Why Does Therapy Fail? What’s the Solution?

Hi Web Visitors,

One of my colleagues, Dr. Daniele Levy, who helps teach the Tuesday training group at Stanford, created a neat brief quiz for members of the TEAM-CBT list-serve. I have modified it slightly. If you want to submit your answers, I will try to publish a few of them!

  1. What is the #1 cause of therapeutic failure?
  2. What is the therapist’s role in addressing therapeutic resistance?
  3. What is the patients role?

She is offering free wine and cheese to the winner. I’m not offering that, but you might still enjoy taking a crack at it. And if you like the quiz, I might create some more of them for you!

By the way, I have an article on this topic that will be featured in the March, 2017 edition of Psychotherapy Networker. The title is “When Helping Doesn’t Help.” If possible, I will try to link to it when it appears, but don’t yet know if they permit this. If not, I might be able to print the final draft here.


2 thoughts on “Why Does Therapy Fail? What’s the Solution?

  1. From reading about TEAM Therapy, and based on my own personal experience, these are the answers I came up with.

    1. The failure of the therapist and the patient to establish an empathic relationship, that results in the inability to melt away the resistance that the patients hold onto based on whatever individual beliefs they may have.

    2. The therapist’s role in addressing therapeutic resistance to the patient is to help them to acknowledge that in order to get better, they will need to change whatever beliefs they may have, and in doing so, the patient will be able to heal from their own suffering.

    3. As for the patient, they have to be willing to change their views/beliefs, and through working on several therapeutic resistance techniques being implemented by the therapist, the patient is able to determine whether or not they want to change.

    • Thanks Eric, your answers are excellent, and make a lot of sense. Here are the answers suggested by Lisa Kelley. I believe she won the contest among the certified TEAM-CBT therapists on the list serve. The first question was different, so i will give you the answer to my first question about the #1 cause of therapeutic failure–it is the failure of the therapist to do skillful Paradoxical Agenda Setting. Most therapists jump in and try to help or rescue a patient without first finding out if the patient actually wants help, and if the answer is yes, the therapist needs to bring all the GOOD reasons NOT to change to conscious awareness. But here is the original quiz, along with Lisa’s winning answers.

      1] What is the #1 cause of therapeutic resistance?

      The therapist has neglected to address all the good reasons not to change — to hold on to the symptoms.

      2] What is the therapist’s role in addressing this resistance?

      To speak to and for the patient’s subconscious resistance, and have the patient identify all the reasons to hold on to the symptoms and to resist change. These reasons would reflect the positive qualities and values of the patient, as well as some of the very real advantages of the symptoms, such as depression, anxiety, shame, anger, hopelessness, and so forth. In doing so, resistance often melts away as the subconscious gives the patient permission to change. The therapist should never cheer lead or try to sell change. Paradoxically, in not selling change, the client chooses to do so if the benefits and advantages outweigh the costs or disadvantages of change. The client must argue for change to convince the therapist to work with him or her.

      3] What is the patients role?

      The patient’s role is to argue for change. If change is not something the client wants, the therapist is expected to sit with open hands and accept that decision. Is there something else the client wants to work on, the therapist inquires.

      Hope Lisa’s answers compliment and enhance your own good thinking!


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