Roadblocks to Effective Psychotherapy Treatment

Patient Expert

As I've mentioned before, I am a big fan of psychotherapy. Although medication has had a greater role in my successful depression treatment, psychotherapy helped me to recognize my inner demons and banish or deal with them, thereby leading to my becoming a much happier person overall, which I would assume is helpful in fighting depression.

Treatment with psychotherapy is a tad more complicated than treatment with medication, however. With antidepressant therapy, once you've found the right medication (admittedly, sometimes a lengthy process) you basically take your medicine and deal with side effects. Psychotherapy demands more in terms of the right conditions and a commitment from the individual. It's fairly common for roadblocks to come up that hinder the process. I've experienced two of these roadblocks in the course of my therapy, so I thought I'd pass on what I've learned about getting past them.

The first roadblock (and yes, I do see the irony) is depression. One problem that people with major depression run into in therapy is that they are too depressed to participate fully in it. Therapy requires that you really dig into and examine yourself and those who have influenced your life. It often requires that you pull memories out of the distant past. Finally, you have to articulate those thoughts. Many people with depression have trouble concentrating and articulating effectively, so therapy can demand more than they're capable of giving. To be honest, even without depression therapy is demanding, so this is not surprising.

When I was first diagnosed with depression, I was in a major depressive episode. The doctor recommended that I start treatment of both medication and therapy, but for the first six months I refused the medication. However, I was so depressed that I had trouble concentrating, forming thoughts or articulating the thoughts that I could form. This was definitely not conducive to productive therapy. Finally I realized that the therapy, while interesting, was not helping my depression. I started on an antidepressant that lifted my depression completely, allowing me to make great strides in my therapy over the next few years.

So if your depression is getting in the way of your therapy, you need to consider other forms of treatment along with the therapy. Otherwise, you may just be wasting your time and money. By the way, any therapist that tries to discourage you from taking medication for your severe depression is someone to avoid. Therapists should not be threatened by a patient taking medication if it's obvious that the patient's depression is not being alleviated by therapy alone.

The other potential roadblock to therapy that I've run into personally and seen with other people is the fear that can arise when one is actually making progress in therapy and approaching a crucial revelation.

I generally either enjoy or am indifferent to therapy sessions. When I am dreading a therapy session, I know from experience that the therapist and I are close to uncovering something important. One time when I was close to a revelation in therapy about a painful incident in my life, I found myself counting the days till the weekend. I was dying to go out and get blind drunk. Since this was, to say the least, an unusual thing for me to do, I realized that we were close to something important in therapy.

This situation can be a turning point or a dangerous roadblock. I knew a woman who started therapy in her thirties. She had been sexually abused when she was a child and, probably as a consequence, abused drugs and alcohol. She had been in therapy about a year, making good progress from what she told me when, out of the blue, she said that she was not going to see her therapist anymore. When I asked her why, all she would say is that the therapist wasn't helping her. I offered to help her find another therapist, but she refused to even discuss the matter, and she never went back into therapy. My guess is that, far from the therapist not helping her, the therapist was helping her get close to dealing with the abuse. Unfortunately, years later, she has never gone back, and her life hasn't improved as far as alcohol and drug abuse.

These breakthroughs in therapy can be frightening, there's no question about it. It's not surprising that we shy away from them. But avoiding the situation is not going to improve things. If what you're uncovering is this painful, then it's important to examine it and get past it. It's very possible that whatever you're going to work out in therapy is what's at the root of your depression. So the best thing to do is to grit your teeth, gird your loins and work through the pain. Once you start examining the source of your fear, you'll feel more in control of it and your life in general. And that's a beautiful thing.