Progress In Therapy

This handout utilizes metaphors like the 'spiral staircase' and 'snakes and ladders' to illustrate common trajectories of progress in therapy.

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Professional version

Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.

Client version

Includes client-friendly guidance. Downloads are in Fillable PDF format where appropriate.

Overview

Everyone's experience of therapy is unique. Setbacks during therapy are common but can nevertheless be dispiriting. It can be helpful to remind clients about common trajectories of progress in therapy. Helpful metaphors for paths of progress include ‘snakes and ladders’ and the ‘spiral staircase’. The Progress In Therapy information handout graphically illustrates both of these metaphors.

Why Use This Resource?

Progress in therapy is often non-linear, and setbacks, crises, lapses, or relapses are not uncommon. This resource helps clients by:

  • Offering metaphors that explain how people usually progress in therapy.
  • Normalizing the experience of progress followed by setbacks.
  • Encouraging hope and persistence when challenges arise.

Key Benefits

Normalizing

Uses everyday metaphors to normalize experiences of therapy.

Engaging

Incorporates illustrations to bring these ideas to life.

Reflective

Encourages meaningful therapist-client discussions about change.

Who is this for?

Depression

Clients struggling with persistent low mood.

Anxiety Disorders

Individuals who experience a return of anxiety symptoms.

Eating Disorders

Clients who lapse or relapse in disordered eating.

Integrating it into your practice

01

Educate

Use as a psychoeducation tool to explain progress trajectories.

02

Discuss

Initiate conversations with clients about their beliefs and expectations about change.

03

Reassure

Reinforce the idea that therapy as a journey with ups and downs, not a linear path.

Theoretical Background & Therapist Guidance

Clients sometimes have unrealistic expectations of improvement in therapy. This handout employs the 'snakes and ladders' and 'spiral staircase' metaphors to communicate the observation that therapy is rarely a linear process. These metaphors help clients appreciate gradual progress, normalize setbacks, and encourage persistence.

What's inside

  • Explanations of common trajectories in therapy.
  • Visual metaphors that bring these ideas to life.
  • Suggested uses for clinicians inside and outside of therapy sessions.
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FAQs

This handout offers relatable metaphors that normalize setbacks and explain that progress in therapy is rarely a straight path.
Yes, this resource can consolidate discussions that have taken place in session and support clients when their motivation begins to wane.

How This Resource Improves Clinical Outcomes

Integrating this handout into therapy can:

  • Help clients understand the typical progression of therapy.
  • Foster open discussions about both setbacks and achievements.
  • Encourage persistence by viewing perceived failures as normal.

Clinicians benefit from:

  • An accessible and engaging resource.
  • Material that can be used with a wide range of clients.

References And Further Reading

  • Angus, L. E., & McLeod, J. (Eds.). (2004). The handbook of narrative and psychotherapy: Practice, theory and research. SAGE Publications.
  • Kopp, R. R. (1995). Metaphor therapy: Using client-generated metaphors in psychotherapy. Brunner/Mazel.
  • Stott, R., Mansell, W., Salkovskis, P. M., Lavender, A., & Cartwright-Hatton, S. (2010). Oxford guide to metaphors in CBT: Building cognitive bridges. Oxford University Press.
  • Chadwick, P., Birchwood, M., & Trower, P. (1996). Cognitive therapy for delusions, voices and paranoia. Wiley.
  • Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
  • Wills, F., & Sanders, D. (2013). Cognitive behavioural therapy: Foundations for practice (2nd ed.). SAGE Publications.