Looking at Blocks to Progress in Therapy

If you have been in therapy for a period of time and continue to suffer from depression, anxiety, and/or post-trauma stress disorder, perhaps you may be feeling discouraged about your progress. That discouragement is understandable. Yet there are several evidence-based therapies that have been shown to be effective. So, it’s important to think about the possible blocks that might be getting in your way.

One possibility is that perhaps the therapy you are doing is not the right fit. No therapy is right for everyone. For example, many therapists are considering personality styles in looking at what therapy works best. For individuals who tend to be more under-controlled in their personality style, a therapy that focuses on impulse control and emotion regulation would be indicated. For individuals who have a more over-controlled personality style, a therapy that focuses on how to connect with others, how to be less inhibited, and how to have fun and experience joy could be most effective.

Some people feel relief when they understand their diagnosis and what behaviors/symptoms are part of the diagnosis. Sometimes having an accurate diagnosis helps decrease intense feelings of self-hatred and self-blame. There can be a sense of relief at understanding their behaviors and choices that can come from having a diagnosis. Sometimes cognitive behavior therapy that addresses these beliefs is effective.

Your diagnosis is not who you are. For example, if you have a diagnosis of obsessive-compulsive personality disorder, then you are likely to struggle with perfectionism and have a sense that your way is the right way. You may tend to tell others how to do things. These behaviors are likely to interfere with relationships. But these behaviors are part of the disorder, not who you are, and you can make changes. If you don’t know or understand your diagnosis, consider discussing it with your therapist.

Another possibility is that you are not addressing core beliefs about yourself in therapy. Consider how you would answer this question: How do you feel about yourself? If you hate yourself, believe you are worthless, see yourself as a troublemaker, or have other negative views of yourself, those beliefs could be one of the blocks in your progress. While many people change the way they view themselves when they learn to cope more effectively with strong emotions, others continue to judge themselves negatively. These beliefs about themselves are fixed, rigid, and pervasive. They often don’t experience joy or close relationships because they believe they are flawed in some way. For this group of individuals, directly treating/addressing these beliefs about themselves is important for progress.

The negative beliefs that people can have include that they are “crazy,” that they are basically evil or bad, that they are incompetent, that they are weird or different and can never fit in, or that they are basically unlovable. These beliefs can include that they are “screw-ups” who do everything wrong. My clients who have these basic beliefs about themselves are certain that these beliefs are true, and they “know” this at a very deep level. When others disagree with them, they often feel invalidated or misunderstood. Some people may not share these beliefs, as they do not think they will be understood, or they feel ashamed. Yet not addressing these beliefs can mean that little progress is made in recovery, which can be discouraging.

For many, these beliefs were created by years of traumatic invalidation. Dr. Melanie Harned, in her recently published book Treating Trauma in Dialectical Behavior Therapy, defines traumatic invalidation as “extreme or repetitive invalidation of individuals’ significant private experiences, characteristics identified as important aspects of themselves, or reactions to themselves or to the world.” Basically, this means that you were repeatedly told that your private experiences, thoughts, and feelings were invalid. According to Harned, examples of traumatic invalidation include criticism, emotional neglect, ignoring, misinterpreting, denying reality, controlling, blaming, being excluded, and unequal treatment.

If you grew up in an environment where you were repeatedly and consistently criticized, ignored, blamed, and/or excluded, would you consider yourself to have experienced traumatic events? Most of the clients that I see believe that traumatic events mean a severe accident, acts of violence, or abuse. However, Harned notes that severe and pervasive invalidation can be a traumatic event. It can be traumatic when the individual experiences intense psychological pain as a result and have a long-lasting impact on the person's view of themselves and on their functioning. And part of the trauma can be that you blame yourself, or see yourself as a flawed human being who doesn’t deserve kindness or close relationships or could never fit in or belong.

When you see yourself in one or more of these negative ways, you can see how it can impact your relationships. Let’s consider an example. Imagine that you see yourself as unlovable. When you believe this about yourself, you may isolate yourself, hide who you are, and avoid making friendships. Perhaps you stay in abusive relationships because you don’t believe anyone else would care about you. You may expect rejection, even from your therapist, and may end relationships in order to avoid being rejected.

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Here’s another important question. If you have pervasive, fixed, negative views of yourself, could you consider that these views are the result of pervasive invalidation and are not a reflection of reality? Could you be open to that idea? Could you be willing to work with your therapist to treat those views of yourself as being symptoms of traumatic invalidation?

Just as different people prefer different coping skills, different people experience different blocks from time to time in their therapy. I’ve outlined a few here, and there are many more. Discovering these blocks and then problem-solving can help get you back on track.

To find a therapist, please visit the Psychology Today Therapy Directory.