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7 Challenges of Psychotherapy

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).

7 Challenges of Psychotherapy

John M. Grohol, Psy.D.

Dr. John Grohol is the founder of Psych Central. He is a psychologist, author, researcher, and expert in mental health online, and has been writing about online behavior, mental health and psychology issues since 1995. Dr. Grohol has a Master's degree and doctorate in clinical psychology from Nova Southeastern University. Dr. Grohol sits on the editorial board of the journal Computers in Human Behavior and is a founding board member of the Society for Participatory Medicine. You can learn more about Dr. John Grohol here.

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APA Reference
Grohol, J. (2018). 7 Challenges of Psychotherapy. Psych Central. Retrieved on November 24, 2020, from
Scientifically Reviewed
Last updated: 8 Jul 2018 (Originally: 29 May 2008)
Last reviewed: By a member of our scientific advisory board on 8 Jul 2018
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