Why psychotherapy doesn't work
And no, it's not because it is online!
Hey friend♡
Either way this post is for you.
There's a popular argument floating around: psychotherapy doesn't work.
It's not entirely false, but the truth is more nuanced than that dismissive claim suggests. The real issue isn't that psychotherapy is fundamentally broken, it is that the way psychotherapy is often practiced, and the expectations we bring into it, are frequently misaligned.
When psychotherapy fails, it usually comes down to two interconnected factors.
Client factors, and
Therapist factors.
Understanding these factors can take your psychotherapy experience from quite disappointing to genuinely transformative, in a matter of a few sessions.
Let’s talk about why psychotherapy doesn’t always work.
Client Factors: What You Bring to the Room
Many people enter psychotherapy with the wrong map for the territory they're about to explore. They might think therapy is a fancy place you go to get validation and leave feeling nice. They treat therapy like a weekly emotional dump with no clear direction, and the main goal is just to vent. Why pay someone so much money only for you to spend the time venting?
Some other clients come to psychotherapy looking for a savior, someone to fix them. They are under the impression that a mental health professional is the right person to defer to. They want to be told what to do, because taking responsibility of their lives is tough, and scary, and heavy.
In If You Meet the Buddha On the Road Kill Him!, Kopp says, a client might “approach the therapist like a small child going to a good parent whom he insists must take care of him. It is as if he comes to the office saying, ‘My world is broken, and you have to fix it.’” But psychotherapy isn't salvation, and the therapist isn't a messiah. They're a facilitator, not a magician. They are not there to tell you what to do. You decide what you want to do, because you are the expert of your life.
Then there are the clients who approach psychotherapy like a toolkit acquisition program. They came to collect worksheets, strategies, and techniques. When their therapist encourages deeper exploration, they get uncomfortable and bolt. For them, the focus is purely on reducing their symptoms, not on understanding the underlying issues contributing to their suffering. This focus on symptom reduction might be necessary in crises, but it often misses the deeper work that creates lasting change.
Here's what I've observed: your therapist will likely give you the tools and worksheets you are asking for. And you will probably not make use of them. Not because you don't want to improve, but because something inside you, often subconsciously, stops you from implementing. There is a strong resistance. And that’s because what you think you want is not always what you need. Just because you come to psychotherapy seeking quick fixes and straightforward answers, does not mean that that is what you need.
What we want are quick, clever fixes.
What we need is to develop the ability to tolerate ambiguity,
complexity, and uncertainty.
As a psychotherapy client, you need to understand that sometimes the most important work in psychotherapy isn't getting a new tool, rather, it is facing what holds you back when you try to use the tools you already have. Until the inner resistance is addressed, no strategy will truly stick, no worksheet will help, no quick fix will eradicate your suffering. Addressing this inner resistance is a better therapy goal than collecting tools.
Change your expectations of psychotherapy. Stop expecting psychotherapists to fix you. Start seeing it as a space to witness yourself, not repair yourself. Go deeper. Ask bigger questions. Bring your confusion, doubt, and shame into the room. Refuse to stay shallow. Don’t fall for the performance trap of ‘doing therapy well’ which is just another mask you are using to keep your therapist happy.
Real psychological change is difficult, inconvenient, slow, often boring, and no one's clapping while you do it. There are no medals, no awards, and no leaderboards to keep track of. Do not come to psychotherapy seeking what it doesn’t offer. If you are looking for validation and ‘feeling nice’, there are cheaper sources than psychotherapy.
Therapist Factors: What They Bring to the Process
Because of the bastardization of psychotherapy, many people do not have clarity regarding what psychotherapy is, and what psychotherapists do.
Some psychotherapists have come to equate psychotherapy work with compliance. Their main focus becomes, ‘are my clients are using the tools and strategies I gave them? Are they doing the homework assigned in session?’
The danger with this approach is that the psychotherapist then completely ignores, or willfully forgets, that in a psychotherapy session, sitting in a room with another human being who doesn't judge, fix, or abandon you is already revolutionary and healing.
It's the relationship that heals, the relationship that heals,
the relationship that heals—my professional rosary.
~ Irvin Yalom.
If you look closely, this focus on tools and skills is a defense strategy, to quell the psychotherapist’s own anxieties. They want to feel safe. They want to soothe themselves and feel that they have done something tangible, instead of simply listening to, and following the client's needs. For some psychotherapists, deep listening, sitting in the dark with their clients, feeling the heavy emotions with the clients is extremely scary.
If you are a therapist, ask yourself: “What am I trying to achieve with this tool-supplying process: resolution, impact, relief, the satisfaction of fixing?” Are you offering these tools as an extension of the care you have already offered, or is it as a pacifier for your own issues? As Yalom noted, psychotherapy isn't something we do to someone—it's a way of being with them.
In other instances, psychotherapists have their own unfinished business. Every human does. In psychotherapy, this unfinished business shows up as a psychotherapist’s inability to sit with difficult feelings, and the fear of a client’s resistance.
When a client resists or doesn't open up in session, psychotherapists need to pause and notice any quiet discomfort or urgency within themselves. What is that? Fear of inadequacy? The need to be helpful? The impulse to do something, anything? The need to prove yourself? These moments aren't necessarily blocks, they might be mirrors, reflecting both the client's resistance and the therapist's inner world. Your psychotherapist needs to be able to identify all this and address it. Otherwise, you will be in psychotherapy for a very long time, wondering why you never seem to make any progress.
Something else I would describe as a therapist factor, is where a psychotherapist is clearly and rigidly using a therapeutic approach that neither works for the client nor their issues. We have too many psychotherapy modalities. All of them have their merits. But if a psychotherapist is stuck on one modality, and they insist that their client and their issues should fit neatly into that modality, of course, we will have problems. The psychotherapy work is bound to get stuck. Your therapist should be able to customize psychotherapy to you, and if they are not capable of using other modalities beyond what they know, they should refer you elsewhere. As a client, your role is not to fit into a predetermined model of psychotherapy.
Human beings are complicated and complex,
they do not fit into our treatment plans.
~Jennifer Kyalo, Dear Beginner Therapist.
Lastly, remember when I said don’t come to psychotherapy looking for someone to rescue you? Well, I’m glad you listened to that piece of advice, but you might face serious challenges in psychotherapy, when it turns out that your psychotherapist has a misguided narcissistic savior complex. Woe unto you if your need to be fixed, meets a therapist who believes their role is to fix you. Then we have the perfect recipe for utter nonsense, confusion, and unbelievable chaos.
In conclusion
This might sound heretical coming from a psychotherapist, such as yours truly, but it is a real, important, and overdue conversation. Too many people walk out of psychotherapy after spending months and thousands of shillings, more confused, disappointed, feeling nothing, or worse, full of self-blame. They can’t show anything for the time they spent with a mental health professional.
The solution isn't to abandon therapy altogether. It's to understand what makes therapy work: the right client expectations, the right therapist factors, and a therapeutic approach that is flexible enough to accommodate you. When these elements align, psychotherapy becomes what it's meant to be. Not a quick fix, but a profound encounter with yourself in the presence of another human being who can witness your story with empathy.
That's when real transformation begins.
When I accept myself just as I am, then I can change.
~Carl R. Rogers
Till next time,
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