When Weekly Therapy Has Plateaued: When to Consider Adjunctive Trauma Therapy
A client can be engaged in therapy, deeply self-aware, and genuinely motivated—and still remain stuck around a particular issue.
They may understand the origin of the pattern. They can recognize the trigger while it is happening. They may have developed stronger coping skills, greater self-compassion, and a more coherent understanding of their history.
Yet the same emotional or physical reaction continues.
A particular memory still feels present. A betrayal continues to produce intrusive images. Conflict activates an overwhelming fear of abandonment. A medical experience still creates panic. One attachment injury repeatedly takes over the couples session.
At that point, the question may not be whether the client needs a different therapist.
The question may be whether one part of the work needs a different therapeutic format.
What is adjunctive trauma therapy?
Adjunctive trauma therapy is focused treatment provided alongside a client’s ongoing therapy. The client remains with their primary therapist while working temporarily with another clinician who offers a particular trauma-processing method, specialization, or intensive format.
The adjunctive therapist addresses a clearly defined treatment target rather than replacing the client’s primary therapist or taking over the broader course of care.
When clinically appropriate and authorized by the client, the two therapists can coordinate before and after the focused work. The client then returns to ongoing therapy with their established therapeutic relationship intact.
A plateau does not necessarily mean therapy has failed
Weekly therapy can provide something enormously valuable: consistency, safety, context, and a relationship in which patterns can be understood over time.
A plateau does not erase that progress.
In fact, a client’s ability to identify the pattern clearly may reflect how much meaningful work has already occurred.
The client may now understand:
why criticism produces such a strong reaction,
why emotional distance feels intolerable,
why they assume responsibility for everyone else,
why setting a boundary evokes guilt,
why conflict leads to shutdown,
or why a present relationship repeatedly activates an earlier wound.
That insight matters.
But insight and trauma processing are not always the same thing.
A client may intellectually understand that the danger has passed while continuing to experience the images, emotions, physical sensations, or protective reactions associated with what happened.
When the same material repeatedly consumes the session without changing, additional explanation may not be what is missing.
The unresolved experience itself may need focused processing.
Signs that adjunctive trauma work may be worth considering
There is no single formula for deciding when to refer. Clinical judgment, client stability, treatment goals, readiness, and the strength of the existing therapeutic relationship all matter.
However, adjunctive trauma therapy may be worth considering when several of the following are present.
The client has substantial insight but little change in reactivity
The client can explain the pattern and recognize its origin, but the response remains fast, intense, and difficult to interrupt.
They may say:
“I know where this comes from, but knowing does not change how it feels.”
“I understand that this situation is different, but my body reacts as though it is the same.”
“I know it was not my fault, but I still feel ashamed.”
“I have talked about this many times, but I still cannot stop replaying it.”
These statements may indicate that the client does not need more intellectual understanding of the issue. They may need a method that works more directly with the distressing memory, imagery, emotional response, or physical activation.
One particular experience repeatedly takes over treatment
The client’s broader therapy may be moving forward, but one experience continues to dominate.
This could be:
discovering an affair,
a frightening interaction with a partner or former partner,
a sudden loss,
a medical procedure or diagnosis,
a humiliating professional experience,
a sexual trauma,
an accident,
an earlier attachment injury,
or another event that still feels emotionally present.
The treatment target does not always need to be a traditionally defined trauma. What matters is whether the experience continues to produce significant distress or interfere with the client’s current functioning and therapeutic progress.
A trauma response is interfering with couples therapy
Couples therapists may recognize situations in which the relationship needs treatment, but one partner’s unresolved trauma response is making the relational work difficult to access.
For example, one partner may become flooded whenever the betrayal is discussed. They may experience intrusive images, compulsively revisit details, shut down, become highly activated, or struggle to distinguish a current interaction from the original rupture.
The couples therapist may be doing important work around accountability, communication, repair, trust, and the future of the relationship.
Focused individual trauma processing can serve a different purpose.
It may help address the emotional and physiological intensity surrounding the experience so the client can participate more fully in the ongoing couples work.
This does not mean treating the individual so that the couple stays together. It also does not minimize the impact of betrayal or excuse harmful behavior.
It means helping the client process what happened so that their decisions are not continually being overtaken by the most activated aspects of the experience.
The client needs a method the primary therapist does not provide
A therapist does not need to provide every modality that might benefit every client.
An established psychodynamic, relational, couples, sex, grief, or IFS therapist may be doing exactly the right long-term work while recognizing that a particular issue could benefit from a more concentrated trauma-processing intervention.
Referring for adjunctive work can be similar to consulting another specialist while continuing to hold the larger treatment.
The referral is not a failure of competence or a surrender of the therapeutic relationship. It can be a thoughtful expansion of the client’s care.
Why use a therapy intensive for adjunctive work?
Traditional weekly sessions provide continuity, but the structure can sometimes make focused processing feel fragmented.
Time may be needed to check in, reconnect with the treatment target, prepare for the work, approach the most emotionally charged material, and then regulate before the session ends.
A therapy intensive creates a longer period of protected time.
Depending on the client and treatment plan, that time may include:
clarifying the target,
preparing for trauma processing,
identifying connected memories, beliefs, sensations, or protective responses,
completing focused therapeutic work,
taking breaks when needed,
and allowing time for grounding and integration.
The goal is not to rush the client or force a breakthrough.
The goal is to provide enough uninterrupted time for the work to unfold without repeatedly stopping just as the central material becomes accessible.
How Accelerated Resolution Therapy may fit
Accelerated Resolution Therapy, or ART, is a structured trauma-focused psychotherapy that incorporates guided imagery, imagery rescripting, and bilateral eye movements.
ART is designed to work with the emotional, sensory, and physical responses connected to distressing experiences. Clients generally do not need to describe every painful detail aloud, although they must share enough information for appropriate assessment, treatment planning, and safe clinical guidance.
The client remains aware of what happened. The goal is not to erase factual memory or persuade someone that a painful experience was acceptable.
The aim is to help the memory become less emotionally and physiologically distressing in the present.
ART is commonly delivered as a brief treatment, often over approximately one to five sessions, although the appropriate length varies. Outcomes and timelines cannot be guaranteed.
Research on ART is promising but remains smaller than the evidence bases for longer-established trauma treatments. A 2024 systematic review found encouraging evidence for ART as a time-efficient treatment for adult PTSD symptoms while emphasizing the need for additional high-quality research.
How adjunctive coordination can work
A clear referral process protects the client, the primary therapeutic relationship, and the roles of both clinicians.
With the client’s written authorization, coordination may include:
Clarifying the reason for referral and the proposed treatment target.
Discussing relevant clinical history, stability, risk factors, and current supports.
Defining the adjunctive therapist’s limited role.
Agreeing on what information will be communicated after the intensive.
Planning how the client will return to and integrate the work with the primary therapist.
The primary therapist remains the holder of the broader treatment.
My role is limited to assessing and addressing the agreed-upon target when ART or an intensive format is clinically appropriate.
If the assessment suggests that the client needs stabilization, ongoing care, a different level of treatment, or another modality, that should be discussed before proceeding.
Who may not be appropriate for an intensive?
A therapy intensive is not automatically appropriate simply because weekly therapy has plateaued.
A client may need a different plan if they are:
in an active crisis,
currently unsafe,
unable to maintain stability between appointments,
experiencing symptoms that interfere with informed participation,
seeking an intensive as a way to avoid necessary ongoing treatment,
being pressured to participate by a partner, family member, employer, or therapist,
or unable to identify a clinically appropriate focus for the work.
Readiness, consent, stability, expectations, and available support all need to be considered.
The purpose of an intensive is not to compress every aspect of therapy into a single day. It is to create focused time for a carefully selected part of the work.
Referring does not mean giving up the client
Therapists are understandably protective of their client relationships.
A client may have spent months or years developing enough trust to approach painful material. Referring them to someone else can raise legitimate concerns about fragmentation, conflicting treatment, or whether the client will feel passed off.
That is why the adjunctive frame must be explicit.
The message to the client is not:
“We have reached the end of what we can do.”
It may instead be:
“We have developed a strong understanding of this pattern, but this particular experience continues to carry a great deal of emotional intensity. I wonder whether a focused trauma-processing intervention could help us with this part of the work while we continue our therapy together.”
This preserves the meaning of the ongoing treatment and gives the client a clear reason for the referral.
When a different format can support the work already underway
Some clients do not need to start over.
They do not need to abandon a therapist they trust or replace meaningful long-term work with a quick intervention.
They may need focused help with the specific experience that continues to keep the larger therapy stuck.
Adjunctive trauma therapy can provide that bridge.
The primary therapist continues helping the client understand their life, relationships, choices, and patterns. The adjunctive therapist temporarily focuses on the trauma memory or emotional response that is interfering with that work.
When the roles are clear and the client is clinically appropriate, focused trauma processing can support—not compete with—the therapy already underway.
Frequently Asked Questions
When should a therapist consider referring a client for adjunctive trauma therapy?
A therapist may consider an adjunctive referral when a stable, engaged client has developed insight but continues to experience significant distress around a specific memory, trigger, betrayal, loss, or attachment injury. The referral should have a clear clinical purpose and complement the client’s ongoing treatment.
Does the client have to stop seeing their primary therapist?
No. In adjunctive treatment, the client remains with their primary therapist. The additional therapist provides focused work around an agreed-upon treatment target and then returns the client to their ongoing care.
Can adjunctive ART be used alongside couples therapy?
It may be appropriate when an individual partner’s unresolved trauma response is repeatedly interfering with the couples work. ART does not replace couples therapy or determine whether the relationship should continue. It addresses the individual client’s distress around a specific experience.
Will the adjunctive therapist take over the client’s care?
That is not the purpose of adjunctive work. The roles, treatment target, anticipated duration, and coordination plan should be established before treatment begins. The primary therapist maintains the broader therapeutic relationship.
How many ART sessions might an adjunctive client need?
ART is generally a brief therapy and is often completed in approximately one to five sessions. The appropriate number depends on the client’s history, clinical presentation, treatment target, readiness, and response. No particular result or timeline can be guaranteed.
Referring a Client for an ART Intensive
I am Laura Geftman, LCSW, and I have more than 20 years of experience treating trauma, grief, anxiety, relationship wounds, and complex emotional patterns.
I provide focused ART-based therapy intensives and adjunctive trauma therapy for adults who want to remain with their primary individual or couples therapist.
With the client’s written authorization, I can collaborate with the referring therapist to clarify the treatment target, coordinate care, and support the client’s return to ongoing therapy after the intensive.
In-person intensives are available in Ardmore, Pennsylvania, on Philadelphia’s Main Line. Virtual services are available for appropriate clients physically located in Pennsylvania, New Jersey, New York, and Florida.
Learn more about Accelerated Resolution Therapy
Learn more about therapy intensives
Get started or inquire about a professional referral
Suggested Reading
When You’ve Already Done Years of Therapy but Still Feel Stuck
Accelerated Resolution Therapy Intensives: What They Are and Who They Help
Research and Reference Notes
Storey, D. P., et al. “Accelerated Resolution Therapy for the Treatment of Posttraumatic Stress Disorder in Adults: A Systematic Review.” PLOS Mental Health, 2024.
https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000123
Kip, K. E., et al. “Randomized Controlled Trial of Accelerated Resolution Therapy for Symptoms of Combat-Related Post-Traumatic Stress Disorder.” Military Medicine, 2013.
https://pubmed.ncbi.nlm.nih.gov/24306011/
Waits, W. M., et al. “Accelerated Resolution Therapy: A Review and Research to Date.” Current Psychiatry Reports, 2017.
https://pubmed.ncbi.nlm.nih.gov/28290061/