Why Therapy May Be Less Likely to Help Some People

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Friends and family pleaded with Roberta to go to therapy. Depression, isolation, unemployment—she certainly had a lot to work on.

Week after week, Roberta begrudgingly sighed and shrugged through her appointments with me. She greeted me with hostile silence, bristled at questions, responded indifferently, and often smelled terrible. In fact, sometimes after her sessions, I had to open windows or Febreze my office.

For months, I worked to engage her. I applied 25 years' worth of psychotherapy tools—everything in my therapeutic arsenal. I was one of many therapists, psychiatrists, and psychologists who tried their best with her over the years. Nothing made a dent in Roberta.

Then, in the middle of a session, she announced, “I knew this wouldn’t work.” Roberta then got up off the couch and walked out, never to return.

It was the first time I saw her smile.

In truth, I was relieved to see her go. Working with her was exhausting and joyless. But Roberta’s smile revealed her true intention: She was determined to prove that therapy was a waste of time, and she succeeded gloriously.

This led me to wonder: Does therapy work for everyone?

Therapy Defeaters

Roberta was a classic example of a person that I’ve faced many times in my work—people I call "therapy defeaters." They are inexplicably hostile to therapists. Perhaps they were a therapy hostage during their childhood or had their trust broken by a therapist. Whatever the reason, they feel it is their mission to discredit the entire profession.

These folks generally don’t benefit from therapy. When someone is antagonistic to the therapeutic process, it presents enormous roadblocks for therapists. Even if you breach their resistance, they vigilantly look for excuses to escape or devalue the experience.

People Who May Not Benefit From Therapy

Here is a short list of folks who are less likely to benefit from therapy:

• Active substance abusers: If someone is deep in the throes of addiction, they need an addiction specialist or addiction support group. Some evidence even suggests that talk therapy with an active addict can potentially increase addiction episodes. Studies show that addiction programs, such as 12-step groups, have a higher success rate than traditional psychotherapy. (See “3 Reasons Therapy Can Fail With Addiction”)
• Those with extreme personality disorders: Although there is a spectrum for personality disorders, if someone is on the end of the spectrum, talk therapy alone is less likely to be effective. For example, if someone is having a manic episode, traditional talk therapy won’t produce sustainable changes without other more intensive interventions, which may include medication or hospitalization. Other personality disorders that can be difficult to treat with talk therapy include antisocial, narcissistic, and borderline personality disorders, in addition to psychopaths, sociopaths, or people experiencing psychotic episodes.
• Recent trauma victims: When someone has experienced a traumatic event, they often need time and space before engaging in talk therapy. Forcing someone to process trauma prematurely, particularly when they are injured or emotionally distraught, can be traumatizing in itself.

People Who May Benefit Most From Therapy

Here is a short list of folks most likely to benefit from therapy:

• People who voluntarily choose therapy: People who choose to be in therapy are much more likely to benefit from therapy. They look forward to sessions, come with insights and questions, and are eager for self-understanding. They want to change. Such folks are perfect candidates for therapy and a dream to work with.
• People who are recovering from a challenging event: When confronted with a difficult situation, people are often hungry for help. A heartbreak, a layoff, a bout of depression, or a panic attack—such events trigger the wish for help and an eagerness for support. Therapy is a natural fit for such people.
• People who have clear objectives and intentions for their therapy: It’s always exciting when people have clear goals to work on in therapy. For example,

“I want to be a more generous person.”

“I want a loving relationship.”

“I want to learn to manage my anger better.”

Fueled by such resolutions, these folks form a strong alliance with their therapists—a partnership necessary to achieve positive, sustainable change.

Not happy with your therapist? See "5 Signs You Have The Wrong Therapist"