When Mental Health Recovery Plateaus

A mental health recovery plateau can feel discouraging, especially after early improvements in therapy. When therapy progress stalls, many people begin to wonder whether treatment is still working or whether they are somehow failing at recovery.

There are many reasons why mental health improvement stops and why therapy sessions begin to feel slow, ineffective, or repetitive. You may feel bored or frustrated with your therapist for this stall, or turn the blame on yourself.

This article will explain the different reasons for this phenomenon and effective strategies for overcoming a treatment plateau. Many of the causes of plateaus center around the therapeutic relationship, and working through them often requires courage and honesty. Here, we cover:

• What a mental health recovery plateau is in therapy.
• How to recognize when therapy progress has stalled.
• How the therapeutic relationship can contribute to plateaus.
• Why progress slows in recovery.
• How to restart mental health progress.
• The next steps after therapy plateau.

What Is a Plateau in Therapy?

Psychotherapy may be deemed ineffective if there is no improvement in someone’s symptoms over time, or if there’s a deterioration despite treatment.^[1] In contrast, a plateau suggests that there has been some progress so far, but that it’s temporarily stalled.

In the world of physical fitness, gym-goers talk about “gain plateaus.” This is when the body:

• Has adapted to a particular exercise regime.
• Is no longer finding it challenging.
• Stops improving at the same rate as before.

A therapy plateau feels similar. You might be overly familiar with the process, find it unstimulating or unchallenging, and stop seeing the same rate of improvement that you saw in the beginning stages.

Research into plateaus in therapy for adults finds that both therapists and clients pick up on this phenomenon.^[1][2] But a plateau in therapy for adults is a common experience that doesn’t mean treatment isn’t working, and recognizing a plateau is the first step toward addressing it.

Therapeutic Relationship and Plateaus in Therapy

Extensive research into the effectiveness of counseling and psychotherapy finds that the relationship between client and therapist is one of the most significant factors for success.^[1][3]

This means that the therapeutic relationship has the power to make psychotherapy effective or ineffective, as well as influence any progress or plateaus. If you’ve noticed a sense of plateau in your work together, there may be something going on within the unique relationship you’ve formed with your therapist.

There are many relationship factors to explore when thinking about plateaus in therapy. Here are some of the most significant:

Warmth

Some research suggests that therapists with a warmer, more supportive, and engaged approach tend to garner more positive treatment outcomes.^[1]

However, even if your therapist seems less warm and engaged, it doesn’t necessarily mean they are. This is a common complaint of the psychoanalytic approach, which encourages therapists to keep themselves out of the relationship. One important reason for this is to protect your autonomy during treatment.

If you feel your therapist is less supportive and engaged, and that’s causing your progress to plateau, you may naturally be drawn to a more humanistic approach. However, it can be helpful to talk to your therapist about the plateau and any aspects of their approach that you feel are not working for you.

Conflict and Ruptures

Ruptures in therapy are moments in the therapeutic relationship when something seems like it’s gone wrong. Your therapist might have expressed an opinion you disagree with or misremembered something you said in a previous session.^[2]

These interpersonal ruptures can feel powerful, perhaps breaking your trust in the alliance you’ve built together. When unresolved, they can create a plateau that needs addressing.^[2]

Ruptures and conflict can be difficult to face when they occur with your therapist. Research finds that people with depression or anxiety are more likely to be inhibited in this way and find it difficult or intimidating to challenge their therapists.^[4]

However, facing these ruptures can be healing work for your mental health long-term. Though painful, working through them can:

• Deepen the therapeutic relationship.
• Practice healthy conflict resolution.
• Allow you to express yourself fully.

If a therapist can respond to disagreements constructively and mend ruptures when they occur, research finds that the therapy is more effective.^[1] Tackling these may be one possible way to overcome a plateau and begin to see progress again.

Affection

Many assume that, for therapy to be effective, you must have a wholly positive relationship with your therapist. If you feel affectionate towards your therapist, you might be surprised that this could actually negatively affect the progress you make with them.

In some cases, feelings of intense care or friendliness with your therapist can create the conditions for a plateau to arise. For example:

• Friendliness may prevent you from confronting your therapist when you disagree with them.
• Feelings of admiration could be unrealistic and create a sense of dependency on your therapist.
• Wanting to please your therapist too much could make you edit or minimize your difficulties.

Both positive and negative feelings towards your therapist are opportunities to explore unresolved issues from previous relationships because they indicate your patterns of relating.^[5]

However, when these play out, they can create a sense of plateau because they’re a departure from therapy as you know it.^[5]

It doesn’t feel like therapy when you’re secretly feeling misunderstood or when you’re feeling very friendly towards your therapist. However, these interpersonal dynamics are essential to therapeutic work because they say a lot about how you relate to others.

Overcoming these plateaus requires working through any interpersonal dynamic that’s playing out in order to relate to your therapist differently.

Enactments

Enactments are long-term interpersonal dynamics that mimic relationships from your past. They could include both positive and/or negative feelings towards your therapist, which is known as transference.^[5]

For example, if your therapist reminds you of a harsh authority figure in your family or from your time at school, you could unconsciously transfer that experience onto the therapy and expect to feel the same harshness.

This can take you away from the present-day therapeutic relationship and cause a plateau because you’re being taken into a dynamic from the past.^[2]

Since enactments are often long-term, the plateau they cause can feel lengthy. It will be crucial for your therapist to acknowledge the enactment in order to see it for what it is and move through it.

Trust

Understanding why mental health improvement stops often means examining whether trust has been fully established. Trust is hugely significant in therapeutic relationships, and its absence can also lead to plateaus in progress.

Research into the early stages of therapy found that clients will hold back if they fear opening up to their therapists.^[4]

This research is focused on the beginning stages, but trust is still crucial if you have been in therapy for months or years. If you don’t totally trust that you will be safe when you show vulnerability in therapy, it can lead to plateaus in progress.^[6] In this case, it could be that you need more time to feel safe opening up in therapy.

What Else Can Cause Plateaus in Therapy?

Though the therapeutic relationship has a huge influence on your experience, there are other reasons why progress slows in recovery and counseling. These might be related to the type of therapy you’re receiving, whether you have a complex treatment case, or not being challenged enough in therapy.

A Lack of Action

One reason why some people prefer cognitive behavioral therapy (CBT) to something like psychodynamic counseling is because of its focus on action-taking and changing behaviors.

While talking therapies that focus on your past, patterns of relating, and dreams can be illuminating, some psychotherapists think it’s more effective to practice new behaviors and take action.

That’s why many CBT therapists will prescribe homework for you and make plans to:^[7]

• Disprove anxieties.
• Test fears.
• Experience new ways of being.

Talking therapies can bring about change and improve well-being by processing past experiences and talking through emotions. However, you may feel that a plateau could be overcome by taking more direct action to change thoughts and behaviors that harm your mental health.^[7]

Action in therapy might also take the form of reality-testing, which is when a therapist challenges your beliefs and explores alternative perspectives.^[7]

You might also want more involved guidance for processing your emotions, as with emotion-focused therapy, or be encouraged to express yourself through art or music with art therapy.

Therapist Factors

A plateau in therapy might have more to do with your therapist than the type of therapy or your relationship with them. Research into effective therapies found three common factors that can contribute to poorer treatment outcomes:^[1]

1. Therapists having a poor understanding and assessment of client needs.
2. Inflexible therapeutic approaches.
3. Insufficient clinical knowledge.

These findings suggest that the effectiveness of counseling and therapy has a lot to do with the practitioner providing them. Breaking through a therapy plateau could mean changing to a therapist who is more:

• In tune with your needs.
• Flexible in their approach.
• Knowledgeable.

A Lack of Emotional Depth

Plateaus might also feel like impasses or stalemates, where sessions lack depth and resonance. These kinds of plateaus suggest a withdrawal from important emotional material, which can be created by both client and therapist.^[2]

On the client side, you might withdraw from emotional content by intellectualizing.^[2] This describes the way someone can discuss painful events, but in a logical or removed way.

If you think this could be the reason why you’re stuck in mental health recovery, it’s important not to be too harsh on yourself. Intellectualizing feelings is most likely a safety mechanism, which shouldn’t be suddenly dismantled to break through a plateau.

Another way your sessions might lack depth is if they focus too much on only symptoms or on aspects of your life that aren’t connected to your mental health.^[2] For example, this may mean talking extensively about how physical anxiety manifests in your daily life, but not what’s driving it. Or, talking a lot about what’s happened in your week without accessing your emotions about those events.

If these factors are driving the plateau, it’s possible that your therapist is being cautious about challenging you too much. Talking to them about your concerns will be key to laying a new path for your therapeutic work to take. Learning how to restart mental health progress often begins with this kind of honest conversation.

Benefit From Evidence-Based Personalized Therapy With Mission Connection

When therapy is not improving symptoms, it is totally understandable to be frustrated. You want to get better and invest your time and money in an approach that actually works for you.

At Mission Connection, we offer flexible outpatient mental health programs that work with your schedule. Our expert clinical team treats many mental health conditions with a wide range of therapies that are both evidence-based and personalized. These approaches have years of research behind them and can be adapted to suit your needs and preferences.

Whatever you think may be behind your progress stalling, we can discuss the reasons with you when you reach out to Mission Connection. Our caring team will collaborate with you to decide on an approach that is right for your needs.

Call us at 866-833-1822 for a no-cost, no-obligation conversation about treatment options. We’re here to help support you in finding ways to ensure your therapy progresses.