Every treatment has its downsides. Medications have side effects and it can often feel like a revolving door trying to find one (or a combination of a few) that work for any particular person. And while medications’ side effects are well-publicized, few articles are written about the potential “side effects” of other types of treatments, such as psychotherapy.

Psychotherapy can be a powerful treatment for everything ranging from depression and attention deficit disorder, to anxiety and panic attacks. And while there are many different forms of psychotherapy, virtually all of them share the challenges discussed in this article.

1. It can take awhile to find the “right” therapist and you shouldn’t stop at Therapist #1.

Finding the right therapist can be a frustrating hit-or-miss proposition. But it’s also imperative for a person to find a therapist that they feel comfortable working with in the therapeutic environment. Sticking with a therapist you don’t quite click with could mean weeks or months of frustratingly little progress. But find the right therapist for you, and suddenly each week can bring new insights and changes into the way you’re feeling and behaving.

I recommend people “try out” their therapist, much as one does for a hair stylist or even a blind date. If you don’t feel a strong connection after a few sessions, it’s time to move on. A strong psychotherapeutic relationship is one of the reasons psychotherapy works. Without it, you might as well just be talking to a friend.

2. Therapy is a strange, unnatural combination — an extremely personal, intimate relationship in a professional setting.

The very nature of one’s relationship with a therapist is a little weird. Professionals rarely acknowledge it, but there isn’t another relationship of this kind in the world. You’re expected to open up and share the thoughts and feelings that are causing you pain or trouble in your life, but it’s a completely one-sided relationship. All the while, it is a professional relationship as well, so while you’re sharing your innermost secrets you’re doing so in someone’s clinical office setting.

Of course, some professionals recognize the dichotomy inherent in the therapeutic relationship and work to make a client feel at ease in the professional setting. Although a little strange, the duality of this relationship usually starts to feel more natural the longer you’re in it. If it doesn’t, that could be a sign that something isn’t quite working well in the therapy relationship – an issue to talk to your therapist about.

Just because it’s a professional relationship you’re paying for doesn’t mean it will necessarily be easier to open up and talk about potentially embarrassing or difficult topics. Some people find it just as hard to talk to therapist as anyone else in their life about emotional topics or thoughts they are thinking. For therapy to be effective, however, you will need to find a way to overcome your fears and hesitation and open up to your therapist.

3. Therapists leave and therapy ends.

You can keep taking a medication forever, barring any unpleasant side effects. And we don’t form emotional attachments with our medications. But psychotherapy is different. If you’ve been involved in a good therapy relationship, chances are you’re going to feel a natural emotional or spiritual attachment to your therapist. That’s natural, but it also makes ending the relationship all the more difficult. And when it’s done against our will – because, for instance, a therapist is moving far away, changes jobs, or retires – it can be devastating.

Good therapists will recognize that such changes can be especially challenging for their clients, and will spend the time needed to help them through the transition. All therapists are trained on how to best handle the ending of the relationship, for whatever reason. It usually hurts most people, just as the end of any important relationship in our lives.

4. It’s only 50 minutes a week.

It’s funny how a human being is expected to turn their emotions on and off at will. And yet that’s exactly what a therapist asks you to do once a week, for only 50 minutes. You come in and start talking and most people need time to ease into the session. It takes most people 5 to 10 minutes to get into the “therapy mode” of being there with their therapist and start talking about the serious stuff.

The worst part, though, comes at the end of your 50 minutes. Good therapists keep track of time and don’t let their clients get into new, emotional material near the end of the session, in order to ensure the client doesn’t have to leave in the middle of something. But sometimes that can’t be avoided. When it can’t and time’s up, it can feel like the therapist doesn’t care that you’re an emotional wreck and are being kicked out of the office.

By the way, there’s no scientific reason why it’s 50 minutes and not, say, 2 hours a week. This seems to just be a reasonable amount of time two people can talk to each other (and in modern times, how much insurance will pay for).

5. Sometimes a friend will work just as well.

One of psychotherapy’s little secrets is that up to 40% of new clients never return for a second session. Why is that? Researchers speculate that it could be for a variety of reasons, including feeling uncomfortable with the process (#2) or the therapist (#1). Or because one session is all the person needed – the ability to just talk to a stranger and let out everything one is feeling or experiencing can itself be cathartic.

At times like this, many people might gain similar results from talking to someone you trust – a close friend or family member, or even your favorite pet. While such people (or animals!) can’t replicate a therapist’s training or experience, for many people this may be sufficient enough. The challenge, though, is to find someone who won’t blab your feelings to others. With a therapist, you’ll never have to worry about that.

6. “Side effects” of psychotherapy are unpredictable.

At least with psychiatric medications, you have a laundry list going into your prescription knowing what to expect. In psychotherapy, you never know what to expect. You could go into a session feeling perfectly comfortable, end up discussing a traumatic childhood experience, and come out feeling completely exposed and re-traumatized.

Unfortunately, many therapists won’t discuss or acknowledge such “side effects,” but they occur all the time. And the worst part for an individual is that you never know what might be in store in any given week. Being aware that psychotherapy is often a very emotionally trying experience helps, but it can still catch you off guard.

7. Therapists can be just as crazy as any of their clients.

Just like the old joke about the general contractor’s house being the one that is most in need of repair, sometimes a therapist can be the person who is also need in some of emotional “repair.” People aren’t barred from becoming a therapist just because they have their own psychological demons they battle — although it may be discouraged unless the person is actively working on themselves in their own private therapy sessions.

You can try to find out if your therapist is seeking therapy themselves by asking, but not all therapists will tell you. That’s not an attempt to deceive you, but some therapists have the belief that the less you know about them, the better. This is to encourage the formation of transference, which some therapists believe is crucial to the psychotherapeutic process.

If you’re uncomfortable with this possibility, ask the therapist before you even begin therapy with them. If you’re not comfortable with their answer, it may be a sign that another therapist may be more compatible with your needs.

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Therapy can be a powerful treatment modality, when wielded by experienced and well-trained professionals who understand these issues. Being aware of these challenges ahead of time can help you better a more informed and empowered consumer, and help make your psychotherapy experience a positive one.

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    Last reviewed: By John M. Grohol, Psy.D. on 30 May 2008