Therapy Doesn’t Always Work: Belief, Hope and Evidence Based Practice

depressed shattered manI remember reading two articles in the popular press. The first told the story of a man struggling to control his depression and the second of a man unable to control his temper. In both cases extensive therapy was undertaken but the ‘problem’ continued.

Implicit in both articles was the belief that therapy has the magical quality of being able to help anyone with any problem at any time. I realised that many therapists, consciously or unconsciously, collude with such magical thinking.

When I took my first steps in therapy training back in 1976, it never occurred to me to think that therapy could be inappropriate, ineffective or unhelpful. Indeed, had such things been suggested I suspect I would have been deeply offended and passionately defensive. I was on an evangelical quest. I genuinely believed everyone could benefit from therapy, that there was no problem too great that it could not profit from therapy and no one so damaged that therapeutic skill and Rogers’ Core Conditions could not heal. These thoughts, together with my own journey of healing and self-development together with my optimistic nature, had made me, with the benefit of hindsight, dangerously naive.

Looking back, I don’t blame myself for my naivety as, at that time, issues of social context, oppression and power were not part of the syllabus. The focus was on the inner world. Little if any time was given to issues of psychopathology and how such understanding can save the client and therapist time, money, guilt and despair.

Person-centred therapy brought hope of helping everyone find their true self and was seen as a new and exciting way forward. Therapy was little more than embryonic and practitioners like me did most of our learning ‘on the job’. In the last thirty eight years great strides have been made in considering each of these subjects. Therapists now leave diploma courses far better equipped than my generation. However, I still see well-meaning, overly optimistic therapists unwilling or unable to consider the limitations of the counselling they offer. Such therapists never really ask themselves the question what type of client or client problem would not benefit from my approach?’

Working with clients involves, amongst many other things, belief and hope; the therapist’s belief in his or her chosen therapeutic orientation; the therapist and the client’s hope that a useful therapeutic alliance can be forged, and that the motivation on the part of the client and the skill level of the therapist match. However, false hope and misguided beliefs cause despair for both parties. After all, most clients, whether they are aware of it or not, have faith in the therapeutic process. Many believe if they just work hard enough one day all will be well. Perhaps that is the case. However, perhaps the best some people can hope for is to manage their situation more effectively. If clients are not realistically prepared for what therapy can and cannot do, disappointment sets in.

Much has been achieved in creating understanding of the therapeutic process yet there is still a long way to go in educating the media and, in turn, the general public. However, each one of us needs to consider our own balance of belief and hope. To me belief is based in CBT evidence based practice but even with this there are times I find myself wondering whether are we too idealistic and, if so, could we do damage?

Does considering limitations plunge us into disillusionment and despair and, if so, why? Finding a realistic balance which maintains belief in evidence based practice and hope without abusing faith makes accepting the limitations of therapy one of our most difficult tasks. Of equal difficulty may be the task of transmitting this balanced view via the media to the general public.

 

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