We go to therapy when we lack the capabilities to handle our life problems. We expect it to help, to lead us towards a better life. Only it not always does. There is still a long way to go for therapy processes before they become truly effective.
The concept is partially flawed
The whole idea of therapy is somewhat paradoxical.
As a patient, you are expected to bring topics to the session. In practice, this means you guide the conversation and decide what to discuss. At the same time, you do not actually understand the therapeutic process. If you do not know how change happens, how can you reliably choose the right topics to work on?
In many forms of therapy there is no detailed session plan. Goals may exist at the beginning, but they easily disappear in the routine opening question: “How have you been since our last session?”
If you do not deliberately bring another piece of the same issue that relates to the original goal, the session can drift. It becomes a stream of experiences, reflections, and associations that may or may not move the process forward.
There are therapeutic approaches with more structure and others with less. Cognitive-behavioural therapies, for example, tend to emphasise agendas and goals more than psychodynamic approaches. I appreciate that difference. However, even when working with therapists who claim to use structured, short-term methods, the structure is not always present in practice.
Therapists often describe their role as accompanying the client on their journey of change. But accompanying someone is not the same as guiding them. In many cases the therapist follows where the patient leads, assuming that the patient knows what is best for them.
The difficulty is obvious. If someone does not know how to make progress, they also do not know what to focus on or how deeply to work on it. The result can be touching many topics without achieving meaningful change.
No clear deadlines
Another problem is the lack of timelines.
Imagine you go to a doctor with a strained muscle in your leg. The doctor confirms that you need therapy to recover. When you ask how long it will take, the answer is:
“It depends. On your willingness to work, your ability to process things, and many other factors. It’s impossible to say.”
You receive one exercise, but no explanation of why it should work. Next week you return and the doctor asks:
“So what would you like to work on today?”
You request a massage because you read somewhere that it might help. The following week the doctor again asks what you want to do. Now your other leg hurts because you have been compensating for the injury, so you ask them to focus on that.
Eventually you realise that the original leg is still not fully functional. When you return again, the doctor asks the same question: what would you like to do today? In such a process it would be difficult to recover efficiently. The original goal gradually disappears while the treatment circles around symptoms.
Of course this is an exaggeration, and not all therapists work this way. But when people describe long-term therapy that continues for years without measurable change, it raises questions.
Research reflects part of this concern. Studies of psychotherapy outcomes show that many clients improve within the first 10–20 sessions, while others remain in treatment for much longer without additional gains (Howard et al., 1986; Probst et al., 2013). This has led some researchers to argue for clearer goals and regular progress monitoring. This also rises an important question – would the same patients not improve if there was no therapy? Could it be the effect (even if partial) of regression towards the mean?
Therapy should be targeted
Without a clear target, therapy can become endless. And pointless.
Just imagine you want to create a mobile application. The goal is clear – you have target audience, you know your target income. So you go to a software house and… they just give you people so you can run your own project. No goal, no structure, no tracking. Would it feel efficient? I guess not. Therapy is similar.
Goal-focused approaches, such as cognitive behavioural therapy or solution-focused brief therapy, attempt to address this by defining measurable outcomes and evaluating progress regularly. Evidence suggests that tracking progress and adjusting treatment accordingly improves results and reduces dropout rates (Lambert & Shimokawa, 2011).
Intellectual capabilities mismatch
Therapists do not always evolve with you. Sometimes it’s even worse – you have to explain your progress to them, which is counterproductive.
Therapists are human, and if you change quickly, they may not keep up.
This leads to a broader problem. If your ambitions or life ideas go beyond what your therapist has experienced, they may not be able to help you with them. Not because they are unwilling, but because they do not know how.
There is also a widespread belief that you should stick with the same therapist for a long time. I am not convinced this is always productive. If you are in the middle of a structured process — for example, a short programme with a defined goal — then it makes sense to finish it. But therapy is not a lifelong contract. Different phases of life may require different perspectives. What I experienced though, was that we should stick with a therapist because it’s the relationship that heels (I doubt a paid relationship can actually heel anything, to be honest, but it’s a different topic). I disagree with it – what ‘heels’ is progress. So sometimes changing therapists simply means adapting to new challenges.
Another problem I see is that your therapist asks you a closed set of questions. Yes, they vary from one session to another, but after a while, you learn what their approach is and what they would ask you in a specific situation, what they would advise, or tell. The smarter you are, the quicker you will get at it. And this is the moment when – if the therapist doesn’t evolve with you – they stop fulfilling their purpose. If you add to it that there is no goal and no deadline, it’s easy to get to the conclusion, that there is also no benefit to stay in therapy.
It doesn’t increase our sense of community
It could also be that the way individual therapy is designed, how a therapist is not supposed to share much about themselves or just be with the patient, doesn’t actually help. Since community can impact our well-being so heavily, it’s a pity that individual therapy doesn’t focus on it. Even the way you sit with your therapist, with a table between you or a few metres’ distance, suggests that you are there to talk, not to be together.
Knowledge stinginess
Another issue is the limited sharing of knowledge.
If I had not spent time studying psychology independently, I would understand very little about my own behaviour. Therapy often operates on the assumption that insight will emerge through discussion rather than through explicit teaching. However, many clients want to understand the mechanisms of change. Research on psychoeducation suggests that explaining psychological processes can increase engagement and sense of control, especially in structured therapies.
Psychotherapy is supposed to put you in control of your life, your behaviour, and your thoughts. This is its ultimate goal. Just how can you be in control when you don’t understand what is going on with you, what to expect from the process, and when the knowledge is not shared with you?
Mentally, you’re back to school with a teacher who knows it all but only shares what they decide to share (which, actually, when it comes to therapy, is very little). This takes all the control of the world away from you, leaving you helpless, while at the same time you are supposed to control your life. Therapy is for really strong people who know where they are going and what they want to achieve and who can overcome this, to say the least, hurdle.
Mistakes we make as patients
The therapy relationship itself also creates behaviours that are not always helpful.
One common mistake is putting therapists on a pedestal. Because they are professionals dealing with psychological issues, it is easy to assume they know better about everything. In reality they are specialists with certain tools, not authorities on every aspect of life.
Another mistake is trusting them too much. Therapists can be wrong, just like doctors or researchers. Professional training reduces mistakes but does not eliminate them.
The opposite mistake also happens: refusing to trust anything the therapist says and automatically doing the opposite. If someone cannot accept any authority at all, therapy will probably not work until that issue is addressed first.
Then there is familiarity. Over time therapists can become part of your routine. It becomes harder to leave because the relationship feels comfortable or because therapy has become a habit.
But therapy does not have to be continuous. It can come and go in phases. Sometimes you need help, sometimes you work independently.
Is there any hope?
Yes! What you get is someone else’s perspective that broadens your own. A therapist can help you identify areas where you need some work. They can help you get unstuck. They can help you relive your traumas in a secure environment, in case you need that. They can show you how to cope with your daily life issues, they can teach you some strategies.
What is crucial though is to find the right one for yourself, and never be afraid of changing them to a different one. And most of all – never give up on self-work, only relying on your therapist to lead you. You are in charge of your life and of your goals.
Here’s what you can do as a therapist
Choose a goal and a target date. If as a therapist you see that the goal needs to change temporarily, agree on it with the patient, and change the agreement you had. Whenever you see the patient themselves move away from the goal – let them know.
In the coaching approach, there is what is called a contract that both client and coach sign. It has a form of an agreement covering the rules and responsibilities of each party as well as the timeline and the goal of the client. This should also be part of the therapy practice.
As a therapist, you should always have your patient’s goal in front of you, so you don’t dwell on topics that get your patient nowhere. I appreciate that sometimes it’s difficult to tell upfront if something is related to their issue or not. But try to spend as little time on other things as possible, and always go back to the goal at the end of each session. Check if you are making any progress. If not – you have to figure out why.
As for a deadline – it doesn’t have to be a few weeks or a few meetings. It can be a year, half a year, or 9 months… as long as you both have it in mind and stick to it, make sure that the progress is tracked over time and that the goal is actually reached within the timeframe. Your patients do not come to you to rummage through their guts for pleasure. They come to you to fix something in their lives. So help them do it quickly.
Another thing to do is to educate your patients. They need to know what’s going on and what to expect. A need for control is not something to be diminished or neglected. You want them to take control and be responsible for their lives, so don’t take the control away from them.
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Given all that, would I recommend therapy in general? Well, yes – but not to everyone and not all kinds of it. Decide only after doing proper research to match your goal with the therapy method, and make sure you choose someone who is goal oriented. And don’t be afraid to change your therapist or ditch it if it doesn’t work.