Could I Be the Reason Therapy Is Going Nowhere?

Dear GoodTherapy.org,
I have been seeing a psychodynamic therapist for about three years for dissociation related to child abuse. She has a PhD, is accredited as a clinical social worker, belongs to professional associations, and is in therapy herself. I have several concerns about her. I have not seen conclusive improvement in the time I've been seeing her. Nor have I gotten knowledge on how to know how long treatment will last or when it will end. She knows little about other options for therapy in my city and thinks they are not qualified to treat my condition. We've discussed the lack of progress several times. She implies that I must proceed at my own pace and that we do not progress because of my lack of trust. It's true that I've never "gone there" with any therapist, though I have seen some that I liked. I feel like I am proceeding with the work on my own time, entirely alone, without any support. I don't know if the problem is with myself or with her. I would like to get past the trust issues, but I feel a lack of closeness with my therapist and wonder if another fit would improve things. How do I know if it's me, and what should I do? —Not Clicking
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Dear Not Clicking,

Thank you for your letter. I’m sorry to hear that you aren’t experiencing the therapy you’re receiving as helpful, and I hope that I can provide some assistance. I’m going to start by offering a brief description of psychodynamic therapy and how it works.

Psychodynamic therapy is one of many “depth” psychotherapy processes. It is insight oriented, and a lot of the work is based on free association, where the client simply talks about whatever is on his or her mind at the moment. Eventually, patterns and processes stemming from past experiences and unconscious drives become apparent. The focus of the therapy then goes to the client becoming aware of how these patterns and drives are affecting his or her life. The goal of psychodynamic therapy is not simply to make symptoms go away but to improve one’s life in general. Those are lofty and worthwhile goals that often require some amount of time to accomplish. The experiences one has in life, including trauma, abuse, and neglect, become embedded in the way that person interacts later in life, and it may take some time to work through these more complex aspects of being. There is really no set time that anyone can give on how long one would be in psychodynamic therapy, as it is all dependent on many individual factors that are specific to the client, his or her needs, and the therapeutic relationship.

Now for the specifics of your question: It sounds as if your therapist is well credentialed and doing well by engaging in her own therapy. That indicates that she is a responsible professional, but, of course, without knowing her personally, I can’t say with any certainty one way or another.

What I can tell you with some measure of certainty is that one of the necessary conditions for optimal therapy is that there is a relationship between the therapist and the client. This means a relationship of trust, honesty, respect, healthy boundaries, and mutual willingness to work together. If any of those conditions aren’t present, the therapy process will not go as well as it could. Without knowing you, the therapist, or the relationship between the two of you, it’s hard to say what could be slowing down the process. However, as you reflect on your relationship with your therapist, I would invite you to explore the ways in which you engage in the therapy. Is there a part of you that withholds in therapy? Do you feel like you have allowed yourself to trust the therapist? You mentioned that you haven’t allowed yourself to “go there” with your therapist, and I’m curious if that is holding back the process in any way.

Because one of the most important pieces of a therapeutic relationship is mutual honesty and trust, I would suggest that you start with speaking openly and honestly about your concerns with your therapist, if you feel comfortable. If you can raise your concerns to your therapist, even when it might be a bit uncomfortable, you will be taking another step in trust and vulnerability with the therapist, which can serve to help the relationship. If you do so and you feel as though your concerns are still not resolved, the relationship hasn’t improved, and you don’t feel some sense of resolution, then it may be time to consider moving in a new direction.

If you do decide to go another direction with therapy and your therapist is not able to recommend anyone, GoodTherapy.org’s search engine can help. If you decide to go that route, I suggest that you take your time in finding someone new to work with and that you interview the therapist on how he or she works, what he or she expects, and how he or she anticipates the therapy progressing. If you decide to go with another therapist, take your time and make sure that it is the right fit for you, your needs, and your goals.

I applaud your willingness to seek out therapy and to ask for help when you need it. I trust that you will continue your journey with courage.

Yours truly,
Lisa

Lisa Vallejos
Lisa Vallejos, PhD, LPC, specializes in existential psychology. Her primary focus is helping people to be more present in their lives, more engaged with their existence, and to face the world with courage. Lisa began her career in the mental health field working in residential treatment, community mental health centers, and with adjudicated individuals before moving into private practice. She is in the process of finishing a PhD as well as advanced training in existential-humanistic psychotherapy, and provides clinical training and supervision.
  • 7 comments
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  • Gabby

    Gabby

    December 8th, 2013 at 4:36 AM

    I am not a therapist but to me it sounds like it could be time to find a new one.

    It sounds like there are some definite blocks for you with this therapist and he ir she is always putting all of the blame back around on you, like you are the one not doing the work so that’s why you aren’t seeing success and improvement.

    Who needs more of that? I am sure that there are plenty of others that you could go see who might help to make an even bigger difference in your life. That’s the direction that I would suggest taking.

  • marianne

    marianne

    December 9th, 2013 at 4:52 AM

    sounds like there is some kind of disconnect here that isn’t allowing you and your therapist to develop the strongest relationship with each other, in which case, if you feel like you still need therapy sessions with someone, it could be time to move on

  • Kent

    Kent

    December 10th, 2013 at 3:58 AM

    How about just sitting down and having an adult conversation with this person? Maybe he or she does not even realize that you are feeling this way and they would be more than happy to help if they only knew some of your real feelings.

  • Debra

    Debra

    December 10th, 2013 at 2:53 PM

    Kent, It appears as though ‘not clicking’ HAS talked to the therapist about these concerns & the therapist behaves as if it’s the client’s dilemma.

  • Steven Krautkramer

    Steven Krautkramer

    December 10th, 2013 at 4:30 PM

    If she knows little about other options in your area, then how does she know there aren’t qualified people to treat your situation? But before we blame the therapist, have your tried discussing your concerns with her? You should be able to do that, and if you have not been able to do that, why not? It sounds like she’s a professional so you should be able to have this kind discussion with her. I don’t know you or her of course, but a therapist can only open the door for you to explore things and hopefully improve, in the end the client has to take the steps forward.

    The therapist’s job is to be supportive and be healing, but no one can force a person to improve. Since trust has been mentioned as an issue, have you both explored the reason for the lack of trust? At some point you’re going to have to trust the person and “go there” if you want to progress. If not with your current therapist, then the next one. Otherwise, you’ll stay stuck. I realize this is easier said than done, but you have to start somewhere, even if the first few steps are small ones, keep at it and work your way up to the bigger issues.

  • yanika

    yanika

    December 16th, 2013 at 3:51 AM

    just leave, there are others out there who would be more than willing to take you on and help if this person has drawn a line in the sand and refuses to help even though they know that this is something that you still want to actively pursue.

  • iam

    iam

    June 3rd, 2017 at 7:04 PM

    Remember when you started college and you dated a lot of nice people? Just because someone is nice, doesn’t mean there is Kismet. Dump your therapist. They were never right for you. It takes a couple of dates to know for sure. The problem is that the therapist believes that just because they are a good person they are a good therapist. And even if the person is a good therapist, clearly, they are not good for you! Interview at least 4. You deserve someone who will “get” you, someone who doesn’t say, “you can trust me,” but someone who resonates that for YOU.

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