“I feel worse leaving this session than I did when I came in,” Paul said through tears in his eyes. “Therapy is supposed to make me feel better!” I don’t think this is helping me!”
“You’re supposed to know how to make this pain stop! You’re the professional. I pay you to help me,” were words Janice frequently shared with me when I failed to give an immediate answer to a question or responded to a question with “I don’t know.”
“If you don’t know what’s best for me, how am I supposed to know what’s best for me?” I came to therapy to know how to have a better life and all you do is listen to me!” Jake said in frustration when he wanted to know how to handle a particular relationship.
“I need a plan with specific action steps,” Alan said. “We should have operational objectives so that I know when we’ve achieved our plan. Sometimes I don’t even know what we’re working on.”
Focusing on Feeling Better
I’ve heard these very statements, or some variation, many times in the years I’ve been doing psychotherapy. There is an assumption that the goal of therapy is to feel better, to do better, or to live better. And ultimately we do hope that therapy will have a positive impact. The journey toward feeling better and living differently, however, isn’t necessarily the result of leaving each session feeling happy or better.
I admit that I have sometimes found myself leaving work at the end of the day, feeling frustrated that my clients didn’t feel better after a session, or that some of them even voiced feeling worse. I can get locked into seeing progress as unswerving. I might notice this at the end of a session, or at the end of a term of therapy. And as hard as it is to believe, at times, I remind myself that therapy isn’t neat, or clean, or even linear.
Doing Better Later
Brad was seeing me upon the request of his wife because she experienced him as “argumentative and abusive.” He considered himself a mandated client because, if left up to him, he wouldn’t be in therapy. It was only because his wife threatened divorce that he agreed to see me. It took months of therapy to build a relationship with Brad as I tried to help him see me as an ally rather than an enemy. He frequently voiced that he didn’t see therapy as helpful, but at the same time, I felt him relax in our sessions and allow himself to be more vulnerable.
With this vulnerability, however, I also began to see that Brad often masked his vulnerability with sarcasm, criticism, and raising his voice. I often found him talking over me in sessions, interrupting me, and dismissing my comments as irrelevant. Slowly I began to bring Brad’s attention to our interactions. I shared with him how at times I thought I might be feeling some of the things his wife felt in their relationship.
After a year in therapy, Brad’s wife filed for divorce. He was devastated and felt betrayed. “I did everything she asked,” he lamented, “and she still decided to end our marriage. You were my therapist and all you did was tell me the same things she did!” And soon after his wife asked for a divorce, he discontinued therapy.
I’m fairly certain that Brad didn’t see our work together as helpful or productive. I also went through a period where I questioned myself about my effectiveness. At the same time, however, I had a sense that Brad left therapy with some new consciousness. His wife wasn’t the only one who experienced him as argumentative. Someone he trusted had given him the same feedback. Although his marriage ended, there was some movement on his part toward greater self-awareness. He didn’t achieve his desired outcome, but I am hopeful that he will enter future relationships with greater attention to his actions.
Feeling Better Can Be Scary
Karen came to see me because of an extensive and prolonged history of sexual abuse perpetrated by her father. As an adult, she shared this with her mother and sisters, but none of them believed her and instead questioned her mental health. It was with self-doubt that she entered therapy. Even the way she sat on the couch, on the edge of her seat, with her hands punched into the cushions, signaled to me her readiness to flee; her acute hypervigilance around possible danger.
Our work together was cyclical. We spent a great deal of time establishing safety and rapport, but when we moved into territory that felt painful or scary, she stopped coming to sessions without warning. My phone messages went unanswered, and I received no response from letters I sent, though my letters always ended with an invitation to return to therapy at any time. I also always offered to help her find another therapist if for any reason she decided our relationship wasn’t helpful.
When she left therapy the first time, I was certain I would never see her again. And when I heard her voicemail after several months, I was certain she was going to ask me for a referral. Instead she wanted to schedule another appointment. When we resumed, we talked about how we ended and she insisted that she felt better as a result of our work. “It scared me,” she offered. “I don’t know how to feel better and how to trust a man. I had to go.” And while I saw our initial time together as potentially harmful, she found it almost too helpful!
Feeling Better in Starts and Stops
Isolation was the reason Jennifer sought therapy. She was a teacher, and despite being around people all day, she felt disconnected. In particular, she felt as though she had nothing to bring to a romantic relationship and so she avoided putting herself in any situation in which a relationship might develop. Her history included many losses; some due to death and others due to people in her life ending relationships with her for reasons she didn’t understand or weren’t explained to her.
During one session in particular, she shared she had gone on several dates with different people, but never accepted a second date because she didn’t want to risk rejection. She also shared that in friendships, she tended to be quiet and passive. Some of her friends saw her as aloof and unavailable, but for Jennifer, this was more a result of her fear around rejection and loss. She reported losing friends because they tired of “chasing her” to get together. I never call people to get together,” she explained. And when I have something planned with friends, I often cancel at the last minute because I feel like I just have to be by myself.”
Soon after we began seeing each other, I noticed the same pattern emerging in our relationship. I would see Jennifer for two weeks in a row, and then she would cancel because she had to stay late at school. Then I might see her for another three weeks, but the next two weeks she would cancel—-always for reasons that were difficult to challenge. I made a commitment to share this observation of our dynamic in our next session. And then she would come to our next session and I would fail to bring it up.
For almost a year we continued with this rhythm of seeing one another for several sessions, and then missing a week or two. During the weeks she missed, I made a mental note to discuss this pattern in session each time it happened, but for unconscious reasons at the time, I said nothing. I also felt like I really wasn’t helping Jennifer because we couldn’t gain traction or momentum—-at least that’s what I thought was happening. I was critical of myself for not making her pattern of cancellations explicit and for not inviting her to consider how it paralleled how she managed other relationships in her life.
Sometime in the beginning of our second year of work together, there was a noticeable shift. Jennifer consistently came to sessions. If she had to cancel, she asked to reschedule that same week. She talked more in sessions. She socialized more. We were able to explore her losses in more depth, and we were able to better understand where her fear of rejection originated. At the conclusion of her second year of therapy, Jennifer was frequently vacationing with friends, and had initiated a romantic relationship—still with fear, but also with a commitment to remain engaged.
I saw not addressing Jennifer’s pattern of cancelations as a failure, and left many sessions feeling cowardly for not bringing this up. In retrospect, however, I believe that had I addressed these cancellations in therapy explicitly, I might have been repeating the dynamic that arose with friends. Jennifer would have seen me as yet another person who was “chasing her,” disapproving, or rejecting. I’d like to claim it was intentional, but because I was hesitant to address the session cancelations, Jennifer began to see me as someone who would accept her unconditionally. This acceptance allowed her to gradually invest in our relationship.
Helpful Therapy is Subjective
As Brad, Karen, and Jennifer demonstrate, what looks like “success” is subjective and temporal. While I might be frustrated with myself for what felt like an unproductive session, when I consider the total arc of therapy, even these difficult or frustrating sessions contribute to important and more lasting changes. Still in other ways, what my client might see as an unproductive session or even an unhelpful therapy experience might better prepare him or her for later life experiences and relationships.
I’m not implying that any time a client experiences therapy as unhelpful or anytime therapists experience therapy as unhelpful that somehow a happy ending will always be the result. I am, however, inviting each of us to consider what constitutes helpful therapy or a helpful session does not always manifest in immediate satisfaction. I’m also inviting us to consider that growth almost always has periods of rest and periods of pain. As we move to better ourselves through therapy, the trip toward our destination requires stamina.
Sometimes we can be critical of our therapists when a session ends without resolution or we feel worse as we leave. Sometimes we can be critical of ourselves as therapists when our clients tell us we aren’t helping. Undoubtedly, there are times when we can and should take these experiences as truthful and learn from them how we can be better at our work. There are other times, however, when it is important to take a closer look at exactly what is happening in each session and over the long haul.
While we all want therapy to help, ending each session with relief, or insight, or happiness isn’t the only indicator of growth. Just as we ask our clients to trust the process, it’s important that as therapists, we do the same.
Maybe it’s not about the happy ending. Maybe it’s about the story.
by Jeff Levy, LCSW, CTRS