Creative Hopelessness and Getting Unstuck
Why some people benefit from therapy and others don't
Why do some people not benefit from therapy?
At first glance, it looks like there are many reasons:
They're not ready to change.
They are too fused with their thoughts.
I'm not a good enough practitioner.
We don't have a strong enough therapeutic alliance.
I'm sure you can think of many other possibilities. What if all these reasons boiled down to the same one or two reasons?
Two reasons why clients don’t improve
When my clients don't seem to be improving in therapy, I tend to think it's for one of two potential problems:
They aren't doing the work.
Their current behavioural patterns serve other unknown functions.
When your clients aren't doing the work
We all relish the easiest path of resistance:
To be fitter without doing so much exercise.
To become more confident without taking on the scary stuff.
To have more energy without getting moving.
It's natural to want rewards without taking risks. However, as someone much wiser than I once said, discomfort precedes growth (thanks, Robyn!)
Many of your clients will harbour, if not say explicitly, that they want you to take away their pain and distress. The reality is that you can't wave it away with a magic wand; they need to do the work. If their behaviour stays the same, then so too will their struggles.
Their patterns serve unknown functions.
Sometimes, neither you nor your client can see the whole picture. They may tell you that they struggle with anxiety or depression, but they don't know what other painful emotions sit somewhere in the background.
Sometimes, when a person procrastinates about or avoids homework, they're under the control of rules that experiential avoidance helps them solve other problems. For example, take the single parent who hides away in the bathroom to rehearse their compulsions. Preoccupied with thinking 'bad' thoughts, they rely on reassurance to alleviate their anxiety.
However, when it comes to letting go of this habit and building up to something wiser and more workable, they continue to go to the bathroom.
What if going to the bathroom serves another purpose, such as providing much-needed time alone? Unless you explore other possibilities for the persistent pattern, you may never discover that their behaviour makes sense from a self-care perspective. Therefore, you may need to explore different ways the client can carve out time for themselves that work better for you.
What can you do when your client is not making progress?
You've probably heard it before, but it's valuable advice nonetheless.
When nothing changes, it's often helpful to leverage Creative Hopelessness interventions.
Creative Hopelessness is the process of undermining control and avoidance as a way of approaching life. It's powerful to start therapy, and it helps us out time and time again.
People may understand that what they do doesn't work, but we are likely to stay the same unless we feel uncomfortable enough.
As another wise ACT Practitioner once said (Rikke K!), you need to rearrange the consequences to help someone change their behaviour. In other words, if they're stuck repeating an unhelpful pattern, then there is more you can do to put them in contact with the discomfort of doing nothing different!
What to do in your next session
The next time you're in a session, and you notice that things aren't changing in the client's behaviour, bring Creative Hopelessness into the room. Try to resist the urge to tell them it doesn't work, and instead invite the pain closer.
Here are a few steps to make it happen:
Could you invite the client to recall a time when they felt the urge to repeat the habit they want to change?
Go slow and encourage them to do the same.
Guide their attention to notice and describe what they feel in their body.
Gently go deeper by asking permission to explore what happens next.
Stay present to the pain of what they lose when they repeat this pattern, e.g. notice how you're still alone, isolated, and struggling when you stay in the bathroom. Can you see how you continue to suffer when you go there?
I am aware that it can be intimidating to visit these places with your client. Many of us want to help our clients feel better, but when we avoid discomfort, nothing new happens.
It can be helpful to remember that our job is not to help our clients feel better, but to help them become better at feeling.
As you hold that in mind, you open a bigger space for you and your client to walk about.
Take care and keep going.
Jim
Great post Jim! I have a feeling I am going to enjoy this Substack...
As an ACT therapist, I appreciate this article on creative hopelessness! I focus quite a bit on values, but this is an area I can be more thoughtful and practice on!