Dealing With Setbacks During Therapy

Setbacks are a common part of therapy. Periods when progress stalls, or when difficulties you thought were settling return, can be discouraging. This page sets out what a setback usually is, what tends to bring one about, and what you and your therapist can do when one occurs.

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Understanding Setbacks in Therapy

Definition and Common Causes

A setback in therapy usually shows up as a stall in progress, or as the return of a difficulty that had begun to settle. Common causes include stress from outside the therapy, reaching material that is hard to put into words, and uncovering problems that need longer or more careful work than was first apparent. Noticing what came before the setback is the first step in addressing it.

Psychological Impact

A setback can bring frustration, confusion, and doubt about whether therapy is working, and feeling discouraged at these points is common. For most people the discouragement eases as the setback is understood and worked through, although how long that takes differs from person to person.

Setbacks Are Not Unusual

Setbacks are a normal feature of therapy. They do not mean that you have failed, and they do not mean that your therapist has. They often accompany work on longstanding or deeply rooted difficulties. Holding that in mind makes it easier to stay with the process rather than to conclude it has broken down.

Strategies for Managing Setbacks

Realistic Expectations

Therapy involves difficult emotions, and for many people progress is uneven rather than steady. Knowing this in advance can make a setback less alarming when one arrives, and can make it easier to raise in session rather than sit with alone.

Therapeutic Techniques

Therapists draw on specific methods when progress stalls. Cognitive reframing examines how you are interpreting the setback, and can move it from evidence of failure to information about what needs attention. Mindfulness practices are used to help you notice difficult feelings and thoughts without immediately acting on them. Which methods are appropriate depends on your therapy and on the difficulty being worked on.

Role of the Therapist

Your therapist's part during a setback is to help you look at what has happened, to point out progress you may have lost sight of, and to revisit the goals of the therapy where they need adjusting. Understanding what brought the setback about is often useful material for the work itself.

Your Part in Working Through Setbacks

Active Participation

Saying plainly that progress has stalled, and describing what that is like, gives your therapist something to work with. It also helps to keep applying what you have worked on between sessions, including in the weeks when it does not appear to be doing much.

Personal Strengths and Support Systems

Support outside the consulting room matters during a difficult period. Family, friends, or a support group can offer practical and emotional support. So can the things that already help you cope, whether that is exercise, absorbing activity, ordinary routine, or enough rest.

Reflective Practices

Some people find journalling or meditation useful between sessions. Keeping a short written note of when the difficulty is worse, and what preceded it, can surface patterns that are hard to see from inside a session. Meditation is used by some people to sit with a difficult state rather than act on it straight away. Neither suits everyone, and whatever you notice can simply be brought to the next appointment.

Learning from Setbacks

What a Setback Can Show

A setback often marks where the work actually is. It can show which situations you are most vulnerable to, how you respond under pressure, and what you fall back on when things become hard.

Adjusting Therapeutic Approaches

A setback can also be a reason for your therapist to change approach. That might mean bringing in a different method, changing the pace, or revising goals that no longer fit your circumstances. If nothing shifts over a longer period, it is reasonable to raise that directly.

Keeping Going During Difficult Periods

Setting Small, Achievable Goals

Smaller goals are easier to hold onto when a larger one feels out of reach. They give something specific to aim at in the coming week rather than the coming year, and they make it easier to tell whether anything is moving.

Noticing Progress

Progress during a difficult period is often small and easily overlooked. Noting what has actually changed, and mentioning it in session, keeps the account accurate rather than shaped by the worst week.

Taking a Longer View

Therapy is usually assessed over months rather than weeks. Comparing where you are now with where you were six months ago is often more informative than comparing this week with last week.

Building Resilience

Working through a setback can leave you with a clearer sense of what helps you and what does not. For many people that knowledge remains useful after therapy has ended.

Key Takeaways

• Setbacks are part of the process. They are common in therapy and do not mean that it has failed.
• Adjust collaboratively. Raising the setback with your therapist allows the goals and the approach to be revised where they need to be.
• Stay involved. Describing what is happening, and keeping up the work between sessions, gives the therapy something to work with.
• Draw on support. The people around you, and the coping strategies you already have, matter during a difficult period.
• Note what changes. Small progress is easy to miss during a setback, and recording it keeps the picture accurate.
• Say so if nothing shifts. Where there has been no movement over a sustained period, reviewing the approach or considering a different one is a legitimate step.

FAQ

What should I do immediately after recognising a setback in therapy?

Take some time to work out what may have contributed to it, then raise it with your therapist. Between you, you can look at what sits behind the setback and adjust the plan where it needs adjusting.

How do I talk to my therapist about a setback without feeling like a failure?

Your therapist is not there to judge your progress. Saying plainly that things have gone backwards is useful information for the work, and this is what the therapeutic relationship is for. If you find it hard to raise, that difficulty is itself worth saying out loud.

Is it common to feel like quitting therapy after a setback?

Yes. Wanting to stop after a setback is common. It is worth saying so in session before acting on it, so that any decision about ending is made once the setback is understood rather than at its worst point.

How can I tell the difference between a typical setback and a sign that therapy is not working for me?

Raise the pattern with your therapist: how often setbacks occur, how long they last, and whether anything has changed over months rather than weeks. Where there has been no movement over a sustained period, it is reasonable to review the approach, ask for a second opinion, or consider a different therapist or a different form of therapy.

Additional Resources

• Jobes, D. Setbacks in Psychotherapy. Psychotherapy.net.
• Joseph, S. (2018). How to Deal With Setbacks and Challenges. Psychology Today. On problem-focused, emotion-focused and avoidant ways of coping with a setback.
• Eisenberg Family Depression Center, University of Michigan. Depression Center Toolkit. A free public toolkit covering conditions, treatment, self-help strategies and worksheets. United States based, so the services and crisis numbers it lists apply there.