Why Psychotherapy Can Fail

A number of years ago, a group of therapists published a book. Rather than showcasing their treatment successes, they described their failures.

This was brave on their part. Therapists, like other professionals, want to trumpet their successes. But, rather than do this, each therapist wrote a chapter describing a therapy failure.

The premise of the book highlights an important point: while psychotherapy can be helpful, even life changing, sometimes it doesn't work out. In this blog I want to outline some reasons why therapy can be disappointing or even fail. Here are a few of the most common ones:

--Sometimes it’s a personality clash. For instance, you may be light-hearted while your therapist has a serious style. Or maybe you are highly sensitive, and this doesn't mesh with your therapist's direct and challenging style. Once you get a sense of your therapist's personality, see if it matches with yours.

--A therapist mistake: A therapist error could cause a client to leave therapy. If it were human error on the therapist's part, I'd encourage you to talk to him or her first rather than just ending. Therapists are human; there are times when therapists may fail the client. Perhaps your therapist forgot an appointment time or double booked. Or the therapist may have made a comment that inadvertently stung or offended. Understand that no one is perfect. (However, if the mistake is egregious, for instance, an ethical violation involving sexuality, then discontinuing therapy would be the right course.)

--Administrative issues: Unfortunately, money and payment issues can cause problems between therapist and client. In my experience, the main ones involve insurance. For instance, insurance refusing to pay a claim, which is then turned over to the client; insurance companies discontinuing paying for sessions; clients having to pay the full fee for late cancellations and no-shows; or insurance case-managing or auditing case records can cause clients to stop treatment.

While cost-efficient, using therapy for insurance adds a bureaucratic feature to the experience, which in some cases may mar it. Before embarking on therapy via insurance, make sure that you are aware of the potential challenges to the therapeutic relationship (please see a couple of blogs that I wrote on the subject of using insurance for therapy). My advice here: if you won't take insurance issues personally, then seeing a therapist through insurance may work. However, if insurance problems may cause you to feel upset at the therapist and then leave, think twice. There's no reason to save money but then, in the end, leave therapy prematurely and disgruntled.

--Unrealistic expectations. Before you see a therapist, be aware of your expectations. What kind of therapy are you seeking? Do you want intensive, depth therapy? Or are you looking for practical support for problems in the present? Or perhaps you would like to see a therapist who offers both: that is, exploration of the past and help with the present? If your expectations clash with those of the therapist, treatment may not work.

And check in with yourself about other expectations. Do you want an interactive therapist? Or would you prefer a therapist who is mostly silent and listens intently?

Lastly, make sure that you have realistic expectations for therapy. If you are wanting an immediate magic bullet, you may be disappointed. Just like physical therapy for an injury, psychotherapy can take time and patience. But if you and your therapist are on the same page, the potential for you to meet your treatment goals is much higher.