Why Has My Therapy Stopped Working? What a Therapy Plateau Really Means
Episode 41: Behind the Therapy Door
This article draws on a conversation between therapists Sarah Thome and Matt Gallagher. Listen to the full episode for the stories behind the takeaways.
You used to leave sessions feeling like you had made real progress. Now you walk out wondering what you even talked about. The breakthroughs have stopped. The tears have dried up. You are not sure whether you are done, stuck, or wasting money. On Episode 41 of Behind the Therapy Door, Sarah Thome and Matt Gallagher explain what a therapy plateau actually means, why it happens, and how to tell the difference between healthy integration and genuine stagnation.
Related: About Sarah and Matt.
Related: What is the Process Communication Model®?.
Is a Therapy Plateau Actually a Sign of Progress?
Sometimes a stall means success. Sarah describes clients who arrive with clear goals, reach the point of accomplishment, and begin spacing sessions out. “That can look a little bit like stagnation, but with purpose.” The work is done. What feels like a plateau is actually a landing.
Matt introduces the shock-absorber metaphor. When your nervous system’s shocks are blown, every bump hits hard and you keep bouncing. As therapy works, the system stabilizes. “Something happens, we can respond to it and then stabilize again.” Integration is the word Sarah uses for this phase: neural synapses rewiring, taking new shape and form. That takes time, and it does not look dramatic from the outside.
Related: PCM® personality types.
How Does the Process Communication Model® Identify Stall Patterns?
PCM®’s failure patterns offer a diagnostic lens for therapy plateaus. Matt tells Harmonizer and Imaginer types: “If you’re feeling sad or negative about yourself, it’s probably wrong. Don’t trust it.” For Persister-Thinker combinations: “If you’re angry, it’s probably wrong. Don’t trust the first draft.” These patterns can masquerade as therapy failure when they are actually personality-based distress doing what it always does.
Sarah uses a funhouse mirror metaphor. While shopping for graduation clothes, she found a cartoony distortion mirror in a kids’ dressing room. “Don’t trust that view. Pull in your therapist, your spouse, your healthiest friends as your real mirrors.” A perceived therapy stall may be your distress pattern telling you a story that is not true.
If you’re feeling sad or negative about yourself, it’s probably wrong. Don’t trust it.
Matt Gallagher, Behind the Therapy Door
Related: Compare personality frameworks.
Related: PCM® vs 16 Personalities.
What Causes Therapy to Genuinely Stall?
When integration is not the explanation, several real dynamics can cause stalls. Reassessing treatment goals is the first step. Matt recommends scaling questions: “On a scale of zero to ten, where were you when we started? Where are you now?” and then asking directly: “Is there anything you are avoiding?”
- Secondary gains. Clients may subconsciously stall to maintain the therapeutic relationship. Sarah explains: “If I stall, I don’t have to walk away from this relationship. This has been the most nurturing, healthy, attachment-focused connection I’ve ever had.” The relationship itself becomes the reason to stay.
- The unspoken collusion. Matt identifies a dynamic where both therapist and client avoid hard topics: “I’m not going to ask the hard questions because I like talking with you.” Both parties settle into comfort rather than growth.
- Deeper layers surfacing. Matt’s “clear out the basement before you find the cellar door” metaphor describes discovering deeper issues only after initial progress. A medical procedure triggering old trauma is a common example. Clients call back discouraged: “I thought I was over this.” Sarah reframes: “Another several layers of the onion being peeled.”
Related: PCM® training for therapists.
Related: Explore workshops.
How Do Therapists Help Clients Move Through a Stall?
Referring to other modalities is one option. Sarah sometimes sends clients for somatic experiencing or brainspotting when talk therapy reaches its ceiling. Matt describes how brainspotting was discovered through David Grand doing EMDR and noticing a particular optic focus creating neurological shifts. Different modalities access different parts of the nervous system.
Closing rituals mark healthy endings. Sarah describes her “treasure box” with seashells, worry stones, and “angel in my pocket” items. Clients pick something meaningful, sometimes paired with a poem reading or bilateral tapping to install the therapeutic work. The ritual honors the relationship while signaling that the client is ready to carry the tools forward independently.
Related: Contact us.
Related: PCM® vs Enneagram.
Frequently Asked Questions
Is it normal for therapy to feel like it has stopped working?
Yes. Therapy plateaus are a normal part of the process. They can indicate successful integration of previous work, the emergence of deeper layers, or a need to reassess goals. The key is distinguishing between healthy consolidation and genuine stagnation by having an honest conversation with your therapist about what you are experiencing.
How do I know if I should switch therapists or modalities?
If you have had an honest conversation about the stall and progress still feels blocked, exploring a different modality like brainspotting, EMDR, or somatic experiencing may help. Switching therapists is appropriate if the relational fit is no longer serving your growth. A good therapist will support your decision.
What are secondary gains in therapy?
Secondary gains are unconscious benefits of staying in the current pattern. In therapy, the most common secondary gain is the therapeutic relationship itself. Clients may subconsciously slow progress to avoid ending a connection that feels nurturing and safe. Naming this dynamic openly usually resolves it.
How long should therapy take before I see results?
Therapy is a slow marathon, not a sprint, and progress is not always linear. Complex trauma and personality-based patterns often take longer to shift. Scaling questions comparing your current distress level to your starting point frequently reveal more progress than you realize when you are in the middle of the work.
Add PCM® to Your Clinical Toolkit.
Add PCM® to your clinical toolkit. Our therapist training helps you identify stall patterns by personality type and move clients forward.