Is Therapy Working? Red Flags to Look for in Therapy

therapy

People enter therapy for a variety of reasons, be it a mental health issue such as depression or anxiety, a behavioral issue such as alcoholism or overeating, or a general life issue such as marriage problems or feeling stuck.  For most people, therapy is not a first-choice solution when problems arise, but rather is a last resort once things become uncomfortable enough or a crisis arises. There is one thing people want more than anything else in therapy – relief.  Through the therapeutic process, individuals are ideally able to gain awareness and insight, receive support and hope, learn coping and communication skills, and find a resolution to their presenting concerns and problems that drew them into therapy in the first place.

Sometimes therapy does not work the way we feel it is “supposed” to.  Sometimes we may find that therapy is not really “working.” Or sometimes we may be in therapy for a long time, only to find that not much has changed.  There is nothing wrong with seeking out therapy long-term for self-improvement, but being dependent on therapy for relief can bring on its own host of issues.  Below are some warning signs for if therapy is working for you, or if it is stunting your growth process.

A red flag that therapy may be impacting your growth and progress is if you are only acquiring information from your therapy sessions but are not acting on the information you are learning outside of the therapy sessions.  While gaining insight is certainly a fundamental component of therapy, insight alone will probably not get you the results that you sought out therapy for in the first place. As we always tell our patients, knowing is not the same as doing.  It is akin to buying a gym membership, going to the gym, but not using the equipment. It is important that you take the insight in conjunction with the tools you are learning in therapy and apply them to your life outside of therapy. As such, you will realize if therapy is working not only by an increased awareness of what is causing the symptoms that you sought out therapy for, but perhaps more importantly by your ability to cope with unwanted symptoms, reduction of problematic behaviors, ability to set better boundaries with people, having an increased sense of self-worth, self-efficacy and improved mood, and other such tangible results.

Viewing oneself objectively is very difficult for most individuals.  When doing so, individuals may come to realizations about themselves during the therapeutic process that they do not like.  When uncovering uncomfortable emotions and experiencing negative feelings, individuals can become apathetic towards those emotions and feelings as a way to cope with them.  Apathy may become a defense mechanism so that they do not have to feel on a deep level. If one notices that they are becoming apathetic, they should explore this with their therapist.  Such individuals may not be ready to explore the particular area that caused them to become apathetic. While it is ok and sometimes even healthy to delay such exploration, facing these uncomfortable feelings and emotions is what therapy is for, and is generally a necessary component of the healing process.  As we often tell our patients, sometimes you have to feel worse before you can feel better.

It is not uncommon for individuals to hold back from telling their therapist the truth in order to get their therapist to like them, or due to feelings such as shame or guilt.  Individuals sometimes keep things surface level in therapy due to fear of judgement, fear of rejection, or even fear of intimacy. The irony of this is that you are essentially paying someone to lie to.  While feeling afraid to share deep secrets of our lives is normal, it is important that you feel comfortable being vulnerable with your therapist. Therapy should be a safe place that you feel comfortable to share without fear, and not hold back.  Omitting certain details, not disclosing certain feelings, or outright lying will not help you on your journey to healing, and is a red flag that therapy is hindering your growth process. In fact, one of the single best predictors of if therapy will be beneficial is the therapeutic relationship (i.e. if you feel comfortable with your therapist and if the two of you are a good fit).  It is important that you find a therapist who you feel accepts you, understands you, hears you, empathizes with you, and who you feel you can be open and honest with. If your current therapist is not that person, it may be time to try someone new.

Individuals generally seek out a therapist as a last resort once their symptoms get bad enough, and once they realize that they can not get well on their own.  While it is perfectly healthy to be in long-term therapy for self-improvement, one should not be dependent on their therapist to cope with unwanted mental health symptoms in the long run.  The goal of therapy should be to work through issues and get to a place where the individual has the skill set and coping mechanisms to deal with their issues on their own without the aid of their therapist.  Being dependent on your therapist is a sign that therapy is impacting your growth and progress. Therapy is just one step in the right direction of one’s healing journey, but it is not the whole journey. Therapy should afford individuals with the tools and lifestyle changes to enable them to cope with life on life’s terms without being dependent on their therapist.  A good therapist should recognize if one is becoming dependent on them, but it also may take some self-awareness, insight and honesty from the individual going to therapy.

What makes individuals feel good and feel happy is taking action on their goals and making progress.  As such, it is easy for some individuals to feel that they are getting better simply because they are going to therapy, or even by taking the step to seek out a therapist prior to even initiating therapy.  They may tell themselves that they are making progress in their healing process because they are doing what they are supposed to do by seeing a therapist. In such cases, individuals may be ignoring reality, resulting in them not really dealing with the underlying issues for which they were seeking therapy in the first place.  It is akin to putting a Band-Aid on a wound that needs stitches. Seeing a therapist may bring temporary relief, but without dealing with core issues the wound will re-open. In cases like this, once the individual discontinues therapy they will often be left in the same place as when they started. While unwanted symptoms may not come back immediately, they generally will over time without the lifestyle changes, processing of feelings and emotions, and coping skills that are meant to be learned during therapy.  As such, it is critical that individuals be honest with themselves and use their time in therapy wisely. This is also why many therapists will slowly reduce therapy sessions and spread out appointments once and individual is getting ready to discontinue therapy, allowing them the opportunity to see if they are able to manage unwanted symptoms without the aid of their therapist.

It is not uncommon for individuals to hold back from giving their therapist honest feedback, or even from being afraid to discontinue therapy when they feel it is not helpful or when they feel it is no longer needed.  One reason an individual may behave this way is because they are people pleasers, and act accordingly even with their therapist. They may be afraid that they are going to hurt their therapist’s feelings by telling them that a certain approach or strategy is not helping them, or by not wanting to terminate the therapy relationship.  Such individuals should know that therapists are used to individuals terminating therapy, and sometimes even being “ghosted” by their patients who simply stop making contact with them without notice. As such, if you are willing to tell your therapist that they are not helpful it will allow you an opportunity to practice assertive communication skills, and may also benefit the therapist if you give them honest and constructive feedback.  They may appreciate your candor. Conversely, if you feel you have benefited so much from therapy that it is no longer needed, this should be a compliment for the therapist that they will appreciate.

Author
Lin Anderson & Aaron Sternlicht

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