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10 Reasons Why Therapy May Not Be Working

A few months ago I was called to be an expert witness at the county court. Not my favorite thing to do. What makes it hard is the tendency lawyers have to ask complex questions and expect a “Yes” or “No” answer.

I have learned to slow myself down, detach myself from the process, and be absolutely truthful while remaining as unprovoked as possible. Otherwise it is an exhausting exercise.

One question did get me going, though. It revolved around whether or not a person can change and what causes a person in therapy to improve or not improve.

The conversation below is a dramatic re-enactment of real events…

57 Comments to
10 Reasons Why Therapy May Not Be Working

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  1. How about fear of death keeping the patient from improvement. It feels like the elephant in this article’s room.

  2. One reason you left out is the fact that there are a few folks with some sort of personality disorder or impairment that may be undiagnosed, yet interfering with treatment. I know this firsthand, having unsuccessfully worked with 6 different couples counselors, only to have the 7th one (who was also a practicing psychiatrist), finally recognize that my wife had Borderline Personality Disorder, later verified via clinical testing. While the diagnosis explained a lot in retrospect, the possibility had never occurred to me before, but certainly it hadn’t occurred to any of our previous counselors either!

    • Classic.
      It only took you 6 therapists to discover that your wife has a mental illness.
      I wonder if there’s any other possibility.

  3. Scarlet, You make an excellent point. When it comes to anxiety all roads lead to fear of death. You gave me something to think about. Thanks.

  4. I ceased Therapy, because redundancy seemed to take over the issue! I actually enjoyed the sessions. No, I don’t fear death, since it is inevitable. And that is the way it is……

  5. Hello,
    I stopped going to alot therapist because there was never any clear goal. My last therapist talked about herself alot. Another tried to talk me into believing that prostitution(which was what I was doing at the time) was ok and failed to notice I didn’t think it ok and I was there to talk about it.
    When I tried to talk to my last therapist about sexuality and my difficulites with intimacy all she did was give me tips for what my partner could do, but I wanted to talk about why not how. I have had only one good therapist unfortunately out of about ten.

  6. I am in therapy and it has done wonders for me BUT the one hold-back i have found is that i am so in love with my therapist, and I mean in love with her more than any other person in my life. I don’t want to leave therapy, thus leave her. In an attempt to deal with this, i have scaled back to once a month therapy sessions but she is still always on my mind and i miss her like crazy and it is driving me crazy. all in all it seems counter productive to love someone you don’t know and could never be with.
    just saying… it seems like a big set back to the therapy profession because i know i am not alone, at all, and that this is a fairly common occurrence. I am open to suggestions on moving past this. it’s really a big problem in my life

    • If you have scaled back therapy perhaps you can afford to start seeing another therapist in parallel. Find a same-sex therapist or I guess opposite-sex if you are gay…someone older than you, someone you don’t find attractive at all. Although it sounds like your dependency on your therapist is your attraction to the therapist. Use the second therapist to deal with the issue you’re having with the first therapist.

  7. @slowgo Dude, isn’t that called transference? Did the therapist try to address it?

  8. By the way, I read the following on the info page for ‘Psychotherapy’:

    “Most psychotherapy today is short-term and lasts less than a year. ”

    Are you for real? From my experience (and what psychos have told me) the correct answer is ‘how long is a piece of string?’. I understand it’s a process that is generally lengthy and slow-moving. That, I understand, is the norm. Of course, it depends on the person and what’s being treated but, that is what I’m told is the norm.

    I went into it thinking I’d be there for 6 months. Six years later …

    • Therapy times do vary, but in research, there’s just a ton of literature suggesting treatment of most common mental health concerns in under a year (and most in even less time than that; see for example Sharf et al., 2010 for a summary).

      In the real world, of course, things are a bit more complicated and messy — people rarely go into psychotherapy with just one problem or complaint. This may mean a more complicated and longer road to recovery.

      • “In the real world, of course things are a bit more complicated and messy … ”

        There is another world other than the real world in which we live? I thought only religious types believed in other worlds.

        What’s the point of making a statement about psychotherapy that has no bearing on reality? If, in the real world, this are a bit more complicated and messy then doesn’t that mean that’s what psychotherapy is? IE complicated and messy? And doesn’t that then differ from the notion of psychotherapy being short-term and easy?

        Keep it real, bro.

  9. I have found so-called therapy to be a waste of time and money and even harmful. I do not see the point of talking to these people about things if they offer no help or solutions. They seem to think their job is simply to listen to someone’s troubles, a shoulder to cry on. And they charge a lot for it. I don’t see that they do anything or that it goes anywhere. It only stirs up trouble, imo. It’s no wonder insurance companies will not cover it. I have stuck it out a few times but it was not good for me and a financial drain.

    The field needs a lot of work and therapists should be under supervision to provide actual treatment plans, goals, and methods. That are followed.

    • therapists are trained to guide the client towards self-healing… sometimes hold up a mirror to the client. therapist are not supposed to tell you what to do. they can’t know what is ultimately best for you… you have to figure that out with them. you are looking for too much from the therapist and not enough from yourself

    • I agree with you leave. If the therapist has no answers and it is entirely up to the client to fix everything, then why should the client pay for therapy? He or she would be better off talking to a friend in that case. Of course it’s not the therapists job to fix “everything” but you would think with how much they get paid they could at least try to help! What a joke the mental health industry has become, it’s quite sad.

      • I’m getting fed up/cynical myself after years
        of therapy with various doctors, and don’t
        get my started on the new psychiatry which
        is mainly glorified pharmacy, usually.
        The trouble is for many, their friends or
        family are even worse or more screwed up/ill/
        dysfunctional, so that’s not always helpful,
        either. I’m starting to think it’s mainly all
        a giant joke. Some therapists are good some
        are terrible, some are just plain crazy or
        jerks, and none of them are there to FIX
        your life, they don’t have that power and
        never will. I mean, they can’t accompany
        you every day of your life and help you,
        it’s someone to go talk to and bounce your
        problems off off.
        This doesn’t seem adequate to me, especially
        after years on and off, of it. And how are
        they gonna FIX someone with PTSD, who was
        sex. or otherwise abused as a child or adult,
        someone like me with Asperger’s, etc., whatever?
        Answer: you cannot change the past, all you can
        do is go forward and hope you can get past
        your “past” and make progress somehow.
        But you can go through 1000 doctors and still
        not find a great one. That’s the sad part.
        Same with regular primary MDs and other specialists. Some of them might be good
        clinicians but are nasty, impatient, inhuman,
        or overworked, and just don’t care.
        And don’t EVER let the govt. control any
        of this: before I got my disability case
        sorted after 10 years of legal battles with
        NY State, I was once sent to some awful
        Medicaid medical office in midtown NYC
        and I was terrified I might get some disease
        it was so awful. I felt like going back to
        the Jamaica, Queens office that had sent me
        for whatever reason (to keep getting food
        assistance or whatever services) and KILLING
        them all. Bunch of evil, nasty trolls.
        Stay far away from that system if you can.
        You’re still better off going to private
        therapy if you can or MDs or even a decent
        clinic that’s privately run as it were, than
        ever getting involved with the govt. stuff.
        And that includes therapy and psych. doctors
        and services. You don’t want to ever end up
        so “mad” that you are in prison or a state
        hospital, that’s one thing I can tell
        everyone. Even going to a therapist or two
        per week is better than any alternatives,
        but it would be nice if they can really help
        people actively instead of just sitting there
        passively listening and earning a paycheck,
        like most of them tend to do.
        It’s a money-making scheme no matter what
        since they’re doctors, after all. It’s sometimes
        a very sad and frustrating situation but
        we all need to rise above it and help ourselves
        as much as possible. That’s IF possible.
        I feel worse for those kids or adults who
        are so disabled or ill that they just can’t,
        that’s an even worse situation. A nightmare.

    • I so agree with you. ‘Therapy’ left me feeling so much worse about myself. Once I began studying psychology I became able to understand what had happened in my life and how I could find a way to cope with the results. The answers were not within myself, I needed education to understand.

  10. when my therapist today told me that we are stuck in therapy so that means i should quit? what should i do without wasting my time with this therapist

    • your therapist told you to quit? if yes, then find another therapist… if they were compassionate they would find you one that can help you better than they can. there is no shame in ending this professional relationship… sometimes it just doesn’t click and you are better off with someone else. ultimately they are there to help you so you’re better off with someone who is committed to going the whole way with you

  11. From my experience of therapy it seems to involve paying someone to listen while you tell them what you think is wrong with you, and this carries on indefinitely. This may provide consolation to someone in distress, but I could not see how it could reverse the effects of bad parenting. Sometimes therapy is justified by saying that if the client keeps coming back they must be experiencing some benefit from it, but it could be no more benificial than other useless compulsive activities. In my opinion evidence for a therapy providing the client with a benefit would be some practical improvement in their life, but I don’t read of examples of clients giving up prostitution, or leaving their abusive partner as a result of therapy.

  12. Totally agree with Leave. I’ve been for myself in therapy but thanks God I left the sessions before I was totally drained out of money and hope. Not only it did not do any good to me, but I went even deeper into trouble with my personal problems. I swear in fron of the God that I have followed psychologist advices like a blind person. I even feel naive sometimes about it now. I bad a terrible experience with the therapy and I wished I never was there. And yes, he was a college educated therapist, with 15 years of experience in the field. Only now I understand that this professionals not only do not help people but they create more harm to them in the name of financial benefits to them. Its very said but this is the ugly truth. Now I’m better in my life and learned to solve things on my own. I use every chance now to share my bad experience with anyone, anywhere. This fake medicine must be exposed to the public and tell the truth for what is worth for.

  13. A layman’s view on general psychotherapy:

    I think therapists’ egos are missing a problem, exemplified in the part about “Who makes you the judge? Your patient does not wish to fire you. She is getting something out of therapy.” … is continued attendance really the criteria for successful therapy? I see that patient as emotionally dependent or ‘addicted.’

    Ever see the documentary Kumaré, about the fake guru who changed people’s lives about as effectively as so called ‘real’ gurus might? I’ve been thru two major depressions, at about ten years apart. And without drugs or therapies, both depressions completely went away on their own. If you have a common cold/bug/fever, you may visit an ologist or take an elixir, but when you get better, was the treatment really that effective, or was it more your natural ability to heal over time? For example, I read how the considerable success rate for people using hypnotherapy to quit smoking, is about the same success rate for those who just go cold turkey. Yet those who quit by throwing away money on hypnotherapy are convinced it really works, along with those who profit from it. But they ask the same question you are about the ones who dont seem to benefit from hypnotherapy.

    So I think you overlooked an important reason why therapy may not always appear to be effective, and that reason is that much of therapy works as a subjective placebo. Like hypnosis, it is less effective on those less susceptible to suggestion. In judging a client as being ‘in denial’ of the wisdom of therapy, the therapist may themselves be in denial. I see that the perceived effectiveness of many widely embraced psychotherapeutic methods is masquerading within effectiveness for reasons other than the method itself. How do you differentiate the many clients of therapists who claim to feel better after therapy, from those who were just as likely to feel better without it? Popular approaches to fulfilment such as CBT, ACT, meditation and mindful-whatever, hypnotherapy, positive thinking, prayer, yoga, aromatherapy, touch healing, chiropractic, acupuncture, homeopathy, healing crystals, magic, meridians/chis/chakras or whatever new age feel-goody thing-of-the-month… in themselves, these methods have little effect beyond placebo, and one approach may help as well as another with say a general despondence. The effects of placebos can be profound, even when the person knows they are taking a placebo, and there is NO shortage of sterling testimonies for all these subjective approaches to happiness. BUT any ‘perceived’ benefit is too often temporary, or nonexistent in the face of more serious problems, which indicates to me that the technique is not really all that potent. In times of desperation, we give up our cash to any one offering ‘the way.’ Your mood may be lifted, and if you feel better, then the associated method must be effective… or is it some other overlapping process that the healer has nothing to do with, or perhaps is even aware of?

    Primates have been exceedingly successful at adapting and flourishing for millions of years, and yet so many STILL feel the need to pay someone to show them ‘how to’ live. I read that the psychotherapy business has only been booming in recent decades. ‘We’ seem to only be getting sicker, as depression, anxiety disorders and prescriptions rise in the U.S. So how is a therapist capitalizing on a desperate individual’s dependency for $130 an hour (in L.A. here) alleviating what seems to be a general mental illness in modern living? The best marriages I know are people who never read a book on ‘how to’ be married, nor did they speak to any experts on relationships. They just DO it, and wind up with relatively healthy, well adjusted kids. Someone is ALWAYS there to take your dough in exchange for ‘breakthru’ techniques, books, and artifacts that have little actual power in themselves. If the real change comes from within, why are we so conditioned to need an external catalyst to feel ok, and always for a price? Common psychosomatic problems are just as likely to be more or less cured by any one of these common psychosomatic solutions. The proper therapist tries to remain objective (which is impossible), holding up a revealing mirror, guiding me to figure out what helps me. But I’ve seen a couple of therapists over the past six months, and I see little difference from talking to a thoughtful friend, except that a friend saves me a lot of cash. Of course, not everyone has an understanding friend, so like everything else in capitalistic society, you can purchase one.

    The first time I went to therapy, it struck me how similar it was to going to a strip club…
    I am unhappy, so I pay someone to be nice to me and make me feel special. I get all caught up in this intimate situation with a stranger, until suddenly they say ‘time’s up… that’ll be $20 bucks’ (my copay happens to be the same amount as the going rate for a lap dance). Then there’s this awkward moment where they just look at me while I fumble in my wallet for the cash, and I suddenly feel like a sucker, realizing that the only reason this person is paying attention to me is because they profit from my desperation. They hope I will become ‘a regular,’ but they will never have anything to do with me personally outside of ‘the club.’ They are concerned with gaining my trust, but how much can I really be expected to trust someone I am paying for a relationship? They are in control, are not risking anything, and there is no loyalty on their part. The moment the money stops, its over. I may walk away in a better mood, but I am soon eager for my next fix, as it is easy to become emotionally dependent on the special treatment. Although I am not getting what I REALLY want or need. Its an expensive habit, and naturally they suggest I should continue to see them, and to perhaps come in more often. And I notice that healers and lawyers are the only professions I can think of where they expect to get paid regardless of whether or not they actually benefit the client in any way, unlike strippers. There is no clear plan or goal for getting me out of therapy. I am steering the bus, setting the pace, and deciding how long I keep going. I read that the number of therapists and the number of people seeking therapy has only greatly increased over recent decades. When the economy is bad, more people go. It all just wreaks of a ‘lucrative racket’ to me. And like ‘psychics’ the practitioners come to believe they have more power than they actually do.

    • I just left therapy last week after a year and a half. What you wrote is so accurate. In all that time I have not changed one bit and it’s not that I didn’t try. Therapist cannot fix you. They cannot change your life – get you a job when your unemployed, make your family normal and loving when they are not, etc. When I told my therapist I was done because nothing has changed in 18 months all he did was ask what I thought would be another way to approach my therapy. Hello, he is the one with a doctorate in psychology not me. He is the one being paid so why am I the one whose has to figure out the right approach?

      • This is precisely what I’ve been saying recently
        to family and friends, in some cases, more so
        than ever. I’ve had good therapists but so few.
        And for sure they cannot always fix all your
        problems or sometimes cannot change a thing
        in your own life. All they can do is talk to you,
        suggest things, and encourage and try cognitive
        things, meditation, mindfulness, or other
        techniques which aren’t going to always help
        everyone, and it depends on the patients’ own
        issues and situations and everybody is totally
        utterly different, obviously.
        A flat tire on your car is a quick fix: an abused, bullied and disabled human being is never a quick fix. But some of these doctors are USELESS or worse, and they are not magicians.

    • excellent! I need YOU for a therapist

    • You all sound like what you want is directive therapy – such a thing exists – it is when someone else sets homework for you to do so you feel like you are doing something practical about your problems and someone else is providing the ideas. It’s very helpful for some problems. Try CBT.

      Non-directive therapy, like counselling, relies on the belief that clients always have their own answers inside of them anyway and they can do it alone – it assumes the client’s independence. The therapist is used as more of a sounding board for the client to bounce off, which can also be helpful. If you do not feel that you can independently help yourself at the moment, then try directive therapies.

      Also, I’m not sure if the client that is coming back despite being stuck is emotionally dependent. They might be conscientious and simply believe something is wrong and want to fix it, but perhaps they haven’t actually worked out what is wrong yet. The other possibility is that they have something to say but are too afraid to say it – just as the example described. Others might be emotionally dependent, but I think most of us can tell the difference between someone emotionally dependent and someone not.

  14. I saw my therapist for almost 4 years. She left the country for 8 months, and is back now. I’m trying to decide if I should go back. I don’t feel different these 8 months than I did before, but I feel lonely. I also really miss being able to talk to her?

    I don’t think I’ve changed at all over the 4 years. Should I quit therapy all together?

  15. I agree about letting the client benefit in ways the therapist doesn’t see. Mine tells me that as long as I’m getting something from it, she thinks we are moving as fast as I need to move, and I appreciate that.

    I think my therapist sees us as stuck currently. I guess I do too. I do think she’s the right therapist for me, and I’ve been seeing her for a year. After the first of this year, I started going twice a week, at my request. I do have anxiety, which I think is the root of everything. I think it’s the root of being stuck, so thank you for saying that in your article.

    Also, I’ve been to a lot of therapists in my life. I’d say 3 or 4 of them were good, and I’ve seen about twice that many. But I went about 10 years without therapy between the last two, so I’m not in therapy all the time. I am also afraid of rejection, so thank you for that as well. And if I do get better, will my life be recognizable any longer? Will the people in it now fit in it? How do I deal with losing my therapist, which I’m not even ready or willing to bring up in therapy. I really don’t have a vision of change that makes me unrecognizable, so I think fear of not fitting into my own life less of a problem.

    I’m pretty genuine. I just have a lot of anxiety that causes intense muscular pain in certain areas of my body, but mostly my head and neck. This pain is nearly unbearable, and I have had a headache almost constantly for 5 years. I am both afraid it will kill me eventually and that treating it won’t ever work. However, my therapeutic plan is helping my pain tremendously. I see a psychotherapist, and some other specialists that deal with this type of pain. I know that therapy helps when I leave therapy with less of a headache.

    Writing all this has helped me believe that where I am in therapy is where I’m supposed to be, that I am improving, that the stuck thing is already being addressed, and that what I’m experiencing is normal.

    I can’t even scratch the surface in a comment like this, but if the author, or anyone else, reads it and would be so kind as to respond, I would really appreciate it. Thanks for writing it.

  16. My first experience with therapy was horrible. I started going at the request of my husband when I was in my early 30’s.
    When I felt comfortable enough around him I revealed a traumatic childhood experience that I had never shared with anyone, up until that point.
    After this supposed trauma occurred I didn’t have the benefit of a therapist or trusted adult to help me make sense of any of it. I had to be my own therapist and was able to put this experience in a neat little compartment in my head. It served its purpose. I moved on and was able to function, be relatively happy, and grow into the person I became.
    My therapist’s reaction to what I revealed to him caught me off guard. I was angry and at that point I felt that he was the one who actually traumatized me by making this such a huge deal and acting as if this was the reason behind all of my current problems. Of course more would be revealed that make him realize that this in fact was not the only reason for my current condition.
    Soon after I was diagnosed with bi-polar disorder.
    I guess what I’m trying to get at is I was stuck with this therapist because I could not get past the anger I felt towards him, and I felt that he was incompetent.
    I quit therapy with him and didn’t go back to therapy again for a few years.
    By that time I could look back at this experience with that therapist and see the great benefit I got from from his methods. I still don’t agree with everything he told me about my so called childhood trauma. I in fact don’t believe that I was traumatized at all. Bad things happen in life, and we all react to these things differently. Sure, I realize that what happened to me was horrendous, but I survived and moved on. Did this event change the course of my life and some problems? Sure it did I needed therapy to resolve some of my issues.
    Anyway, the benefit I received was that, in fact, he gave me a hard push. Basically forcing me to re-frame my thoughts. I tend to be a black and white thinker and having this skill to be able to re-think my position on any of my thoughts about something has had a huge, positive influence on my life. I’ve now a more compassionate, patient and loving person. I now can form strong bonds with the people in my life. I can also see how some of the people in my life are toxic to me.
    I don’t know if the therapist’s reaction was intentional? Maybe he did know what he was doing after all? Or was it just a natural human reaction to what I revealed to him. I guess it really doesn’t matter. I did in fact benefit from this experience.

    I currently see a therapist for different reasons. I’m still bi-polar, but for personal reasons I am no longer medicated. I guess I view my therapist a paid babysitter. He is good at monitoring where I’m at emotionally when we have our sessions. Sometimes I am at one extreme or another. I am not always able to think clearly at these times and he knows when intervention is necessary. He’s never found it necessary to have me hospitalized. I am very grateful for that. Sometimes he is just someone there to listen to all of my wild thoughts and ideas when I’m manic. He’s paid to at least pretend like he’s paying attention. When I’m like this with others in my life I tend to wear them out quickly. When I’m really depressed sometimes he is just there to sit with me and very little communication is taking place. When things are “normal” sometimes I do indeed feel stuck. That can have benefits too.
    Therapy isn’t for everyone. Some of us need it. Others don’t. Sometimes we may need it only briefly, at certain times in our lives. But whatever the reasons are, I think it’s important to be able to look inside of yourself and have the confidence that you know who you are better than anyone else in this world. You may find that you have the ability to work things out for yourself, or you will be able to know that you could use someones help to guide you through a difficult time.

    Sorry this is so long. As you have probably figured out by now I am, in fact, a bit manic at the moment.
    I hope that at least some of my thoughts on this topic have made some sense.

  17. I have found that in three years I have left an appointment feeling heard, understood and like it had a point only twice. I usually leave more frustrated and enraged than when I went in. The woman keeps telling me I am doing it wrong but will not explain what right is. She refuses to explain how any of it is supposed to work. I have tried others and they are all about the same.

  18. I’ve been to half a dozen psychologists over the last ten years for depression, social anxiety and motivation. With most of them there has been some mix of harm with a little good, but for the most part it has been totally ineffectual.

    I have never been disrespected by anyone more than by a therapist. They think they have a license to say whatever they want. For some reason, we look toward psychologists as experts. In my experience, their advice and skill is no better than anyone else’s. The article above has long list of reasons to blame the patient when they don’t get better. How convenient..

    In my twenties, two different psychologists told me I was too crazy to work in a professional field. Fortunately I didn’t listen to them and went back to school and have been a continuously employed computer programmer ever since, quadrupling my income. Actually, working in the field made me face a lot of my fears and caused me to grow as a person.

    The last therapist I saw, tricked me into trusting her with her fake compassion. It must be something they teach in psychologist school. After a while she started to become condescending and would second-guess everything I said. She really made me feel like a loser. This is the last thing I need, and I am trying to get her out of my head. She seemed to jump from one conclusion to another without ever really listening. It seems that we act in a ways that are reflected back by other people. The therapist often just reflects it back even stronger, magnifying the problem.

    In my late thirties I discovered Buddhism. Through the combination of the philosophy, meditation, and the community, I made rapid progress in my ability to relate to people and have increased clarity and awareness. It was more than I ever thought possible. Sure, I still get nervous when meeting new people, but I am able to regroup my thoughts and focus on other people rather than focus inwards.

  19. This article ascribes far more magic power to psychotherapy than it can possibly offer.

    Psychotherapy essentially is a performance, a Wonderful Wizard of Oz performing as a wise man, manipulating the insecurities and weaknesses of some groveling “patient.” Its illusion of improvement pairs with the underlying message that the acolyte remains hopelessly inferior to the Master.

    Psychotherapy delivers fundamental indignation. Counselors seem to forget the “intimacy” they peddle is as contrived as they robotic vocabulary they employ.

    I love Pauly Gone’s strip club metaphor.

  20. Maybe talk therapy isn’t working is because it never does. I have suffered from panic attacks most of my life, I’ve had over ten years of talk therapy and it never made a bit of difference. I say this, I don’t think you can talk away panic any more that you can pray away the gay. In my opinion panic and most other “mental problems” have biological causes and need biological treatments, medication. Am I perfect on meds, no, but I’m a lot better than when I was in yak therapy.

  21. I have been in therapy for 18 months, after a significant life event. My counsellor eventually identified issues I wasn’t prepared to deal with, but ultimately have started to talk about. He’s been extremely patient with me, and has used a combination of therapies, including EMDR and DNMS, in order to help me re-engage in life. It’s been a difficult process, but effective. I have times of extreme ambivalence – I want to stay, I want to go, I want to stop altogether – but he patiently talks me through everything and is very supportive and encouraging. He was not the first therapist I approached, but I can say that once you find someone you are comfortable with, it can be an immensely positive experience. Be patient with yourself and get the help you need. You are worth it.

  22. I’ve found a way to work with the fears that keep someone from getting better: Emotional Freedom Technique (EFT). It’s a simple technique that may be incorporated into therapy or used on its own, but it increases the client’s ability to heal, especially if they are stuck.

  23. I sought counseling because I was going through an extremely difficult 10 weeks. I am through the worst of it now. I am appreciative of the counselors support very much. She is a Christian counselor. I happen to be an educated person and have much life and work experience as well. My only frustration here is that I often leave feeling as though this person is speaking down to me and must ultimately view me as such an inferior, pitiful individual. This is a feeling I get often. Considering ending therapy. Just have not totally decided. Thanks for the blog.

  24. I was raised in a drunk, poor, violent home. Fought in Nam At 18. And have been a mess ever since. Had 9 DWI’s. 2 marriages, and 3 kids. I’ve been through more “therapy” than I could ever count. NONE of it ever helped. None of it ever helped to teach me how to sort it all out. If I had to put a name to it all it would be LOSS. Well I’m 63 now. I haven’t drank in 12 years. All of them did there best to label me an Alcoholic and that I needed AA meetings for the rest of my life. Well I proved them all wrong.
    The answers I needed I found on the internet. The war demons I suffered with for over 30 years I was finally able to put to rest at a reunion I went to with my old war buddies. I finally realized I had followed the program I was taught as a child. I’ve changed all I can. I am what I am.
    NONE of the therapists I’ve tried has ever been thru any of the stuff I’ve been thru. They can’t relate to me and I can’t relate to them. So just how are they supposed to help me. They can’t. I never last long because I get bored with it all pretty fast. But they sure don’t mind helping themselves to my money. Sooner or later your going to have to figure it all out for yourself. Being “streetwise” is a term we used to use. Streetwise is the difference between how you want it. How society thinks it should be…..and how it really is. And how it really is can have a very bad smell when you come from the background I did.
    Happy Trails

  25. Wow! This forum is depressive.

  26. I am really saddened to hear all the negative experiences that you (commenters) have had with therapy. I do not disagree with much of what has been said, but I wanted to share a positive experience, as well.
    My story is not necessarily relevant, but for interests’ sake, I will share that I have been “disabled” for over a year due to “mental illness,” have suffered through hospitalizations, meds upon meds upon meds, and a lot of ECT. I was diagnosed with a neurological disorder that may be the root, but that is still in question.
    Anyway, I believe that therapy has been very beneficial for me, regardless of my diagnoses. I have seen two therapists (only due to moving, I didn’t chose to change), and each therapist has had very similar, yet dissimilar approaches. What has helped me in therapy has been having someone help guide me through my own thought processes, identify feelings to which I couldn’t put a name, and offer tools (techniques for coping) that I have practiced and found effective.
    Considering the multiple schools of thought in psychology, in combination with the psychologist’s own approach, personality, and personal issues, it is no wonder that it can be difficult to find a good fit between patient and counselor. I am fortunate that I have been comfortable with both of my therapists, and I believe that they are sincere in their desire to help others. However, I don’t agree with everything that they have said, and I am comfortable disagreeing when I feel it is relevant. No one is perfect, and in the end (as many of you have said), only I can “heal” myself. I am just receiving guidance in doing so.
    I guess my point is that I have found therapy is not about someone just listening to you/ consoling you (I, for one, don’t want someone to console me), telling you what to do, “fixing” your problems, or telling you that things aren’t so bad/ everything’s okay.
    If you find the right therapist, accept that you are ultimately responsible for the course of your therapy (and make it clear to him or her, if needed), but be open to using your therapist’s knowledge and skills to learn to cope/deal/”get better”/whatever the need. However, in my non-professional opinion, if your therapist makes you feel worse about yourself (as some have mentioned)–I would guess that he or she is not the right fit for you!

  27. I found these comments to be very interesting and informative– for the most part, mirroring my own feelings and perceptions about so called “therapy”. I have just restarted “therapy” after not being in it for several years; already, I am feeling uncomfortable, and wanting to quit after just one session. I have had about 30 therapists, and out of that, have found maybe 3 of them to be decent (but one died, one was transferred, and the other one, I had to leave behind when I moved). Basically, I find most of them to be dismissive, condescending, or even downright abusive. I have also had almost every dx thrown at me, so I wonder how scientific any of this can be? Seems to me that the entire experience is subjective and fraught with misunderstanding. I have occasionally got a hold of my records; the therapists’ inaccurate info there has been astounding. I feel as though I “ought” to be in therapy, but honestly, it usually makes things worse for me. Thanks to all who commented here. I, too, especially liked Pauly Gone’s strip club metaphor!

    In addition, I was sexually and physically abused by a quack; that sure didn’t help things! Nothing could be done about it, because he didn’t have malpractice insurance.

    Oh: and I am also angry at the way the client is targeted if for some reason, the therapy is a failure. Generally, like all so-called health care, this faction is a mess, and poorly regulated. Though since our governing bodies are also a mess and all our values in flux, I am not sure who ought to be doing the regulating, either.

  28. Wow, sadly I’ve been in the same boat as those who’ve not had a productive experience in “therapy”. The quotes may be annoying, but, my reason for using them is, is it really therapeutic? I have been molested numerous times by my first “therapist”, back when I was just 22 years old, and from a devastatingly abusive home. I did report him to the clinic. The next one they assigned me too, this creep Brian, physically assaulted me and I had bruises on both my upper arms. Years later, I went to another “therapist” who, after 5 sessions, kissed me goodbye on my neck saying, see you next week. I never went back. My abusive childhood for some strange reason had me become too afraid to report him, so I just never went back, knowing I was in danger.
    Now, at 55 years of age, I thought I would try again. The therapist I have now is a decent human being. I do not feel intentionally abused by him. However, there have been incredible blunders- falling asleep, finding him to be lying occasionally, things lime that. It seems the thing I am learning more then anything else, is that I am made to be treated less then, less then should be expected, less then what others shoul expect, etc. What is going wrong, or has perhaps always been going wrong, with therapy and these very frequent problems people are posting, complaining about??? It’s really awful.
    It must be the real lack of accountability. It’s too bad that every single therapist, whether in a clinic or private practise, is not required to submit maybe bi-annual questionaires from their patients on how therapy is going. Some central place where there is an accountability, or funding would be pulled from the clinic, something like that.
    Anyway, hoping for the best for all of you posting, and for me too. And don’t forgetthe value of reading a couple of good self help books, try to make sure they’re good tho’. Over the years, they helped me more the any so called professional.

  29. I just ended after the sixth session with a “therapist” who came highly recommended b my psychiatrist . The first two sessions seemed ok because he wrote out a cbt plan and said all the right things . Third session , I show up and I think he forgot we had a standing appointment at that time . I noticed that he never opened my file , didn’t write anything down , never saw him typing on a laptop – and couldn’t remember anything about me from one week to the next . I think the written plan is the only thing he knew how to do , I believe to make it look good to collect insurance . He mentioned what a stunningly beautiful woman I was way too many times . He gave written assignments he never read , then asked me the next week to do the same assignment he assigned the week before . He forgot what medication I take, my age , everything . I have not told my psych everything yet but I’m going to at our next appointment . I would like to report this so called therapist but don’t know the process . I do trust my psych and I believe my issues will always require meds – ocd, adhd, anxiety. He recommended this therapist because I want to eventually be off the meds , but I am more discouraged than ever that this will ever happen . This idiot damaged what little trust I was beginning to have in other people . I’m back to square one , maybe worse . Therapists should not be allowed to do the harm . I want to get back all the written assignments but I cant bear the thought of going back there .

  30. What is this mirroring thing mentioned a few times above? Hold up a revealing mirror? What does that mean and how do they do this?

  31. I’m doing much better after about a year of psychotherapy. I’m much less anxious, more mindful, better with people, and much kinder and more gentle with myself. I still struggle with some compulsive type behaviors but I no longer let them define me. I don’t make a big deal out of things anymore. If I start off a day in a bad mood I can work myself into a better one using my “tools” learned in our sessions. Prior to starting therapy, I was able to get off of antidepressants as a result of mindfulness meditation and yoga. But I found that those practices only took me so far, so I decided to start therapy. I have not been disappointed. I’ve been off antidepressants for the longest period of my adult life (I’m 57). I don’t see any future need for them because I know what’s really going on now. I’m no longer distorting, seeing things negatively. I will say this: what I learned from mindfulness meditation and yoga has very much informed my therapy. I’ve seen and understood things that I might not have otherwise as a result of them and I’m very grateful that I learned them. Finally, and especially given the overwhelming negativity here regarding the profession, I have to say that my therapist is amazing. She is unfailingly supportive, kind, gentle and patient while also being upbeat and positive. I’m coming into my own now, though, and soon I’ll no longer need her services, thanks to our mutual good work together.

  32. Hi All, this is an extremely interesting discussion. I guess it tends to be negative because it is responding to a piece about why therapy might be failing.

    I am working with our government on advice, based on research, for therapists and professionals working in our Public mental health service. (Wales, UK). I am a therapy user, not a professional.

    I’m doing a piece on the therapy relationship.

    It’s about what works, mostly, but partly that is because there has not been enough research about what doesn’t work, or about the risks of therapy making things worse.

    I’ve also had good and bad experiences of therapy, and like many of you the number bad experiences has far outweighed the number of good. At a meeting recently with about 30 people, I asked how many had had therapy, about 28 had. I asked how many had had a really good experience of therapy, about 27 had. I then asked how many had had a really bad experience of therapy and about 27 had.

    I want to try to condense what you have all been saying, and would be grateful if you could let me know if this has been successful.

    Basically there appear to be 3 main clusters of reasons for therapy failure

    1) Poor fit between therapist and client
    therapist- dislikes client
    – doesn’t understand client
    Client/therapist mismatch
    – wrong gender,age, culture,
    language, faith etc

    2) Poor process
    therapist – lacks knowledge and skills
    – incompetent
    – lets own emotional problems
    disrupt therapy
    – doesn’t notice or fix
    relationship problems
    between therapist and client
    – doesn’t keep accurate,
    insightful or complete
    records and therefore
    forgets or repeats things
    – doesn’t provide the kind of
    therapy most suited to the
    individual, their problems
    and their preferences

    (there are many different kinds of therapy. some designed to help people to begin to talk about and understand their problems (eg psychodynamic therapy) – suitable for those who don’t know what is going on for them, which provides no advice or solutions, and other therapies which are ‘solution focused’ ie techniques and skills are taught which the client can then apply, advice is given, and specific remedial treatments are used eg Cognitive Behavioural Therapy (CBT) or EMDR)

    system – lack of regulation or
    accountability of therapists
    – inadequate supervision for
    – lack of quality assurance

    3) Poor attitude of therapist
    Includes – superiority
    always right
    no negotiation

    I find it difficult to think of client factors that aren’t a reflection of therapist factors, such as not being able to open up (therapist is distant or jusdgmental), not trusting therapist (therapist is not trust-worthy) etc.

    Although I suspect that being in love with your therapist (I’ve done that too, but only once), and wanting to kill your therapist, are probably neither likely to have a beneficial effect!

    Pleased if you could comment,

    Yours Geek

  33. Why therapy might not be working? Where to begin?

    Therapy has demonstrated some effectiveness in helping those suffering from emotional distress. However it is not effective for treating mental illness.

    Mental illness is a medical condition that can only be diagnosed by a medical doctor. Under what other circumstances would a practioner be permitted to treat an illness they could not even diagnose?

    Therapy is not well researched or regulated. There are many different therapeutic approaches. The therapist chooses the approach to study based on what they ‘feel’ is the best approach for them, rather than being guided as doctors would by regulated evidence-based training courses. They are allowed to practice un monitored wherever they choose from their shed to a hospital room. They are not required to prove their work so to speak – to show their treatment is effective. They are only judged by the client, person who is ill, usually in distress and desperately want to be well. In many cases a person who is vulnerable to suggestion and prone to self blame and will not tend to asses whether their treatment is working because of the merits of the treatment itself.

    Therapists do not receive adequate training about human physiology including a detailed understanding of the brain and nervous system – which is critical to understanding the route causes of mental illness. The mind does not exist in some mystical realm – our thoughts, feelings and emotions as a result of the interaction of our brain and body as a whole with the environment. We are only just beginning to understand the complexity of our brain, consisting of 100 billion neurons, intricately organised and controlled by complex chemistry. We have yet to discover all the neurotransmitters involved in the brain.

    Therapy is unscientific and based on approaches that were created years before we had a good understanding of the human nervous system. It is based on individual ideas that became popularised rather than being rigorously tested and proven effective. The ideas have stuck around because we do not have the same level of respect and understanding of mental illness that we do of other medical conditions. Just as in the past, where there are areas of mystery someone will always jump in with an answer – whether it is actually an effective answer or not.

    Where new approaches have some proven efficacy such as CBT – therapy is still failing. Firstly because we do not regulate CBT therapists well enough – so the therapy is not actually being replicated in an effective form. There have been studies which have concluded this I have been told. Secondly CBT is not a one size fits all approach. It will not work for everyone just as one treatment does not work for all illnesses.

    The underlying assumptions of therapy are wrong. They begin with the idea that there has been wrong doing either to the patient or by the patient. They assume this can be rectified after the fact. In the case of emotional distress this is not always the case. Numerous studies including those done after 9/11, have shown that talking about emotionally distressing events actually increases distress both during and after discussion. Therefore ineffective in many cases of PTSD. Fundamentally therapy assumes that by modifying behaviour (that was some how previously in error) you can cure mental illness. This is wrong for so many reasons.

    We have no model of behaviour to guide us which guarantees mental health for all. We have no reliable way to induce that behaviour in others. We can not assume that a persons behaviour or actions led them to mental illness nor can we assume that by rectifying those behaviours by suggestion (if it is possible when illness is due to physical illness/chemical disregulationn) that we can cure them of their illness.

    I say all of this not because I want to anger or hurt therapists. I want to reach out to those who may be searching for this subject because they are themselves Ill and may be feeling lost and hopeless. Who feel like failures because they a have been told by so many that therapy works and that they just need to change what they think, change what they do. As if in some way the mentally healthy stay so because of some merit to their character.

    Therapy is effective for mental illness in the same way that therapy can help if you have cancer. What you need to cure the cancer is chemotherapy or another proven treatment. It may not always work but it is the best we have. The support of therapy is useful and helps us find ways to get through the distress the illness causes but it does not treat the illness. People suffer from mental Illness all over the world in the most poverty stricken regions to the richest. It doesnn’t matter what you have or haven’t been through it may strike us all. Think of all the circumstances that people are in who suffer from mental illnesses throughout the world?. Do they all need to just think more positively? Do some yoga? Eat vegetables? Commit more to Therapy? Or is it possible they all show similar symptoms because the same structures of the brain or neurotransmitters are not working optimally?

    If you are struggling with therapy please do not blame yourself. Go to your GP and if they are horrible or useless find another one. Get a medical diagnosis of your illness. If you need treatment with drugs, take them if you can. They may not work brilliantly yet (believe me I know) and they are not without effects but they are the best we have so far. Sometimes it is a case of management rather that cure. Look after yourself if you can- this helps when you are trying to recover from anything! EDucate yourself as much as possible. Google Scholar is invaluable for finding peer reviewed literature to look up treatments.

    If you go to therapy find the most highly qualified and regulated one you can. Preferably one who practices as part of a team. Someone trained by a recognised university. Take what you need from them and what helps – leave the rest. They are still wading in the dark like the rest of us. Don’t take my word for it either – research all of this yourself or ask someone to help you.

    As for the person in the article who writes of ‘fear of change ‘ being the cause of therapy not working – what a ridiculous and ignorant notion. Anyone who lives with mental illness would no more be afraid of being well than someone with any other illness. This shows a grand ego and arrogance and an ignorance of human psychology and neurology. Not to mention a lack of compassion and a superior attitude. Perhaps the author might look into the imperfections of the therapist a little further.

  34. Therapists cannot fix medical progressive illnesses no more than an M.D. can for some in their mid 50’s who’worked their whole life to be reduced to living in poverty. Yep and if that makes for does. Limitations affect what one can do…volunteering is even not an option..if it was one would be working. Acceptance to limitations driven to next to nothing but exisistence is not living. So i ask…what therapy or medication fixes that. None. Its about money that someone like myself now living in poverty cant even afford meds or therapy…so now whats your creative tool box answer????

    • Darius
      I understand what you are saying. The reality of illness, age, lack of money and family makes it impossible to not be anxious and depressed. The therapist I see is very supportive but nothing changes because I have so little resources to make any real change. How do people get by when they have lost everything? That is the real issue!

  35. Since I have a great deal of insight therapy became redundant. No therapist told me anything I didn’t know. I still have many self esteem issues. What kind/type of therapist would I seek? How would someone like me go about therapy.
    I was in therapy for 6 months about 4 yrs ago. I tried therapy again and didn’t learn anything new.

  36. In many ways my therapist helped me work through many issues, however recently I noticed our relationship was not exactly a business type relationship. Over the years I have actually been to her house on numerous occasions from just riding a long in her van to drop her daughter off after picking her up from school, to fix her internet by bringing her computer back online which her computer was located in her bedroom, to attending her divorce care party with others from her group she created at the church we both attended. I’ve met her sister, daughter, what used to be her boyfriend, along with other important people in her life. We have on one occasion gone out to eat after having a session of therapy. I grew to really care for this woman. In a conflict of interest she was seeing someone who used to be a friend of mine until that person tried to control me and use me. When she couldn’t she dumped the friendship. My therapist at the time still sees that person and since she is in her fifties (the friend) and has no one else to take care of her after death responsiblities, the therapist agreed to help her. She has also been to my ex friends home to help her clean it up as she is a hoarder. I couldn’t continue to see the therapist when an enemy is her good friend and client. I dont feel safe. Besides i know that there have been small things that have been said to me that were the other persons words like tells me my issue in our breakup was that i was half way in and half way out of our relationship which she doesn’t know she wasn’t in it she is using the other persons words. I question my therapist when I stopped and wonder is this healthy? I mean what other therapist does these things? Where are the boundaries? Now im hurt and frustrated due to the conflict of her seeing and being friends with my old friend plus her lack of clear boundaries. Im so hurt. But i guess im just being resistant and difficult right?

  37. I honestly don’t see anxiety or a fear of death as the reason it doesn’t work and I think blaming the person is the easy way out. Maybe the therapist just sucks? Maybe the therapist googles online “depersonalization” cause he doesn’t know what that means etc. And maybe people get tired of talking about they’re day and watching someone with a note pad just nod and write? And offer no real feedback on the condition or w/e it is. And maybe people come in and don’t feel any progress, no treatment outline, and when the time comes to go, they simply feel like its not worth it? I don’t have a PHD but I can tell you, its not just the patients fault, nor even just the therapist. THe mind is so complex etc. My own opinion, it often fails because therapists CANNOT get to subconscious trauma’s and other issues and surface talk doesn’t help. Thanks.

  38. and btw, its good to read this thread. I have a had little benefit from therapy myself and its nice to read im not alone.

  39. one last thing, good post. EVERYONE is afraid to change and is anxious about that when they come to therapy. That is not a reason to blame them! The whole point of the psych doctor is to create a safe place, sometimes the first time that someone never had. If its done right, that in itself as part of the healing process drops the fear of change because the person fully see’s how bad or how its not working. I am going hang a PHD on my door. Wink. Btw, I always thought the PHD’s knew more than the social workers who do therapy. I was wrong. Just my opinion.

  40. before you call yourself a doctor and parade this legal case, know your stuff! Any good doctor knows more than his/her client. In medicine, we go for treatment because we trust that the doctor knows more about our bodies then we do. For counseling, we go because we hope the doctor of philosophy knows more than we do. With both, people need to feel SAFE. Everyone has fears, fears this and that, its part of the healing process! The job of ANY healer is to provide a space so that fear dissolves in the space of insight and healing, AND the doctor should be able to work around the clients mind and give feedback so the client see’s him or herself. The feild never ceases to amaze me. I had one year of grad school and quit. This is why.

  41. one last thing, I am very sorry for another post. Do you ever hear the public or the medical community calling a patient a failure cause they die of cancer?

  42. How if the therapist simply doesn’t like the patient, and is too greedy and unethical to curtail the relationship?

    I had this happen to me. I went to someone for grief counseling, my first and, so far, only experience with therapy. The person belittled me, often rolled his eyes when I said something, and gave me a disgusted look, used an icy tone of voice, and said “this isn’t drama class” when I dared to express emotions.

    After a number of sessions, I realized that this person simply didn’t like me at all, but was unethical enough to continue charging his hefty fee. It was simply impossible for me to make any progress, or find any comfort, with that therapist.

  43. Your reasons for therapy not working all include “the client fears this, that client fears that.” That assumes the problem with counseling is ALL lack of understanding on the part of the participant, NOT the therapist. What about the skills and understanding of the counselor? They are supposed to be the experts, not shifting blame onto the person they are supposed to help. Counselors take money while also taking weeks to decide if they can help someone without informing the client of that process; they can then summarily drop the client or shift them over to someone else without much notice. For insurance purposes, counselors rush to label people with disorders, psychoses, or addictions to get counseling sessions paid for. So clients are labeled even if they don’t have those disorders, psychoses or addictions. Medical doctors take the Hippocratic oath to save patients’ lives; what oath do counselors ever take?

  44. I would like to pick something up about intelligence not making a difference. I have definitely been with therapists who were less intelligent than I am, and there is no way the process can work with that gradient. I had to simplify my language constantly and ensure I didn’t say anything too challenging. Not the best situation in a therapy context, where one is supposed to be honest and unfiltered.

    There are people much smarter than myself out there. How do they ever find a good therapist? Sheer blind luck?



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