When progress is slow, presence still matters
There are moments in clinical work that feel quietly defeating.
Not because something has gone wrong, but because nothing seems to be moving. The client returns week after week with the same concerns, the same patterns, the same stuck points. You listen carefully. You reflect. You offer what feels appropriate. And still, things look much the same.
I remember a client who embodied this perfectly.
He showed up week after week. We talked. We problem-solved. I introduced strategies and tools. I checked in with him about whether they felt doable, and he agreed that they did. Then the following session he would arrive and tell me that the tools had not helped, that he could not bring himself to do the task, or that nothing had changed at all.
His demeanour was heavy. The room often felt low in energy when we sat together. And I remember finding myself thinking, why does he keep coming in.
In supervision, experiences like this often bring up frustration or self-doubt. A questioning of competence. Am I missing something? Shouldn’t we be further along by now?
We are rarely taught how to sit with this part of the work.
Training tends to emphasise outcomes, goals, and change. Progress is framed as movement forward. Insight gained. Symptoms reduced. Behaviour shifted. When these markers are slow to appear, it can feel as though the work is failing, or worse, that we are.
Over time, I came to understand something important about that client. I don’t think he was coming to therapy because the strategies were working, or he was looking for a magic tool to solve his problems. He was coming because someone was staying.
Staying with him in his stuckness. Staying without withdrawing, pushing, or becoming frustrated. Staying when things felt repetitive, slow, or unrewarding. I think for him, that consistency mattered more than any particular intervention. Each time he came in, he was equally happy to see me, to talk, to share. He never vented frustration or questioned the perceived lack of progress.
Many clients arrive in therapy not ready to change, but ready to be understood. Ready to test safety. Ready to see whether someone can tolerate their pace without needing them to be different.
Change, when it comes, often follows a long period of staying the same.
You might be wondering what happened with that client.
Did he eventually come in energised and changed? Did something finally click? Did I find the right tool or intervention that helped him move forward?
As much as I would like to offer a neat or satisfying ending to that therapeutic story, there was not one. After some time, the sessions were booked further and further apart, and then eventually he stopped scheduling sessions and dropped off.
I reflected on that for a long while. I wondered whether I had done something wrong. Whether I had not done enough. Whether there was something I had missed or should have approached differently.
And yet, with time, I came to a quieter understanding.
Sometimes, clear therapeutic change is not a given. Wanting things to be different does not always mean someone is ready or able to make that change. I think he wanted things to improve, but something in him was not yet ready for what that would require. What that was, I may never know. But in that, I am still happy that he showed up for himself, and I hope that the consistency of this still gave him something.
We are rarely prepared for endings that are not clearly marked. No discharge session. No celebration of progress. No sense of completion. Just an absence where the work once was.
It is important to acknowledge that sometimes therapy does not end with a transformed client and a clear outcome. And that does not make the work any less meaningful or valuable. Presence still mattered. Consistency still mattered. The relationship still existed, even if its ending was quiet and unresolved.
Learning to tolerate these endings is part of learning to stay with the work.
To Sit With This Week
- Notice how you respond internally when progress feels slow or absent.
- Reflect on whether your urge to push for change is shaped by the client’s needs or by your own discomfort with waiting.
- Pay attention to signs of safety, trust, or engagement that may be present even when behaviour remains unchanged.
- Consider what it might mean to stay with a client, making space for their thoughts, emotions, and needs rather than pushing the work forward.
- Gently remind yourself that consistency and presence can be meaningful in their own right.
Thank you for sitting with me in the clinical space this week.
Warmly,
