Could I Be the Reason Therapy Is Going Nowhere?

I have been seeing a psychodynamic therapist for about three years for dissociation related to child abuse. She has a PhD, is accredited as a clinical social worker, belongs to professional associations, and is in therapy herself. I have several concerns about her. I have not seen conclusive improvement in the time I've been seeing her. Nor have I gotten knowledge on how to know how long treatment will last or when it will end. She knows little about other options for therapy in my city and thinks they are not qualified to treat my condition. We've discussed the lack of progress several times. She implies that I must proceed at my own pace and that we do not progress because of my lack of trust. It's true that I've never "gone there" with any therapist, though I have seen some that I liked. I feel like I am proceeding with the work on my own time, entirely alone, without any support. I don't know if the problem is with myself or with her. I would like to get past the trust issues, but I feel a lack of closeness with my therapist and wonder if another fit would improve things. How do I know if it's me, and what should I do? —Not Clicking
Dear Not Clicking,

Thank you for your letter. I’m sorry to hear that you aren’t experiencing the therapy you’re receiving as helpful, and I hope that I can provide some assistance. I’m going to start by offering a brief description of psychodynamic therapy and how it works.

Psychodynamic therapy is one of many “depth” psychotherapy processes. It is insight oriented, and a lot of the work is based on free association, where the client simply talks about whatever is on his or her mind at the moment. Eventually, patterns and processes stemming from past experiences and unconscious drives become apparent. The focus of the therapy then goes to the client becoming aware of how these patterns and drives are affecting his or her life. The goal of psychodynamic therapy is not simply to make symptoms go away but to improve one’s life in general. Those are lofty and worthwhile goals that often require some amount of time to accomplish. The experiences one has in life, including trauma, abuse, and neglect, become embedded in the way that person interacts later in life, and it may take some time to work through these more complex aspects of being. There is really no set time that anyone can give on how long one would be in psychodynamic therapy, as it is all dependent on many individual factors that are specific to the client, his or her needs, and the therapeutic relationship.

Now for the specifics of your question: It sounds as if your therapist is well credentialed and doing well by engaging in her own therapy. That indicates that she is a responsible professional, but, of course, without knowing her personally, I can’t say with any certainty one way or another.

What I can tell you with some measure of certainty is that one of the necessary conditions for optimal therapy is that there is a relationship between the therapist and the client. This means a relationship of trust, honesty, respect, healthy boundaries, and mutual willingness to work together. If any of those conditions aren’t present, the therapy process will not go as well as it could. Without knowing you, the therapist, or the relationship between the two of you, it’s hard to say what could be slowing down the process. However, as you reflect on your relationship with your therapist, I would invite you to explore the ways in which you engage in the therapy. Is there a part of you that withholds in therapy? Do you feel like you have allowed yourself to trust the therapist? You mentioned that you haven’t allowed yourself to “go there” with your therapist, and I’m curious if that is holding back the process in any way.

Because one of the most important pieces of a therapeutic relationship is mutual honesty and trust, I would suggest that you start with speaking openly and honestly about your concerns with your therapist, if you feel comfortable. If you can raise your concerns to your therapist, even when it might be a bit uncomfortable, you will be taking another step in trust and vulnerability with the therapist, which can serve to help the relationship. If you do so and you feel as though your concerns are still not resolved, the relationship hasn’t improved, and you don’t feel some sense of resolution, then it may be time to consider moving in a new direction.

If you do decide to go another direction with therapy and your therapist is not able to recommend anyone, GoodTherapy.org’s search engine can help. If you decide to go that route, I suggest that you take your time in finding someone new to work with and that you interview the therapist on how he or she works, what he or she expects, and how he or she anticipates the therapy progressing. If you decide to go with another therapist, take your time and make sure that it is the right fit for you, your needs, and your goals.

I applaud your willingness to seek out therapy and to ask for help when you need it. I trust that you will continue your journey with courage.

Yours truly,
Lisa