"Of course it isn't working..."

I was thinking to myself today about how patients tell me they are considering quitting therapy. Usually I anticipate this conversation well in advance. After working with someone for a time, seeing them deal with their "stuff" and meeting treatment goals, they are done and we both know it. For others, it is not quite as straight-forward. A common line I hear is, "I don't think counseling is working." Now I am not under any delusion that I am the best match for every patient, but I have learned that if a patient stays long enough to use this line, it is not a "match" issue. I usually sense a desperation in their tone, as if to ask for help. I find there tends to be a common theme of helplessness, dare I say "victim." This is not the same tone as willing desperation. Willing desperation with do whatever it takes to get better.It is quite normal to peak, plateau and even lose some ground when it comes to therapy or recovery. I remind people this almost daily when they feel discouraged. It is OK to express feelings of helplessness and even whine and complain a bit. However, it is always problematic when patient live in this place. These are the patients who inevitably say, "counseling is not working." These are the patients who may come for a few "feel good" sessions but don't want to do any work. They want me to take away their problems...... If I were really that powerful there would be world peace. I have seen patterns like this... 1) patient starts therapy and has a few "feel good" cathartic sessions, 2) patient starts to act more depressed and helpless, 3) I notice patient stopped really working after the first few sessions, if at all, 4) attendance suffers, 5) "I don't think counseling is working," 6) quit therapy. How do you respond to this question when a patient hasn't kept an appointment for over a month? Of course a good therapist spots this before a client voices his or her discouragement, but we sometimes don't have the opportunity to address a clients discouragement when they never make it to our office. I guess you can say they never showed for even the first appointment.This isn't a forum for me to express my frustrations, nor is it appropriate to discuss an actual patient. In fact any and all mention of patients are composites of several, usually past, and some theoretical. My purpose is really to encourage those out there who may feel counseling isn't working for them. Maybe it isn't, and if that's the case you NEED to discuss this with your therapist or counselor. A good therapist won't be offended or get defensive with you. Maybe there is something your therapist can do differently and sometimes that is all we need to know to make a change. But maybe you aren't taking responsibility for your own recovery. When I give assignments in therapy, most couples or individuals don't remember what the homework was the following week. I remember a former supervisor in graduate school told us if we felt like we were working too hard with a patient, we were. We [therapists] sometimes need to get out of the way so our patients can do the work. If you are feeling like quitting counseling because it isn't working, first ask yourself, "are YOU working."

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