I was talking with someone a few days ago who said to me that she had left therapy because "the therapist wasn't helping her". And this set me to thinking because this is a common complaint.
Now if I go to the dentist because I have pain in my mouth and the dentist doesn't help leading me to seek help elsewhere, that seems reasonable. But I look to the dentist to *do* something to make me feel better. The dentist does not usually, at least in acute situations, require of me that I do more than be cooperative and hold my mouth open. But psychotherapy is a different thing altogether. Therapists do not perform procedures upon patients in order to relieve their suffering. We might sometimes wish we could ad certainly patients wish we would, but it just isn't that way.
In any depth psychotherapy, the therapist does not tell the patient how to solve problems. The focus of treatment is exploration of the patient's mind and habitual thought patterns. The goal of treatment is increased understanding of the sources of inner conflicts and emotional problems. This understanding is what we call insight. Now insight without action is pretty useless. But the therapist doesn't say to do this or that but instead might ask how this new understanding might be put into action in the patient's life.
In order to accomplish this work of therapy, the patient and therapist must have a good working relationship, or therapeutic alliance. The patient needs to feel that the therapist is on her side, so to speak, allied with her in her desire to have a better, happier life. And in turn, the therapist needs from the patient a willingness to do the work of therapy, to put feelings into words, to talk about what she is thinking and feeling. And that includes being willing to talk about feelings of anger, disappointment or frustration about the therapy or therapist.
Most often when I hear people saying that therapy isn't helping, I am also hearing an expectation that the therapist will tell the person what to do in order to feel better. And to a very limited degree, we can do some of that -- like take a walk or write in a journal or try painting or some other creative outlet when having difficulty between sessions. But on the big things -- like whether or not to stay in a marriage or change careers or leave home or any of many many other important life decisions, we cannot tell a patient what to do. We, as human beings ourselves, have enough trouble finding our way through the complexities of our own lives and not only cannot, but really should not presume to be in a position to make decisions for others in their lives. No matter how much the patient may want it. But talking about wanting that, being angry that therapist won't do it -- that is the stuff of therapy.
When therapy isn't going well or the patient feels dissatisfied in some way, the solution is to talk about it. Not every therapist/patient combination is a good fit. But it is difficult to arrive at knowing that without talking about it. One way to honor the process, even when it is not going well, is to give it the time required to talk about it. The therapeutic pair may arrive at a mutual decision to end the therapy or they may find through this often difficult kind of discussion that they move into a better and more solid working relationship.
To refer again to In Treatment, Paul had a good therapeutic alliance, achieved through some tough work, with Sophie. He could trust her to keep coming and she could trust him not to cross boundaries and to listen carefully to her. Alex didn't trust Paul and acted out his hostility instead of putting it into words. Their alliance was tenuous and would need a good deal of work to become solid. Without a good working relationship, one of mutual trust and understanding, it is very difficult to accomplish much in psychotherapy.