Impasse, Intrigue & Inspiration: Effecting Change Through Psychotherapy

Our theme, Impasse, Intrigue, & Inspiration: Effecting Change Through Psychotherapy, explores those times when the therapy seems stalled, at an impasse, and the therapist feels at a loss as to how to unclog the process and effect the change the client (or part of the client) seeks. People come to therapy to change - or do they? - yet clients often seem to resist that very change. Therapists sometimes attribute these stuck places to client resistance or ambivalence. Nothing the therapist says or does seems to break the impasse and motivate change. Sometimes ambivalence seems present from the start, the client has one foot in and one foot out. Other times, an impasse is reached after productive work, when a steady client hits a plateau and just can't seem to move forward. Some impasses reflect a rupture between client and therapist. Any of these scenarios can lead to a frustrated client, headed out the door, and/or to a discouraged therapist, feeling helpless or inadequate.Therapists are also sometimes stumped in other ways. Have you ever been intrigued about the topics your clients talk about - or don't talk about! - wondering why they're paying to talk about that? Are you left wondering just what keeps them coming? What about those surprises when your patient buries the lead or drops a major revelation while walking out the door? What?! Or those moments when you hear, too late, how your own words landed on your client's ears with a heavy thud, threatening a conflictual impasse, and know you need to back-pedal, fast? Any of these moments can leave the therapist struggling to find solid footing again.For this issue of Voices, authors considered their most challenging moments in psychotherapy: the times they felt stymied, not sure what to do next.Linda Buchanan's reframe depathologizes client resistance as the guide to the pain and fear underlying the ambivalence that often accompanies change, absent which clients could likely make their desired change without seeking our help; resistance shows us where the heart of the work is. Tali Silver gives us a poignant vignette of how the angst of one client's abrupt departure led to the therapist's continued self-work. Marilyn Schwartz offers her own experience with an abrupt ending, reflecting on both the impact of rupture on the therapist and the healing that comes with separating what is the therapist's from what is the patient's part in the rupture. Jerome Gans shares several clinical experiences in which humiliation could have ended in impasse or rupture and how this was, in most cases, avoided.Blake Griffin Edwards narrates an early career experience of feeling stuck with a client; when none of his training in techniques seemed to help, he learned the power of the therapeutic relationship. John Rhead tells how recent plumbing work in his home led to fresh insight about structuring a therapeutic container so that it is less vulnerable to a clog. Grover Criswell explores the ubiquity of obstacles and impasses in therapy (and life) from both the chair of the therapist and the couch. Likewise, Paul Shultz recounts his personal experience as both patient and therapist with resistance to change in psychotherapy.Shirley Tung shares her experience with a client in the aftermath of the Uvalde school shooting, exploring how impasse can enter the therapy room through events in the larger cultural context to which both therapist and client have a reaction. Ellen Schiff relates how an impasse within herself impacted decisions about her practice. Penelope Norton explores how two very different client responses to new adult recognition of repressed childhood sexual abuse triggered her own reflection upon the personal costs of her history of repeated, difficult work with such abuse.A selection from the Voices archives, taken from a 1968 issue (Vol 4, No. 3) similarly themed "Therapeutic Impasses," fills out the issue.