I feel like I’m not moving forward, why? This is a question that patients sometimes ask psychotherapists. Certainly, we are all different and this is what makes each session a challenge. When a patient feels that they are not progressing no matter how much they attend the intervention sessions, it is necessary to know how to pay attention to the signs that indicate the causes of this. We will now explore this topic.

Why might psychotherapy be failing?

First it is important to understand that the process of psychotherapy is twofold: psychotherapist – patient. All psychotherapists work differently , they have their own style of therapy, varied knowledge, etc., and above all they are people who have a private life, with problems, emotions, their own idea of what happiness is, etc.

However, no matter how much variability there is, there are certain general factors that influence whether psychotherapy is successful. If they are absent, the progress will not be as expected or the intervention will fail completely, bringing with it disappointment, frustration, anger and above all, feeding a thought that is very common in people who attended therapy and it was not effective: psychology is not useful, it is a scam or the psychologist is not useful, it is bad.

Psychotherapy can fail because…

I will mention some reasons why a therapy process may fail, not be rewarding and successful or generate too slow progress.

1. Therapist – patient/client relationship

For a therapy to begin on the right foot, it is essential to create a good relationship with the patient/client. This relationship must be strong, positive, and based on healthy empathy. Above all, it is important to focus on everything concerning the patient’s problem and his/her life in general. On the other hand, the patient must feel understood, comfortable and accepted by the therapist.

When this relationship has not been well forged and therapy is forced, this may be the reason for no progress. This is a more common situation in the care of adolescents and adults with addictions or other similar disorders.

2. Working methodology

As I mentioned earlier, all therapists have their own style of therapy. Some work with approaches based on changing thought and behavior, others have a more humanistic, person-centered approach . Therefore, the structure of their therapies is different.

Some will start the session with a long interview, asking what thoughts are frequent when the problematic behavior occurs, and others with attentive and interested listening without making any notes, etc. On the other hand there are therapists who are more organized, keep track of appointments along with the planned session and the material ready to work, others may be more of an improviser or let the patient set the pace of the therapy.

If the therapy does not progress it may be because the therapy approach is not suitable for the patient’s problem , it does not make the patient feel comfortable, it is too passive or too active, it is task-centred and the patient does not like doing it, the patient does not like the therapist’s disorganisation, etc.

I recommend letting the therapist know if there is anything about his style of therapy that you are not comfortable with. On the other hand, if you are a therapist it is good to explain to the patient what the therapeutic approach you are using is.

3. Therapist’s reluctance

Sometimes patients or clients come to the office with a personality or attitude that the therapist cannot digest or tolerate. This is normal, it is a person who also feels and is entitled to not achieve total acceptance of the patient as he is. When this happens it is a good option to refer the patient/client to a colleague.

4. Patient reluctance

In the same way as the therapist, the patients may be reticent to the progress of the professional , showing themselves to be negative, defiant, annoying, uncomfortable, unpleasant, uncooperative, desperate, etc.

If the patient does not cooperate with his therapy process, he will not progress. This is common in therapy; therefore, it is important to inform the patient that it is necessary to collaborate in everything that is requested, from tasks to techniques that will be performed in each session to more general ones, in order to achieve significant progress.

5. Some aspects of the therapist

Sometimes, when therapy does not progress, it may be because the therapist is not fully prepared to deal with it, because of fear, lack of confidence in their skills, lack of interest in updating, because they use ineffective therapies without an evidence base, because they do not like their job but need money, etc.

Therefore, it is good for patients to look for references , ask the therapist if he or she has his or her license, degrees and membership in order, etc.

Remember that…

If you are a therapist and you feel that your patients are not showing great progress, make a detailed review of your sessions, analyze if your therapeutic approach is the most appropriate for the type of population you are treating, have confidence in them, don’t be tormented and above all keep up to date, since the field of clinical psychology is very broad.

If you are a patient, don’t be afraid to create a therapeutic bond , trust your therapist and if you don’t like something, let him/her know. Therapists are here to support the person who asks them, so remember to collaborate with your therapy process as much as possible.