Why so many people leave therapy disappointed

Many people leave therapy feeling disappointed, even when the therapist they work with is kind and attentive. The problem often lies not with the therapist's behavior, but with the expectations and understanding of the client. In a first appointment, a common phrase heard is, "But nothing actually changed." The issue is that many clients arrive at therapy without a clear understanding of what it entails or what to expect.

They may have been exposed to videos or descriptions of therapy that depict a simple, straightforward process, but therapy is far more complex and nuanced.

Clients often have no template for what psychological treatment should look like, as they have grown up observing others go through doctor's appointments and physiotherapy sessions, which are more straightforward processes. Without guidance from their family or others, they must piece together their experience from what they have seen on screen. While watching someone sit in a room, have a conversation, and cry is accurate in describing the setting, it does not capture the true work of therapy.

The relief clients feel from being properly listened to is powerful, but it is temporary. Describing thoughts and feelings out loud can lower the emotional charge for a while, but the charge returns, and the client continues to feel the need for ongoing therapy. This process can feel like effort, as the client must continue to articulate their experiences and work through them over a long period.

Treatment requires a structured approach. The therapist and client work together to develop an account of why the problem persists, focusing on what is holding it in place now rather than what caused it years ago. This account produces a target, and the client is given practices to engage in between sessions to address that target. With a clear target and practice, the client can gauge progress over time.

The warmth and empathy provided by the therapist are essential for creating a safe space for clients to share their experiences, but they are not the treatment itself. A good clinician understands the difference between providing warmth and delivering therapy, and they communicate this to their clients. If a client is never told the difference, they cannot ask for what is missing.

In some cases, clients may need a different approach to therapy. Someone in acute grief may not require a behavioral target, while someone who has spent their life managing the feelings of others may need months of being allowed to express their own emotions before engaging in structured work. A skilled therapist recognizes these differences and tailors their approach accordingly.

The failure to communicate the nature of therapy lies in the silence surrounding the work being done and why. This silence often affects men more than women, as they may arrive for therapy more frequently, having been referred by someone else, and may decide after a few sessions that it is not for them. They may not see the need for ongoing therapy, viewing it as an unnecessary expense of time.

If you are considering therapy or are currently in it and unsure about its direction, it is crucial to ask about the work being done and how progress will be measured. A good therapist will have an answer or will acknowledge that the two of you are still working it out together, providing a sense of when the goal will be reached. Asking these questions ensures that you are both on the same page and that you have a clear understanding of the therapy process.