When a Client Feels They Aren’t Making Progress

Photo by Michelle Tresemer on Unsplash

You see an email from a client between sessions that states they don’t feel like they are making enough progress in therapy. You find your stomach tightening and your mind begins to spiral. You catch yourself thinking, “am I not an effective therapist? Am I failing them somehow?” After all, many mental health professionals take ownership over session progress or failure as we have a lot invested in the clients we serve.

I want to normalize this experience by stating that an initial emotional reaction to perceived negative feedback is valid. Our desire to help others is valid. Even the client bringing up their progress or lack thereof is valid. To truly embrace this experience as a growth opportunity for our clients and ourselves, consider the following steps to remain grounded and present through the process.

Notice Your Own Stuff. It’s important to notice our reactions and responses to a client saying they don’t feel they are making progress. We may question our abilities. We may find ourselves hurt or defensive. We may want to argue with the client. Notice how you want to respond and hold space for those feelings. Seek supervision or consultation if it can help you hold and process those emotions in preparation for moving forward to the next step.

Remain Curious. It’s important to remain curious about why a particular response is coming up for you. Do you recognize a people-pleasing part of that wants all clients to be happy with the work you do? Are you fearful of a negative review? Did their comment reveal deeper fears of feeling out of your element or incompetent? Perhaps you are feeling blindsided by their feedback because you felt the last few sessions were full of powerful processing. Remain curious about what response is showing up loudest and why.

Boldly Brainstorm. Once you’ve recognized your own response to feedback and work through it, you are ready to re-engage your client. What would it be like to explore their bravery at naming how they feel? Can they identify the barriers that prevented them from bringing it into the room in a previous session? Is there an expectation that needs to be clarified for them to feel good about the work? Or do they need a different fit or referral based on their progress to date? By modeling for the client that these types of conversations are welcome, not only can we better understand where they are coming from to brainstorm solutions, we can also encourage transparency in communication going forward.

Although a client reporting they feel they aren’t making enough progress can be initially upsetting, it can serve as a powerful opportunity to reconnect and communicate on the expectations and structure of therapy for the better. I hope these ideas can help you navigate unfamiliar territory with grace so that future feedback can not only enhance a client’s therapeutic process, but your clinical skills as well!

Seven Tips for Building Rapport with New Telehealth Clients

Telehealth is a necessity in the face of COVID. Professionals and clients alike are feeling grateful to have this option to provide space for services and support clients with change, uncertainty, and the unknown. If you are like me, you weren’t fully prepared for the shift to telehealth back in March. Perhaps it wasn’t part of your business model as a therapist. Maybe it wasn’t an interest for you as a professional. Nevertheless, as we adapt to continue this meaningful work, let us take a look at some helpful tips for rapport and by-in when engaging new clients through telehealth.

1.     Look at the Camera Frequently. It’s hard not to feel self-conscious being on a screen. Invest in a light ring and elevate your camera so you are looking forward instead of down. Be sure to look at the camera directly when asking questions and when closing the session, as it encourages connection in feeling like you are truly looking at the client instead of looking at an image of you or them.

2.     Explain Loss of Eye Contact. You don’t have look at the camera the whole time. In fact, you need to be able to glance down from time to time to see how the client is presenting when it comes to body language. Be sure to name why your gaze is shifting, such as writing notes or referencing something in their initial paperwork.

3.     Review Documents. Review their initial documents beforehand and reference them in session. Not only does this show you are paying attention, it prevents your client from feeling like they have to repeat themselves.

4.     Obtain Consent for Telehealth. Engage your client in reviewing the telehealth software and protocols to obtain their consent. This includes emphasizing how their information will be protected and what to do when a call is dropped or requires another method due to connectivity issues.

5.     Encourage Questions. When building rapport via a screen, encourage your client to ask questions. This allows them to address any anxiety or worry about the work and permits them to feel like the conversation isn’t one-sided. Summarize goals and next steps for feedback and to demonstrate active listening.

6.     Explore Therapy History. A powerful question in building rapport can be normalizing that therapy is not a one-size-fits-all approach. Encourage your client to open up about what works for them by asking what they liked or disliked about past therapy experiences. Are they brand new to therapy? Ask how you’ll be able to gauge if something you say or do upsets them. This highlights our humanness as providers and encourages new clients to be honest and self-aware about triggers for upset as well as opportunities for therapeutic repair.

7.     Be Transparent. As the intake session comes to a close, summarize what you’ve heard them share, including what they want to work on and scheduling needs. Are they open to weekly therapy? Biweekly? Did you capture their initial goals? Scan and share your intake notes for complete transparency, inviting them to provide corrections or feedback as appropriate.

These tips are by no means an exhaustive list. However, the hope is that they compliment your own experiences as a professional adapting to telehealth. Allow these ideas to support your best work by providing a meaningful first impression. Your clients will be grateful for your attention to detail and your efforts will encourage their active participation in scheduled telehealth sessions going forward.

Humanity: Transforming Therapy into an Art of Holding Space

“Do you know what it’s like? Has that ever happened to you? Have you experienced it too?” Your client sits across from you, disclosing some of their most personal experiences in a desire to connect and be seen. In a genuine effort to maintain rapport, you nod your head, agreeing with them. You think to yourself, “Yes, I can connect with just about everyone! This is such meaningful work!”  But then it happens, they’ve sensed something and they begin to pull back, both physically and emotionally as they sit in your office.  They are shutting down and you can feel the energy shift in the room as they begin to disengage, to retreat. What will you do?

What would it cost us as mental health professionals to be transparent and thus more vulnerable in session? Is your client seeking an expert, a confidant, a compassionate ear? Or perhaps they want someone to hold space, to witness their pain. Research tells us that the most important and meaningful indicator for progress and healing is the therapeutic relationship, that the best fit relationship catalyzes positive change. We as mental health professionals desire to help others, to support them in their journey to self-awareness and growth, yet there are times we will witness their story and wonder if what we provide is enough. Our ability to be human and connect can help.

Transparency

Back to our scenario. You sense your client is pulling away, disengaging in an attempt to protect themselves. Can you name that in the room, support them in acknowledging what is happening for them in an effort at self-awareness and retained connection? Can you ask them to help you understand what just happened for them in their experience? The client responds by saying, “I just feel like I can’t trust you, that you are judging me.” So, you respond by acknowledging how important trust is and how you want to understand where they are coming from. They share more information, disclosing how they need you to hold space for their processing and truly connect with them. You agree to the importance of connection and ask for feedback on how you can support them in building trust for the work you will do together. You offer a genuine apology for any misunderstanding and resulting hurt. Your client visibly relaxes, feeling seen and heard by you in this moment of vulnerability. You continue the positive momentum, supporting them in exploring other times they’ve felt this way in their community and bear witness to their experience.

Vulnerability

Asking a therapist to be vulnerable with a client in session can be intimidating and anxiety provoking. Depending on our own background, experiences, and training, we may feel uncomfortable connecting in this way. There are therapy modalities that deter us from showing emotion or advise against self-disclosure. Yet when you ask therapists in the field about how they use emotion or self-disclosure to connect and support their clients, there are those of us who can recall vulnerability leading to some of the most powerful and meaningful work of our career. As Brene Brown states in her book Daring Greatly: How the Courage to Become Vulnerable Changes How We Live, Love, Parent, and Lead, “Vulnerability sounds like truth and feels like courage. Truth and courage aren’t always comfortable, but they’re never weakness.” Our vulneratbility and truth can show up in the room with our clients in the following ways:

• Admitting we can’t fully understand their experience as they know it but want to know more what it was like for them.
• Admitting we don’t understand slang or other word choice and can they educate us so we can best support them.
• Acknowledging their pain and the tears that show up in our eyes as we witness it.
• Apologizing when we misunderstand or unintentionally offend.
• Accepting responsibility for our actions and showing their concerns are heard and can be addressed in our work together.
• Self-disclosing with the purpose of connecting to their pain, providing validation or humanity, and not for our own gain.
• Rescheduling due to illness and letting them know we want to give them our best.
• Recognizing our own triggers and how they show up in the room.

“Courage starts with showing up and letting ourselves be seen.” Brene Brown in Daring Greatly: How the Courage to Become Vulnerable Changes How We Live, Love, Parent, and Lead.

Holding Space

Transparency and vulnerability interact in developing a human connection. The art of showing up and staying connected can be further defined as the concept of holding space, written in detail by Heather Plett. Heather writes, “holding space means we are willing to walk alongside another person in whatever journey they’re on without judging them, making them feel inadequate, trying to fix them, or trying to impact the outcome. When we hold space for other people, we open our hearts, offer unconditional support, and let go of judgement and control.” As therapists, let us support transparency, vulnerability, and holding space to best serve our clients in being their own agents of change, thus engaging in a process of healing we are fortunate to witness.

For more information on vulnerability, visit brenebrown.com. For more information on holding space, please visit heatherplett.com.