Therapy plateau


Therapy plateau


your avatar   Not Very Far Out of the Woods (37-year-old man)

I have been struggling with a cyclical pattern of depression for several years. This year I had an extreme crisis and plunged into despair, bordering on suicidal, triggered by the devastating failure of a project I had been working on for over a year and had woven into my self-identity. I began seeing a therapist at a local low-cost counseling center. It helped get me through the crisis and I'm no longer suicidal, but I feel like I've reached a plateau and that I'm not really getting what I need to move forward with my life.

I feel like my therapist is attentive during our sessions, but he doesn't retain details from session to session and it makes me feel like he doesn't consider me too important. I'm poor and am only paying $10 a session on a sliding scale, so I feel like I'm lucky to be getting any counseling at all and that I don't really have the right to ask for more. But I really want to figure out how to make progress in shaping my life into something I'm comfortable with. I've brought that idea up, but we never seem to go anywhere with it. I feel like I'm starting to more fully understand why I have negative beliefs about myself, but it's not leading to anything I can DO about it. So now instead of just being hopeless and miserable, I'm hopeless and miserable and self-aware. The thought of having to find a different therapist is depressing, I hate going over the details of my life and having to go over it all again with someone else seems really unpleasant.

How can I get more out of therapy? How much is appropriate to ask for when I'm paying the minimum a sliding scale permits? It's actually making me angry because I'm finding out I have to ask my parents for what I need from them in our relationships, I'm having to ask my employers for what I need from them in my work relationships, I'm having to ask everyone in my life for what I need from them, and I would really like it if ANYONE in my life could actually just be what they're supposed to be without me having to blueprint it for them. Please help me understand what's okay in this kind of circumstance and how I should best approach it.


    Susan Maroto,

HI -

How can you get more out of therapy? By doing exactly what you don't like doing - asking for what you need. Yes, it's appropriate for you to bring up your concerns and the plateau you're experiencing with your therapist, even though you are paying the minimum. You are still entitled to the best quality of service that your therapist can deliver. That said, it may also be true that the therapist simply isn't the right person, the right match for you, to help you cover the issues you now wish to address, even though he was very helpful when you were in crisis. So, although I know you don't wish to think about starting over with a new therapist, you may need to consider it if you bring up your concerns with your present therapist and still don't make forward progress.

You expressed frustration at having to ask everyone in your life for what you need and said "I would really like it if ANYONE in my life could actually just be what they're supposed to be without me having to blueprint it for them." That's an interesting viewpoint. So in other words, what everyone around you is "supposed to be" is what YOU want them to be - AND they're supposed to figure out what it is that you want them to be without you having to go through the tedium of explaining it to them. Wow! You not only expect people to be mind-readers, but you also expect that they should want no more from life than to be whatever it is that you've decided is right for them. It's no surprise that you're depressed with expectations like that. Your expectations for other people are unrealistic, and you are therefore setting yourself up to be disappointed by other people over and over again - a depressing scenario.

Ultimately, you are the one who is responsible for you - for making sure that you get what you need out of therapy (even if it means changing therapists). You also expressed frustration at there not being anything you can DO about your negative beliefs about yourself. Start by setting short, attainable goals for yourself. For example, if your goal is to express more of your needs (to your parents, employer, therapist, whomever), then begin by noticing when you do so and giving yourself credit for it. Start to feel good about yourself because you made a positive step by speaking up. Now, the tricky part is this: the other person's response is not part of the equation. So if the other person does not do what you asked of them, try not to allow this to take away from the positive feelings you have about yourself for having spoken up. You can only control your own actions, not those of other people, so it is a losing proposition to only allow yourself positive feelings if the other person responds in a particular way.

Good luck. I hope that you're able to make the changes that you need - either with your present therapist or by starting over- to bring about the life that you want for yourself.


Susan Maroto, LCSW

This question has been answered by Susan Maroto. She is a Licensed Clinical Social Worker working out of Mount Laurel, New Jersey. She uses an eclectic approach to holistic healing, mind-body relationships, life transitions, depression, and anxiety.For more information visit:


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