I’ve extolled the virtues and benefits of psychotherapy for years. But therapy isn’t a cure-all, and it won’t help every person, with every problem, in every situation. In fact, it’s important to realize when going to see a therapist isn’t likely to help your situation much, because it can save you time, money and needless frustration.
Therapists, by their nature, tend to want to help every person who comes through their door. Even well-meaning therapists may not fully appreciate when they are largely going to be ineffectual in treatment because of the type of problem presented. After all, psychotherapy isn’t some magical elixir. Talking about some topics simply won’t do much to help the situation.
Here are five things that psychotherapy won’t help you much with.
1. Your Personality.
While indeed personality disorders make up a good chunk of the Diagnostic and Statistical Manual of Mental Disorders (the so-called DSM), they also got their own category within that reference book for a good reason — they’re really hard to change.
Personality disorders are typically more ingrained and therefore more difficult to change than most other mental disorders. After all, our personality — the way we relate to both ourselves and the world around us — starts in childhood and is shaped by decades’ worth of experiences, wisdom and learning. You can’t expect to undo decades of personality development in a few months’ worth of psychotherapy. (Years, maybe.)
While psychotherapy won’t likely cure you of a personality disorder or long-term personality trait, it can help mitigate some of the worst features of the problem, or reduce its intensity. For instance, while someone with narcissistic personality disorder may still go through life thinking they’re better than everyone else, they can learn to tone it down in their individual dealings with others so it becomes less of a social and work impediment. Introverted people will still be largely introverted, but they can learn to feel more relaxed and comfortable in social situations.
2. Your Childhood.
Sigmund Freud and many others of his era traced a lot of emotional health problems back to a person’s childhood. As much as we would like to try, however, we can’t go back and fix our lousy childhood. It is what it is — a piece of our history.
What you can fix in psychotherapy is how you interpret what happened in your childhood… And whether you choose to cling to those issues, or whether you can grow from them after obtaining insight into their significance. But therapy won’t cure you of your bad parents, rotten siblings, crumbling childhood home, or sketchy neighborhood where you grew up.
3. Half a Relationship.
It takes two to make a healthy relationship work — and to continue to grow and move forward after the relationship has hit a few rocks. Psychotherapy can help couples through those rocky parts, but only if both people agree to counseling with an open mind and a willingness to work on the relationship. This means both partners also have to be willing to undertake some changes (not just pay lip service to them).
While one half of a couple can go into counseling to work on relationship issues, it’s not going to be nearly as effective as having both halves in therapy. Therapy with only one side will usually only help that person to better cope with their partner’s problems or issues (this is more of a band-aid than a long-term fix). Or, worse, help that partner to decide whether the relationship is even working at all.
4. A Broken Heart.
Nearly all of us have gone through it — the feeling like your heart has just been ripped out of your chest and stomped upon. When love dies, it’s one of the worst feelings in the world. Sadly, it rarely ends after just a couple of days.
But talking to a therapist isn’t likely to help much with this issue. The end of a relationship is one of those really difficult times in almost everybody’s life where there are no shortcuts or quick solutions. Talking to a close friend, focusing on activities (even if you don’t feel like doing them), and immersing yourself in things that will keep you busy are your best bets, as time does its magic.
Therapy may help a person who gets “stuck” in ruminating over the details of the old relationship, even years after it’s over. If a person can’t move on, talking to a professional may help them understand the relationship better, and bring perspective to their life.
5. Losing Someone.
The proposal for the new revision of the DSM suggests that normal grief may become diagnosable as depression, but grief isn’t typically considered a mental illness in need of treatment. Despite the popular common wisdom of the “5 stages of grief,” the reality is that everyone grieves loss differently and uniquely.
Like in love, psychotherapy isn’t going to do much to help speed the natural processes of time and perspective. Grief needs space for remembrance and being with your thoughts of the person who’s passed away (in other words, grieving is best done when it’s done mindfully and with patience).
Therapy can help, however, a person who gets “stuck” in a life oriented toward grieving or a person who, even years later, still cannot get over the loss. But for most people, psychotherapy is both unnecessary and overkill for what is a normal process of life and living.
Like an antidepressant or aspirin, psychotherapy isn’t a treatment that can be used for any challenge life throws at you. But even in many of the circumstances described above, there are exceptions when therapy might be a helpful alternative to consider. Understanding when it’s likely not a good use of your time, money or energy may help you avoid unnecessary treatment.
42 comments
Hallelujah!
I’m finding out how true #1 is. My question is, what do we do about it?
There are amazing, intensive, programs that combine individual and group therapy (Center for the Intensive Treatment of Personality Disorders)to increase the functioning of those with personality disorders. All is not lost, it just requires a considerable amount of intensive work and dedication.
Agreed. People with serious personality disorders have a few choices, including seeking out intensive change programs which may be more helpful. But these aren’t to be confused with traditional, once-weekly psychotherapy.
As I mentioned in the article, regular psychotherapy can help someone with personality concerns to minimize their severity, or to alter the most debilitating symptoms to be less debilitating. Even this work is not always quick or easy, but it can be done with someone who is both motivated and dedicated to personality change.
I found that it is our perspective or the way we look at things. Gratitude has helped me; just trying to find something to love and appreciate has helped me feel loved. Don’t settle for things that make your life miserable: change jobs, put up some boundaries by saying no, lose weight, leave a dead end relationship…action is the key word here…and You will feel the power if you take action. It is good that we are sad when someone dies…not bad…embrace it..time heals those wounds too. Everything changes all the time…if it’s bad or good expect it to change…learn to dance in the rain…do unto others as you would have them do unto you…and if they are still mean…let them go and don’t hold on to the resentment…Be human and let others be human…only sweep your own porch. that should keep you busy for a while.Try to stop talking about and living in the past…you will never change that. Now live and Laugh….lol
For many people it’s not a therapist’s knowledge of Freud, Jung,Bowlby or whoever, that keeps things together on the journey to recovery. As you have touched on, its having a friend to be there and listen when they are really needed that provides a key role in recovery. For this psychotherapist qualifications are not needed.
I would disagree a bit with #1, albeit the change would take much effort and lots of therapy, but, I have met some patients in my career that have altered personality traits because they wanted to and had the motivation for the work needed. I will say this to the non clinician readers, change NEVER happens because someone else asks for it, and the change in personality will not be dramatic unless there is some sizeable life altering issue at hand playing a role in the change.
One thing is almost etched in stone: personality change after a certain age is not going to happen, I would not give a specific number but I do not see change likely after being in your 30s. Otherwise, I agree with the other 4 points, and go further with #5, you can’t even medicate grief unless someone has deteriorated into major depression, and still needs therapy along with meds to experience improvement. There is one physician here who would argue otherwise, but, I defer to the readers who have lived the experience to tell us otherwise or support my position.
Happy Holidays.
In reply to the commenter who said personality change CAN happen…even he agreed it was impossible after 30. I am 40 years old and was a prisoner of my fagher til he died last year. I mean this COMPLETELY LITERALLY. he carefully crafted total dependence pn remaining living with him….and i had an almost pavlovian conditioning to not challenge him. I literally WAS NOT ALLOWED to leave thw house without him. I hate.to mimimize tje siffering.of child soldiers.or warcrime victims
.but i feel i experiwmced pretty much the same thing. Apparently i will NEVER be able to form ANY healthy relationships EVER. whh should i go on living. Since i will only be torturing myself umtil i die..and.my messed up brain scientifically GUARANTEES that i will NEVER be happy or loved?
I find it so strange that you don’t think therapy can help someone who is going through a difficult breakup or mourning a loved one.
I have many clients who come in after having their heart broken and say they benefit a great deal from having a professional to talk to. And while I don’t deal with greiving in my practice, there are therapists who specialize in bereavement and brief counselling. Are you suggesting they are charlatans on whom people should not waste their time nor money?
I think you do a great disservice to the therapists who specialize in this area, and the many potential clients who could benefit from a session or two to help them get over the loss of a relationship or a loved one.
I didn’t say psychotherapy couldn’t help such people, I merely suggest that therapy isn’t going to be much better than accessing other resources within their social economy. There’s little evidence, for instance, that talking to a therapist about a relationship breakup results in better outcomes than simply talking to a friend about it.
In terms of grief, I was primarily focused on normal grief and the normal grief process, not the slippery slope of what researchers and clinicians term “complicated grief.” Complicated grief would be equal to what I refer to someone being “stuck” in grief in the article, and therefore might be an appropriate time to see a therapist.
I agree with you and the author is a fool to suggest a therapist cannot help with grief or brokenheartedness. Maybe he is just a lousy therapist and I thank him for putting his name out there for the whole world to see. Personally trying situations as death, loss of love and serious problems in the household as a child were the ONLY things that led me to 2 very gifted therapists in my life who really gave me hope. insight and helped me reciver.Sadly one is deceased and the other long ago retired. What does the therapist do if not help those in emotional pain? The author of this article should try a new line if work. His customers must certainly be wasting their money.
Has it occurred to the author that perhaps some people do not have a great personal support network, or perhaps their “support network” has died or abandoned them and that is why they are seeking counsel? I would think a professional therapist would understand that no one would throw their money away on a doctor if they had such a strong personal network. Where do you Dr? In dreamland? Where did you earn your degree? How could you have such a limited vision if the human experience. Like I said, thanks for putting your name out there to let people know the type of “therapist” you are – or are not. Get a different job. You do a disservice to your profession.
Dr. Grohol,
I agree in essence with your points but I would be cautious about #5. While the current research shows that, yes, most people do tend to have resilience around losses, therapy can also provide a space of respite for the griever, a place where the person can go to say or do whatever needs to be said or done during the grief process. Sometimes friends and family members are ready for the griever to “get over it” and the therapy room can provide the needed environment for the person to continue to explore their thoughts, feelings, and behaviors around the loss.
That said, I agree that INSISTING that grieving people seek counseling is overkill and can actually be harmful. This is certainly the case with Critical Incident Stress Debriefing, a well-intended but potentially harmful approach that may re-traumatize the person experiencing the trauma or loss.
I worry about the medicalization of normal processes of human living, such as grieving. Grief is not something to be “fixed” or alleviated through therapy. It is something to be felt, experienced, and worked-through.
I agree, however (and as I mentioned in the article), that when a person gets “stuck” in grief (or a broken heart), that may be something therapy can help with (e.g., it’s gone on for years with little respite).
But for most people and most losses, no.
Dr. Grohol – I think you may be missing the point a bit in your reply . . . In many cases, friends and family members are ready for you to be “done grieving” well before you have actually completed your grief process. In my family of origin, any mention of sadness or grief after a week or so would be greeted with comments like, “you should be OVER that by now,” “it’s time for you to move on with your life,” or even crueler remarks like, “she’s gone, get over it.” (Basically, “It’s been a couple of weeks, and we don’t want to hear it any more.”) In cases where the bereaved person has no support, a therapist can be an excellent option; providing validation that it’s “normal” to take a few months to recover, and that missing someone or crying when you get smacked in the face with a sudden reminder of them doesn’t mean you’ve “gone mad with grief.”
I would prefer people find support for grief outside of a professional’s office, because again, I think we are too quick to “medicalize” a normal human emotion. Even when it goes on for weeks and others think we should be “over it” already. So like a grief support group (in your local community or online) would be my first choice for such a concern, or sharing with a trusted friend or two your feelings.
While indeed a therapist can help you express your grief in a safe environment (and indeed, this is one of the reasons a person might seek out therapy for a variety of concerns), my point was to say therapy won’t “cure” you of your grief. That’s still something that only you can do with time.
Thank you for commenting.
6. Existential Angst
Therapy can’t cure the sense that we are from dust, and to dust we will return. That our time on this planet is a blink of an eye, and that our planet is a mote in the universe.
Agreed with this one as well. Although therapy might be helpful for a person to clarify issues about what their life means (or what they would like it to mean), or what their purpose is on this earth. I don’t think it’s a good fit for most therapists or necessarily a good use of their time, but some people do seek out a therapist to explore these issues.
Well, that’s his opinion. There are other opinions out there. I love The Work of Byron Katie. We need to know what he means by “curing.” Eliminating things that cause us pain? Hardly.
These are things I have throughout my many years of working with behavioral health. As an RN and a therapy intern, I have the double whammy of wanting to help fix people; however, there really are some things I cannot even fix, only help my client learn how to live with or through the problem appropriately.
Erythrophobia, cant cure that – and if you can please tell me how…
Yikes, I strongly disagree with #1, especially if ‘personality’ is defined as ‘the way we relate to the world around us and to ourselves.’ In fact, if therapy can’t change this I think that there is hardly any use for it at all! My chronic depression is rooted in the way I relate to myself and to the world and it is only by slow, steady and persistent work that I am managing to alter these bad patterns. I agree – its a slow slow process. I’v been conditioned from infancy up, and a lot of undoing is necessary. But, if I could not do this work my life would not be worth living and I probably would have suicided years ago.
Dear Dr,
I couldn’t agree more. I have been under psychoanalysis for about 7 years, yet and dissappointedly there has been not even a bit of satisfyng change in my repetitive life issue, you can surely feel how frustrating it could be after piles of ups and downs having passed throug my life, I haven’t been able to reach the most encouraig dream of mine which is having a permanent loving relationship…, you surely could realize how sick , tired and hopeless I feel after all these years. If only the reason, at least, could be found…!
This is one of your best posts ever. I work with military families and therapy is often recommended as a cure-all. But in light of #3–that therapy can’t cure being only half of the relationship–I think folks can enter into a therapeutic relationship in a more productive way. Well done.
Wow there is much in this article that would discourage one to consider therapy at all.
I disagree that personality is a fixed state with the best that can be hoped for with Therapy is akin to a bandaid. I was told the same by my Therapist more than 20 years ago.
As for the age at which change , transformation can occur and probability that it can happen decreases in the later stages of life is also erroneous.
I think one big reason we see such a high failure rate are the lack of availablilty of consistant experiences with emotionaly mature people.
I believe that most interaction and the experiences had within society are of defensive and offensive reactivity with the degree of severity from least healthy to somewhat more healthy in that the later behavioral responses are considered the “norm” and it is this “norm” that is a far cry from sound emotional health.
Many of us are completely unaware that we are emotionaly reactive and this in turn allows us to justify or believe the cause to be something outside of ourselves such as person, circumstance ect.. the real cause going unquestioned thus leaving the internalised beliefs to remain.
Its the patterns repeating over and over that reveal one by one the erroneous conclusions as to the cause of current life circumstances causing us to fall back in on ourselves.
I believe this happens at a much swifter pace when our experiences are with people who have truly emotionally matured who can field the many onslaughts that come from the wounded soul with deft, skillfuly using every opportunity to faciltate healing. The artful application is done with great understanding for the person who can do this has learned by knowing himself to the depths.
She who has mastered the self becomes the most clearest reflector and while the benevolence is not gentle it is irrefutably kind.
Cultivate yourself so that we can see the potential of us all..
Right?! What a negative view!
I’m working hard in therapy on all five of those counts, and am feeling discouraged after reading this. Not a productive read.
To use the term ‘cure’ suggests that the person is either broken or in need of a fix. Perhaps therapists/psychologists etc need to change the way they view the client and change their language to a more holistic view.
P.S If I had seen a psychologist or someone else who holds a medical model view for my eating disorder I would probably have been diagnosed and labelled as ‘borderline’.
Whilst this may be the only way some health professionals are able to see and then label my suffering… I certainly don’t feel stuck in this. It doesn’t define who I am.
A loving psychotherapist who didn’t pathologise my suffering and who viewed me as ‘whole and unbroken’, enabled me to heal and transform my suffering.
I find a lot of the statements and language (eg. mental disorders)in the above article to be extremely pathologising.
It’s interesting; I’ve only ever received once-weekly, tradional(-ish) therapy, and it was over the course of maybe two calendar years – and I’m considered to have recovered from borderline personality disorder (though, to be fair, my psychiatrist and CPN sometimes debate amongst themselves whether or not I ever actually had it, though I myself believe that I did).
Whilst I happily take a biopsychosocial approach in the arena of mental health, borderline remains an issue for me. Not because I don’t like the language or whatever (to me, it doesn’t matter what it’s called), or even that I don’t like the stigma against it that is seen even amongst some MH professionals (though, of course, I *do* hate that when it’s present). It’s more because there’s ample research out there to suggest that (a) there’s abnormal amygdala functioning in affected individuals, thus potentially rendering worthy of Axis I inclusion; and (b) it is very, very frequently seen in childhood trauma victims (thus lending itself to the idea that it may be on the PTSD spectrum, though arguably most PDs stem from some sort of childhood disruption, so that point is debatable I suppose). So it sometimes seems – to me, as an utter layperson – inappropriate to class BPD as a PD at all (though I do take on board that its traits are ingrained).
As a side note, it’s worth noting that in the ICD (as used here in the UK), unlike in the DSM, personality disorders are *not* listed separately from the traditionally-considered ‘organic’ mental illnesses.
Thanks for a thought provoking article!
I like what ZigZag had to say. Seeing a therapist for many years was a godsend for me. He wasn’t the endall, though. He encouraged me to seek other avenues and I did. All these combined, I am healthier mentally. There are still times of depression. I do not have the awful overwhelming feelings I experienced in the 1st depression and I am grateful for everyone and everything that helped me grow out of depression and into the light of day.
I saw a program on Ophra en 20/20 and it’s called brain training. I went with my daughter to do the assessment and she will start doing this but I met a woman who told me she has so much anxiety that she couldn’t drive anymore and after the training she was able to drive again. Another person was deeply depressed and couldn’t sleep and now he sleeps 8 hours and feels happy again like a weight was lifted. Well I pray to God that it does help everyone.
I do not know how much I agree with number #1. Through intensive, long-term work, personality disorders can be worked through.
I’ve been in therapy on and off (mostly on)for over thirty years and my depression is worse than it was when I started. My last therapist did discover,at least, that I was also a victim of “Borderline Personality Disorder.” Now I know the “why” of certain feelings and responses, but the depression never ends. I’ve been on medication for it, or I wouldn’t be able to get out the bed.
Debbie, would you please contact me through email ([email protected])and let me see if I can assist you in finding out why you have been feeling a sense of depression for over thirty years? I am not sure that your therapist has the information or has led you to unearth issues that are lodged in your latent consciousness. Looking forward to hearing from you.
I’m currently seeing a psychologist for therapy on how to deal with chronic illness, many ofthem. I’m not sure if it’s helping me or not, some days I feel a tad better, others not. Lately it has been feeling more like not, probably because my health is worsening. I’m not sure if I signed up with her hoping she’d be my godsend and some how cure me orwhat I was thinking. Has anyone else gone thru something like this? Am I on the right track or should I just stay home and suffer in silence?
I agree that whilst traditional psychotherapy on it’s own may not relieve the suffering of the above, in combination with other treatments (clinical psychology interventions for example which are not “just” talking) all of the above can be managed successfully. In my experience psychotherapy can be very helpful in preparing people who are “stuck” to undergo therapeutic interventions such as CBT, ACT, DIT, or any of the many other effective therapy models out there.
I thoroughly agree with the article- both as a therapist and a recipient of services I believe that it is a two prong attack. For many meds and talk therapy work best…in no case have I seen just meds do the job unless the person is in a support group such as AA…or other 12 step groups. So many people with depression ( number one mental disorder) use self-medication to deal with their pain it is overwhelming to see the number of people in 12 step groups who are also diagnosed as depressed….we all have personality disorders – some are more obvious than others but we all have to learn how to retrain ourselves if our lives are not going in the direction we want. It is not rocket science to understand that if you do not have an objective person to help you clear away the forest so you can see the tree then it will be near to impossible to get on a road of self awareness and revival of your spirit. Good luck to you all I am using my connection to a therapist to help me learn how to best deal with issues regarding my grown children… and she has helped me by opening up a new point of view and using specific tools to help me not make the situation more untenable. We all need an outside voice no matterhow well trained we are…that’s why therapists do not treat their family/friends…objectivity is not possible. Enjoy the holidays and keep on trying to make you a better person for you and you will find others changing their behaviors too. :O)
Therapy also cannot cure physical conditions such as physiological alcoholism, ADHD, dyslexia, etc. It can help the afflicted manage the conditions assuming the therapist understands the situation.
An awfully good list of the things one can’t expect from therapy – either for yourself, or for anyone with whom you have a relationship. You could make them even more concise and they could be issued as a advisory to those seeking therapy. Of course, a lot of folks who might benefit from therapy might avoid it if they were aware of the lack of magic …
I suspect my adult daughter (31)has BPD as she certainly demonstrates the traits. She refuses to accept that she has a problem although her life is problematic due to her personality. It has got to a stage where her chaotic lifestyle has alerted Social Services for the protection of her young children.Although I hadn’t raised the alarm initially I have been part of the process giving my account of my concerns of my grandchildren’s health and well being.This has now caused the biggest rift between my daughter who refuses to let any family member (every single family member)have access to the children and has isolated herself further.I’m at a loss of what to do. My daughter is fully aware that all family members have got to the end of their patience with her and if it wasn’t for the children no one would have had anything to do with her over the past decade. Writing these words down sounds dreadful but it’s how we all feel.I also accept my parenting style of my daughter as a child did not see to her emotional needs and I have regretted the past so many times but it feels like we are all suffering the biggest on going punishment for my mistakes.
What a bizarre editorial. The introduction would lead most people to believe that if your problem fits within any of the listed five categories, you shouldn’t waste your time on therapy. The author goes beyond saying there wont be a cure – he says therapy “wont help you much” if your problem is on the list. Some people (perhaps those among us with ADHD?) might just read the list and not the discussion after each point, and so might not learn that (in the author’s opinion) years of therapy might indeed help someone with a personality disorder, and therapy can help with some of the worst features of the problem. Therapy can’t make your rotten childhood disappear (duh! How many people would expect such a thing?) but it can help you change how you view it, let it affect you. Regarding fixing half a relationship – why not explain up front that some might think going to therapy alone could fix their relationship, but they need to understand that they can only work on themselves – and by the way what’s so bad about helping someone in individual therapy clarify their thoughts and decide a relationship needs to end? The author actually explains how therapy might indeed help someone with these problems, So why give the entree that therapy won’t help much, starting the reader out with a feeling of hopelessness, instead of saying “here’s how therapy can help – it might be quite different or lengthier than you were expecting”? I’m willing to put in the time and do the work, I’ve chosen my therapist carefully. He and I both knew what we were getting into. And my life is very likely to improve dramatically over time, slowly but surely. My expectations are modest, realistic, and yet still hopefully. Many others who have been discouraged by this article might also be within reach of help. I hope that the author is disturbed by the comments here by people who see so little hope after reading this that they are talking about the rationality of suicide.
This information could have been presented in a way that educates people about what is needed to make progress in these situations, instead of discouraging people from even trying.
Well, I do hope people actually read the article and not just skim on the 5 things I identify that, in my opinion, aren’t going to be much helped by most kinds of psychotherapy.
The point is that you can’t make much progress in therapy when confronted with one of these situations — therapy won’t be able to cure it. It can certainly help some people some of the time… but so will time alone. And time is usually cheaper.
Of course, this is just my opinion. That’s why it appears on my blog here… 🙂
Seeing a lot of problems raised in this article, but not many solutions… they seem to mostly be limited to “talk to a friend about it†(because clearly burdening someone who isn’t qualified to help you with all your problems isn’t going to have any adverse effects on THEIR mental health; and that’s before we get into the issue of whether or not the patient has friends in the first place) or “distract yourself with something that makes you happy†(great option for people whose problem is that nothing makes them happy). Honestly, in the absence of any practical advice, I’m very curious as to what you were trying to do for people by writing this.
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