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5 Reasons Why People With Mental Illness Don’t Get Better Even After Counseling

5 Reasons Counseling Doesn't Help Everyone With Mental Illness

  • Poor Fit
  • Patient Resistance
  • Misdiagnosis
  • Transference and Countertransference
  • Lack of Benchmarks

Some people with mental illness may not get better after counseling. This could happen for a number of complex reasons. Some may be the fault of the counselor or patient, but others are simply due to the dynamic between the two.

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1. Poor Fit

Sometimes, a counselor and a patient simply do not click just as coworkers or even family members do not. A patient may prefer a counselor who is more or less confrontational or supportive. Some people are looking for a counselor who is more hands-on in terms of guidance while others primarily want someone who will listen without interjecting too many of their own thoughts. In some cases, there may be a personality clash in which the patient and counselor do not work well together.

2. Patient Resistance

While some patients and counselors may be a bad pairing, some patients are resistant to any form of counseling. Mental illnesses will not get better with counseling if the patient is not an active participant. There are a number of different ways that a patient could push back against counseling and make it ineffective. The patient might not be honest with the therapist. The patient might simply see counseling as a place to vent without making any real effort to change. The patient could refuse to do any exercises the counselor suggests or might have unrealistic expectations about what counseling can achieve or how quickly counseling is supposed to help.

3. Misdiagnosis

Different kinds of mental illness require different approaches. What helps a person with anxiety may not help a person with depression. A person might have been diagnosed with borderline personality disorder while actually having bipolar disorder. A person could be getting the wrong type of counseling for the illness or could need medication in addition to the therapy, but if the person is misdiagnosed, neither the patient nor the counselor may realize this. Furthermore, a particular counselor may not have the background, experience or education to treat certain mental illnesses, so a misdiagnosis could also mean the patient is seeing the wrong person.

4. Transference and Countertransference

These are tendencies recognized in psychology that are not necessarily unhealthy. Basically, transference occurs when a patient transfers emotions to a counselor. For example, a patient could transfer feelings about a parent to the counselor. Countertransference refers to various reactions the patient triggers in the counselor. Both patient and therapist can have valuable insights as a result of transference and countertransference. However, there are times when these tendencies can interfere with counseling. For example, some patients might start to believe they are in love with a counselor. Some counselors might begin to have negative reactions to a patient because the patient reminds them of someone in their own past. As this Psychology Today article points out, countertransference can even be harmful in some cases if the associations for the therapist are positive, and this can mean that the person with the mental illness does not improve despite counseling.

5. Lack of Benchmarks

Establishing agreed-upon goals at the beginning of therapy is important. Without these goals, an assessment of whether the person has improved may be subjective. Furthermore, goals provide something for both the therapist and patient to aim for. Without these, counseling might simply be counterproductive or might seem as though it is doing nothing for the patient even when it is.

If these or other issues interfere with a patient's treatment, the patient can seek another counselor or another approach. It is important for people with mental illness to understand why they don't get better after counseling so they can seek a solution.