Therapeutic Impasse

The term therapeutic impasse may be used to describe a number of situations that can arise in psychotherapy. Impasses can occur as a result of disagreement between the therapist and client, unacknowledged issues within therapy, or stagnation in therapy. When an impasse first occurs, therapy stops making progress. A client may previously have been feeling better or exploring previously unexplored issues, but an impasse makes further exploration difficult. It can also cause a therapist to question his or her competence.

Examples of Therapeutic Impasse
Therapeutic impasse is an extremely broad term that can apply to a wide variety of situations. The only thing these situations have in common is that they slow down or halt treatment and may cause conflict between the therapist and client. A few examples include:

• A client who becomes resistant to exploring vulnerable feelings or experiences to such a degree that he or she is also unwilling to explore the resistance
• A disagreement between the therapist and client about the proper way to resolve a conflict
• Unresolved sexual feelings between the therapist and client
• An unhealthy relationship between the therapist and client
• An unsuccessful therapeutic intervention or modality

A therapeutic impasse does not necessarily have to be permanent, and therapists and clients frequently work through impasses together. In some cases, working through a therapeutic impasse is an important aspect of the client’s therapy process and may increase the client’s level of trust and safety within the therapeutic relationship.

Therapist’s Role
Therapists may arrive at an impasse when they no longer have the necessary skills or knowledge to treat a client’s particular concern, when a therapeutic modality they are using is not working for the client, or when the client refuses to acknowledge or discuss a particular issue.

Critics within the field of mental health frequently point out that therapists have a tendency to pathologize therapeutic impasses and label them as “bad.” Therapists may blame the client for the impasse and see the impasse as a result of the client’s mental health condition. For example, a therapist might believe that a client who is angry at her therapist is angry because of depression, not because of something the therapist has actually done. It is important for therapists to explore therapeutic impasses as objectively as possible. In many instances, therapists will consult with a supervisor or more experienced clinician to resolve the therapeutic impasse. There are also many articles, books, and trainings that explain strategies that therapists can use to move through or past a therapeutic impasse.

Client’s Role
Clients may arrive at an impasse in therapy when they have a disagreement about treatment with their therapist, when they are not making the progress they would like to be making, when they feel the therapist is not competently meeting their needs, or for other reasons. It is important to note that therapeutic impasses are not a particular person’s “fault”. Also, impasses may lead to an improved, more successful therapeutic relationship between client and therapist, or may lead to termination of therapy, or some resolution in between those two outcomes.

References:

1. Diamond, G., & Liddle, H. A. (1996). Resolving a therapeutic impasse between parents and adolescents in multidimensional family therapy. Journal of Consulting and Clinical Psychology, 64(3), 481-488. doi: 10.1037//0022-006X.64.3.481
2. Pope, K. S., Sonne, J. L., & Holroyd, J. C. (n.d.). Confronting an impasse. Ethics and Malpractice. Retrieved from http://kspope.com/ethic/chap10.php
3. Vichick-Johnson, S. (n.d.). The therapeutic impasse. Moultrie News. Retrieved from http://www.moultrienews.com/column/The-therapeutic-impasse

Last Updated: 08-28-2015