Series: Notes for New Therapists — Part 3
A client tells you therapy isn’t helping.
You have some thoughts about why. But what to say? And how?
It’s often easy for us to notice what a client is not doing. Maybe they attend inconsistently. Maybe they agree in session to try something later and don’t follow through. Maybe they want change very badly, but also seem unable or unwilling to do some of the things that might help create it.
Do you say so?
Yes. I think you do.
But one thing you may not realize is that delivering challenging news to someone you want to continue to work with involves walking a path together.
If a client tells me they’re unhappy with their progress, I might start with something like:
“I’m glad you brought this up. It tells me you’re ready to have this conversation, and I think it’s an important one.”
Followed by a question:
“Can you tell me more?”
Then I’d sit with my listening ears well fastened, and my pie hole shut.
I would make a note of any important points I want to remember from what they say. I might ask small clarifying questions. Then I’d restate what I understood back to them.
Before I start telling the client what I think is happening, I want to understand what they think is happening.
Before you share the reasons you can see that they aren’t making much progress, it’s a good idea to feather the nest a bit.
Remember: this is someone you want to see you as a supportive advocate.
There’s some interesting relationship research behind this idea. John Gottman’s work with couples found that stable, satisfied couples maintained roughly five positive interactions for every negative one during conflict.
Therapy isn’t marriage, and I’m not suggesting you carry a clicker.
But the underlying idea is useful. Challenging interactions occur within the context of an entire relationship. What proportion of this client’s experience of you communicates that you see what they’re doing right?
Spend a little time talking about what you appreciate about the client. The work they have done. The realizations they’ve had.
This isn’t about flattering the client so they’ll tolerate criticism. It needs to be true.
What strengths have you seen? Where have they grown? What do they bring to therapy that makes change possible? What is working between you?
Talk about those things honestly, and you’re feathering a cushion that will make it possible for you to introduce something harder.
Use it carefully.
This is probably not the time to produce your entire catalog of concerns.
Pick one or two.
“I’ve noticed that we make plans here that seem important to you, but it’s been very difficult to follow through once you leave.”
Or:
“You’ve told me you really want this to change. I’m also noticing that we keep getting right up to the edge of working on it and then moving away.”
Then stop.
You don’t need to convince the client that your observation is correct.
You’ve put something into the room that the two of you can look at together.
See what happens.
Your client may feel ashamed. Or defensive. Or angry with you.
They may tell you that you’ve misunderstood them completely.
Use your skills to welcome those feelings.
This begins with being fully present with your own. Not to share, just to have and allow.
You can treat someone with warmth, respect, and compassion and still say something they find difficult to hear. Then you can stay with them while they have whatever feelings they have about it.
Research on therapeutic alliance ruptures gives us some reason to take this seriously. A meta-analysis found that successful repair of alliance ruptures is associated with better psychotherapy outcomes. More recent qualitative research has emphasized something that matters enormously here: the therapist’s capacity to tolerate emotional discomfort and remain reflective while the relationship is under strain.
That makes sense to me.
If your client is angry with you, can you remain curious?
If they become embarrassed, can you resist rushing in to make the embarrassment disappear?
If they disagree with you, can you consider the possibility that they’re right without immediately abandoning your own observation?
That is part of the work.
Eventually, you need a plan.
But it should be a plan based on the client who is actually sitting in front of you—not the imaginary client who attends every week, completes every assignment, and cheerfully implements every therapeutic suggestion.
If they can’t afford weekly therapy, they can’t.
If the between-session work isn’t happening, find out why.
Maybe the assignment is too big. Maybe they forget. Maybe agreeing with you is easier than telling you they don’t want to do it. Maybe avoidance itself is part of the problem you’re treating.
Make the next step small enough to be possible. Agree on one or two things. Find out what might get in the way.
And if it doesn’t work?
You have more information.
Then you talk about it again.
Therapeutic confrontation can simply mean being willing to notice a discrepancy and bring it into the relationship.
Something isn’t working.
You both know it.
Now you can look at it together.
The goal isn’t to win the confrontation.
The goal is to create a relationship strong enough that neither of you has to look away.
Part 1: How Do I Evoke Emotional Processing in a Therapy Session?
Part 2: How Do I Stop Being a “Coping Skills and Psychoeducation” Therapist?
Part 3: Therapist Skills: “I’m not making much progress here.”
Anne Lindyberg, LMHC (Iowa), LCPC (Illinois), integrates the transformational therapy of Virginia Satir with Deep Brain Reorienting (DBR) and the Alexander Technique. She specializes in helping adults with complex and developmental trauma create lasting emotional change through therapy.
This work is created on the traditional and unceded lands of Indigenous peoples; a fuller acknowledgment of the land, its history, and its peoples is available on this website.
The Gottman Institute. The magic ratio: The key to relationship satisfaction. https://www.gottman.com/blog/the-magic-ratio-the-key-to-relationship-satisfaction/
Eubanks, C. F., Muran, J. C., & Safran, J. D. (2018). Alliance rupture repair: A meta-analysis. Psychotherapy, 55(4), 508–519. https://pubmed.ncbi.nlm.nih.gov/30335462/
Margetts, A. E., et al. (2026). A systematic review and thematic synthesis of qualitative literature on the experiences of alliance ruptures within psychotherapy. British Journal of Clinical Psychology. https://bpspsychub.onlinelibrary.wiley.com/doi/10.1111/bjc.70079
This article is intended to support professional reflection and learning. It does not constitute clinical supervision, formal training, or individualized professional guidance. Clinicians remain responsible for practicing within their competence, scope of practice, and applicable professional and licensing requirements.
This article and other informational content on this website are provided for educational purposes only. They are not a substitute for individualized professional care, do not constitute advice specific to your circumstances, and do not establish a therapist-client relationship.
Midwest Center for Transformational Change PLC