When Therapy Isn’t Working

Richard Nicastro, PhD examines a number of reasons clients can feel like they aren’t getting what they need out of therapy.  A lack of personality fit or therapist’s theoretical orientation mismatch for the person are just a few of them.

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There are numerous reasons why clients end therapy. The most obvious is that the clients feel ready to take what they’ve learned from therapy into their lives. Another common reason is that the circumstances of a client’s life have changed and the therapy has become less of a necessity because of these changes. In these instances, there is a natural stepping away from the therapy out of a reduced need for it.

But there are times when clients end therapy because it isn’t working for them for some reason; or more specifically, there was something about a particular therapist/counselor that didn’t work for them. The client might have felt that there wasn’t a good fit between their personality and the therapist’s personality; or that the therapist’s particular way of working (which is guided by a counselor’s theoretical orientation) didn’t resonate for the client.

These situations are unfortunate because, unlike the first scenarios, the clients would have benefited from continuing therapy and weren’t seeking to end therapy in general.

Over the many years I’ve had a clinical psychology practice, I’ve worked with a number of people who have come to me after prematurely ending treatment with another counselor or therapist. 

The exploration of these reasons can help both clients and therapists better understand the ways in which the therapy process can break down.

3 reasons why clients prematurely end therapy

“I felt like I was on deadline to feel better.”

Goal-setting is often an excellent practice for certain aspects of life. Indeed, clients often begin therapy with certain goals or markers in mind. When that’s the case, it can be particularly useful to the therapist and client to collaborate on setting a plan for how the goal(s) will be reached, for how to assess for progress along the way, and how to determine when the plan should be adjusted or altered.

However, not all clients need to or want to participate in a goal-driven form of therapy, and even when goals are in place, feeling pressured (in both subtle and not-so-subtle ways) by the therapist to reach those goals can be extremely counter-productive.

We are all extraordinarily unique, and any therapist imposing a rigid schedule for when therapy should resolve an issue is doing the client a disservice and perhaps setting the client up for frustration or worse.

For instance, I once worked with a client grieving a significant loss who came to me because the therapist that had been recommended by a friend told the client he’d “be back to work in no time.” The client recalled to me that he had never once told the therapist he was even thinking about returning to work. In this moment in the therapy, this client no longer felt emotionally safe because of the counselor’s self-imposed agenda.

Emotional healing must not be rushed. Vulnerability is key for effective therapy: a client feeling like the therapist is keeping an eye on the calendar runs counter to a safe space required for meaningful self-exploration. One of those unfortunate takeaways for the client: that the therapist for some reason does not like the work being done and wants to hurry the client along. Now that may not be the case in reality, but you can see why the client, in this example, would assume that.

It’s easy to understand why clients who have confided their deepest secrets to a therapist and then are met with being hurried toward the finish line would interpret that as the therapist failing to accept them.

And if the client does reluctantly continue therapy under these conditions, the pressure to create a false self that will comply with the therapist’s agenda can parallel childhood family dynamics where the client/child was forced to accommodate to rigid parental demands. Here the therapist would be unconsciously colliding with the client’s problematic past.

“I felt like my therapist was helping me divert from the pain.”

Most humans are naturally averse to pain. Arguably, that hardwiring may be one of the reasons our species even survived. So it’s understandable when we shy away from painful situations and experiences and move toward things that make us feel better. However, when we are working to reshape deep-seated, unhealthy patterns and reclaim our emotional lives, that almost always involves a process that will entail discomfort.

Making unconscious patterns conscious (we can’t change what we’re not aware of, after all) means we’ll have to look at why we’ve adopted those patterns, and that exploration often requires us to revisit painful times in our lives.

You’ve heard the adage “you can’t go around the pain, you have to go through it.” Going around the pain will mean that the repercussions will keep coming up in different ways until the pain is properly dealt with (not avoided).

If you feel your therapist is complicit in diverting you away from painful subjects, you might feel that your therapist is not accepting you or what you’re working on. This might unfold in therapy in very subtle ways, but the final pathway leads to the client feeling like s/he is “too much” for the therapist.

It’s common for clients in therapy to consciously and unconsciously defend against their pain. One example of this is through over-intellectualizing the events of one’s life in an effort not to delve deeper into the feeling level of the experience. If the therapist doesn’t identify that this is occurring, and doesn’t work with the client to get past that defensive avoiding, it may feel like therapy has devolved into mere intellectual conversations. It’s hard for the client to feel truly seen and understood in those situations. 

Clients can benefit tremendously when they become aware of the myriad ways that they protect themselves from painful emotional experiences, a protection that could inadvertently keep them stuck in some way.

“I didn’t feel challenged by my therapist.”

Most of us have friends/family in which we can confide when we’re dealing with something stressful. And yet, if that type of sharing and support were sufficient in each and every situation, no one would ever seek therapy.

“I needed a therapist, not a friend.”

We all exist within a known range of subjective experiences. The familiarity of our inner life follows us around from place to place, person to person; even within the range and variety of our emotional experiences, something familiar remains. In one sense, this inner familiarity centers us; it offers a psychological footing that helps us navigate life.

At another level, however, our familiar patterns of being can keep us stuck — an inner strait-jacket that restricts our aliveness and limits possibility. When this occurs, we can become trapped in patterns of feeling and relating that do not serve us. In these cases, support and empathy alone may not be enough to help us become aware of and change these patterns — we may need to move past the edges of our experience that have long contained us.

It might feel counterintuitive to have a therapeutic relationship include an element to it that challenges you, but that is exactly when counseling can be its most effective. Ideally, you will feel supported by your therapist and this support sets the groundwork for the therapist to use their training/experience to help take you past the edges of what you already know about yourself. In these therapeutic moments, you are entering into unfamiliar emotional/relational territory. And within these novel and unknown self-experiences (what the psychoanalyst D.W. Winnicott called “potential space”), opportunities for meaningful change exist.

One of the first questions I ask new clients who recently stopped working with another therapist/counselor is their reason for ending that treatment. Their answers to this question have helped me understand the different ways in which we (as psychologists, social workers, counselors) may contribute to premature therapy endings and how to better serve our clients.

Therapist flexibility is central to helping clients uncover what is preventing them from living more fulfilling lives. This flexibility must include an openness to the ways in which our clients teach us about who they are and how they get stuck — they both tell us in the self-narratives they share with us, and they (often unconsciously) show us by the relational patterns that play out in their lives (patterns that may also show up in the therapy relationship).

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Dr. Rich Nicastro is a psychologist in Austin, Texas.  Permission granted to publish by the author. See the original article here.

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