Dr. Mike Ronsisvalle: Not Making Progress in Therapy? Make Sure You and Your Therapist Are a Good Fit
By Dr. Mike Ronsisvalle // December 11, 2021
Hope is real and help is real, and you can find both
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In the clinical office I often hear stories about how therapy hasn’t worked for some clients. Sometimes, it’s a couple who has tried marital counseling over and over again but never seems to develop the communication skills to solve problems and cultivate a happy, productive marriage.
Other times it’s an individual who tells their story of trying different counselors over the course of many years but never quite reaching full recovery from a mental health problem like depression, anxiety, or addiction.
Whatever the case, it’s clear some people struggle to feel like they’ve made progress even after they’ve mustered up the courage to ask for help.
This pattern begs the obvious questions: “Why doesn’t therapy work for everyone?” and “What do you do when asking for help hasn’t worked?”
Start with the therapist
It would be a mistake for me to not start with an honest discussion about the need for every person to be a good mental health consumer.
That means everyone who’s ready to seek counseling should understand from the get-go that not all psychotherapists will be a good fit for every individual.
Many times this has to do with the goodness of fit between the personality of the therapist and client, and how they relate to each other.
For instance, if you highly value humor and you find a therapist who is very serious in nature, there’s a high likelihood you won’t feel a good connection with this therapist.
Others who are rational and sequential in the way they think will most definitely be turned off buy a free willing, intuitive therapist.
In addition to basic personality, it’s also important to find a therapist who shares your value system.
While it’s a mistake to demand your counselor agree with you on every important issue, it is essential you both agree on matters related to concepts like meaning, purpose and morality.
The goodness of fit between a therapist and the client has consistently been identified in the research as one of the most important predictors of success in therapy.
For that reason, our first job as we are looking for a counselor is to try to find someone who is relatable and who shares our principles.
One way to make sure you don’t jump into a long-term therapeutic relationship with a clinician who is not a good fit is to adjust your expectations about the initial therapy appointment.
It’s important to view this moment as an interview. You are interviewing your therapist and they are interviewing you.
The only goal for that first session is to make sure both parties feel harmony between one another.
Most of my therapy relationships began with this conversation early in the first session.
The client and I make the decision together that we will use the first session as an assessment where I ensure I feel like the problems we will address in therapy are consistent with my therapeutic skill set, and the client makes sure they feel like I’m relatable and share their value system.
While using the first session as a two-way interview can be very effective, I have found over the years there are two fears that tend to block some clients from making an honest assessment of the goodness of fit.
First, I find some clients are scared to be open and honest with the therapist about a lack of connection.
That’s a shame because every therapist should welcome feedback on the relational goodness of fit and is ethically responsible to refer any client, who is not feeling connected to other, possibly more relatable therapists.
My encouragement to you is to lead with honesty when first engaging with the therapist, and my hunch is the clinician will be more than open to help you find the best person for you.
Secondly, some clients feel blocked from making an honest assessment about the quality of the relationship with the counselor because of fears about insurance coverage.
I can’t encourage you enough, it’s not worth it to make a decision about which therapist you see based on who happens to be on your insurance panel.
You might be surprised to find cash pay prices are not that much more than insurance co-pays.
Also, it’s entirely possible the time spent in therapy will be shorter if you truly connect with the therapist.
If that’s the case, the total cost of your counseling experience could actually be less if you pay out of pocket as opposed to paying more co-pays over a longer period of time. If insurance is your only block to connecting with the right person, talk to your therapist directly and work out a creative solution.
Take a hard look at yourself
If you’ve been a frequent flyer at multiple therapy offices, it probably makes sense for you to look inside to see what you’re bringing to the table that might be interfering with your progress.
Here are a few of the mistakes I see often in the therapeutic process that consistently prevent people from making progress in therapy.
1. Many people wait until they are in a therapy session to try to deal with issues.
While your counseling session is a space for you to receive information and guidance on how you can cope with life’s problems, the only way to generalize the coping skills you’re learning is to actually practice out in the real world. Imagine you encounter a situation outside of your therapy session, and you reflect on what you’ve discussed with your therapist.
Now you’re able to put the coping skills into play right in the moment.That’s the only way you can move past all the patterns you’re stuck in and build new healthy behaviors. There’s no way our therapists can fix our lives for us in 50 minutes. We have to be willing to ask the hard questions and make the hard choices to do the work outside of each therapy session.
2. Another mistake clients often make is failing to disclose significant trauma from the past.
Trust me, I get this one. It’s hard to think about sharing difficult experiences, especially with a new therapist who is basically a stranger to you.
It’s also easy to believe the current issues you’re seeing a therapist about have no connection to certain traumas that occurred in your life many years ago.
Having said all that, I need to be clear it’s crucial to not withhold information.
While your counselor might not necessarily need all the gory details of your story, it’s important for them to know the essential parts, including the events that caused shame, sadness or other pain formations.
Bottom line: if your therapist doesn’t have all the information they might use interventions that don’t fully address some of the deeper issues you’re dealing with.
3. One of the bigger mistakes people make in therapy is to frequently deflect from uncomfortable emotions using humor or debate tactics.
It is your counselor’s job to challenge you and point out the patterns in your life that are causing problems.
You’re not in therapy just to vent about your week, you are there to learn positive and healthy coping strategies in order to get healthy and stay healthy.
If you find your knee-jerk reaction to any challenge from the therapist is to deflect, crack jokes or get angry, that’s a big problem which will probably lead to less than favorable therapy outcomes.
Getting in the way of your own progress is not easy to acknowledge or accept, and that’s why many people choose, consciously or subconsciously, to deflect.
Sometimes we might feel shame or disappointment, and instead of allowing ourselves to process that emotion we want to avoid it and maybe even tell our counselor why they are wrong.
The good news is that there’s a great solution to this problem. Anytime you find yourself arguing, being defensive or deflecting with humor, step back and try to pay attention to what’s going on inside of yourself.
At the very least, allow yourself to identify and verbalize the emotion to your therapist as it is probably going to provide important clues surrounding emotions you tend to avoid outside of therapy.
Typically, this leads to greater self-awareness and progress toward your therapy goals.
My hope in sharing these strategies is to help you feel more encouraged and empowered to pursue personal change and growth through therapy.
If you have asked for help previously in your life and it hasn’t worked, please don’t give up hope. The reality is psychotherapy works!
The research has shown for years the majority of people who receive counseling experience symptom relief and meet their therapy goals.
There’s also a tremendous amount of research that suggests the progress gained in the clinical office actually does generalize to the real world, and that therapy helps people function better in their everyday life.
Some studies show that as much as 75% of people who enter psychotherapy benefit from the experience.
Other research consistently shows that therapy improves an individual’s emotions and behaviors and links these transformations to positive changes in the brain and in the body.
If you happen to be living with a mental health problem like depression, anxiety or an addiction, please know your past experiences attempting to find help does not have to define what happens next. Hope is real and help is real, and you can find both.
ABOUT THE AUTHOR: Dr. Mike Ronsisvalle is a Licensed Psychologist and the President of LiveWell Behavioral Health, a psychological services agency that provides counseling to clients of all ages and addictions treatment to adolescents and adults. You can find out more on their website at www.livewellbehavioralhealth.com or call 321-259-1662.