One Reason Why You May Feel Stuck in Therapy

Discussing the meaning of symptoms is often necessary for effective therapy.

Reviewed by Lybi Ma

Key points

• Providing information about the meaning of symptoms is one common factor of effective therapy.
• Psychological research like comparative psychology provides useful information for explaining symptoms.
• Asking a therapist about their opinion regarding the meaning of symptoms can often help therapy move forward.

As a therapist who works every week with several new clients, I see many people previously in therapy. I am often surprised (and a little disappointed) when people have no response to the question: “What did you learn about yourself with your previous therapist?”

When clients do answer this question they often respond with some reflection of diagnoses laid out in books like the DSM-5 (American Psychiatric Association, 2013). This is the main text of psychiatric diagnoses. Although useful, it only defines diagnoses in what symptoms are present. It answers the question: “What specific problem do I have?” It does not answer the question: “Why do I have this problem?”

Please don't get me wrong. I am not presenting clients with any form of the question: “What's wrong with me?” It is a much more complex and human question where I am asking clients—who likely spent at least a few hours talking with another individual about themselves—what they learned about themselves through those conversations. To me, helping individuals understand themselves is one of the most important things therapy offers that no other type of social interaction offers to the same degree.

My impression that psychotherapy needs to offer individuals an opportunity to learn about themselves is supported by clinical research (Locher, Meier, and Gaab, 2019). There is a large body of psychotherapy research showing that therapy effectiveness likely boils down to several common factors. These include empathy and effective listening. If you think of how therapists typically present, even as portrayed in movies and television, you can see where those factors fit.

Providing meaning to experiences
But one other common factor necessary for effective therapy is meaning. People benefit from therapy when it provides some meaning to the experiences they have. People indeed come into therapy typically with problems. Where they would benefit most here would be the meaning they can gather about why they have the problems they have. This is often what I am asking about when I ask new clients what they learned from previous therapy.

I recently published a book along with two other authors titled, “Comparative Psychopathology” (Marston, Gopaul, and Maple, 2024). Our goal for this book was to help psychotherapists and other mental health professionals recognize what comparative psychology research (essentially the study of behaviors across all animal species) contributes to helping understand why psychological symptoms appear and last. This is an example of a text where the focus is to provide information to help therapists provide more useful and meaningful information to clients. In my opinion, one of the best ways for therapists to provide clients meaning is to have a lot of information about what psychological research shows regarding mental health conditions.

Comparative psychology research in particular is useful for helping clients understand their symptomology better because a great deal of psychological symptoms are not entirely problematic but are more extensions of instincts and behavior patterns all animals (human and nonhuman) have. This has been a concept in therapy since the days of Sigmund Freud. One example commonly discussed is anxiety as an extension of the fight-or-flight response. All animals have an instinct to either run away or fight when they sense danger. This works directly for animals in the wild but humans often have to use some other sort of behavioral approach than fighting or running away. Anxiety occurs when the person responds to their physiological response indicating they are supposed to do something but then cannot identify what they can do that would not cause more problems.

There is a good deal of other connections between instincts and psychological symptoms. Depression can be seen as an overextension of the natural instinct for animals to want to show signs of giving up before they even have to try and fight an opponent that is clearly bigger and stronger.

Repetitive thoughts and behaviors, like those associated with obsessive thoughts and perseveration (often seen in autism), are an overextension of behaviors being reinforced. The behaviors themselves become reinforcing separate from any sort of outcomes the person might expect from the behaviors. For example, the person starts to repeat the same phrase to themselves not because the phrase has any meaning but just because the specific words become reinforcing. This shows why therapeutic interventions like mindfulness are effective because they help the individual separate behaviors from any sort of specific outcome the person might expect from the behaviors. In this way, repetitive negative statements become just words rather than having any actual meaning.

Getting the most out of psychotherapy often involves gaining some sort of understanding of the meaning behind symptoms. Most therapists want to do everything they can to help clients and have sufficient knowledge to provide useful and meaningful information in understandable ways. Therapists not talking to clients about the meaning of their symptoms may simply be because therapists just do not think clients would be interested in an explanation. Healthcare professionals in general often expect that clients are looking for results and not necessarily for any sort of explanation.

That may often be the case. But if you or someone you know feels stuck in psychotherapy, or otherwise feels therapy is just not moving forward, it might be useful to ask the therapist directly what they think is the explanation for the symptoms being addressed. Perhaps, what your therapy needs to get restarted is more understanding of the meaning behind the problems.