Ep. 198- 5 Things That Make Therapy Not Work
This episode breaks down practical strategies for getting more out of therapy and the common mistakes that can quietly get in the way of real progress.
Have you ever left a therapy session feeling better for an hour, only to find yourself stuck in the exact same patterns a week later? Or wondered why someone can spend years in therapy without seeming to change?
In this episode, Dr. Kibby explores the habits that often prevent therapy from being effective. She talks about emotional avoidance, people pleasing, staying in "problem talk" instead of focusing on change, and why honesty with your therapist matters more than trying to be the "perfect" client. She also explains how to choose the right therapist, what questions to ask before starting treatment, and why the work that happens between sessions is just as important as what happens during them.
Whether you're in therapy yourself or supporting someone who is, this episode offers practical ways to make treatment more meaningful and increase the chances that it leads to lasting change.
Resources:
- Chapman, A. L., & Rosenthal, M. Z. (2016). Managing therapy-interfering behavior: Strategies from dialectical behavior therapy. American Psychological Association.
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Welcome back, Little Helpers Today I'm going to be talking about what makes someone a bad therapy patient. And the reason why I'm talking about that is because some people have had great experiences with therapy, but some haven't, right? And you might have loved your therapist, but felt like, you know, I I really didn't change a lot, or this didn't really work, or I don't believe in it, it didn't really help. And I
And it's it's it's really a shame that we don't have a ton of options for mental health treatment besides for psychotherapy. So I agree that there's a lot of limitations in in traditional therapy. However, as a therapist myself, there is a lot that the patient themselves can do to make the most of their therapy. What they put in, they get they can get more out of it.
And I've seen this a lot where people are in therapy for years and years and years. And I'm like, I don't know if this is working. Like, I don't even know if they're getting better. so I think it's a real disservice to, you know, the mental health community or people in general that we don't know how to actually make the most out of therapy. Like, no one teaches us, and I don't I think their therapists are
I'm probably not the best at trying to tell patients how to do it. So, how to do therapy, how to be a patient. So, I'm gonna talk about today the five things that we commonly see therapy patients do that get in the way of their own progress, their own treatment, their own transformation. and I'm also gonna talk about it like what you might be doing, but also what you
You know, if you have a partner or another one who's going to therapy and you're like, great, they're finally getting help, and you're noticing that they're not changing, like what why that could be happening. It's not always that the therapist is good, but you know, it might not be the therapist. It might be how that person or you are engaging with the therapy. So I'm gonna talk about the top five mistakes or things that people do in therapy, but of course, I'll talk about
the opposite, like what to do to make the most of your therapy. It's like the the opposite of those points.
And real quick, wanna tell you that if you have a loved one who is struggling with mental health, like they have anger issues, they have trauma, they are struggling with addiction, and the c relationship between you and them is really, really hard. That is what my whole program is all about. KulaMind is built for people like you who want the skills, the knowledge, and the support to be able to
Support your loved one with mental health issues while not losing yourself. So I teach a lot of skills in that program that I talk about here, like setting boundaries, validating feelings, how to communicate, how to talk to someone about going to therapy and getting help or dealing with intense crises, like someone's trying to hurt themselves or texting you angry things all the time. Like, how do you actually handle those situations? So
That's what I teach in my program, KulaMind . And I it's so fun. I just got off of the group call where I taught about we talked about how to talk to your loved one who is at risk, like at higher risk of hurting themselves. And it's just such a great group. And I I I don't know, I just I just love it so much. And not only do I teach these skills, but I I really make sure that I help you apply them.
So there's so many people who say, I have trouble setting boundaries and I know I should say no and not let them hurt me, but here I don't know how to stop. And that's really where I help is being like, okay, let's walk through that together. So that's interesting you check out our link in the show notes or the description or you could look up KulaMind k-u-l-a-m-i-n-d . com. And you could apply or reach out to me and we could talk further about whether this is a good fit for you.
Anyway, okay. So what makes you a bad therapy patient? before I dive into that, actually, I want to take a little detour and talk about what to do before you actually start therapy. I think that's really important too. I think in general, like how to make the most of your treatment, even from the very beginning, I think is really helpful. So the number one thing is really do your research and look around for what therapist is a good fit for you.
Even I, who knows a lot about this, will if I'm looking for a new therapist, I will go on my insurance, look up yeah, I'm looking for a provider, looking up who's the therapist who's like closest to me or has an availability, and I'll pick them and I'll do a consultation session or call with them. And then I'm like, well, now I've opened up to them, I'll just kind of ride this out until I I
don't need therapy anymore, right? And a lot of people don't realize that it's okay and expected to look around, to shop around, to try out different therapists at first, get get on a call with them for a few minutes, get on a Zoom, maybe do an initial session and just see what the fit feels like. It's a lot of people when they even do that, it's natural to just like
Tell them all your problems, right? Because like you're, finally, I got a therapist. Let me just tell you everything. But a a better way to go about that is asking them questions, asking them, what is your specialty? What kind of patients do you usually treat? What are your strengths as a therapist? What modalities or types of therapy have you been trained in? when I talk about these problems of mine, what do you think about them? What do you think is the way that I should
That we would want if we work together, like what is the way that I should address these problems, right? So you really get a sense of how that therapist is thinking and what their background is. very, very important. And so two parts of that fit with a therapist are one, their specialty, whether they have training or experience in the thing that you're looking for help on. So if you're looking for a therapist for eating disorders and the therapist doesn't have a lot of experience with that.
It they could be great, it could be great therapy, but you might have a better, better experience with with someone who has like kind of behavioral therapy for eating disorders or has worked in an eating disorder clinic or has had that those patients before. Right. So looking into their background and thinking, okay, I'm struggling with work anxiety, or I'm struggling with the relationships. And does that person how how what's their what's their background? What's their training in that?
The other part is just this human connection. Do you feel safe with this person? I can't tell you exactly how to pick that. sometimes that takes a lot of self-awareness on your end to be like, what is the type of person, a type of therapist that will actually help me towards my goals? Right? It's not always
the one that is fun or that you like or that's just very nice, right? That might be great. So that might, you know, you might feel safe with them, which is important. But another piece is who's gonna get me to change? Who's going to what what kind of therapist is going to actually like, you know, help me get to where I need to go, right? Sometimes a fun, soft, sweet therapist feels good, but
They're not going to push you in the way that you need. So this is time for you to be really honest with yourself and say, if I want to get the most out of therapy, who what kind of person is going to be like that? Is it male or female or non-binary? do they the certain religious background, political background? are they warm? Are they empathetic? Or are they very strict and firm and direct?
are they funny? Like, is it in person? Is it online? Right. so all of these things, even group therapy too, think about that. and also think about what kind of practice they're in. If they are in their own practice, and they're like just solo, they just have their own practice, that's gonna have a lot of a lot of benefits. Like they might have flexibility, they might have negotiable rates, I don't know. But
If they're in a group practice, that has different pros and cons. sometimes people in group practices, sometimes therapists and group practices have a lot of resources, right? They have other colleagues that they can consult with. They, if they are go on vacation, it might be easier to say, hey, someone else in my clinic will cover the time that I'm away. but there are downsides of like whatever the clinic's policy are policies are.
You kinda have to listen to that. So think about all these different all these different things and know that this is a relationship, right? This is this is something that you will it it should push you to out of your comfort zone. it should make changes in your life that are healthier. That's always that's not always gonna feel good. So you wanna make sure that you feel safe, but also
Is this a space where I can really grow? and it's okay to do a couple sessions and determine that it is not the right fit and try someone else.
On the other hand, if you know that you're the kind of person that is more critical or takes a harder time to warm up, if you still feel that with your first sessions with someone, you might be more of the kind of patient that needs like one or two initial sessions to feel out the fit, right? So it depends on you and what you need, but this is a totally
Totally a part of the process to shop around for the therapist. That's a that's a good fit for you. The fit makes a huge difference. Okay. So that is pre-therapy, right? That's just like finding the person. Once you're in the therapy process, there's a couple things. I'm still going back actually to the pre-therapy. There's a couple things that you should know. One is that you
should always be able this is something that my my advisor taught me when I first started training in therapy. And I thought it was so weird because I never thought about it before. But then when I'm in session and when I'm working with people, I'm like, I see.
I don't know why, but probably from the Freudian era. going on off a tangent, so so bear with me, guys. But back in the Freudian days where it's like the Freud is or like the psych psychoanalysis look like someone sitting behind you and they're sitting on a couch, and you know, it's like them talking and you're like getting better, but don't really know how. It's kind of like a black box. I think in traditionally
when therapy was more authoritarian, like there's an authority figure and they're the expert and they know how to heal you and you're kind of like their patient, right? When it's more like hierarchical in that way, as a lot of healthcare was in, you know, generations before. People have still come to expect, even now, that they're gonna go to therapy and they know that therapy's helpful.
But they like don't know what's happening, right? They don't know what you're working on, the the techniques or the what we call mechanisms of change, like how how things actually change and improve. Like you don't, I don't know, right? We we're I come in for work stress and we're talking about like my mother and I don't know why, but like I guess that's gonna make me feel better, right? You shouldn't feel like you have no idea what's going on in your therapy treatment.
you should be able to ask, and you should ask in the beginning, during, at any point, like, hey, what are we working on here? Like, what do you think? What do you think my problems are? and what do you think is the way that we're addressing them? Or what do you think would be helpful for making this change? Right. a good therapist should ask you in the beginning what your goals are. And that should sound like something like,
If you got better, what would that look like? Or what are you looking for? What are you hoping to get out of treatment? What are your biggest problems? what would it look like if you if you change and improved, right? And I'm all sorts of words. But unless it's really obvious, like I'm here for eating disorders treatment and I want to be healthy, like to overcome the eating disorder, right? Either way, it should be very clear what.
We're all working on. You shouldn't get to the point where you're like, my I think my therapist keeps talking about eating disorder, but I'm thinking about my mother, right? So there shouldn't be a disconnect there. You should really understand, like, okay, here is what we're working on, and this is how we're working on it. And this is how the therapist thinks about that problem, how they conceptualize it, and how and their model for change, meaning, what do they think the problem is? And
How do they think we should solve it? Seems very simple, but so many people don't know. So if you don't know, feel free to ask your therapist. They're actually dying to talk to you about this stuff. This is like the stuff they think about all day. and they would love to share it, actually. And if they don't, that's a little suspicious of their like, why? You know, you should be asking these things. Like, that's not a great therapist. so everything should be clear, right?
You this is a service, this is a treatment, you should know what you're treating, and you should know what the treatment is all about. So that being said, that's like laying a good foundation. Now, let's say you are working with a therapist. here is the stuff that I see people do that is really normal, but gets in the way of them getting better.
And I'll I'll list them out and then I'll go into depth on each one. The first is emotional avoidance, avoiding the real pain, the real issue. Two is lying, not being honest with your therapist. Three is trying to be the good client, people pleasing and showing the therapist sides that you think that they want to see or that you think is
More acceptable. Four is staying in problem talk, not change talk. Venting, just venting, only venting. And five is not changing outside of therapy. So
I'll go into each one of those in detail. All right. So, and I'm lemme let me be clear again. If you do any of this, or if someone you know is doing any of this, this is actually part of the therapy process. So we expect a lot of this stuff as therapists, but if you keep doing it without addressing it or changing it, you're gonna get in your own way and you're gonna feel like I'm not getting the most out of my therapy, or I'm just feeling good.
After the session, like I just, you know, dumped all my stress and now I feel good, but it doesn't actually improve your life, right? So here is what is going on with those things and what to do instead.
One of the most common causes of mental illnesses, causes things that maintain it, whatever, is avoiding emotions. That has come up over and over again. That's how therapy was born was born, right? Freud was like, these poor women are not talking about how much they hate their husbands and how they're depressed and now their hands aren't working, right? So it's actually like.
Once we actually talk about emotions and even the painful ones, the difficult ones, regulate them, accept them, that can do wonders for a lot of people's mental health. So it's really a natural thing for people to avoid the real pain that they came in for, the real issue. But the problem that got them there, they might maintain while they're in therapy. So
What it what it looks like is talking about this is the most common one. I see this almost in every patient.
Okay, this is sorry, let me let me back up backing up in my head. Avoiding the real issue, focusing on the thing that is a problem in your life, but not realizing or not discussing or addressing a deeper pain. This is really common. I see this all the time. People come into therapy and they go.
You know, I'm just my boyfriend is driving me nuts or my job is awful and I don't know what to do with my career, and all I'm doing is ruminating about how my career sucks. But then in the first session, usually actually I get the you know, people actually say what the real issue is, because you're trying to understand their whole life. Like, yeah, I'm really stressed out about work.
yeah, my dad used to beat me a lot when I was a kid. Anyway, I'm wondering how to really like my job again. And then I'm like, okay. there is like a surface level issue that is on the front of their mind. But there are other types of pain that they're so used to smushing down, avoiding, suppressing, that it's coming out in these different ways. Right. So
Talking like really focusing on no, this is the problem, not this other thing is one is one way that people really avoid the pain. another common thing is talking about other people, right? The whole blame defense where they might feel ashamed, they might feel sad, they might feel whatever, and they're talking about how this other person sucks, right? This
friend or my husband, I wish he would go to therapy because he is a jerk and he's ruining my life and blah blah blah. Like, you know, if it's if you're finding yourself in therapy, always talking about another person, right? Always fixating on it's almost like thinking like, my life would be better or my anxiety would be better. My my mental health issues would be better if this person changed.
That is actually a way of people avoiding their own pain. if you're like, wait a minute, what about other people are part of my pain? The thing is that in therapy, we can't actually change other people, right? I but we say this a lot as therapists, like, yeah, your husband might be a jerk and they have all these problems, but he's not here with me. Right? He's not in the treatment. It's you. It's it's you who will have to make the changes.
Right. You could make changes in response to their changes or what their their behavior, but we're working on you, not him. So sometimes it just feels like there's an avoidance that's a strategy for avoidance, emotional avoidance.
there's another way that people avoid emotions and therapy but actually look like they're being really good patients, which is being very intellectual. boy, that's one of the hardest because it is so tempting when you have a smart, self-aware, informed patient who can talk until the cows come home about all their issues.
I understand that I I suppress my emotions and I intellectualize and I really need to work on my emotional regulation skills. It's probably because of my trauma from my abusive narcissistic mother, blah blah blah, right? Like there's so much on Chat GPT on the internet and social media that people come in sounding like they went to get a psychology degree.
or not, they're just really good at explaining their feelings, explaining their problems, almost like they're mapping out the problems for you as a therapist. that could feel really pro productive, you know, for both the therapist and the patients, like, wow, they're talking about so much stuff, they have so much self-awareness. But if you are doing that in sessions and you're not feeling anything.
Like, I'm not saying you have to cry every session, but if you don't feel vulnerable, if you don't, if you find yourself like dancing around a topic that you really hope doesn't come up in the in therapy, and you're spending a lot of time trying to figure things out, like you're literally living in your head and not your body, you might be avoiding emotions through intellectualizing. And that's really hard for everyone to to pinpoint, but it really gets in the way.
And then there's other really normal human ways of avoiding emotions in therapy. My God, some of the funniest patients I've had are like delightful and they tell great stories. they're the hardest because it's slippery, right? Like they some they start to talk about something painful and then ooh, you know, make a joke out of it or change the subject or flip it on me, right? It's so there's all these different ways that, you know, actually.
can be sometimes useful in other contexts, where like social skills to avoid emotional pain. But in therapy, of course, people are human. They're doing that again. They're in a relationship. Of course, they're gonna do the things that they're doing outside. however, not knowing that making a joke is actually bringing them out of the pain, right? It's actually like a way of blocking the full experience of that, of that feeling. So all of that is
avoiding the real pain and emotional avoidance that is very, very common in therapy, but gets in the way. The second one, not being completely honest, not being honest with your therapist. one workshop I I went to where this therapist said said this beautifully. He was like, you know, we go to therapy to become whole again. And I was like, wow, that is such a beautiful way of describing it.
It's we have in our daily life parts of ourselves that we don't like, or parts of ourselves that we keep hidden or can't be shown or that we forgot about, right? We're very complex people and there are feelings and ways of behaving and details that
You know, get pushed aside or hidden from from view. so it it makes total sense that you go into therapy and you go into a mode of whatever patient feels like to you, and you go, here is the issue, here is this, here's that, and you present one side of yourself. That's really common. I do I've I certainly have done that.
Yeah, I've I I I tend to when I'm in therapy, even when I was a kid, I was never that vulnerable. Like my therapist have said has said to me, like, I don't see you cry that often. And I'm like, that is crazy because I feel distressed or sad or anxious all the time, but I don't seem like it. Right. So I'm like showing them one side of me, even unconsciously. so people come in, we'll just
show one side to their their therapist and they're downplaying other parts of them. The I mean some ways that they do it unintentionally or intentionally are like leaving out important details. there was a I'm gonna try to I'm gonna obscure the all the details so you don't
So I don't betray their privacy. But there was a patient that I was working with who was like, I am so sad. Like, my biggest problem is that I feel disconnected from my spouse. And I like, I think we're gonna separate, and that it's breaking my heart. Like, please, I I wanna do anything I can to get back together with them. And the spouse was just not having any of it, was not, didn't want to talk.
To my patient, didn't like kept them far apart. Like it, and it didn't make any sense because he seemed so loving and desperate to like care for a spouse and everything. You know, it just seemed like confusing to me. And then I ended up talking to their couple's therapist, their previous couples therapist, and the couples therapist revealed that
They have gotten violent. So my patient has phys had physically harmed his spouse and she was afraid of him. Right. I didn't know that. Like we worked together for months. and I've asked all sorts of questions and that never came up, right? So there could be leaving out important details because the person just doesn't remember or doesn't think about it, but there could be other things of like shame or like just not wanting.
the therapist to see that side of them or to make them seem like the victim when really they're hiding other things that they've done. I see this a lot when it comes to people with borderline personality disorder or addiction or other kind of like dysregulation is that they will go to their therapist, talk on and on about how their parents are abusive.
But they don't reveal that they themselves were abusive to their parents, right? So, if so they present themselves as like I'm a victim of something, but they'll never say, yeah, I tried to strangle my mother, right? Or that I that I text horrible things to both of my parents, and that's why they're not talking to me anymore, right? So lying or deceiving or keeping a part of
their life or things that important is a problem. Now I will say that it makes sense to it makes sense that you not you might not know everything that would actually you should disclose, right? There's I've I've seen a bunch of cases where people just didn't think that
smoking weed, like vaping, or their medications or you know, a sick an illness that, you know, they didn't think was related or had a problem. Like they some people just like forget that there's stuff that happens. Like I've talked to patients who are like, I don't know why I'm so anxious all the time. and then I find out that they're like downing Xanax every night or clonapin. And then the next day they feel so anxious and I wonder why. And I'm like, like and we've
We spent like months and months, you know, assessing, but they just did they forgot to tell me about that, right? So some sometimes you just don't know what you're supposed to say in therapy. and but if you don't know, you could ask. Be like, you know, with these issues, is there anything that you feel like is missing from what I'm telling you or something that doesn't make any sense, or hey, I I've actually been vaping weed for, you know.
Five times a day every day. Does that does that have any impact on my emotions? And the therapy and you could talk to your therapist about that. So lying. Three is impression management, right? Trying to be the good client. So all of these things, I mean, it's so weird, especially when you're if you are socially anxious or have relationship problems, it's so weird that we
That our main treatment is like going to make a relationship, a very intimate relationship with someone, sharing all of your secrets and trusting them, right? For people who have trouble with that, it's crazy that this is what we have as of the treatment. It's kind of like, yeah, we have great treatment for, you know, like fear of flying.
It's on an airplane. So why don't you get on? And then when you get up in the air, then we'll start the treatment. I mean, it's just like, you know, it's hard. so there's a lot of stuff that people tend to do that they're coming to treatment for, that they end up doing in the treatment that get gets away in treatment. this is common when you have people who are have good social skills or have ways of coping with.
fear of intimacy or, you know, relationships or people in general. where patients try to, you know, seem good to their therapists. They agree with everything the therapist is saying. They never question
what the therapist is doing. Like all the questions that I talked about before of like asking them, What are we working on? And they'd be like, I never would say that. I would never want them to feel bad, right?
And I I I find this really interesting too because this is this is one of the biggest disconnects. I'm like, I wish people knew this more. They would get so much more out of therapy. I hear from my friends and other people that they might have a problem with their therapist, right? Like, I find her annoying, or the she made a comment that made me feel bad. I actually don't know if this therapy is working. And
I don't know if this therapist is any good. or you know, I I I don't know what to talk to them about anymore, right? There's like an issue with the with therapy. And what people tend to do is they go in, they do their groove of talking about whatever they talk about, and then they go like biasing next week. And then they just stop coming, right? They ghost the therapist because they're like, the therapist sucks, right?
The problem with that is that those frustrations, problems should be discussed with the therapist. They want to hear it. Right? it's an important part of therapy. First of all, from just a practical standpoint, right? If like you're not feeling the therapy is working, br bring that up, right? Like, you know, say like, hey, you know, I just wanna talk about the therapy. I don't.
Feel like I'm getting as much out of it as I, you know, I'm hoping. but like talking through these frustrations is super important. And people don't do that because for all sorts of reasons, like, they'll hate me. they will, they will, you know, they'll I'll lose this like perfect image that I've made of myself for them. Like they'll be mad at me, they'll disapprove of me. or even just like the awkwardness.
Like people just stop going to therapy because it feels awkward, uncomfortable to say, hey, I'd like to stop therapy. Can we talk about that? But the less authentic and the less honest you are, the more it's gonna be a problem. And the more and the and these interpersonal issues that are probably present in your other relationships are popping up in your therapy relationship.
And you are missing an amazing opportunity to work on them. Right. Every time I've heard people say, I'm I feel judged by the patient by by the by my therapist. Like I think they don't like me. Well, most of the time, that's the thought or feeling that that person has had in other relationships, and this is why they're going to therapy. But they're silent with their therapist, they don't bring that up. And then, wow, there could have been such a rich amount of conversation and work.
On hey, I felt judged by you. Right? So hiding your frustrations and hiding your true feelings in order to craft a perfect image or to, you know, make them happy is, you know, it's let me tell you, us therapists are not here to do this because like we want you to just please us. If we were, we wouldn't be very good therapists.
So it's we're not here for us. We're here for you. So, you know, get in there. And if you're afraid of hurting their feelings or making them feel judged whatever, trust us. Right? This is what we're trained to do. This is what a lot of our training is is not just the techniques, but it's like how to hold space for someone being upset with you and or d you know, feeling like
There's a frustration or there's a problem in the way you're working together. This is what therapists are trained for. So give us that chance to hear your real feelings. Maybe we could handle it. four is staying in problem talk instead of change talk.
Oof.
It is really hard when you're seeing someone for a while as a as a therapist and they're talking about the same thing. They come in and they vent and they talk about their problems and they repeat the same story and they you know ruminate on something. They want to blame someone else, right? The same kind of avoiding the real emotions, but they they're just looking sometimes patients just
Expect that therapy is a place where they can just vent.
About what they don't like, all their stresses, and they don't talk about changing them.
this is really common and this is really frustrating for therapists because we want you to get better. I've had people say, like, don't you therapists just love and we just come in and, you know, vent and you know, pay you and then leave? Like, no, we want you to get better. Like, we don't want to hear the same thing over and over with no change. I know that talking about a problem over and over is very common, and sometimes it just like helps with the processing, right? Like a trauma or an issue or
you know, someone who's, you know, like me too in therapy, like I probably sound like a broken record for years. But if there's no change around it, like it's the same problem every time. Nothing changes. and especially the thing that drives me nuts when patients refuse to do anything differently. I get it, change is hard, right? And it might feel good to come in, complain about something and
For an hour a week and then leave. Might feel good at the end of that session. You're like, phew, that feels good to get off your chest. But that's a different thing than mental health treatment. Mental health treatment should change your behavior, your feelings, your thoughts, the way you live your life, whether you're living a life that you value, whether you're connecting the people that you want, right? You should.
You should have something different. You should look at the world differently. You should approach the world differently because of therapy. If you're going in being like blah, blah, blah, this person sucks. This coworker, I hate them, they're so annoying here, blah, blah, blah. And then you leave and everything stays the same. By all means, do that, right? If it's doing something for you to make you feel good, great. But you're gonna get in your own way if you don't.
Ever consider what I can do differently? Can I change the way I think about it? Can I change the way I talk about it? Is there something about it that I haven't addressed yet? Can I react to it differently? Like if you're not willing to talk about what you can do, like what you can do, really, what you can do differently at all, then this is not really treatment, right? It's just kind of maintaining.
It's a is it's more social support. It's more feeling so like supported and having be having hurt been been heard by someone than actual treatment. Let me be clear, being heard is a very important part of the treatment. But if that's all you're doing and it's just making you feel kind of good, it doesn't actually change anything, then it's not that helpful. and the fifth one is not changing outside of the therapy. Now
Cognitive behavioral therapy and and other kind of more contemporary behavioral therapies like DBT, the whole thing is like what this is what we say. We are trying to work ourselves out of the job. And the way we do it is we're gonna talk in these sessions, but the real work is going to happen outside of the sessions in your life. And we're gonna assign homework assignments or practices or skills or whatever you wanna call it, but we're gonna talk about doing things differently.
In between our sessions. Because we know from a lot of research on therapy that one talking to someone one hour a week and doing nothing differently during your week doesn't really change much. Right? You have one hour a week, it's supposed to change like it all the rest of your life. No, like even if even if you go to therapy and
It's like even talking through it or talking it out loud with your therapist or bouncing ideas off changes your perspective, your mindset. And it you get some insight. And that that changes the way you approach things in your day-to-day life. Great, that's change, right? That's a skill that's thinking differently. You could also behave differently. You could act differently. Instead of grabbing that bottle of wine, you
do yoga instead. Instead of yelling at someone that they're a jerk, you say, Hey, you really hurt my feelings. right, or taking medication, right? So there are what's really important is like therapy is a space for you to
Yeah, it's a space outside of your life in some way. Like it's a new context where you can feel safe enough to like let things jumble up and explore and touch into emotions or topics that like is that pain or vulnerability that you might not get to in other spaces? And then you talk about how can you improve your life? How can you change and become the person you want to be?
but if you're just going in venting and then not doing anything different, it's not gonna work. Therapy is not gonna work.
a way that people are doing that, and this is also emotional avoidance that I find really annoying, is people are using the insights that they're getting or the things they learned in therapy, to like
like reaffirm or reify, if that's a word that I'm looking for, but even get more staunch in the problems. Like they're making the problems worse. Right. So they're using all their insights, they're using the therapy speak, and they're actually becoming worse in their day-to-day life. I know that you have seen other people do this, where people go to therapy or couples therapy and they leave. And instead of
being kinder or being more accountable or changing the behaviors that are hurting other people, they're using the words to justify their shitty behavior, right? Like, I'm hearing this a lot, which I know this is going to be really testy. but if if a lot of people are doing this where they're like, you know, I you gaslit me, or you I'm this way because you gaslight me, or
I hit you because that was reactive abuse and it doesn't count, right? Or yeah, I mean, I it's I I'm not getting a job or I'm not connecting to people or whatever because of my trauma. And now that I've discovered that I was abused as a child, there we go, right? Now I'm just gonna sit in this and my
problem to begin with was that I don't have a job and you know now I know it's because of my trauma and it's just now I'm gonna continue not being employed or finding a job. When you're seeing no change in the person in the ways that they want and they're using all the therapy speak, that's not being a good therapy patient. That is just going to find paying a person to make them feel better about themselves.
And that might actually lead to some good things, but I've I've seen that not lead to some good things too. Right. So if you're feeling like I am not connecting to the people around me and not feeling heard, and you are just using the words and saying, I have this insight. It was so helpful. you know, thank you for the share like wow, I've I've seen and then
not connecting to any more people, you're not trying anything differently, thinking differently. That's that's like that's not that's not it. Right. I don't care if you label it. I don't care if you're like, now I have ADHD and that's how that's why I know that I play video games all day and not do any of the things that really matter to me. It's like you can name it, but if you're not working towards a life that is meaningful to you, then therapy is only gonna be very limited.
It's only gotta be there to soothe your shame or guilt about it in the moment and really reinforce you making the same mistakes. So those are the five things that I see all the time, and that therapists are like, man, like the patient keeps doing this, and I know that they they have so much potential, you know, but this is this is what's going on. So I'll quickly go through if these are the five things that
Make people bad at therapy patients, here is a way to actually make the most of your therapy. So the opposite of avoiding the real pain, number one, is actually addressing and talking about really difficult emotions. The more you have the thought, no, I shouldn't talk about that, or like I I can't go there. if the more that signals to you that this is something you're avoiding, that's very normal.
Say that to your therapist. Say, you know, there's this memory, or there's this part of me, or there's this feeling that really upsets me, and it's really hard for me to talk about. I don't think I'm ready yet, but it's there. try talking about a vulnerability that you didn't think the therapist will want to hear, but feels more like I'm I'm pointing to my body right now and
That's a real sign of like when you feel the discomfort in your body, that's a good signal that that is an emotion. And that, you know, you what you're trying to do in therapy is to practice, build the skills to bring up vulnerable feelings, uncomfortable feelings, uncomfortable parts of your life, right? Like, you know, therapy is uncomfortable. And to learn to relate to them in healthy ways, even and just like being like
I have this part of me that I'm super ashamed of. And it doesn't feel good. It makes me want to hide right now. It makes me want to think that, you know, you're the bad therapist, blah, blah, blah, blah. But here it is. I'm talking about it, right? It's like instead of avoiding emotions, approaching them and experimenting with different ways of navigating them, of relating to them. So don't avoid emotions. Talk about your emotions. And st if you're noticeed that you're
The kind of intellectualizer, like, you know, like I I know everything, I know what my problem is. Notice if you're up here in your head or if there's anything going on with your body, right? And if you're really not sure, slow down. Stop talking. It's okay not to talk in therapy. You can just slow down and just feel and just describe, like, this really sucks to talk about.
I feel really uncomfortable. This feels icky. this pause is really weird. Like, you don't have to give all these explanations and seem like you got it under control. Like, be a little out of control. That's what the therapist is there for. and if you feel like, I don't know if I can't, like, I don't feel comfortable doing that with that, with this therapist, tell them, talk to them about that. Two, not being completely honest.
Tell the truth. That's the to tell tell the therapist everything. if you know, they here here's some things that people often leave out but are very important. Biological stuff that happens every day. You forget this is a problem, sleep, hormones, how much you drink alcohol, what you eat and your diet, and that that has an impact on you know your mental health.
medications, I am sh medications and drugs, I'm always surprised by people like, yeah, I've been taking this medication for years. I totally forgot that this has an effect on my depression. Like, yeah, tell them that.
Anything that feels like a missing puzzle piece, that's a really hard thing to say. But like you might picture your problems and your family and your identity in this one particular way. I am a man who is a investment banker and I'm strong or whatever. and that so people fixate on like this one part of me that I'm gonna show you. But try to talk about other parts of you, other details, other other things that you might think.
Nah, this is not important, or then I don't want to hear that. Just say it. Just say say that and see what happens, right? Especially if there is any risk to safety. you hitting someone else or getting violent, self harm. If you have thoughts of death, if you have thoughts of hurting yourself, shitty things that you've done to other people, right? That's okay.
Like tell your therapist that they're not going to. And then they judge you and they they're they might say it out loud and then you work through it, right? So and it might be super important to you getting better to be like, here's this thing that I'm really ashamed of. Here's this weird addiction. The here's this weird habit that I've kept for my wife, and here's here's what what's going on. the risk things are s the utmost importance. if you hurt yourself, hurt someone else.
have thoughts of it are doing a dangerous drug or doing something else dangerous, tell your therapist that. I know that some people of are afraid of well, if I tell them that I you know, hit my kid or you know, w did this horrible thing, then what what what's gonna happen, right? What if they, you know, call the police or like whatever or I get in trouble.
That's what therapists are trained for, right? This is what this is like all the training that we had is like how are we gonna keep you safe? So it's really important to talk about, you know, when you have thoughts of death. And if you're afraid of like, what if someone's gonna find out? Like clarify that up front, what the bounds of confidentiality are, right? Like,
Hey, what are the situations where you tell someone else, or are you gonna keep this private or will I get in trouble? Right. And know that the therapist is there to to for you to keep, you know, to keep people safe. So, they're gonna do what is necessary, but they're not gonna just lock you up, you know, like it'll be a total shock, right? They if they if they do send you to higher level care, it's it's for safety. It's not it's
I know it's terrible. I know it's not great to be sent to an emergency room or hospital, but if that's what it takes to keep you alive, we will do it. We're here to keep you alive. Right. trying to be the good client. Number three, don't. this is a this also goes with the not being completely honest. Show the ugly parts of you to your therapist. Be mad. Show them anger.
Show them the your messy side. Say things that you feel about your therapist that you were like, my God, I shouldn't say that. Say it to them. Say, hey, I have this weird thought. Or last session, you know, that comment you made really hurt my feelings. And I've been thinking about that. And I'm thinking about dropping out of therapy. But I wanted to come here and talk to you about it. I actually in my my treatment, I'm so
I work with a lot of people with personality disorders or social anxiety and relationship issues that that is like a central part of my treatment. I say in the beginning, like if you have a problem with me, if you have a feeling, a negative feeling, a bad reaction, you want to get out of here, you want to quit on me, great. I want to hear about that. So do me a favor and instead of just like running off and never seeing me again, like come into the next session and give it to me. Just tell me, tell me what I did wrong.
Number one, this is an important part of relationships. Expressing your frustration, expressing what's not going well. That's how people learn, right? Your therapist is learning how to help you. Right? They're they're not always we're human. We're not always gonna be here like, I know exactly what to do to help. If there's something that we messed up, tell us, and then we could work through it together. And also.
The most amazing productive, insightful conversations come when people are talking about the elephant in the room in therapy. Sometimes the biggest changes I've seen in my patients are when I tell them about stuff that I don't like about them. Right, like frustrations I've had about them, judgments, times where I'm like, what? You know, like.
And I I I know how to say it. That's part of my training. I know how to say it in a way that is for their benefit. Like I'm not there just to trash on them, but I would say, like, you know what? Sometimes it's hard for me to get a word in and to really like feel like we're talking through something because you talk the entire session and don't let me get a word in. Does that happen in other relationships? Right. So you know, it's a delicate balance that I I I do, but
But talking about the problems in a relationship, that is such a unique thing that you can do in therapy that it's harder to do like with your boss or other kinds of relationships. Therapists are like, Great, that's the meat, actually. Right? It's like it usually happens after they, you know, you guys get attached, like after like a month of working together or something. And then the bad stuff comes out, right? It's like, like I wanna.
You know, I wanna humiliate the therapist or I hate her or I wanna just run away because I I'm I'm afraid that she actually is judging me. That's the important stuff in the therapy. Talk to the therapist about that. There are
I've had patients who were so awesome that they were like pissed at me for months. And I could feel it, right? Like we could I could kind of get a sense. I'm sure there's a lot of therapists of patients who were pissed at me and didn't say anything. But I was like, that last session, you didn't seem that thrilled by what I was saying. He kind of went silent. What's that all about? And they were honest with me. They were like, you know, I felt like you were.
Kind a jerk, or I had my suspicion, or I didn't like what you blah, blah, blah. And we would have the best breakthroughs. my God. First of all, it's like talking about the elephant in the room just like opens up a whole new level of therapy. It's like, then I can give them my perspective on that same situation, right? So they could say, wow, like it's almost kind of like like.
Like looking behind the curtain or like popping up the hood and looking at engine and how it works is like they're like I I you felt I felt like you were judging me. And I was like, wow, that's what you thought. You thought like you thought I was judging you? Actually, I was super tired and I looked probably unhappy. Huh, that's so interesting. Does this happen outside of this therapy side like this therapy relationship? Do you ever feel like people are judging you when you're not sure?
what they're feeling, right? And so it's a way to like break down this social dynamics and be like, you might be having this problem elsewhere, but in here we could workshop it. In here we can talk openly about it. You're not risking anything, right? This is literally what we're what we're trying to do is figure this out. The best, best conversations in therapy have been through talking about frustrations about each other. So
So good. It's just so good. So please, like, if you're like, I want to quit my therapist, tell them that. Right? And then see what how they react. for the issue of staying in problem talk instead of change talk, engage in ch change talk. So if you find yourself going over the same problem every time, and if you are feeling that
You know, I don't want, I I don't react well to suggestions that there's something that I could do differently, or any part of it is my fault. Or I if you're just stuck in this feeling of like helplessness, like here's my problem, I'm gonna talk about it, and there's nothing I can do. I hate to say it, but this that's a choice. this is what we say. We're like, you know, s wal like staying the same.
Staying in the same patterns, the same problems, you know, just venting about a problem is a choice. You can choose to do other things. You can try to it'd be like, what do you think I should do differently? What do you see as the problem? How can what does it look like to change? What does it look like to do things differently? Right. Maybe talk about another problem, right? So if you're noticing that you're just complaining for 50 minutes, change it up.
But it'd be like, hey, I'm noticing I've talked about this problem a lot. Do you see any changes? Do you see any improvement? What can I do differently?
And then five, not changing outside of therapy. that's super hard. I think that's the the easiest way to notice that. People have a hard time seeing whether they're changing or not. But this is why measurement base care is so important. And that means having some sort of benchmark or a progress report or tracking of progress over time can help you go.
Is this therapy working? Am I making changes in the way that I want? Right. So if like you're going into therapy because you're depressed, you talk to your therapist about like either they you fill out a depression scale, like a measure of that, or you talk about what change would look like. Right. If I were less depressed, I'd be exercising more, I'd be hanging out with more friends, I'd be making more friends, I'd be actually like moving forward my career.
And then look over time in the last couple weeks, months, how how has that been going? Because we're not very good at like assessing ourselves in the moment, right? Like noticing, am I changing? am I improving? But over time, you can you can kind of track your own changes and be like, hmm, yeah, I mean, I'm still stressed about the same thing, but I'm really like, I'm really handling it differently. I'm really like advocating for myself a little bit more. Right. So just notice.
And then you can ask your therapist if you're like, what should I do this week? How should I change that? it should be uncomfortable, right? You should you should experiment with different ways of approaching things. And I'm not saying like, let's say you have an anxiety or trauma or something, and you're like, I want it to be gone, right? But like practicing skills and changing outside of therapy looks like
Can I think about it differently? Do I think about it differently? Can I see another part of it that I didn't before? can I do I have flexibility around it? Flex flexibility is a big sign of using skills. If you're like reacting to the same thing, same way, you're you're you're in your habits, your mental health habits, and you're like, every time I get pissed off, I drink, right? This is a habit. If you're noting flexibility, hey, this week I did something differently when I was pissed off.
I didn't pick up that bottle of wine. I went to the gym and did some boxing. Right? That's change. So if you're if you you notice that, like if you're able to like experiment and try doing something differently than you normally do, go out of your comfort zone. you can ask people, you can ask the people around you, like, have you noticed changes in me? And what changes do you think I should make? and if you find yourself like not
to do any of the things that I'm saying, that maybe there's something you're avoiding. So those are the five things I would recommend making the most of your therapy. One is actually talk about the pain, talk about your vulnerability, go into the places that you're afraid of, and then see what happens when you actually sit with it. Two is tell the truth. Tell parts of the story or yourself that you're afraid
Of bringing to light, especially things that would affect your mental health. three, stop trying to be the good client, be the bad client. Show some of the so show some of your authentic feelings about the therapy, in the therapy. four is think about change. Really talk about the problem, assess, go deeper, but then then what? How are you gonna make changes in your life, right?
What is what is the solution? How is this going to improve? and again, five is change outside of therapy. you shouldn't just be sitting there week after week talking about stuff, being like, Yeah, I feel good. And then outside, your life is exactly the same. You should transform, you should change, you should be reacting to things differently, you should have more flexibility so you're not just stuck in habits, like doing the same thing over and over and over.
So I hope this was helpful. all this really this topic is on what my advisor called, Zach Rosenthal called therapy interfering behaviors. And you know what? It's funny because the therapy interfering behaviors are super common, but addressing them can like exponentially help your treatment. It could
really make the most and really make huge changes and make you a better person in the way that you want. So I'd love to hear what you think. you could always write me on the comments in YouTube or Spotify or wherever you're listening to this. And if you have any suggestions, let me know. I love talking to you guys. I'm I'm talking to you more and more. and I just love meeting you. So I'm here.
I'm real person. I love, you know, I love people, obviously. So don't be shy and contact me. and I will see you next week.