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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).
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19 Responses to “7 Challenges of Psychotherapy” (Pingbacks/trackbacks not shown below)
wordmeister at 8:40 pm on
May 29th, 2008
Wow! What a super article. I wish I had known years ago that #1 was okay, I’ve had too many #4s, #6 has kept me from going back at times (like now), and the heading of #7 made me laugh out loud. I truly think a therapist who walks a few steps away from the center line is a gift. Empathy comes more easily and thinking is understood.
Thanks.
Kalea Chapman at 11:28 am on
May 30th, 2008
Great article, but I think therapists often acknowledge that the relationship is very unusual. That comes up frequently.
This is one of the best articles regarding therapy / therapists that I have ever read. These are all things that come up in the relationship, yet some of them are never acknowledged.
ClinicallyClueless at 6:45 pm on
May 31st, 2008
Really good article. I wish everyone who goes into therapy with this information. It should be on the informed consent information. I dread the day when I leave my therapist (funny, after continuing to think that he is going to leave me).
I’ve known my therapist since 1987 and have been in treatment except for five of those years and generally saw him 2 -5 times per week. And, at one point 6-7 hours per week because an hour wasn’t enough. Now, I’m only 4 days/4 hours. We’ve watched and helped each other grow…the thought just terrifies me.
But, I did have to shop around a lot…for more than a year or so.
Anonymous at 1:56 pm on
June 1st, 2008
I’ve always said therapy should come with a warning label.
Most therapists neglect to explain the process from beginning to end. They want the therapy to be mysterious so they can build an attachment from patient to therapist. It isn’t meant to be devious but it should be explained.
Then, some will punish patients for thinking the relationship is more than it is.
my guess is many therapists can’t handle the attachment and make it the patients issue.
Anonymous at 9:50 am on
June 2nd, 2008
I believe that many therapists think that ending therapy can be handled in a few sessions and off you go. Perhaps for them it is easy, for the attachment is not there, but for the patient it has become so much more than that and a pat on the back combined with the words good luck is in no way closure.
Wendy Aron at 10:43 am on
June 2nd, 2008
I think you have to “click” with a therapist, in much the same way you “click” with someone on a date. Deep in your heart, you know right away if he/she is the right therapist for you because he/she “gets” you. Often, this comes down to whether you both have the same sense of humor. I’m not saying that this should be a substitute for finding out about a therapist’s credentials or treatment modality; it should come at the very end of your assessment. You’ll have a lot to cry about during therapy–with the right therapist you can also find moments to laugh.
Wendy Aron
author of Hide & Seek: How I Laughed at Depression, Conquered My Fears and Found Happiness
www.wendyaron.com
Wendy at 9:29 am on
June 3rd, 2008
I wish that I had read this article when I started therapy, it would have saved me a tremendous amount of emotional pain. My first therapist bullied me, and when I finally terminated treatment, I found myself suicidally depressed with no back up. Fortunately, my new therapist has been a life saver.
Heather at 11:54 pm on
June 3rd, 2008
My brother was voted “Therapist-of-the Year” in the hospital where he works. He and one other shrink were chosen by that hospital to come to NY and do grief counseling in the immediate aftermath of 9/11. (They came home a 5 AM, crashed on my living room floor, and looked devastated, night after night.)
He also has a successful private practice and I just know there are patients suffering the agonies of transference for him. And for what? He’s a walking fruitcake.
I’ve been a patient, have idolized my doctors (sometimes) but see the other side because of my brother. He called a while back to wish me a happy birthday and then said, “Gotta go. Got group therapy with a room full of nut jobs down the hall — ugh!”
How many of my therapists have said the same thing about me? I cringe to think.
Max at 1:57 pm on
June 4th, 2008
Excellent article. Very good point about how many clients waste their time with therapists who they don’t click with, when they should be changing therapists.
I don’t know why so many clients are scared to change, even when it isn’t working.
Susan Blackburn, M.A. at 2:51 pm on
June 4th, 2008
Thank you for this excellent article, John. It’s very insightful and well-written.
I once read that 40% of clients do not attend their second session.This could mean that they recieved some insight from the first session or they decided not to continue for whatever reason. Some may want collusion and we all know that this is not very helpful. They may be frightened of challenge,so tend to stay safe. Better the devil you know than the devil you don’t.
Regards
Dawn pugh
http://www.dawnpugh.com
Samuel Lopez De Victoria, Ph.D. at 2:35 pm on
June 14th, 2008
I love that last point: “Therapists can be just as crazy as any of their clients”
I totally agree. I’ve had many patients tell me about nightmarish relationships with their therapists in terms of how they were disrespectfully treated, how their therapists projected on the patient their own issues, etc.
I’m not saying that I’m beyond my own dysfunctions but I do agree that every clinician has “crap” of their own. Sometimes it seeps through in a therapy session. That’s unfortunate.
Samuel Lopez De Victoria, Ph.D.
http://www.DrSam.tv
Be a Part of the Conversation! Comment on this Entry Now:
Wow! What a super article. I wish I had known years ago that #1 was okay, I’ve had too many #4s, #6 has kept me from going back at times (like now), and the heading of #7 made me laugh out loud. I truly think a therapist who walks a few steps away from the center line is a gift. Empathy comes more easily and thinking is understood.
Thanks.
Great article, but I think therapists often acknowledge that the relationship is very unusual. That comes up frequently.
This is one of the best articles regarding therapy / therapists that I have ever read. These are all things that come up in the relationship, yet some of them are never acknowledged.
Really good article. I wish everyone who goes into therapy with this information. It should be on the informed consent information. I dread the day when I leave my therapist (funny, after continuing to think that he is going to leave me).
I’ve known my therapist since 1987 and have been in treatment except for five of those years and generally saw him 2 -5 times per week. And, at one point 6-7 hours per week because an hour wasn’t enough. Now, I’m only 4 days/4 hours. We’ve watched and helped each other grow…the thought just terrifies me.
But, I did have to shop around a lot…for more than a year or so.
I’ve always said therapy should come with a warning label.
Most therapists neglect to explain the process from beginning to end. They want the therapy to be mysterious so they can build an attachment from patient to therapist. It isn’t meant to be devious but it should be explained.
Then, some will punish patients for thinking the relationship is more than it is.
my guess is many therapists can’t handle the attachment and make it the patients issue.
I believe that many therapists think that ending therapy can be handled in a few sessions and off you go. Perhaps for them it is easy, for the attachment is not there, but for the patient it has become so much more than that and a pat on the back combined with the words good luck is in no way closure.
I think you have to “click” with a therapist, in much the same way you “click” with someone on a date. Deep in your heart, you know right away if he/she is the right therapist for you because he/she “gets” you. Often, this comes down to whether you both have the same sense of humor. I’m not saying that this should be a substitute for finding out about a therapist’s credentials or treatment modality; it should come at the very end of your assessment. You’ll have a lot to cry about during therapy–with the right therapist you can also find moments to laugh.
Wendy Aron
author of Hide & Seek: How I Laughed at Depression, Conquered My Fears and Found Happiness
www.wendyaron.com
I wish that I had read this article when I started therapy, it would have saved me a tremendous amount of emotional pain. My first therapist bullied me, and when I finally terminated treatment, I found myself suicidally depressed with no back up. Fortunately, my new therapist has been a life saver.
My brother was voted “Therapist-of-the Year” in the hospital where he works. He and one other shrink were chosen by that hospital to come to NY and do grief counseling in the immediate aftermath of 9/11. (They came home a 5 AM, crashed on my living room floor, and looked devastated, night after night.)
He also has a successful private practice and I just know there are patients suffering the agonies of transference for him. And for what? He’s a walking fruitcake.
I’ve been a patient, have idolized my doctors (sometimes) but see the other side because of my brother. He called a while back to wish me a happy birthday and then said, “Gotta go. Got group therapy with a room full of nut jobs down the hall — ugh!”
How many of my therapists have said the same thing about me? I cringe to think.
Excellent article. Very good point about how many clients waste their time with therapists who they don’t click with, when they should be changing therapists.
I don’t know why so many clients are scared to change, even when it isn’t working.
Thank you for this excellent article, John. It’s very insightful and well-written.
I once read that 40% of clients do not attend their second session.This could mean that they recieved some insight from the first session or they decided not to continue for whatever reason. Some may want collusion and we all know that this is not very helpful. They may be frightened of challenge,so tend to stay safe. Better the devil you know than the devil you don’t.
Regards
Dawn pugh
http://www.dawnpugh.com
I love that last point: “Therapists can be just as crazy as any of their clients”
I totally agree. I’ve had many patients tell me about nightmarish relationships with their therapists in terms of how they were disrespectfully treated, how their therapists projected on the patient their own issues, etc.
I’m not saying that I’m beyond my own dysfunctions but I do agree that every clinician has “crap” of their own. Sometimes it seeps through in a therapy session. That’s unfortunate.
Samuel Lopez De Victoria, Ph.D.
http://www.DrSam.tv
