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Q I have had psychotherapy for many years withdifferent therapists, why don’t I get better?
By Douglas Berger, M.D., Ph.D. on August 9, 2014
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There may be a number of reasons whypsychotherapy may not seem to help
someone, each person’s situation being unique.
Assuming there is actually some mental healthissue at hand, we need to break up theexplanation into persons who may benefit frompsychotherapy alone, and those persons whoneed something different or in addition topsychotherapy (i.e., to change a situation; tointegrate psychopharmacology withpsychotherapy; or to receive treatment for aunderlying medical condition that affected one’smental state).
Persons who may benefit from psychotherapy
alone but still do not improve are frequently
persons who actually have or believe they havesome benefit from their issues and on somemental level do not wish to change. These may
be persons who feel inferior to others but brag or must always be the leader to cover this up. They
may be bossy or have problems following authority. These persons stubbornly hold on to theirmaladaptive relationship styles which cause them to have secondary problems in relationships
which are hard to fix.
Persons who are in difficult situations often continue to have stress and a variety of mental
symptoms regardless of having psychotherapy. Stress with one’s spouse or work environment,
financial or medical problems, living conditions etc., can all perpetuate negative feeling states.
Changing one’s job or getting different qualifications, changing living arrangements with a spousesuch as having a private room inside or nearby the home to have “down time”, changing from asedentary to active lifestyle etc., may be very effective in reducing stress. A therapist can provide
concrete and creative means to change the difficult situation, but in the end it is up to the person
themselves to effect this change.
Some persons may actually have a problem in their nervous system but do not easily accept thisbecause it may mean they need to integrate medication into their treatment. These persons
commonly have depression, anxiety, manic-depression, attention deficit with or without
hyperactivity, or other problems. Their symptoms tend to be chronic and they often have a family
history of similar problems suggesting they have inherited the problem. While speaking to a therapist
may provide these persons with some alleviation of distress, many have years of psychotherapy
without real improvement if they or their therapist’s orientation is that their low mood, irritability,anxiety etc. are caused by some kind of childhood experience rather than symptoms of a biologic orinherited syndrome.
Medical problems that can cause mental symptoms are varied and range from diabetes andhypertension, to hyper- or hypothyroidism, brain disorders, medications used for any kind ofproblem, and of course street drugs. Consultation with an internist and a psychiatrist can help toelucidate if these are the cause of symptoms of low mood, tension and anxiety, panic, fatigue, poor
concentration, etc.
If you or someone you know continues to have problems in spite of many months of psychotherapy
with one therapist, it would be prudent to get a second opinion. I would suggest meeting anothertherapist or counselor in addition to an M.D. psychiatrist, and perhaps have some medical testing.
Flexibility in willing to change oneself or the treatment orientation is usually key to success intreatment of mental health problems.

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About Douglas Berger, M.D., Ph.D.
Dr. Douglas Berger and his staff at the Meguro Counseling Center in the Shibuya-Ebisu area
provide mental health care for individuals, couples, and families, in both English andJapanese. www.megurocounseling.com

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