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7 Challenges of Psychotherapy

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.

7 Challenges of Psychotherapy

John M. Grohol, Psy.D.

Dr. John Grohol is the founder and Editor-in-Chief 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 August 4, 2020, from
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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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