When Therapy Isn't Working

As therapists, we should often remind ourselves how challenging it can be for clients to find the courage to share their deepest thoughts and feelings with us. So many clients come with a relationship template that associates closeness and connection with getting hurt in some way. This means their capacity to trust and to be their most authentic selves might be compromised before we even begin the work. A client might also come into treatment with a prior therapy experience that was, at best, not gratifying, and at worst, exploitative or harmful in some way. This often means that the client already has preconceived notions and expectations about how therapy will play out with us. Some clients come in to treatment thinking they want to change, and then discover that making the changes creates too much inter-personal conflict and dissonance in their lives, or requires way too much ongoing energy. Some clients initially appear accommodating because it’s a self-protective strategy learned in childhood, not because they actually agree with our advice or recommendations. In those instances, the changes they make are not sustained. Sometimes, it’s a significant other who is demanding the changes, so the client isn’t actually the one who sees change as necessary. Some clients present with one issue that they want to work on, then uncover deeper issues that frighten or overwhelm them. And of course, the timing of therapy as it relates to the larger context of what’s going on emotionally and financially in a client’s life, is important, too.

There are many reasons why therapy sometimes doesn’t work out. The aforementioned possibilities don’t fully take into account the role the clinician might be playing in preventing the work from moving forward. Therapists can easily be triggered by their clients, which can result in a loss of objectivity, a desire to “fix” or change a client, or a demand that the agenda for treatment becomes the therapist’s and not the client’s. It’s actually impossible for a therapist to remain completely neutral throughout treatment, and probably not a good idea, as neutrality can be misinterpreted as consent or agreement about a client’s destructive behavioral choices. Sometimes, the chemistry just isn’t right, and although we might not be able to fully articulate why it’s a bad fit, we just know that it is. Clients who are more aggressive, narcissistic, or emotionally demanding can leave therapists feelings afraid, frustrated, tired, angry, or overwhelmed. In these cases, it’s not hard for the therapist to pull back, lose interest, or put less energy into being a compassionate, available helping professional.

So when therapy isn’t working, we have an ethical responsibility to address it with our clients. The trick is to process it in a way that isn’t blaming or shame-inducing. Instead, we need to present it gently as a statement of fact and one that is worthy of exploration and understanding so the issue can be reconciled in a way that serves the client’s best interests. It’s helpful to not frame it as a “failure” but rather as an opportunity for the client to figure out what the roadblocks are, what they do need, and then how to use their voice and take proactive steps to get their needs met. If a client “settles” for therapy that is not truly helping, they are re-enacting a dynamic of not asking for or seeking out what they need and deserve to really grow and heal. Sometimes, the best gift a clinician can offer a client is permission to seek treatment elsewhere, or to pursue a different paradigm in order to jump-start progress again. This is particularly useful when both the client and therapist agree that they have come as far as they can and now a new chapter can begin with another clinician. When we can help clients make that transition with ease and without guilt or regret, they really will continue on their healing journey and we will have played a vital role in helping them get there!

Feel free to share your experiences of therapy not working out, and how you handled it.