How to Tell When Therapy Won’t Work

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Learn to recognize these three red flags that the therapeutic process isn’t likely to work for a character disturbed individual in your life. Successful therapy for character disturbance does not depend on any of the these mainstays of traditional therapy, like focusing on feelings, trying to ‘see’ what the person is doing, or working on fears and insecurities and self-esteem issues. Part 3 of a series.

I get so many enquiries on this particular matter that I’ve posted a series of articles on how to find the right kind of help in dealing with a problem character in your life. As so many have already experienced, traditional methods of therapy and counseling are not likely to be effective (see “Getting the Right Kind of Help With Character Disturbance”). There are some advance precautions you can take to improve your chances of success (see “How to Find a Therapist Who Can Help With Character Disturbance”). But you can still find yourself in a situation where, despite initial optimism, the right ingredients are just not there to make things better.

There are two main reasons for this: First, character disturbance is an inherently difficult problem to deal with, even for a well-trained and seasoned professional. As a person’s personality style solidifies, change becomes much more difficult. Besides that, most character-disturbed personalities are perfectly “comfortable” with their way of doing things (although others in their lives most likely aren’t), which negatively impacts their motivation to change. Second, effective treatment of character disturbance is a relatively new and slowly evolving art. So, achieving success is tenuous, even under the best of circumstances. But there are some red flags that can alert you to the possibility that the therapeutic course you’ve embarked upon will not yield beneficial results. Here’s what to watch out for:

Much of the therapy session appears devoted to uncovering and processing feelings.
Traditional therapies focus a lot on people’s feelings. That’s because neurotic folks are prone to repressing certain feelings that nonetheless influence much of their behavior. Get in touch with your emotions, traditional therapies urge, work through them, and you’ll feel much better. But when it comes to disturbed characters, the troublesome behaviors they display and even the poorly managed and irrational emotions they experience are engendered primarily by the erroneous beliefs they hold, the problematic attitudes they maintain, and the distorted ways they perceive things. In short, the way they think and not how they feel is the problem needing attention.
Effective therapy with character disturbed individuals should always focus on the inextricable interconnection between their problematic thinking patterns as well as the destructive behaviors that result from them. A husband who no longer believes that women should always be subordinate is much less likely to become irate when his mate fails to honor his every wish. A therapist who calls attention to erroneous and distorted thinking, reinforces its correction, and encourages re-direction of dysfunctional behavior patterns is much more likely to aid in the improvement of matters than a therapist who prefers to focus on feelings.
The therapist spends a lot of time and energy trying to get the disturbed character to ‘see’ what they’re doing.
This is a strategy designed to help neurotics who have so successfully repressed their feelings about things that they’re no longer conscious of much of the motivation for their behavior. But character disturbed individuals already ‘see.’ That is, they’re very aware of the things they do as well as the reasons why they do them. And they’re also acutely aware that other folks would prefer that they do things differently. They see, but they disagree with the rules most of us play by. They know what others would like them to do, but they prefer their way. So effective therapy is radically different in character. Instead of an insight-oriented or awareness-heightening approach, it’s more of a confront, correct, and reinforce approach. And there’s a highly specialized art to confronting and correcting in a sufficiently palatable, benign manner that the disturbed character might actually respond positively. It involves gentle but persuasive leading, modeling, challenging, encouraging, etc. so that the disturbed character becomes willing to at least ‘try out’ more functional alternatives and then experience the positive consequences of so doing.
The therapist focuses a lot on fears, insecurities, and self-esteem issues.
Neurotic individuals struggle with fears and insecurities that impede the development of a positive sense of self-worth and a sense of personal efficacy. So, nurturing a therapeutic relationship that is empathic, warm, and understanding is often all that’s necessary for them to face and overcome their ‘hang-ups.’ Many therapists tend to conceptualize everyone’s problems within this same framework. But this can be very problematic when it comes to intervening with a disturbed character. For example, it can be not only ineffective but potentially even harmful to conceptualize a disturbed character’s penchant for thrill-seeking, shallow interpersonal exploitation, and craving for sexual conquest as a “fear of intimacy.” Such a perspective not only completely misses the mark, but also sends a message to the disturbed character that the therapist doesn’t ‘get it’ and therefore can be easily manipulated and impression-managed. As I stress repeatedly in my book Character Disturbance, trust is the most essential foundation of a therapeutic relationship. And for the disturbed character to place some trust in a counselor and to at least be open to the idea of some guidance by that counselor, they have to have some level of belief that the counselor sees the issues clearly and accurately and is both willing and able to address them adequately.

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Compared to neurotic individuals, disturbed characters need very different things from therapy. I have addressed many of these differences in some prior posts, such as my series on neurosis vs. character disorder. And in my book Character Disturbance, I illustrate some of the principles advanced in the prior posts and outlined above through vignettes, some of which depict actual therapy encounters. The vignettes highlight the radically different process involved in facilitating change in the character-disturbed individual. Many people who write to me expect me to endorse the notion that there’s simply no hope for change with character disturbed individuals. And they’re often quite surprised when I respond that there actually is hope, and that the bigger problem is the lack of appropriate resources. Hopefully, my prior posts on the topic and the points I’ve stressed above will help you determine if you’re on the right track to making things better.

All clinical material on this site is peer reviewed by one or more clinical psychologists or other qualified mental health professionals. This specific article was originally published by on and was last reviewed or updated by Dr Greg Mulhauser, Managing Editor on .

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