Top 5 Reasons Therapy Doesn’t Work…and what to do about it

One of the most commonly used rationales for why someone won’t go to therapy is, “It doesn’t work.” While there is a vast amount of research to the contrary, sometimes therapy doesn’t work. Here are the top five reasons therapy doesn’t work and what you can do to turn it around:

1. Poorly trained therapist — There are some folks who hang a shingle, claiming to be counselors or therapists who are not properly trained. The words “counselor” or “therapist” can be used by anyone who thinks they are a good listener, whether they have an advanced degree or not. Contrary to some opinions, there is a science behind counseling. It is not simply listening to people and giving them advice. In fact, a good therapist rarely gives advice. When selecting a therapist, it is important to do your homework. Be sure the therapist has a master’s degree in counseling or a related field (psychology, social work) and is licensed by the state. Most state licensing boards have webpages where you can search by last name and see if someone is licensed and if there are any disciplinary issues with the therapist.
2. Bad therapist/patient fit — Ever met someone and walked away knowing your personalities were not a good fit? While first impressions are often wrong, there is something to be said for finding a good fit in the therapy relationship. Have you ever watched NBC’s Biggest Loser? The approaches of the trainers are very different. When Bob and Jillian were both on the show, some people wanted Bob’s softer approach, while other’s knew they would need the kick in the pants that Jillian would provide. It’s the same in therapy. If you therapist has a very direct approach and you don’t respond well to that, you may have a bad fit. If you are looking for a direct approach and don’t get it, you may have a bad fit. It is crucial to the therapy relationship for you to let the therapist know what works and what doesn’t work.
3. Miscommunication — Speaking of communication, a miscommunication between the therapist and the client is often a major reason behind therapy not working. There is research showing patients often do not talk much with their doctor’s during appointments, even if there are questions or concerns. This also happens in therapy. In order for progress to occur, therapist and client must be on the same page. If you feel as if your therapist is way out in left field, tell him/her. Therapist’s do their best to listen and try to understand, but they often do not have personal relationships with their clients and do not know their full history or story. Therapists appreciate when a client clarifies what is going on and are taught to listen to the feedback of their clients and adjust their approaches. You will not hurt their feelings if you kindly tell them that you’re on two different pages. In fact, most will thank you. Odds are, if you feel things are a little off and there is not a mutual understanding, the therapist may feel that way, too, and be waiting for the right time to bring it up. In these situations, the tendency is to cancel the sessions or simply no show and never go back. That is more hurtful to the therapist than if you were honest and gave them a chance to clear up any miscommunications.
4. Unrealistic expectations — Most of the time, therapy and the suggested changes that come about through therapy do not happen overnight. Think about how long you have had the problem or the habit you want to work on. Three months? Six months? A year or longer? That’s a long time to establish the habit. Expecting the problem to resolve after a month of sessions is a tall order for even the most seasoned, educated therapist. Keep in mind that the real work of change happens outside the therapy session and has very little to do with the therapist. It is the client who has to take what was discussed and suggested in the therapy session and apply it to his/her life to make the desired changes. That’s where the hard work comes in.
5. Patient isn’t ready for change — This is a tough one. Prochaska (1979) developed the Stages of Change model. What it boils down to is the idea change doesn’t always come quickly and is a process. First, we think about the need to change. Then we prepare to change.  Next, we take action and start to implement behavior changes. Then we commit to maintaining those changes. Finally, in some cases there is relapse. Some folks enter therapy at the contemplation stage and talk about the change. But, when it comes time to start taking action, they simply aren’t ready. And, that’s okay. But, rather than blame therapy for not having a magic potion to change things overnight, call it what it is. The client isn’t ready. Change is hard. No one really likes the hard work that has to come in order for change to occur. It’s okay. When the behaviors that need to happen in order for change to occur become less scary than life with the continued habit, clients will move into the next stage and start taking action. Sometimes it takes a great therapist. Sometimes it takes an insight the client has never had before. Sometimes it takes a diagnosis that carries with it the choice of life or death. Sometimes it simply takes time. When you’re ready, you’ll know and be able to take that first step.