What to do When Therapy isn't Working: A Transdiagnostic Model for Assessing Progress, Changing Course, and Improving Outcomes in the Treatment of Anxiety and its Related Problems

Thursday, April 5: 3:30 PM  - 5:30 PM 
Master Clinician Session 
Exhibit Level 
Room: Lincoln 3 
When it looks like a client is not getting better, therapists often may feel "stuck" when trying to figure out why their anxious patient's presenting problems are not resolving. Often, this can be a demoralizing experience for the clinician and client alike. In this workshop, we offer an in-depth look at ten pivotal explanations that will help therapists more accurately assess actual and perceived treatment failure, and guide them in modifying therapy to facilitate achievement of client goals and improve outcomes.

Transdiagnostic case formulation offers numerous windows into what might be driving patients' problems, as well as possibilities for resolving treatment impasses. Using the presenters' road map (Frank & Davidson, 2014) specifying a methodology for categorizing transdiagnostic mechanisms (TDMs), identifying relevant TDMs, and targeting them in individualized treatment plans, participants will learn to reassess and modify their transdiagnostic formulations when patients appear to not be improving. For example, the psychological mechanisms originally identified may not be correct, and new hypotheses about clients' underlying vulnerabilities and coping responses may need to be explored. Alternatively, clients may struggle with motivation and willingness to change - especially if they have to modify or relinquish long-held and valued safety, and other types of coping, behaviors.

General case conceptualization models also are useful in helping therapists consider where the problems lie when treatment appears to not be working. Specifically, and perhaps most importantly, how is progress being measured, and is it appropriate to both the client and the difficulties for which they are seeking therapy? Also, are there family or cultural considerations that potentially impede - or could improve -therapeutic gains? Similarly, the client may have specific concerns they have not yet revealed due to feelings of shame which, undetected and unaddressed, could negatively impact treatment outcomes. Ruptures in the therapeutic alliance, as well as the therapist's own TDM-driven limitations (e.g., perfectionistic strivings that convey pressure or are perceived as judgmental by the client) also can result in premature termination or treatment failure.

Addressing these and other avenues of investigation to explain actual and perceived treatment failures, participants will learn ten key considerations when attempting to understand why clients may not be improving. Video demonstrations, experiential exercises, and group discussion will augment didactic instruction to illustrate both identification and resolution of these problems.

Learning Objectives

1. Identify ten pivotal reasons why clients may not appear to be getting better, or why clients may not actually be improving in therapy.
2. Utilize a transdiagnostic model to investigate and resolve actual and perceived therapy failures by revising case conceptualizations, treatment plans, and clinical interventions.
3. Identify and resolve specific reasons why their clients may not be making progress, utilizing general case conceptualization models. 


Joan Davidson, PhD, San Francisco Bay Area Center for Cognitive Therapy
Rochelle Frank, PhD, Private Practice & University of California, Berkeley

Audience Level





Diversity - Yes


120 minutes



Treatment Approach