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Overcoming 3 Common Obstacles in Therapy

Overcoming 3 Common Obstacles in TherapyIf you’re new to therapy, you may not know what to expect. To help you make the most of the process, we asked seasoned clinical psychologist Ryan Howes, Ph.D, to share the three biggest obstacles in therapy along with how to overcome each one.

1. Shame

Howes believes shame is the most debilitating obstacle to therapy because it stops people from seeking help in the first place.

“Shame has a way of doubling the issues: There’s the original problem (depression, anxiety, grief, trauma, etc.); then there’s the shame about having that issue…”

Howes spends a lot of time with clients addressing their shame, before delving into the reasons they came in. He helps clients accept their problem, and normalizes it. He reminds them that “this could happen to anyone” because you’re never alone in your thoughts, feelings, needs, worries or concerns.

“Shame lies and tells us that if ‘people knew the real me, they wouldn’t like me,’” Howes said. But we can chip away at this shame.

For instance, making an appointment with a therapist and talking about minor issues in your life reduces shame, he said. Diving into your deepest, darkest stories demolishes it, he said.

“One of the biggest lessons I’ve learned as a therapist is that everyone, and I mean everyone has their baggage, their insecurities, their quirks and hangups. Once you accept that you have yours too and that’s OK, it all becomes much more manageable.”

2. Lack of Information

Many people don’t know how therapy works, which makes them feel awkward and uncomfortable in their sessions. They’re not “sure if it’s OK to ask the therapist personal questions, if they can swear in sessions, or what to do when they feel like it’s time to end therapy,” Howes said.

He knows many clients who’ve left therapy because of undefined rules, which only made them feel worse about the process and themselves.

“One woman asked her therapist of several months if she would come to her birthday party, and the therapist said no and offered no explanation. The client felt rejected and left therapy, and I don’t blame her.”

People often use the media to fill in the information gap. But media portrayals are distorted. On-screen clinicians are typically caricatures, Howe said. “[S]ome are so cold and detached they’re mute, others are so critical they seem sadistic, and therapists in comedies are usually so wacko themselves they can’t possibly be of any help.”

Even reality shows rarely feature therapists who are caring, ethical, skilled and human, he said.

Of course, these portrayals are meant for entertainment purposes. But they still color people’s perceptions of what therapists and therapy is like.

Howes underscored that clients can ask anything in therapy. You can ask questions about comments your therapist made. You can inquire about a specific technique or their body language. You can ask questions about their fees or waiting room, he said.

“[Y]ou might not always get the answer you want, but the response should be non-defensive and make sense.” And if it doesn’t make sense or you don’t even get an answer, then you’re allowed to feel upset, and maybe even leave and find another therapist, he said.

For additional information, Howes pens a thoughtful blog on therapy called “In Therapy.” He also recommended Irvin Yalom’s The Gift of Therapy, which he called “the most enlightening and entertaining book describing therapy for therapists and their patients, from the initial session through termination.”

3. Trust

Clients often feel hurt and betrayed by loved ones. But in order for therapy to be successful they need to reveal their innermost thoughts and feelings to a qualified but complete stranger. In other words, therapy requires that clients trust their therapists. “We’re asking a lot,” Howes said.

Naturally, trust becomes a big obstacle, because clients may hold back or leave before their issues are resolved, he said.

If you have significant trust issues, Howes said, take your time and build trust gradually with your therapist. He suggested starting with light topics and seeing how your therapist handles them. “They say past behavior is the best predictor of future behavior, so if you felt your therapist was trustworthy with lighter issues, this might hold true for deeper issues as well.”

It also might help to tell your therapist directly that you’ve been betrayed in the past, and you’re revealing information slowly “according to how much trust you feel. Now you’re in the driver’s seat, instead of feeling pulled into a premature disclosure of your issues.”

Overall, Howes stressed the importance of clients communicating honestly with their therapists, whether it’s about the shame you’re experiencing, a point you don’t understand or how certain circumstances wounded your trust.

“Therapy is all about the relationship in the end, and many of these obstacles can be overcome if and when you acknowledge your issues and share them with your therapist,” Howes said. “That’s what we’re here for.”

Overcoming 3 Common Obstacles in Therapy

Margarita Tartakovsky, M.S.

Margarita Tartakovsky, M.S. is an Associate Editor and regular contributor at Psych Central. Her Master's degree is in clinical psychology from Texas A&M University. In addition to writing about mental disorders, she blogs regularly about body and self-image issues on her Psych Central blog, Weightless.

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APA Reference
Tartakovsky, M. (2018). Overcoming 3 Common Obstacles in Therapy. Psych Central. Retrieved on October 30, 2020, from
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Last updated: 8 Jul 2018 (Originally: 15 Nov 2014)
Last reviewed: By a member of our scientific advisory board on 8 Jul 2018
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