“I quit therapy because my analyst was trying to help me behind my back.” —Richard Lewis
Despite an estimated 90% of Americans acknowledging there is a mental health crisis in our nation, only an estimated 30% will ever show up at a therapist’s office and, according to the American Psychological Association (APA) 50% of them will leave treatment before it’s completed.
While finances and access to services are two primary roadblocks to seeking help, the reasons that psychotherapy clients are often “one and done” are less obvious, but, in the long run, easier to overcome if addressed properly.
Psychologist and author David Burns identifies two types of resistance that hinder the therapeutic process and contribute to the early termination of sessions.
- Process resistance. This is typified by the example of someone who wants to lose weight but does not want to alter their diet. Psychotherapy offices are filled with well-intentioned individuals seeing relief from some form of suffering who are under the impression that simply showing up for therapy was the key element. These clients are confused when, after listening empathetically to their stories, the therapist moves to the next step of initiating the necessary changes to bring about the desired results. In many cases, the change that takes place is the client deciding to change therapists to find one who will not press for them to do the work.
- Outcome resistance. This is harder to address as it’s often related to secondary gains that the individual is either unwilling to admit to, or, not fully aware of. A common example is the person who comes for “anger management,” often as the result of someone giving them the ultimatum to work on it “or else.” In these cases, the outcome of being less angry is not the true desire. When one digs into the issue, one finds that anger has served multiple helpful purposes, such as keeping other people at safe distances or intimidating them from ever expecting too much.
Beyond the above forms of resistance, there are multiple other reasons why psychotherapy therapy sessions often leave both the client and therapist frustrated. Following are five that I’ve noted during 40 years in the field:
- Flight into health. This is the phenomenon where the client, after the first sessions, feels cured. This is often a genuine experience after having someone empathetically listening to a life story. Comments such as “I feel like a great weight has been lifted” speak to the benefits of catharsis. However, behind this lies the hope that one session was all that was needed, and that the “work” of therapy can be avoided.
- The “I can’t believe I shared that” reaction. Some people enter therapy ready and willing to throw open the secret vault of his or her life. Often beginning with “I’ve never told anyone this,” these sessions are intense and often hard to contain. However, once the person reflects on what they’ve done, the natural human reflex of shame kicks in. Many people find it hard to sit with someone, even a professional, after having exposed their darkest secrets.
- The “I tried therapy, and it didn’t work” response. While it’s true that therapy is not for everyone and that there can be a mismatch between counselor and client, this expression is often the result of the fact that therapy can make one feel worse before they feel better or that unrealistic expectations of a life free from suffering were not met.
- Terminal uniqueness. A hallmark of those struggling with addictions, this is when a person in need of help asserts that unless a therapist “truly gets me” they cannot be of any assistance. Based on the false belief that the therapist needs to have a similar lived experience as the client, this idea prevents many people from experiencing recovery. In the addiction world this feeling that what works for others won’t work for me can block sobriety and be potentially fatal.
- The “how can simply talking about my problems make anything better” response. This one is spot on, in that only talking about problems will most likely not lead to progress. At some point the story needs a rewrite and that task falls squarely on the person seeking help, albeit with the careful guidance of a trained professional. The AA slogan, “When I focus on the problem the problem increases and when I focus on the solution the solution increases” gets to the heart of this issue. Put anyone’s life under the therapeutic microscope and you will discover endless areas for investigation and risk paralysis through analysis—spending more time thinking about life than living it.
Unlike the medical field, where one enters with various symptoms, receives a diagnosis and then treatment, psychotherapy is a dynamic interactive process in which the therapist does not present as the “expert” but as a healing helper who, through the development of a therapeutic relationship, helps the client better understand him or herself. In this way, all of the above issues that can lead to the termination of the process before healing begins are grist for the therapeutic mill. Whether this process takes weeks, months, or years is based on a professional’s assessment of need combined with the individual’s informed consent and understanding of the unique qualities of the therapeutic alliance.
Knowing that one needs help and asking for it are not the same. Much like physical pain, mental suffering will worsen over time and, ironically, the deepening of mental illness can leave one feeling even further from helping hands. In a time of increasing tension, fear, anxiety and trauma, overcoming the resistance to seeking professional help for one’s mental well-being is critical to not ending up like the character in the poem by Stevie Smith who “…was much too far out all my life and not waving but drowning.”
To find a therapist, visit the Psychology Today Therapy Directory.