Psychotherapy is often associated with active reflection, deep analysis and effort, but what do we do when there is simply no energy for that? In times of prolonged stress and war, we increasingly find ourselves at a point where even the need for help feels like an additional item on an endless to-do list, and there is a lack of resources for that as well. Is it possible to go into therapy when there are no words to explain "what is wrong"? How to distinguish fatigue from psychological resistance to change? And can a session be a place of rest rather than mandatory "digging deep"? Is "minimalist" psychotherapy possible and useful, or is it better to put it on pause? We asked the psychotherapists of the Treatfield platform.
Psychotherapist Masha Tsukanova
There is a state where a person acutely feels the need for help, but at the same time has no resource even to simply formulate "what is wrong." What should a client do when they feel total intellectual or emotional "dumbness"? Can therapy be effective if it seems like there is no energy to talk and "explain all this"?
If a person doesn't even have the strength to simply formulate what's wrong, I would start not with a psychotherapist. First, we must rule out physiological causes for this condition. Perhaps the person has anemia, iron deficiency, hypothyroidism, a tumor, or some other trouble that leads to complete exhaustion. Therefore, I would start with a medical examination.
Second, I would check such a person for depression. There is the so-called depressive triad—signs by which we can suspect that a person is actually ill, and it’s not just some situational coincidence. The depressive triad includes:
- Intellectual decline. Memory and attention decrease; thinking becomes more difficult.
- Physiological decline. No energy for habitual things. In the initial stages, for example, a woman might stop wearing makeup because it seems exhausting. If the condition worsens, there may not even be enough strength to take a shower or buy food. I remember my first episode of depression when I didn't eat for three days because I couldn't go to the store. Against the background of physiological decline, chills, constipation, a drop in libido, etc., may begin.
- Emotional decline. This is apathy and anhedonia—when even things that were guaranteed to bring pleasure no longer do so.
The depressive triad can be tricky: one or several indicators may seem normal at first glance but mask themselves as some incomprehensible illnesses. For example, pain of unknown origin, skin reactions, gastrointestinal disorders, and so on.
Characteristically, with depression, the most difficult time of day is the morning.
If a person notices that a condition like this lasts for more than two weeks, then it’s worth saving strength and going not to a psychotherapist, but directly to a psychiatrist. Depression is an illness, and it must be treated responsibly because, unlike many other illnesses, it can lead to fatal outcomes.
Modern antidepressants are wonderful: safe, effective, developed for various cases—and within a month, improvement is already visibly real. And it is at this stage that it’s worth going to a psychotherapist to understand what brought the person to this state and how to avoid falling into it again.
Can therapy be effective if it seems like there is no strength to talk and "explain all this"?
Therapy can help even without a "constructive" dialogue. In my first session as a client, for example, I said a single sentence and then just cried silently for an hour—and it was incredible, because that sentence was a terrible secret that was destroying me from the inside. Finally, there was someone I could confess to, and from then on, I was no longer alone with my burden.
The mere presence of another person, the feeling that you are not rowing alone, that someone cares about you, can be healing.
If a client sits and remains silent, too exhausted to say anything, they might still manage to take something away—for example, the therapist's reaction.
And ultimately, verbal techniques are not the only tool a psychotherapist has. To start with, one of the fundamental pillars of Gestalt therapy (which is the approach I work in) is phenomenology. The therapist, in any case, has access to the client's first signaling system: facial expressions, gestures, posture, breathing, flushing or paling of the skin. The therapist also has unlimited access to their own phenomena that arise in the presence of the client: sensations in the body, feelings, metaphors, memories, thoughts. All this material can be worked with.
There are therapists trained in bodywork. Such work can be almost entirely wordless, yet surprisingly effective. There is also a variety of art therapy techniques through which one can experience something difficult or better understand oneself.
Finally, there is one more thing clients need to know. Therapy is not only for development (with processing, digging up childhood traumas, self-immersion, and all that painful stuff). Therapy can also be simply for support.
In short, yes, therapy can help even an extremely exhausted person.
Psychotherapist Marina Kondratenko
Sometimes, a while after starting the work, therapy begins to feel like hard labor that you seemingly have to go to additionally after your main workday. How to distinguish a healthy signal from the psyche about the need for energy conservation from destructive resistance that hinders progress? What to do if the very thought of a session causes fatigue rather than relief?
It's very cool that we are talking at all about the existence of such a thing as resistance in therapy, because sooner or later it arises in almost everyone, and it’s very important to understand the naturalness of this process. Not knowing that this process is part of therapeutic work, a person is left alone with the questions: "What is wrong with me? What is wrong with my psychologist? Is everything happening as it should? Why am I not getting better, or maybe sometimes even getting worse? Why am I doing this if the benefit is less than the effort I’m putting in?"
The desire to leave arises, and that is natural, but from a therapeutic point of view, it’s not always the best way out. At the very least, because leaving silently is often a habitual, familiar way a person leaves relationships where they could have been preserved along with intimacy. And in the case of psychotherapy, it’s not just about preserving the relationship, but also about deepening self-understanding and seeing some previously unconscious patterns of behavior. In this case, the psychotherapist plays the role of a mirror: they won't create anything new, but without them, you won't see your own back. And you carry that back through your whole life; perhaps it was precisely what brought you to the psychologist in the first place.
To distinguish a healthy signal from the psyche about the need for energy conservation from destructive resistance that hinders progress, we need what your psychologist often asks about—your feelings. They are signals from your psyche and a key to your needs, including those in therapy. So try to understand what feelings your resistance consists of: are you irritated, feeling helpless before something, or is shame making every step in therapy ultra-heavy? Perhaps you feel danger or boredom? All these are important markers that will help understand what influences your resistance, because in some cases we may be irritated by the psychotherapist's excessive pace or their too passionate desire to fix everything, and in others—boredom may reveal that you want to talk about other topics, although maybe you don't even know which ones yet. Or you know, but don't dare—and that is a reason to look into the theme of trust.
You might not like what I’m about to say, but if you are right now at a stage where every visit to your psychologist or psychotherapist causes fatigue and an unwillingness to interact, then you need to discuss this with them. Often this is not an easy task, because the last thing one wants in such moments is to go into conflict or intensify the already palpable tension. However, this is extremely important, because direct discussion of difficulties is a vital skill that cannot be acquired while avoiding all tension. Remember that your psychotherapist is on your side, and in the process of psychotherapy, you don't have to worry about their comfort or feelings. Timely payment for sessions is your way of caring for them; in all other matters, try to act out of care for yourself.
For some readers, my suggestion to talk this through with the therapist might seem risky, as a terrifying expectation of persuasion or pressure due to financial interest might hide inside. Well, I won't give you guarantees that you will never experience something like that, but then you at least will have a reason to conflict more boldly :)
But you know, we psychotherapists are usually bad businesspeople, because the very goal of our work is for us to stop being necessary to you. But don't take my word for it; better to talk to your psychotherapist about your doubts, because behind all this stand deep questions of trust, distribution of power, the authority of vertical figures (which parents once were for you), and control.
Fortunately or unfortunately, the path of psychotherapy does not always go only through relief, sometimes it goes through "burdening." It can be painful or difficult, but there is good news—you are not alone in this.
And finally. I wouldn't be sincere if I ignored the fact that psychotherapy is a process that requires resources. It requires not only money and time, but also strength. Strength to try new things, take risks, endure tension, or even escalate a conflict. And sometimes it happens that it is this resource that is lacking, and this too is worth discussing during the session, because it’s possible that it’s not resistance but simply a lack of a certain type of resources—and then you can look for ways to acquire them, or make a decision to terminate psychotherapy or involve a psychiatrist in the work who will be responsible for pharmacological support.
Psychotherapist Anastasiia Viktorovska
Is there such a thing as a "minimalist therapy" format for those in survival mode? How can a specialist change their approach so that the session becomes a place of recharging rather than a place where one must dig "deep," analyze childhood, or work on trauma when there is no resource for it?
Does a "minimalist therapy" format exist for those in survival mode? Of course, it does.
For a person in a state of survival, the main directions of work in therapy are stabilization and support. No "digging" into the depths/childhood, etc.
The primary task is to acknowledge that I am "on the edge / surviving / can't handle it."
It is also very important to review the demands on yourself. Because when you have trouble sleeping, live in constant fear and tension, demanding that you work like in the best of times, look like a snowdrop in spring, or compare yourself to others or your past life is a failed tactic from the start that worsens an already difficult state.
An important mechanism of work for stabilization and support is working with the body. The ability to lean on it, to "ground" oneself, and to concentrate on reducing the level of tension and anxiety. There is a great variety of techniques and exercises that can be selected for a specific need and that work specifically for you.
And, of course, the search for meaning and support in life. Learning to ask for help and understanding, knowing exactly what kind of help and from whom.
The goal of the therapist is not to "pull" the client out of survival mode, but to be there—to create a sense that the person is not alone during this period of life. Learning to take care of oneself.
How can a specialist change their approach so that the session becomes a place of recharging rather than a place where one must dig "deep"?
Actually, it all starts with the request :) The psychotherapist should clarify the request at the beginning of the session, or the client can express what they would like to get out of the allocated time themselves.
A session as such does not have the goal of "digging deep" or working with trauma—rather, the direction of work is built after clarifying the request and the needs of the client.
A session can be quite silent, without strategies and searches. Because sometimes there is no strength even to search for a request, questions, and answers, etc.—then it will be better to acknowledge this and talk about your state in general, about fatigue and exhaustion.
Because most people are lonely in this.
The simplest way to make a session a place of recharging is to try to expand the client's focus of attention, to look for resources.
Because a resource is not what makes you stronger, but what helps you not to fall. There are quite a few of them.
For example, things that bring pleasure to the body—food, breathing, any pleasant interactions with the body (massage, swimming, yoga).
Acquaintances, relatives, close people who do not just encourage but stay with you in this difficult state—that is, share it.
Small, pleasant things that surround us every day, and the search for new meanings.
But the most important thing is the recognition that it is hard for you, that you are tired, and you have no strength even to decide anything. Sometimes even this recognition is enough for the resource to begin to appear ;)
Psychotherapist Liliia Skuibida
We live in conditions of war, where external reality drains a huge amount of strength every day. Is it worth continuing therapy "through force" in order not to lose momentum, or on the contrary—is it important to allow yourself to stop? What to do if therapy feels like an additional burden?
Yes, unfortunately, war has been our reality for 4 years now. We live in a state of constant tension, anxiety, uncertainty; we encounter horrors, losses, direct threats to life. The nervous system works at high speed, fails to recover fully, and becomes exhausted. In such a state, physical and mental strength may only be enough for the necessary minimum of functioning, and psychotherapy may begin to be perceived as an additional burden.
Then the question arises: "Continue therapy through force or allow yourself to stop?"
And it might seem that there is an unequivocally correct answer to it. But no, for every client, in every unique situation of life and therapy, there will be a right decision of its own.
Let's try to figure out how to find it.
To begin with, what you definitely should not do:
- disappear without a conversation, abruptly cut off contact, not giving yourself the opportunity to complete the relationship and your processes in it,
- endure without voicing your state, or pretend that you are fine and nothing has changed.
And what is worth doing? It is worth exploring both poles. Understand what stands behind the drive to continue therapy through force? And what emotions and thoughts arise from the idea of stopping?
Because actually, what matters is not what you eventually decide, but that you make your choice while realizing your true needs and motives, fears and prejudices.
And the best way to do this is to bring it to a therapeutic session and explore your state, desires, and beliefs with the support of the therapist.
So what can you do if you are faced with such a dilemma?
Tell your therapist about it just as you feel it:
- about your fatigue and lack of strength for processing complex processes,
- about the unwillingness to come to sessions,
- about the fear of taking a pause and losing the relationship with the therapist or everything worked on until now,
- about guilt, shame, confusion, and other feelings that arise when making this decision, etc.
Review the therapy format and contract terms together:
- reduce the frequency of sessions,
- change the focus of therapy to support, containment, stabilization, resourcing, mastering relaxation and self-regulation techniques,
- temporarily switch to a mode of supportive consultation meetings when the need arises,
- take a deliberate pause for a clearly defined term and observe how the state will change without therapy, so that upon its completion you can make a balanced decision.
In the conditions of war, we live at the limit of our capabilities. And a mature position is to be sensitive to yourself and the situation, to care about your state, and to reduce excessive load where possible.
If therapy begins to tire you and requires excessive effort, you can:
- stay in the process along with your fatigue and lack of resources,
- change the process in such a way that it corresponds to your current needs,
- put therapy on a discussed and determined pause,
- complete the process at the point where you are now,
- return to therapy when you feel the desire and strength.
None of these options is "right" or "wrong." Only your state, your resources, needs, and your conscious choice matter.
And if you have a therapeutic space where these questions can be sincerely and openly discussed and explored—that is already an additional resource in this difficult time.
