is going well, so the client hears that I see their effort.

One conversation starter I use:

"I'd like to pause and check in on how our work is going for you. What's feeling helpful, and what's feeling stuck?"

It invites the client to share their view first, shows I'm taking responsibility for our process too, and often leads naturally to a next step, like changing goals, trying a different approach, or setting a smaller target for the next few weeks.

Best, Shebna N. Osanmoh I, PMHNP-BC Savant Care https://www.savantcare.com/

I make it about the plan and the data, not the person. I'll say, "I'm noticing we've been at a plateau for a few weeks. Let's look at where we started, where we are now, and what's changed for you before we decide what to adjust." Showing real examples, like a recording from week one next to one from today, helps people see gains they may have stopped noticing. I also normalize plateaus. In stroke and aphasia recovery they're common, and they sometimes come right before a jump in progress, so a flat stretch isn't a verdict.

Then I ask what they think is getting in the way, because they often know. We pick one small change to try for two weeks, such as a different type of practice, a more functional goal, or a shorter daily routine. Naming what has improved first keeps the conversation from feeling like criticism, and it keeps people willing to continue. Ending with a clear next step gives the session direction instead of worry.

In addiction treatment, stalled progress is very often ambivalence rather than lack of effort. The patient comes to every session, says the right things, and nothing changes, because part of them is not yet sure they want it to. Pointing at the lack of progress only makes them defend themselves.

The opener that works best for me is: "We've been circling the same place for a few weeks. I'm curious what you notice about that." It names the pattern without blaming anyone and invites the patient to look at it with me rather than defend themselves against me.

If that opens the door, I go one step further: "If you were completely honest, what part of you is not sure this should change?" Patients are often relieved to be allowed to say it: drinking is the only way they relax, or sobriety means facing a marriage they are unhappy in. Once the hidden reason is on the table, we can work on it directly, and the next step usually becomes obvious to both of us.

The key is treating the stall as information, not as failure. It is usually the most honest thing that has happened in therapy so far.

I haven't experienced clients progress stalling in session. Clients come to session wanting to understand and resolve relational or emotional issues. They come to talk about what's not working, what they want, and wonder what's off, what's wrong. Stalling within sessions doesn't occur.

However, stalling or feeling stuck is often the reason why people enter therapy. For example, a father who is estranged from his daughter or a dissatisfied partner who feels alone in their relationship. My task is to help my clients explore what has made for this. My task is to help them resolve these messy issues.

When they are in session experiencing the emotional weight of feeling stuck, my task is to help them explore every nuance of what made for their dilemma. So I go about addressing their stuckness. I inquire about many aspects their distress to help them clarify issues, help them begin to imagine realistic options, or come to terms with things that won't change.

Feeling stalled or stuck can help us slow down and consider what kind of progress we'd like to make.

I'm Dr. Wildaliz Caro, PhD, and I'm a Medical Contributor at Aura Recovery Center. We're located in Scottsville, Kentucky.

https://aurarecoverycenter.com https://aurarecoverycenter.com/contributors/wildaliz-caro/

Before raising the possibility of stalled progress, I check whether the client and I still share the same definition of progress. I describe my observations in neutral, specific terms, ask for their perspective before interpreting why, and acknowledge any real gains.

Lack of progress can be extremely frustrating and demotivating. The point is to express how you honestly feel, without a personal attack and without sugar-coating it to avoid confrontation. After all, behavior itself is complex and influenced by multiple factors. In addition, patient preferences may not always match specific quality improvement measures. The therapist must also be willing to reconsider their initial assessment.

Don't offer a compromise or concession just because they are not speaking. You knew you wouldn't see changes overnight, but how are you supposed to know if you're making progress at all? One conversation starter is, "How do you feel about the progress we've made so far, and what could we do differently?" Take what you've learned and apply it to future goal-setting strategies. Define clearly how you will measure success in meeting the client's treatment goals. This is an active strategy of making a vague pursuit more tangible. You can come up with indicators that would tell you these things and help you improve the treatment plan. Whenever your goals change, your plan should be adjusted to support them.

Stalls in therapy are common, and often expected. They can happen for many reasons, so when I notice one, I name it openly and frame it as something we figure out together rather than something the client is doing wrong. I’ll often say, “I’d like to check in on our work together and hear your thoughts. How do you feel therapy has been going lately?” Starting with their perspective takes the pressure off and usually tells me more than my own read would.

From there, I explain that lulls often mean something has shifted: the goals we started with may have been met, or they may have changed. That reframe tends to turn a discouraging moment into a useful one, because it opens the door to asking, “So what do you want from this next stage?” More often than not, that conversation gives us a clearer and more energizing direction than we had before.

Ari Goodman is a Licensed Clinical Social Worker in Denver, CO, who works with individuals experiencing relationship distress. He sees clients via telehealth throughout Colorado and Washington State.