Clinical Recommendations for Addressing Impasses in Long-Term Psychotherapy
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Department of Psychological Sciences, Case Western Reserve University
Department of Psychiatry, Perelman Medical School, University of Pennsylvania
Silvia C. Hernandez   

Department of Psychological Sciences, Case Western Reserve University
Submission date: 2021-12-12
Final revision date: 2022-01-19
Acceptance date: 2022-01-23
Publication date: 2022-10-15
Arch Psych Psych 2022;24(3):53–62
Many clients benefit from psychotherapy sessions that extend across months or years. However, there is a risk for therapeutic impasse in long-term psychotherapy in which the work can become repetitive or with limited gains over time. The current paper provides five transtheoretical principles to increase the impetus in long-term therapy. The five principles include: planful spontaneity, habitual creativity, pushing the limits of the therapeutic alliance, guided discovery, and specific broad goals. The therapist is encouraged to share responsibility for creative flexibility with the client in each session, including within the therapeutic alliance and the real relationship. The therapist can use a series of questions to promote a process of guided discovery. A clear focus on principles of psychology and goals that reflect maintenance of gains, development of strengths, and promotion of enrichment can ensure that the therapy continues to produce change over the length of the relationship.