Five reasons why therapy can fail

Psychotherapy can benefit everyone at different points in their lives. When it goes well, it can dramatically shift the way you view yourself, your community, your options and your world in a positive way. When it doesn’t, you can come away from your experience feeling unheard, feeling like it was a waste of time and money, and at worse, feeling unsafe.

(The reasons listed below exclude situations where the therapist behaves unethically, in a way that makes the client feel unsafe. These instances are rare, but they do happen.)

1. You didn’t want to go in the first place. 
That is, you were persuaded or coerced to attend therapy by a well-meaning friend, partner or colleague. Perhaps your spouse issued an ultimatum: “See a therapist and fix your addiction, or I’m out of this marriage”. Perhaps your teacher in school referred you to a counsellor after repeated anxiety attacks in class. Whatever the case, it wasn’t your idea. You came, but in actuality you would rather be at home/work/arcade/mall. You think a therapist who doesn’t know you, hasn’t gone through what you’ve gone through, can’t possibly help. You think you can find a way out. You think it is a giant waste of time. 

Therapists have a fancy term for this- resistance. That is, a part of you strongly doesn’t want to be in the room. If your physical self is present, but your mind and your heart are thinking of the 20 reasons why it won’t work, it doesn’t take a psychologist to tell you that no matter how well trained or well-meaning the professional is, you are probably going to get very little out of your experience. 

2. You are not ready for change. 
Somewhat related to point 1. So you have been thinking of finally fixing that issue that’s been eating up your life for years. You make the appointment, you get to the first session, you decide your therapist seems kind and not half bad. You tell her the issue (or, issues). You kick back and wait for the change to happen. 

Newsflash: It doesn’t happen that way. I’m sorry, I truly wish it does but it doesn’t. I try to make this clear in the first session to all my new clients. I say: “Therapy is a long journey, and it involves our active collaboration. It takes a lot of courage to come, because I ask hard questions, and sometimes I ask you to do difficult things. So it is hard work.”

I often see this ambivalence manifest in different ways. Chronic late-coming, periodic no-shows, coming so infrequently that it is difficult to affect change, not following through with therapeutic assignments. You see, I can’t make you change; I can only facilitate the process the best I can. You have to want to change enough that you would be willing to feel the discomfort that inevitably comes with it. You have to show-up and do the work. 

“You have to want to change enough that you would be willing to feel the discomfort that inevitably comes with it.”

3. You quit too soon. 
The science tells us that no matter the therapeutic modality, it takes about 6-12 sessions to see significant improvement. So six is minimum. However, too many people decide prematurely at the first or second session, that psychotherapy is rubbish.  

Look, we are talking about changing thought patterns and behaviours that have been in existence for years. In fact, most of our negative belief systems usually arise in childhood or adolescence. Can a couple hours of therapy make a significant dent? I don’t think so. 

Let’s start viewing mental health issues as physical health issues. If we broke our leg, would we expect to return to our usual exercise routine in a few weeks? If we have a family history of heart disease, would we expect the problem to go away in months? We would not expect our bodies to recover from a chronic physical health issue so quickly, so why the double standard for our minds?

4. You have unrealistic expectations, or your expectations changed midway through the process. 
Many clients enter the therapy process with a) vague, ambiguous goals or b) a laundry list of goals. It’s completely fine to have a) because part of the therapeutic process is about helping you distill and define those goals. But if you come into therapy with b) and want them ‘fixed’ within a short period of time (see point 3.), then that kind of mindset may impede your progress.

I see therapy is part of your journey to becoming a more fulfilled human being- and that journey does not necessarily begin or end with therapy sessions. Therapy is one factor in the whole pie chart of what it entails to live a well-balanced life. Therefore, it would be much more helpful to think of your therapist as a guide or a facilitator and not an ‘expert’ or a ‘fixer’.

Sometimes clients come in with one goal that is quite easily accomplished (for example, “I want to feel less anxious”) and then want to work on other deeper ones (for example, “I want to change my negative belief that I have to be productive to be worthy.”) That signals an increase of self-awareness, as well as an expansion of one’s capacity to tolerate change. 

But please remember: It is important to communicate your therapy goals to your therapist; and together you both can make them clear, specific and realistic. 

“Therapy is one factor of the whole pie chart of what it entails to live a well-balanced life.”

5. Your practitioner is not the right fit. 
The importance of finding a mental health professional that has the training, specialization, experience, approach, personality and availability that fits you cannot be understated. This applies no matter in choosing any health professional- your doctor, your acupuncturist, your chiropractor- but it is absolutely critical in psychotherapy. 

It is really because the relationship between therapist and client is the foundation of all healing. It is the connection that you have with your therapist-based on trust, respect and mutual understanding- that will determine how effective the therapy process is. This is why, it is quite irrelevant whether your therapist calls herself or himself a counsellor, psychotherapist or psychologist. It is not the title that matters, it is the fit.

Your therapist is human and she will make mistakes. However, for the majority of the time, you should feel safe, heard, understood and respected. If you don’t agree with her pace or approach, please discuss this with her. Working through the doubts and challenges you feel towards therapy is part of the process. 

However, if you feel like you have made sufficient attempts to do so, and have stayed in therapy for long enough (see point 2.), yet still do not feel connected, you are always free to find another therapist. Remember, this is your healing journey, and you make all the key decisions. 


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