Why therapy works and why it fails

If I really knew how to answer those questions, I would write a book and go on the talk show circuit. I don’t think that any of my colleagues could honestly tell you that they can speak with confidence and explain this to you on the basis of the latest empirical studies. Human beings are simply too complex. Any study involves a myriad of variables including age, gender, family experience, genetics, education, socioeconomic group, ethnic background, religiosity, natural aptitudes and talents, type of community, size of home, sibling birth order, etc. Then there are the factors that bring these individuals to therapy. There are phobias and anxiety and trauma and anger and depression and relationships and identity issues. How will we ever figure out what works and for whom? However, I do have some thoughts based on my experience over the years.

Change in a human being usually results from changes that person chooses to make in his/her thoughts, feelings and/or behaviors. Change does not happen from merely sitting in a therapist’s office and listening to what they have to say. Recently I spoke to someone who told me, “I went to therapy and it didn’t help.” I asked her what her experience was. She told me that she had on several occasions presented herself to a therapist, spent one or maximum two sessions with the therapist, and then decided it wasn’t helping.

Well, of course not! What do you think she was imagining? Was she envisioning something which now is only a fond hope—that someday clients will walk into our offices and just the radiance of our presence will enlighten them on some subconscious level and suddenly their boss will become less critical, their children will begin achieving in school and their spouse will be offered a job that pays enough for them to buy a new house, boat, and a trip around the world? Can you imagine how much I could charge for that hour?

Alas, in the world of today, we are left with people needing to take responsibility for their own lives. They need to be able to make choices that lead them to thoughts, feelings and behaviors that enable them to be the kind of person they feel good about being and the kind that others are glad to know.

But it isn’t easy. People who are wounded need to learn to trust. If therapists are honest and caring, then they can become the first person that is trusted and later, the client can begin to trust some select others. But it also takes work from the client. If he/she says, “that’s the way I am; I simply don’t trust anyone and I don’t want to risk trusting anyone,” then no amount of therapy can help. The client needs to open him/herself to the possibility of change and to consider how that could be accomplished. Sometimes clients will take the plunge and begin to change almost immediately. Others will take weeks and even months before they are ready to give up old ways of functioning. The one thing I know is that if they are not willing to give up the old thoughts, feelings, or behaviors, they will remain stuck where they are. And as much as they may wish to blame their therapist, it is clear why the therapy didn’t help.

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