Q I have had psychotherapy for many years with different therapists, why don’t I get better?

By on August 9, 2014

There may be a number of reasons why psychotherapy may not seem to help someone, each person’s situation being unique. Assuming there is actually some mental health issue at hand, we need to break up the explanation into persons who may benefit from psychotherapy alone, and those persons who need something different or in addition to psychotherapy (i.e., to change a situation; to integrate psychopharmacology with psychotherapy; or to receive treatment for a underlying medical condition that affected one’s mental state).
Persons who may benefit from psychotherapy alone but still do not improve are frequently persons who actually have or believe they have some benefit from their issues and on some mental level do not wish to change. These may be persons who feel inferior to others but brag or must always be the leader to cover this up. They may be bossy or have problems following authority. These persons stubbornly hold on to their maladaptive relationship styles which cause them to have secondary problems in relationships which are hard to fix.
Persons who are in difficult situations often continue to have stress and a variety of mental symptoms regardless of having psychotherapy. Stress with one’s spouse or work environment, financial or medical problems, living conditions etc., can all perpetuate negative feeling states. Changing one’s job or getting different qualifications, changing living arrangements with a spouse such as having a private room inside or nearby the home to have “down time”, changing from a sedentary to active lifestyle etc., may be very effective in reducing stress. A therapist can provide concrete and creative means to change the difficult situation, but in the end it is up to the person themselves to effect this change.
Some persons may actually have a problem in their nervous system but do not easily accept this because it may mean they need to integrate medication into their treatment. These persons commonly have depression, anxiety, manic-depression, attention deficit with or without hyperactivity, or other problems. Their symptoms tend to be chronic and they often have a family history of similar problems suggesting they have inherited the problem. While speaking to a therapist may provide these persons with some alleviation of distress, many have years of psychotherapy without real improvement if they or their therapist’s orientation is that their low mood, irritability, anxiety etc. are caused by some kind of childhood experience rather than symptoms of a biologic or inherited syndrome.
Medical problems that can cause mental symptoms are varied and range from diabetes and hypertension, to hyper- or hypothyroidism, brain disorders, medications used for any kind of problem, and of course street drugs. Consultation with an internist and a psychiatrist can help to elucidate if these are the cause of symptoms of low mood, tension and anxiety, panic, fatigue, poor concentration, etc.
If you or someone you know continues to have problems in spite of many months of psychotherapy with one therapist, it would be prudent to get a second opinion. I would suggest meeting another therapist or counselor in addition to an M.D. psychiatrist, and perhaps have some medical testing. Flexibility in willing to change oneself or the treatment orientation is usually key to success in treatment of mental health problems.

About Douglas Berger, M.D., Ph.D.

Dr. Douglas Berger and his staff at the Meguro Counseling Center in the Shibuya-Ebisu area provide mental health care for individuals, couples, and families, in both English and Japanese. www.megurocounseling.com