Have you ever wondered why therapy doesn’t work? Why do some people have problems that don’t seem to go away? Why do some people seem to get labeled as “noncompliant” while others seem to follow all suggestions? There are actually really good reasons why therapy doesn’t work. Here are a few:
When someone doesn’t do what the therapist suggests, he can be labeled as noncompliant. Here are some examples of things that can lead to this label:
- The client curses so the therapist terminates the relationship saying that the client isn’t respecting the therapeutic boundaries.
- The client doesn’t give a response to a question or invitation to speak that lines up with the expected response.
- The client doesn’t do homework.
- The client doesn’t take medication as prescribed.
- The client doesn’t show up for appointments.
- The client speaks up for himself in a forceful way.
There is no such thing as “noncompliance.” Sometimes what is viewed as noncompliance is simply the person exercising their right to self-determination. There is a positive purpose to every behavior. If someone is doing something that appears ineffective, it’s because that behavior is meeting a need. That behavior won’t change unless and until a healthier option presents itself. If the client doesn’t buy into the intervention or understand it, he won’t choose it.
Sometimes the client wants to comply but doesn’t have the energy, knowledge, or ability to follow through. I’ve given some clients suggestions that I thought were self-explanatory and later found out that they just didn’t understand. If someone is severely depressed, anxious, or traumatized, simple homework like taking a walk, drinking more water, or breathing are too much effort. He may need a bit more help and patience to get him to the place where he can do those things.
Sometimes not following instructions or not conforming is about seeing whether or not the therapist will accept the person for who he is. It’s a way of saying, “If I have to be someone else to be here, you can’t possibly help me” or maybe “If I have to change to be acceptable to you, I don’t want to be here.”
Noncompliance is not a client issue. It’s a therapist issue. Every person has a right to decide under what circumstances he will work, but when the therapist narrowly dictates the terms of the helping relationship, it can destroy any possibility of helping.
Sometimes therapy fails because of cultural ignorance or insensitivity. While I was working a a psychiatric hospital, I did the intake interview for an Asian woman and could find no clinical reason for her being there. When I asked her psychiatrist about it, he said he was medicating her and holding her against her will because she was talking to the spirits of her dead ancestors. That’s not crazy. That’s cultural! That was the cultural norm for her.
Another Asian asked a therapist how to honor abusive parents while maintaining physical safety. She was advised to cut them off and never speak to them again. In the context of the culture, this is not an acceptable option. It would be like saying, “Cut off ll ties to your past and go isolate yourself on a desert island.” That client went elsewhere.
A therapist doesn’t have to accept a person’s culture in order to be a good helper, but she does have to make an attempt to understand it. Nobody lives in a vacuum. To help a person requires an understanding of the environment that shaped them, their values, and their beliefs. The therapist can’t be the expert on the person. The client has to be the expert on the person.
Seeing Symptoms Instead of People
People can tell when they are being treated as symptoms instead of people. They can tell when they are a diagnosis, not a person. Therapy needs to be structured for the individual. A ten year old, white, first born, male with anxiety probably doesn’t need the same intervention as a fifty year old, Arab, female, mother with anxiety. People are not symptoms. People are not diseases. Warmth and understanding is a vital component of the helping relationship. Without it, therapy doesn’t work well.
The System Seeks Homeostasis
All nature is balanced. This means that when things are connected, what happens to one effects the other. People don’t live in isolation. When one person seeks treatment, it affects the whole family. Let’s look at the alcoholic family as an example. There is usually one person who is the “identified client” meaning that this is the one people look at and say, “He’s the problem.” Where there is a problem person, there is also usually a helper. If there are children, they generally take on the following roles: the achiever who makes the family look good, the invisible one who stays out the way, the renegade who stirs up trouble, and the clown who makes people laugh. If the identified client gets better, it threatens the identity of the others because their relationships only make sense if there is an identified client. So, they put pressure on the identified client to go back to his old ways so that they feel comfortable again. This works for domestic violence, poor self-esteem, or whatever the problem is. All of us make sense of ourselves in relation to others. All of us learn how to be in the world in relation to others.
What this means for counseling is that some issues really need to involve the whole system/family. It can be too hard for one person to overcome a family dynamic and continue to live in it. If the person is strong enough, he can change the whole dynamic by changing his piece because everything is connected. It’s usually not that easy though. Patterns tend to be firmly entrenched. Results are better when the whole family is involved in treatment.
It’s Not a Mental Health Issue
There are mental health symptoms that have a physical cause. I have had clients with physical problems who were labeled as “mental” and sent for psychiatric care. I’ve had some that were labeled as “malingerers” because they knew that their problems weren’t emotional and continued to search for medical help.
Some examples of mental health symptoms that have physical causes:
- heavy metal toxicity
- head trauma
- various autoimmune diseases – including celiac disease
- any condition that causes pain
The mind and body are connected. What impacts one affects the other. It pays to pay attention to the body when dealing mental health disorders because something as simple as a Vitamin D or B deficiency can create severe emotional disturbances that can be quickly and inexpensively cured without counseling or drugs. In fact, most conditions can be improved with a change in diet and lifestyle.
No Treatment Plan
The most effective counseling has a well defined goal and objectives that are formulated by the therapist and the client. This gives counseling its boundaries. It helps the client know that he’s making progress. It helps both parties know when they are done. It’s rare that therapists work without treatment plans. It’s more likely that the client wasn’t involved in the process or the treatment plan wasn’t fully explained. For example, techniques like Motivational Interviewing and Conversational NLP are invisible. It just feels like you are talking about an issue then it suddenly isn’t an issue anymore. This is demonstrated by the Lao Tzu quote, “A leader is best when people barely know he exists, when his work is done, his aim fulfilled, they will say: we did it ourselves.” Still, when the treatment plan is outlined and the client hits his targets, the client goes away feeling that counseling “worked.”
The role of trauma is often overlooked – even by professionals. The therapist might be really knowledgeable and have great techniques, but if there is underlying, untreated trauma, counseling will only go so far. It will always be an issue of managing symptoms. It takes a lot to hold it together when you are traumatized. If a client feels that counseling is her safe place, she may have a melt down there and appear “noncompliant” or “difficult.” To give up on that client just reinforces the message that the world isn’t safe and can cement the trauma further. Nobody has to live with the ongoing effects of trauma. It’s treatable, so putting a band-aid on it is not the best approach.
Therapy with the best chance of success includes the following:
- is a collaborative effort between the client and therapist
- allows for “I don’t know, let’s explore that…” from both sides
- is respectful
- honors culture
- has strong boundaries that respect both parties
- includes referrals when required
- starts where the client is and moves at that pace
When therapy doesn’t work, it is not because the client failed. As long as the client continues to show up, he’s invested in treatment. As long as a therapist has a little bit of knowledge, engages in client centered treatment, has trust, and makes adjustments, therapy will result in a positive outcome.
If you are in the Richmond area and are looking for a holistic therapist who will not give up on you, contact Laura Giles today.