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Ask the Mental Health Expert Archives 2001-2004

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Ineffective Therapy

Q. I have heard that some people simply don't benefit from therapy. I wonder if I am one of them. I was in therapy for 12 years with several different therapists. I don't feel that I benefited from it in any way. After staying out of therapy for three years, I definitely feel better. But there is often this gnawing urge to go back in, even though the thought of going back into therapy also makes me feel kind of sick. I think the issue is that I have the same problems that drove me into therapy in the first place, so there is always this hope somewhere in the back of my mind that maybe this time it will actually work. How do I know if I am incurable?

A. I can certainly understand your ambivalence about re-starting psychotherapy. There is no question that, for most people who enter competently-conducted psychotherapy, significant benefits are obtained. Hundreds of controlled studies of psychotherapy have been analyzed, and overall, the average person who enters treatment winds up better off than 75% of those who are untreated. (I discuss some of these issues in detail in my book, A Consumer's Guide to Choosing the Right Psychotherapist).

Unfortunately, not everyone benefits, as you can attest. The lack of success may be due to any one or more of a variety of factors, including: 1. The therapist is incompetent; 2. The patient is simply too resistant to change; 3. The therapist is competent and the patient is receptive, but there is a personality mismatch between the two, such that they never really connect; 4. The underlying diagnosis has been missed; 5. The diagnosis is correct, but the particular type of psychotherapy is not appropriate to treat the disorder (an example is the use of psychoanalysis for the problem of premature ejaculation, which can usually be corrected with behavioral therapy within a few months); 6. Psychotherapy may be competently carried out, and partially effective, but the patient's condition also requires medication. (Some types of depressive disorders, for example, require antidepressant medication in addition to psychotherapy).

Because there are so many factors involved, I would advise you to listen carefully to that "gnawing urge" to go back into therapy. I don't believe anybody with a psychological problem should operate from the premise that he or she is incurable--but, you may need to get a comprehensive diagnostic evaluation in order to know what type of therapy would be helpful for you. I hope you will consider that option.

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November 2001

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