A recent question was posted on a listserv I subscribe to. The therapist asked for suggestions on confronting a client’s persistent pattern of dysfunctional choices and behaviors—a pattern that apparently had not changed during the course of therapy. The therapist expressed exasperation with his client: his client was “stuck” (his word, not mine) and had been “stuck” for a long time. The question triggered a number of thoughts, most centering on “stuck points” –those periods of time when therapeutic work appears stalled and when therapeutic tools don’t seem to be effective anymore. Interventions aimed at helping the client get “unstuck” seem fruitless. Frustration builds, and the therapist may begin to feel that he or she has “failed” the client, or worse, that the client has somehow “failed” treatment. The client may also feel frustrated and may even consider leaving treatment.
In many ways, “stuck points” reflect ambivalence about change. Let’s face it: when it comes to making changes in our lives, most of us approach change with some degree of ambivalence. We feel distress and perceive the need to change so that the distress will diminish; but we also feel uncomfortable with entering new territory. This can happen with any problem: leaving a dysfunctional relationship, changing a career, dieting, abstaining from tobacco, drugs or alcohol. We can become "stuck", unable to move forward.
Feeling “stuck”—ambivalent—may also reflect deeper issues. Indeed, it’s been my experience that being “stuck” signals that there is deeper work to be done. The salient issue has not been fully identified. Persistently dysfunctional choices or behaviors have meaning—meaning that has not been fully explored.
Until we work through ambivalence, we often persist in dysfunctional behaviors and remain “stuck”. Until we understand the meaning of the behavior—its role in alleviating anxiety, its role as a defense—it will persist. Likewise, we need to understand what may be happening between the client and therapist in the consultation room; transference and counter-transference dynamics are always at work.
Exploring and working through “stuck points” requires time, courage and persistence—as well as a willingness and ability to sit with ambivalence and uncertainty. The roots of ambivalence can run deep, and quite often we are not fully conscious of the dynamics that create “stuck points.” Sitting with ambivalence also provides an opportunity to look at the therapeutic relationship itself where so many dynamics come into play: transference issues and counter-transference responses are always subject to therapeutic attention and exploration.
In short, “stuck points” are opportunities to explore, learn, and perhaps develop insight. While understanding and insight may not always lead to immediate, visible action, it is important to recognize that an evolution is taking place. Most change is incremental. And sometimes the course of change is surprising—to the client as well as the therapist. Therapeutic activity that supports safe exploration and experimentation will also support movement away from being “stuck.”