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Why Psychotherapy Doesn't Work For Everyone

Psychotherapy. What does that word bring up for you? Even if you haven’t personally attended therapy, chances are you have seen it portrayed on some sort of media outlet or know someone personally that has gone to therapy. As mental health is becoming destigmatized, we are hearing more and more about people’s experiences in the therapy room. With access to therapy services becoming more readily available, we would hope to see an increase in people not only attending therapy, but also feeling like it was a positive experience. However, this is simply not the case for everyone. While we know that therapy can be highly effective, there are still people out there who have attempted therapy and did not feel that it was helpful or a positive experience. The question then becomes, can therapy really work for everyone? In a very typical therapist fashion, my answer is, it depends. In my experience, I truly believe everyone can benefit from therapy at some point or another during their lives. However, CAN and WILL are two different things. Even when we know we need to make a change in our lives, it’s not uncommon for us to come up with perceived barriers to implementing that change. Couple that with hearing others negative experiences of trying to implement that same change in their lives and it’s easy to forget why we even felt the need to make the change in the first place. Rather than assuming that our experiences will be the same as others, we can take the time to understand and educate ourselves on what didn’t go right for others. We then can use that information to help give us the best possible chances of having a different outcome. This is why I felt it was important to open up the conversation and provide some insight into the top five reasons why people typically do not have a positive therapeutic experience: 1) FEELING FORCED TO GO TO THERAPY If you have ever been around children, you learn pretty quickly that they do not enjoy being told what to do. Adults are the same way. While those who surround us can provide valuable feedback to us in regards to our blind spots, at the end of the day we are the ones who actually have to decide if we feel like something is a problem for us or not. Early on in my career as a therapist, I would see this show up time and time again in my office. A spouse or a teenager would be sitting across from me week after week and I couldn’t quite figure out why no progress was being made. I would try and throw more and more interventions at them, seek out supervision from my colleagues, or try and explore if maybe we weren’t the best fit. No matter what I did though, nothing seemed to help and there was a big reason why. When I look back on those experiences, I now realize that the client and I were working towards two separate goals. I was operating under the impression that we were working towards improving their mental health while they were working towards appeasing those in their lives that encouraged/pressured them to get help. Does that mean that it was the client’s fault or that they didn’t take away anything from those experiences? Of course not! They were well meaning individuals who wanted peace in their relationships and at the end of the day they very well could have still taken something out of our sessions together. With that being said, change or progress wasn’t sticking for one very important reason: for true change to occur in our lives, we need to have an awareness of what exactly it is that we feel is problematic, a desire to change that problematic area, and to remember along the way why it’s important to us to make those changes. To truly figure those things out, it’s an inside job that only we have to power to pursue. 2) HAVING UNREALISTIC EXPECTATIONS OF THE THERAPEUTIC PROCESS Some people are completely unsure of what to expect from therapy while others have very specific ideas of what the process is going to look like. The most common unrealistic expectations I see clients struggle with are: 1. Therapy is a quick fix 2. Therapy is one size fits all. 3. It is the therapist’s job to fix my problems, I don’t have to do any of the work. 4. I don’t have to do any work outside of the therapy room. 5. Therapists are perfect and never make mistakes. During the first session, I try and help clients understand as much of the therapeutic process as I can so they can match their expectations accordingly. Those expectations then typically look like: 1. Problems don’t develop overnight and they don’t disappear overnight. 2. Therapy is very subjective, two clients can see a therapist for the same presenting problem and have two very different experiences, both being equally beneficial. 3. The therapist is there to serve as a resource and guide to help the client reach their goals, the therapist does not possess magical powers and can’t do the work for the client. 4. The majority of clients that reach their treatment goals and have a positive therapeutic experience tend to take care of all aspects of themselves (mind, body, soul) which means putting in more time than once a week for fifty minutes. 5. All therapists are human. Humans are not perfect and even therapists are not immune to making mistakes. If you feel that something is off with your therapist or are upset about something that has occurred, please voice that to them! 3) NOT KNOWING WHAT THE QUALITIES OF GOOD THERAPY ARE Similar to any other health profession, not all therapists are going to be great at their jobs. While having an education and license are required to practice as a therapist, those things do not automatically make someone a good therapist. I’ve personally known therapists who struggled to pass their licensing exam but were some of the best therapists I’ve ever worked with. Alternatively, I know some therapists who attend as many trainings as possible, have as many certifications as possible, but at the end of the day are not effective when it comes to actually helping clients. While many different therapeutic styles or theories exist, at the core of good therapy is: 1) A sense of safety 2) A sense of being unconditionally positively regarded by the therapist 3) A sense of being understood by the therapist 4) The therapist does not always agree with you but challenges you in a way that feels caring and thought provoking rather than shaming or attacking. 5) You are aware and understand what you are working towards in therapy 6) The therapist is open to feedback and regularly checks in in regards to how you feel therapy is going 7) If the therapist makes a mistake, they are accountable and attempt to repair the therapeutic relationship 8) The therapist has certain knowledge and understanding of the human psyche, but they do not claim to have all of the answers 9) You feel that you take away something from your sessions, you don’t just go in and vent. The therapist should provide a balance of giving you space to process verbally but also offers you insight and feedback as needed. 10) The therapist does not utilize the session for their own personal benefit. They have a balance between being transparent with you but are not oversharing of their own experiences or feelings. 4) NOT TENDING TO YOUR HEALING OUTSIDE OF THERAPY I referenced this under having unrealistic expectations of therapy but I feel that it is a big enough barrier to discuss it further. When clients ask me what is the best thing they can do assure they reach their goals in a timely manner, I let them know that therapy once a week is not enough. Think about it. If you wanted to learn a new skill you would probably practice that skill as often as you could. The more you practice something, the faster you’re going to learn it. Therapeutic goals are no different, especially since our mind, body, and soul need to all function properly for us to feel a sense of well-being. Some of the most useful things I’ve seen clients implement in conjunction with therapy are: 1) Participating in a physical to rule out any biological factors that could be contributing to things like depression or anxiety 2) Spending 10-20 minutes a day in nature 3) Being mindful of what they put into their bodies 4) Physical activity 5) Journaling 6) Meditation 7) Having a hobby or creative outlet 8) Having a balance between time spent alone and time spent with others 9) Joining a support group 10) Participating in a consistent self-care routine 5) WAITING TILL A CRISIS OCCURS TO SEEK HELP A crisis is not a prerequisite to attend therapy. If a part of a house catches on fire, we are not going to ignore it and hope that it doesn’t spread to other areas of the house. Ideally, we would have the same attitude towards our mental health. I especially see this with couples. When a couple shows up in my office, it is very common that they are in the midst of a crisis. Whether that be infidelity, substance abuse, or a betrayal of some other sort, something major has occurred that has forced them to realize things are no longer working. The truth of the matter is, things probably weren’t working for quite some time. Maybe we previously felt that things weren’t great but they were still manageable or maybe there was fear in a relationship ending so it felt safer to not address those underlying issues. While the reasons may vary for not seeking help sooner, the best thing we can do is to start being more proactive rather than reactive. This applies to not only our mental health, but in all areas of our life that we feel a sense of unhappiness or concern with. My hopes in providing this information is that more people will not only utilize therapy services, but that they can have the best possible outcomes with that experience. If you have had tried therapy and felt that it wasn’t a positive experience, I encourage you to explore if any of the reasons listed in this post resonate or if not, I would love to hear from you about what you felt made it a negative experience. To continue to help people understand how to increase their chances of having a positive therapeutic experience, in my next post I will be further expanding on a topic briefly discussed in this post: qualities of good therapy.