When We “Hold” a Client’s Progress, We Also Hold Their Setbacks

Working with complex clients can quietly invite an understandable fantasy: If I get the formulation right, if I find the right modality, if I stay steady enough… I can carry them through.

It often comes from care, not ego. Many of us entered this work because we genuinely can’t bear unnecessary suffering.

But here’s the tension: the more responsibility we take for a client’s progress, the more accountable we become when progress stalls, reverses, or fractures.

If we’re not careful, that accountability can slide into shame, over-functioning, rigidity, or even coercive “helping.”

Complexity changes the rules of “progress”

With complex trauma, neurodivergence, entrenched patterns, comorbidities, chronic stressors, unstable housing, substance use, personality adaptation, or ongoing relational harm, progress is rarely linear.

In these cases, setbacks often aren’t failure. They can be:

• nervous system predictability (returning to what’s familiar under stress)

• attachment protection (pulling away when closeness starts to feel real)

• capacity limits (insight outrunning regulation skills)

• context reality (a destabilising environment that hasn’t changed)

• developmental timing (the psyche only tolerates what it can tolerate)

If we interpret every downturn as “treatment not working,” we’ll either:

1. change models too quickly,

2. intensify pressure, or

3. quietly blame the client (or ourselves).

None of those are helpful.

The hidden cost of taking too much responsibility

When counsellors begin to “own” the outcomes, a predictable set of problems shows up:

1) Over-functioning

We plan, track, chase, remind, rescue, and carry the structure. The client becomes the passenger in their own therapy.

2) Fragile alliance

If progress becomes a scoreboard, rupture feels like disaster. The room fills with performance: the client tries to “do therapy right,” and the counsellor tries to “make therapy work.”

3) Unspoken power

When we’re invested in a particular outcome, we can unintentionally pressure the client to comply with our vision of healing.

4) Countertransference loops

We feel responsible → we push harder → the client withdraws → we feel more responsible → we push again.

This is how “care” becomes a trap.

A more durable stance: accountable, not responsible

A clean distinction that helps in complex work:

Responsible implies: “I make this happen.”

Accountable implies: “I show up ethically, competently, and transparently—whatever happens.

So what are we accountable for?

• the quality of the relationship (safety, repair, respect, consent)

• the clarity of the plan (shared goals, shared language, agreed pacing)

• the fit of the approach (client-led, culturally safe, neuro-affirming, trauma-aware)

• monitoring risk and responding appropriately

• ongoing reflection and supervision

• adjusting when feedback says “this isn’t working”

But we are not accountable for controlling:

• whether the client does the work between sessions

• what their family, workplace, or nervous system does under stress

• whether they are ready to let go of a protective pattern

• whether life circumstances stay stable long enough for change to consolidate

That’s not detachment. That’s ethical realism.

If we “own” progress, we must be honest about setbacks

Here’s the part your prompt nails: if we position therapy as something we deliver, we also inherit blame when it doesn’t deliver.

Complex clients are often exquisitely sensitive to disappointment. If we over-promise (explicitly or subtly), then a setback can feel like:

• “I’ve failed again.”

• “Even my therapist couldn’t fix me.”

• “There’s no point trying.”

So we do better when we normalise the terrain upfront:

Language that helps (and preserves hope)

• “In complex work, progress is usually spiral-shaped, not straight.”

• “Setbacks aren’t the opposite of growth—often they’re part of integration.”

• “Our job is to notice patterns early, repair ruptures, and keep you in the driver’s seat.”

• “If something isn’t working, we’ll name it together and adjust—no blame.”

This stance reduces shame and increases agency.

A practical accountability framework for setbacks

When a client regresses, drops off, escalates, or repeats a pattern, try a non-shaming audit:

1) What changed in context?

Sleep, conflict, finances, deadlines, health, substances, housing, seasonal triggers.

2) What changed in capacity?

Are we asking more than the client’s nervous system can sustain right now?

3) What changed in connection?

Did we miss a rupture? Did something land as judgement, pressure, or abandonment?

4) What changed in meaning?

Sometimes progress threatens an identity: “If I heal, who am I? Who will I lose?”

5) What changed in the plan?

Is the goal still theirs? Is the method still fitting? Is pacing still consensual?

Notice how none of these questions assume the setback is a moral failure—by client or counsellor.

The “accountability” that matters most: rupture repair

In complex work, repair is often the intervention.

If a setback occurs, many clients expect one of two responses:

• distance (“I knew you’d give up on me”), or

• control (“I knew you’d try to manage me”).

A third response is healing:

• “I’ve noticed things have gotten harder lately. I’m not disappointed in you. I’m interested in what your system is trying to do.”

• “Can we slow down and work out what felt too much, too fast, or too alone?”

• “What did you need from me that you didn’t get?”

That’s accountability in action.

Boundaries are not cold; they’re stabilising

For complex clients, counsellor boundaries are often part of the treatment container:

• clear session structure

• predictable availability and limits

• transparent expectations

• collaborative goals

• documentation and review points

• referrals when scope is exceeded

Boundaries protect the client from the counsellor’s over-responsibility—and protect the counsellor from burnout and resentment.

The quiet truth: we can’t want it more than they do

This one is tender.

If we become the main engine of change, the client learns (again) that someone else is the authority over their internal world. That repeats the very dynamics many complex clients are trying to escape.

A healthier mantra is:

“I will be consistent, skilled, and honest. I will not be the driver.”

Closing: a grounded way to hold hope

Setbacks in complex work don’t mean therapy is failing. They often mean the nervous system is doing its job, even if the job is outdated.

So yes—if we act like we “take responsibility” for client progress, we need to reckon with what that implies when things go backwards.

But there’s a better option:

Be accountable for the process, not in control of the outcome.

That stance is more ethical, more sustainable, and—ironically—more effective.

Because it returns the client to the only place real change can happen:

in their ownership, their consent, their timing, and their meaning.