When No Intervention Is Good Enough

By Robyn D. Walser, PhD

“There is nothing that will ever change what happened…there is no place to turn to. These experiences have invaded and ruined every aspect of my life. There is nothing anyone can do.”  —Client in therapy

Have you ever encountered a client who responds to suggestions, feedback, comments, ideas, musings, reflections, and requests with comments that indicate, in some fashion, that you have got it all wrong? That you in some way have missed the point. Whatever has been said is somehow short of the client’s expectations or is wholly false. The overall sense is that nothing you will say or do will work; nothing will be, nor is, good enough. If you have had this experience as a therapist, you are not alone.

Therapists in these circumstances can come to feel frustrated, impotent, intimidated, criticized, or perhaps all the above. In this context, therapists can feel shut down and ineffective. It is important to remember that clients shape our behavior, too.

What can you do? Here are five ideas grounded in acceptance and commitment therapy (ACT) theory:

1. Remember the client has a history. Review the struggles that the client has been through. The client isn’t behaving this way to try and frustrate you or make you feel impotent. They have a learning history that has led them to engage in this behavior. Detecting its function, rather than its form, can help you get unstuck.
2. Engage in perspective taking. See the therapeutic work through the client’s eyes. Notice that they are in pain. Notice that they are truly stuck, and likely fused with a story about how nothing can help. Be careful not to become fused as well. Buying their story that nothing is good enough will place both of you in the same situation.
3. Focus on the present moment. Bring your awareness to the intrapersonal (what you think and feel) and interpersonal (what is happening between you) processes that are happening in the moment. Give voice to your internal experience. Notice with the client how the rejections of suggestions impact the relationship and the therapy.
4. Compassionately focus on the cost. Explore the cost of “Nothing is good enough” in terms of values. Work with the client to be curious about how this behavior limits their life and leads to rigidity with respect to options and possibilities.
5. Model flexibility. Whenever the client gives you feedback, makes suggestions, or questions what you do, model receptive flexibility. Be curious about what they are saying, and perhaps note that you will give what they are suggesting a try. Invite them to join you in a process of discovery.

One caution: Although defusion might seem like the perfect intervention in this situation, it can backfire. Clients who are fused with “nothing works” can sometimes see defusion in the same way. It can be an opportunity for some great defusion work if you can connect the client with the ongoing process of thinking, but if you do a simple defusion exercise, be prepared for the client to say, “That didn’t work.”

Robyn D. Walser, PhD, is codirector of the Bay Area Trauma Recovery Clinic, staff psychologist at the National Center for PTSD Dissemination and Training Division, and assistant clinical professor in the department of psychology at the University of California, Berkeley. As a licensed clinical psychologist, she maintains an international training, consulting, and therapy practice. Walser is developing innovative ways to translate science into practice, with a focus on the dissemination of state-of-the-art knowledge and treatment interventions.