Verified by 
Key points
- Gains from therapy reach a plateau, with diminishing returns if continued beyond that point.
- The focus of therapy should be to get you out of the hole first, then show how to stay out of future holes.
- Therapy must validate and empower. With validation alone, you’ll feel better but only for a short time.
- Therapy must do more than make you feel temporarily better; it must help you improve your life.
If your therapy is still helping you improve your life and relationships, this post is not for you.
Gains from therapy reach a plateau, with diminishing returns thereafter. If continued beyond the plateau level, it risks building dependency while increasing self-obsession.
Some authors point out that therapists have at least an unconscious interest in keeping clients in therapy. Certainly, there is a financial gain for therapists who continue treatment with diminishing returns. Less experienced clinicians may resist termination because it feels like failure or rejection.
My personal view is that most want what is best for their clients and recognize that at some point what is best includes termination. I believe getting stuck in therapy is an inadvertent result of therapists’ best efforts.
People can get stuck when therapy:
- Is more validating than empowering
- Emphasizes feelings over reality-testing
- Ignores or discourages perspective-taking
- Attempts to change habits by speculating on how they formed
- Falls prey to the focusing illusion (see below)
- Increases resentment
- Turns guilt, shame, anxiety, or fear into victim identity.
Validation vs. Empowerment
Therapy must validate your experience while empowering you to improve it. Validation alone can make you feel better for a while, but it won't lead to lasting improvement. You’re likely to feel stuck in therapy when there is a continual emphasis on validating your experience and blaming the lack of improvement on other people or circumstances.
A common symptom of therapy that validates at the cost of empowerment occurs when therapists diagnose people, such as significant others, they’ve never seen, based on reports of their clients: “Sounds like he’s a narcissist. She’s a borderline personality.”
Therapy then becomes how to deal with a disordered partner and why you might want to, rather than how to act on your values and in your best interests. Diagnoses of unseen partners, parents, or coworkers, in the name of validating clients, are closer to stereotypes and victim-designation than to science and useful understanding.
Origins vs. Habits
In the 21st century, some therapists still invoke 19th and early 20th century paradigms that focus on revealing hidden truths about childhood experience. The assumption is that various incidents in childhood cause internal conflict and patterns of adult behavior; when brought to consciousness, insight will produce positive changes in self-value, behavior, and relationships. Such an approach has intuitive appeal: “As the twig is bent, so grows the tree.” The metaphor breaks down when we expect insight about the twig to straighten the tree.
The human emotional system is not a tree. It functions as a series of conditioned responses and habits. By the time we’re adults, our emotional responses are consistent under similar physiological, mental, and environmental conditions.
Departure from even trivial conditioned responses and habits feels awkward. (Try tying the shoe you normally tie first after tying the shoe you normally tie second.) Deviation from socially conditioned responses, such as replying to your spouse’s greeting with a sarcastic statement, seem uncharacteristic: "I'm not myself."
Whatever may have started a person's series of conditioned responses is not as influential on current behavior as the most recent enactment of the habit. The most recent enactment has strengthened the neuronal pathways that produce the behavior, making it more likely to recur under stress.
Insight alone does not change habits. For example, understanding that you shout at your partner because your parents shouted at you won’t increase your self-value or improve your relationship unless you practice respectful, compassionate, and kind behavior. If you practice such valuing behaviors, you don’t need to speculate about why you used to yell; the good habit will replace the bad one.
In extreme cases, emphasis on the distal origins of undesired habits becomes an excuse for them, further strengthening conditioned responses.
“You know how I was raised. My therapist says you need to be more sympathetic when I shout at you.”
Excuses for undesired behavior increase self-obsession and impair the ability to see the effects of one’s behavior on others. An egregious example of therapy increasIng self-obsession is “trauma work” for family abusers. Many abusers like it because it appeals to their narcissism, but it risks increasing abuse by providing an excuse for it and by placing the onus on the abused to take care of the traumatized abuser. I have seen so many cases in which abusers justify their abuse by citing “triggers” in their partners’ behavior. When they do express remorse, they expect their partners to comfort them. If their hurt or exhausted partners cannot comfort them, more abuse is likely.
Most undesired behaviors begin with the coping mechanisms of blame, denial, or avoidance. Focusing on presumed origins of habituated behavior obscures the self-defeating nature of bad coping habits, at the cost of building better coping skills.
Any of the above risks increasing dependency, resentment, and victim identity. Focus on why you're in a hole and whose fault it is will not reveal how to climb out of it. The goal of therapy should be to get you out of the hole first, then show how to avoid future holes.
The Focusing Illusion
We tend to focus on one aspect of our lives and behavior, while ignoring other aspects. For example, focusing on our intentions makes us ignore the consequences of behavior or minimize its effects on others. Focusing on hardship makes us feel like we’ll never be happy.
Individual therapy that focuses on personal development will harm love relationships if it doesn’t simultaneously focus on perspective-taking. No matter how valid a partner’s perspective, it’s incomplete. Accurate judgments about any given interaction are impossible without seeing both perspectives alongside each other. The reality of the interaction is both perspectives together.
We like to think that we focus on what’s most important, when it’s the act of focusing that makes it seem important. Unless you’re clear on what is most important to you as a person, partner, and parent, clinical shifts in focus can get you stuck in therapy.
If you’re stuck in therapy, it’s probably because you’re trying to change habits with insight and conversation. The only reliable way to change habits is through repeated practice of new thoughts and behaviors that are incompatible with undesired ones.
For example, if you shout at your partner under stress, imagine stressful interactions with your partner and practice binocular vision—seeing your partner's perspective alongside your own. Practice will build a new habit of seeking to understand and care, which is incompatible with the stress-induced habit of shouting at your loved one.
