Why Psychotherapy Sometimes Fails

My problem with psychotherapy.

In this video, I talk openly about why I'm not totally sold on psychotherapy. As a therapist, I've struggled with its drawbacks. I'll explain why I think it doesn't always work well and how it can miss the point when it comes to helping with mental health. Whether you're a therapist or someone considering therapy, this video offers valuable insights into the challenges within the field. Let's explore together and envision a more effective approach to mental well-being.

0:00 My problem with psychotherapy
1:54 The goal of therapy
2:30 Therapeutic Coaching
3:00 Your are not broken

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[maciejsiedziako]

What put me off therarpy was that my therapist was speaking about where my behaviour came from, and what is healthier approach but it didn't helped me at all move into action. I was too afraid. I guess he didn't understand that even that I knew what is better to do, I wasn't able to because of my deadly fear of being judged. No amount of knowledge helped me. I knew everything he told me already.

[leikkivaki]

"independence - not dependence" that is also how I feel. You need to trust yourself 🌻

[Grace-drlv]

Really refreshingly honest and insightful take on the therapeutic space - avoiding the pitfall of assuming individuals are broken. Seeing others experiences of psychotherapy, glad Alex emphasises the importance of not creating dependency. Too many people feel such a loss when therapy comes to an end that it can undo the whole purpose of therapy! Left with the right tools, sharing your inner most thoughts with someone would feel truly empowering and worthwhile.

[thjbridges]

I think the best therapy happens in that crucible where difficult emotions and the memories linked to them are teased out by the therapist and emotion regulation techniques are taught and used to process them.

Emotion regulation is absolutely necessary and so helpful when we are overwhelmed, but it doesn’t “work” by itself. The point of therapy for me is processing. I don’t want to just learn how to cope, and I don’t believe coping mechanisms alone are always particularly healthy. I want to grow and to move past the things which cause me to feel stuck. Sometimes we have to unpick something in the past to give us the perspective and awareness to move forward. That deconstruction and reconstruction, the “reprogramming”, is the most powerfully healing aspect of therapy for me. There is something about therapy that is refining, building, smithing. This creative aspect - “who might I grow into?” - is often neglected when coping mechanisms are the focus. Often coping mechanisms can become just another way to avoid dealing with our emotions and keep us trapped in a state of stagnation.

However, I also think analysis and dependence on the therapist as a “fixer” is extremely damaging. That very dynamic teaches a client that they need to be “fixed”. Digging deep into the past and relying on the positive therapeutic relationship to fix everything is long drawn out and tortuous if there are no tools we can use for relief. And I totally agree that it’s far too long a process and we are not “broken” - and a therapist acting as a fixer can lead to unhealthy dependence.

I like the old Jungian adage - “we do not cure the neurosis - the neurosis cures us". We don’t go to therapy because everything is great. Something IS wrong. But it’s less about fixing something that’s broken and more about creating space for healthy growth. And that healthy growth is spurred on by something from within us, not by the therapist or anyone else. The best therapy helps us to realise that.

[lindatownsend]

Totally agree with this. I have been working for at least 15 years to get into a better space. Have tried therapeutic relationships, community group therapy, alternative medicine etc but nothing really worked. Each time these therapies failed I bought further into the story that I was broken and felt even more broken. Your course was the first that was truly helpful. Thank you so much for making this available and for all the information and support you make available.

[kingfisher]

I have, right now, a great therapist for me. I told her I didn't want the old daddy/child relationship; that I did my own work and always had; and that what I wanted was the sense that I just went to coffee with a good friend who had my back and was wise in different ways than I was. Also, a feature of my high-functioning-autism is an interest in EVERYTHING and I appreciate having a friend who can follow me through context and fruitful digression and then tell me what themes she saw and what questions came up.
From the beginning, it has been great.
Since I think and make sense of life through story, I enjoy using metaphor (and therapists tend to suddenly lose their minds and think I'm being literal and possibly have multiple personalities when I start talking Jungian archetypes -- it's annoying and, frankly, immature and uneducated of them). My therapist knows Jungian philosophy. Thank God. I also make a lot of literary references that are lost on most therapists (who do not have my education). This therapist is well-read and can recognize a reference (because it is not in my normal vocabulary or speaking cadence) even if she hasn't read the book and will ask me to elucidate (because the meaning of the reference is in the story as a whole).
I also said we will NOT be doing Cognitive Behavioral Therapy because I'm a cult survivor (born into it, third generation, been out a long time) and cognitive behavioral therapy is exactly what cults use to brainwash members (constantly re-writing what happened, calling your memory into question, telling you that you have negative expectations and that's not really what's happening). There are some good things in CBT, so, I took a course in it some years ago (designed to give one a certification as a CBT coach). It's manipulative. I wouldn't trust a CBT therapist as far as I could throw him. Therapists using CBT assume that they have the "right answer." Daddy knows best. What does a 30-something baby CBT therapist know about being a cult survivor and autistic and how one such individual navigates the world? I won't tolerate that kind of arrogance in a therapist.

[PlannersByKat]

The older I get the more I don't think going back to your past to figure out the why helps. But I'm probably just old. I know trauma exists, but I think it's a wrong approach for everyone to assume you have to heal it to move on. That can make people feel stuck. So, practical strategies for the present moment and future is what I would like to see therapists focus on and I think more and more do.

[a.grover]

Spot on, Alex (Dr Howard). I'm a therapist and I am turning more to strengths-based modalities because the clients are so resilient already, often through their spirituality, culture/family, or simply having lived through trauma and survived.

[jilldickson]

A psychiatrist recently told me I needed to fix my own anxiety and sensitivity. 😢😢 but he didn’t tell me how.

[humbleviewpoint]

Yeah! I don't know that my opinion is correct but, I think I became a better life coach when it stopped being part of my need to matter. When I got some kind of fulfillment from creating dependency, I was part of the problem, not the solution. My instincts tell me that your approach works with many people.

[katrina]

I haven't met a therapist yet, either professionally or personally, who isn't screwed up themselves. Sorry Alex but that is my own personal experience. I have absolutely nothing against you, I am very supportive of your work, I am just saying, that is what I have encountered. Hence the reason I stay well away from therapists.... I wouldn't trust them with my mind... Personally I have always preferred to do my own inner work, however that isn't always for everyone and many people find 'benefit' from therapy. That's if you can afford it...

[ioanacristinabratescumusca]

... feeling trapped like in a chain of thoughts causing behavioral patterns is a kind of dependence ...unlike awareness of choices of behavior, flow of emotions, which are not necessarily equal to independence, but with a sort of personal autonomy, self-agency that does not exclude self- observation ...

[Krinsta]

I think it's always better to give tools so that people can live a better life without weekly therapy.

[yinchimoon]

I have been struck by the respectful relationship you have achieved with different clients. However I am curious why you don't think it would be valid for more complex mental health challenges. I feel we have bought into the medical model about DSN labels when it seems there is an increasing awareness that these are actually descriptions of adaptive trauma responses an example being dissociation.
Surely the same psycho educational and practical tools are necessary but I would add that groupwork facilitated under Yalom's group as the healing modality, is also a vital aspect of reparative relationship and communication practice for complex trauma, maybe for someone such as Pierre. I have long felt that dependency culture of psychotherapy also heightens the possibility of the abuse of power.
I appreciate you bringing this issue out in the open.

[jenobryan]

Alex have you had therapy yourself? Is this your experience of psychotherapy?
I don’t agree with you at all and as a Therapist who has done my own deep personal work it was the therapeutic relationship that was essential.
Be careful with criticising other therapies to boost your own work here.

[robynparkinson]

Disagree. The therapy relationship is paramount to helping me. A good therapist does not say or make me feel I'm broken BUT it's super important that they also recognised that is how I feel, dysfunctional and broken. I need the experience of consistent, well contai ed, unconditional positive regard, just because that's what was lacking in childhood. I need above all to be seen. I've gone from active suicidality to not being suicidal simply from a human interaction that showed me that: I flipped back from getting the opposite. I don't believe there are quick fixes when it was relationships that created the trauma.
It's not a sign to me that my therapist is creating dependence, no good therapist should do that. The years I need in therapy are a sign of how deep the damage went. And yes, I've tried the quick fixes like EMDR. They only get me so far.
The best trauma therapy is individualsed to the client. The moment you tell me you teach these regulation party tricks to everyone, I'm outta here. I'm hyper sensitive to copy and paste advice. That's the legacy of my childhood trauma. YMMV

[Yavor-Karapetrov]

Psychotherapy Always Fails. Breath work - Too !