Morgan Hagner, PsyD and Sofia Chernoff, PsyD
We all feel stuck at times, even in situations we care deeply about and despite a genuine desire to improve. Our clients are no different. As clinicians, our clients frequently tell us that they feel stuck. This experience is especially frustrating and difficult for clients when they face situations that impact their livelihood, relationships, and other areas of life that are important to them. As therapists, we can also get stuck alongside our clients and feel powerless to help them, despite feeling an incredible amount of empathy and a sincere desire to support them. Thankfully, CBT offers options that can help.
During a recent Beck Institute consultation group, a seasoned mental health professional, “Joel,”* shared that he was feeling stuck with a client and asked the group:
“What can you do when a client is making choices that conflict with their values and keep them stuck in the same pattern?”
In this case, Joel shared that he had worked with the client, “Rebecca”* for several months to address depression, trauma symptoms, and relationship, financial, and parenting problems. Over several months, he provided support and validation, introduced psychoeducation, behavioral activation, mindfulness, and problem-solving skills. However, he noted that Rebecca “just couldn’t get out of her own way,”
making what Joel described as poor choices. After a while, he became so frustrated that he started offering direct advice in hopes of better outcomes. But most of the time, Rebecca was unable to implement his suggestions. This pattern continued, leaving both Joel and Rebecca feeling increasingly stuck and helpless.
When asked to provide a specific example, Joel recalled that in a recent session, he and Rebecca were problem-solving ways to manage and cope with her multiple health appointments and busy work schedule. She had previously endorsed strong values of family and an aspiration to provide for her children. Despite these values, she continued to choose to leave work early as a solution to her high stress, consequently creating financial hurdles and barriers to providing for her children. Joel was unsure of where to go next and directly told Rebecca that skipping work was a poor choice.
During the consultation group discussion, the group members hypothesized that Rebecca may have other unexplored values that conflict with her values of family and being a provider. The group explored using Socratic questioning and cost/benefit analysis as interventions to support Rebecca’s decision-making and to promote autonomy and foster a sense of self-efficacy. Dr. Chernoff modeled the interventions with the following double-sided reflection and question:
“Could I please summarize what I heard to make sure I got it right? On one hand, your financial situation is not great, which has been stressful, and on the other hand, you’re thinking of taking the whole day off because work has been stressful. This sounds like a tough spot to be in. What would you tell a friend if they were in this situation?”
“Would you be interested in taking a closer look at the advantages and disadvantages of each option, so we don’t miss anything important?”
Joel was excited by the group’s discussion and decided to ask Rebecca, in their next session, if she’d be willing to revisit values identification and consider using a cost/benefit analysis.
During the following consultation group, Joel shared that he had apologized to Rebecca for making direct recommendations and proposed looking at advantages and disadvantages of each option in the future. The conversation reportedly went very well, and Joel helped Rebecca explore barriers to making her desired changes. This led to a discussion of Rebecca’s values, wherein she identified additional values of autonomy and freedom that supported her decision to skip work. After the discussion, Joel asked Rebecca:
“What will allow you to move forward as you evaluate your options?” and “What could help you line up your decisions with your values?”
Rebecca identified struggles with her medication regimen and reflected on how this was a barrier to behavior change. Joel continued to use guided discovery to explore her problems with medication adherence and practiced ways for her to express concerns with her prescriber. They collaboratively set an action plan for her to do just that. Joel noted that Rebecca appreciated how the session helped her to hold herself accountable and consider additional alternatives that are aligned with her values.
Joel shared that the consultation group really helped him re-evaluate his own cognitions about feeling stuck and develop a better cognitive conceptualization and understanding of his clients’ strengths and problems.
Beck Institute faculty strive to foster a collaborative and supportive professional environment that encourages continuous learning and growth. We understand that therapists sometimes feel stuck, and we believe that fresh perspectives and collaboration can help support them as they move forward. Please don’t hesitate to reach out to us and set up consultation if you feel stuck with a particular client or treatment issue.
*Both the therapist’s and client’s names and identifying details have been changed to protect confidentiality.