Does therapy work for everyone

Does Psychotherapy Help Everyone?

Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states …Read More

Very recently, someone asked me this question. Actually, it is a commonly asked question and often has another question just hiding behind it. The other question is often in the form of, “I have a psychotherapist but nothing is any better than before.” In fact, I hear another comment behind the first one and it goes something like this: Why should I need therapy, why should I not be independent? The answer to these questions is never simple or easy. However, here is my effort at some answers.

Taking the last question first, “why should I need therapy anyway,” the answer is that it is not just “you who need therapy but, really, most of us.” We live in a complex world where the individual gets lost in the masses of people. That makes it very difficult for countless numbers to feel as though there lives have any meaning. In a mobile world, where war is completely impersonal and includes fatalities among civilians including women and children; where neighbors live near one another for a couple of years and move; where corporations lay off employees as though they are unimportant throw away cogs in a machine; in which marriages do not last and family seems to have so little meaning; it is common for people to suffer an existential angst whereby they wonder why they are on this earth and just what their lives are supposed to mean. If these are not enough reasons to seek psychotherapy I do not know what is.

With regard to the first question, does therapy help everyone, the answer is that there is nothing in this life that is ever true of every person. There is just too much diversity of temperament, life style, economics, personal motivation, personality and so on, for any universal truth about therapy to fit all people.

Having said all of this, let us take a closer look at many of the variables that influence a therapeutic experience and can determine its outcome.

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1. A lot depends upon the motivation to change that a client brings to the therapy. When someone is strongly motivated to change because they feel unhappy and are ready to learn there is a lot of impetus to grow as a result of treatment.

2. Trust between the therapist and client is enormously important. Of course, trust does not develop immediately. Instead, as in any relationship, trusts takes time to build. However, it can help a lot to see a therapist who has been referred to you by friends and acquaintances who know their work. Reputation can be important.

3. A lot depends on how a particular therapist works, but, even so, certain facts should hold true: For example, it is important that the therapist, whether he is psychodynamic or cognitive behavioral, should be someone a client feels comfortable speaking to. Some people prefer a more formal therapist while others prefer someone is warmer and more familiar. Nevertheless, it is important that the client feels treated with respect and dignity.

4. It is my professional opinion that, regardless of the approach, the therapist and client work in the “here and now,” or the present. While client history is somewhat important, present day circumstances are what are most important.

5. Part of working in the “here and now” is focusing on the relationship between client and therapist. After all, it is that relationship in which all the client ways of thinking and interacting get repeated. That is why it is important for both to focus on the real relationship in the therapy office.

It is always vital that the therapist not be critical or judgmental of the client. There may be disagreements and areas of tension and they need to be discussed and clarified. However, the role of the therapist is not to be the judge. Naturally, some people may enter psychotherapy expecting or fearing judgment but that, too, should be clarified and worked through in the treatment.

A few comments about cognitive behavioral therapy:

While a CBT may rest more on changing patterns of thinking, especially automatic thoughts into more helpful thoughts, it remains my opinion that client feelings and transference issues come into play anyway. Those issues, it seems to me, need to be addressed, especially if a client remains in treatment for a long time.

Length of time:

Psychotherapy is not meant to be a life long pursuit. In fact, if a client finds that they are still in therapy for more than two or three years, they really need to discuss that with their therapist. Ultimately, the goal of therapy is to finish and leave. Contrary to what some people believe, even Sigmund Freud, the first real modern day psychotherapist, saw people for no more than a year and many for a shorter time than that. It is true that he worked with patients on a daily basis except for Sundays. Nevertheless, the point is that treatment is supposed to be completed.

How does a client know if therapy is finished?

When someone finds that they are feeling better, functioning at work, has improved relationships at home and has a social life, there is a very good assumption that they have completed their work. It is then important to discuss this with the therapist. In fact, some therapists may raise this issue to the client. Whoever raises the issue of completion first, the main idea is that it be discussed and a finishing date be selected.

This next is related to the second question, nothing is any better than before I entered therapy:

If a lot of time has gone by and there is no improvement then it is important that the client begin discussing seeing someone else or having a consultation.

In summation:

No, therapy does not help “everyone,” but, there are all the variable to consider before deciding that therapy is for you or not.

Today, we have the advantage of using medications in those serious situations where it is called for, to help make therapy more beneficial and available for those individuals who need that.

I would rather make an error on the side of believing a certain therapist or type of treatment is not for me than to simply conclude that it cannot help me.

Your comments and questions are encouraged

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Psychotherapy. What does that word bring up for you? Even if you haven’t personally attended therapy, chances are you have seen it portrayed on some sort of media outlet or know someone personally that has gone to therapy. As mental health is becoming destigmatized, we are hearing more and more about people’s experiences in the therapy room. With access to therapy services becoming more readily available, we would hope to see an increase in people not only attending therapy, but also feeling like it was a positive experience. However, this is simply not the case for everyone.

While we know that therapy can be highly effective, there are still people out there who have attempted therapy and did not feel that it was helpful or a positive experience. The question then becomes, can therapy really work for everyone? In a very typical therapist fashion, my answer is, it depends. In my experience, I truly believe everyone can benefit from therapy at some point or another during their lives. However, CAN and WILL are two different things.

Even when we know we need to make a change in our lives, it’s not uncommon for us to come up with perceived barriers to implementing that change. Couple that with hearing others negative experiences of trying to implement that same change in their lives and it’s easy to forget why we even felt the need to make the change in the first place. Rather than assuming that our experiences will be the same as others, we can take the time to understand and educate ourselves on what didn’t go right for others. We then can use that information to help give us the best possible chances of having a different outcome. This is why I felt it was important to open up the conversation and provide some insight into the top five reasons why people typically do not have a positive therapeutic experience:

If you have ever been around children, you learn pretty quickly that they do not enjoy being told what to do. Adults are the same way. While those who surround us can provide valuable feedback to us in regards to our blind spots, at the end of the day we are the ones who actually have to decide if we feel like something is a problem for us or not. Early on in my career as a therapist, I would see this show up time and time again in my office. A spouse or a teenager would be sitting across from me week after week and I couldn’t quite figure out why no progress was being made. I would try and throw more and more interventions at them, seek out supervision from my colleagues, or try and explore if maybe we weren’t the best fit. No matter what I did though, nothing seemed to help and there was a big reason why.

When I look back on those experiences, I now realize that the client and I were working towards two separate goals. I was operating under the impression that we were working towards improving their mental health while they were working towards appeasing those in their lives that encouraged/pressured them to get help. Does that mean that it was the client’s fault or that they didn’t take away anything from those experiences? Of course not! They were well meaning individuals who wanted peace in their relationships and at the end of the day they very well could have still taken something out of our sessions together. With that being said, change or progress wasn’t sticking for one very important reason: for true change to occur in our lives, we need to have an awareness of what exactly it is that we feel is problematic, a desire to change that problematic area, and to remember along the way why it’s important to us to make those changes. To truly figure those things out, it’s an inside job that only we have to power to pursue.

Some people are completely unsure of what to expect from therapy while others have very specific ideas of what the process is going to look like. The most common unrealistic expectations I see clients struggle with are:

1. Therapy is a quick fix
2. Therapy is one size fits all.
3. It is the therapist’s job to fix my problems, I don’t have to do any of the work.
4. I don’t have to do any work outside of the therapy room.
5. Therapists are perfect and never make mistakes.

During the first session, I try and help clients understand as much of the therapeutic process as I can so they can match their expectations accordingly. Those expectations then typically look like:

1. Problems don’t develop overnight and they don’t disappear overnight.
2. Therapy is very subjective, two clients can see a therapist for the same presenting problem and have two very different experiences, both being equally beneficial.
3. The therapist is there to serve as a resource and guide to help the client reach their goals, the therapist does not possess magical powers and can’t do the work for the client.
4. The majority of clients that reach their treatment goals and have a positive therapeutic experience tend to take care of all aspects of themselves (mind, body, soul) which means putting in more time than once a week for fifty minutes.
5. All therapists are human. Humans are not perfect and even therapists are not immune to making mistakes. If you feel that something is off with your therapist or are upset about something that has occurred, please voice that to them!

Similar to any other health profession, not all therapists are going to be great at their jobs. While having an education and license are required to practice as a therapist, those things do not automatically make someone a good therapist. I’ve personally known therapists who struggled to pass their licensing exam but were some of the best therapists I’ve ever worked with. Alternatively, I know some therapists who attend as many trainings as possible, have as many certifications as possible, but at the end of the day are not effective when it comes to actually helping clients. While many different therapeutic styles or theories exist, at the core of good therapy is:

1) A sense of safety
2) A sense of being unconditionally positively regarded by the therapist
3) A sense of being understood by the therapist
4) The therapist does not always agree with you but challenges you in a way that feels caring and thought provoking rather than shaming or attacking.
5) You are aware and understand what you are working towards in therapy
6) The therapist is open to feedback and regularly checks in in regards to how you feel therapy is going
7) If the therapist makes a mistake, they are accountable and attempt to repair the therapeutic relationship
8) The therapist has certain knowledge and understanding of the human psyche, but they do not claim to have all of the answers
9) You feel that you take away something from your sessions, you don’t just go in and vent. The therapist should provide a balance of giving you space to process verbally but also offers you insight and feedback as needed.
10) The therapist does not utilize the session for their own personal benefit. They have a balance between being transparent with you but are not oversharing of their own experiences or feelings.

I referenced this under having unrealistic expectations of therapy but I feel that it is a big enough barrier to discuss it further. When clients ask me what is the best thing they can do assure they reach their goals in a timely manner, I let them know that therapy once a week is not enough. Think about it. If you wanted to learn a new skill you would probably practice that skill as often as you could. The more you practice something, the faster you’re going to learn it.

Therapeutic goals are no different, especially since our mind, body, and soul need to all function properly for us to feel a sense of well-being. Some of the most useful things I’ve seen clients implement in conjunction with therapy are:

1) Participating in a physical to rule out any biological factors that could be contributing to things like depression or anxiety
2) Spending 10-20 minutes a day in nature
3) Being mindful of what they put into their bodies
4) Physical activity
5) Journaling
6) Meditation
7) Having a hobby or creative outlet
8) Having a balance between time spent alone and time spent with others
9) Joining a support group
10) Participating in a consistent self-care routine

A crisis is not a prerequisite to attend therapy. If a part of a house catches on fire, we are not going to ignore it and hope that it doesn’t spread to other areas of the house. Ideally, we would have the same attitude towards our mental health. I especially see this with couples. When a couple shows up in my office, it is very common that they are in the midst of a crisis. Whether that be infidelity, substance abuse, or a betrayal of some other sort, something major has occurred that has forced them to realize things are no longer working.

The truth of the matter is, things probably weren’t working for quite some time. Maybe we previously felt that things weren’t great but they were still manageable or maybe there was fear in a relationship ending so it felt safer to not address those underlying issues. While the reasons may vary for not seeking help sooner, the best thing we can do is to start being more proactive rather than reactive. This applies to not only our mental health, but in all areas of our life that we feel a sense of unhappiness or concern with.

My hopes in providing this information is that more people will not only utilize therapy services, but that they can have the best possible outcomes with that experience. If you have had tried therapy and felt that it wasn’t a positive experience, I encourage you to explore if any of the reasons listed in this post resonate or if not, I would love to hear from you about what you felt made it a negative experience. To continue to help people understand how to increase their chances of having a positive therapeutic experience, in my next post I will be further expanding on a topic briefly discussed in this post: qualities of good therapy.

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