What Might Make it Difficult to begin Psychotherapy?
- aphillipsarts
- 1 day ago
- 22 min read
I understand there can be many reasons why someone would be hesitant, and find it difficult to begin psychotherapy. If you experience any of these, or other similar examples, I encourage you to let me know. It doesn't necessarily mean we can't work together or that therapy isn't for you. In fact, worries of this kind can be a worthy starting point, and often prove important and valuable to explore.
There can be multiple and very personal reasons behind any of the issues below, and what may seem like a straightforward hesitation can sometimes be connected with more complex feelings. This is not intended to be an exhaustive summary, or give definitive answers, but rather to suggest that whatever your experience is, our task in therapy is to think about it together.
At times it may sound like I am generalising about all therapy, so please bear in mind I am only referring to the type of therapy I practice, and my own way of thinking about it.
I feel embarrassed to talk about it
The fact that you know I am here to accept you just as you are, and listen carefully to whatever you tell me, doesn't mean I expect talking about your life to feel easy. It is usually not the case that patients feel they can simply 'tell me anything' at the beginning, in fact it is often not advisable to dive in too quickly. If something is difficult to talk about, we might turn our attention from the 'thing' or 'subject' you are trying to describe, towards why it feels difficult to express - in this example the sense of embarrassment.
It is okay to climb down the steps into the shallow end of the pool, and gradually swim out to deeper waters, as you feel comfortable to do so. This will of course mean taking the risk of venturing into new territory at times, but first we form a trusting therapeutic alliance/relationship. Part of how we begin is about being careful not to leap straight from the top diving board.
My problems aren't serious enough
Sometimes there can be a concern about not being taken seriously. You may have ideas about who comes to therapy, and why, which suggest that it is something that happens only when a state of crisis has been reached, or a 'last resort' after every other possibility has been tried. Personally I would encourage people to come to therapy much sooner.
People new to therapy sometimes compare themselves with an imagined 'other' who comes to see me because of much more serious matters. It might feel like you would be just taking up my time, or are somehow not worthy of my attention, and other people are. If this is the case then we might start by exploring these ideas about yourself in relation to other people. Perhaps there could be a fear of being humiliated or rejected, that I might think or say "you're only here because of this?" Maybe this might relate directly to experiences you have had when telling someone that you need support. I can assure you that will not be my response when we meet.
Or, it could be an intuitive sense that there is more going on beneath the surface that is asking for attention, and there may be a tendency to minimise your difficulties, which could be done consciously or be happening without your awareness. What we often find in psychotherapy that offers genuine depth, is that during the initial stage of therapy the reason why someone has come (the 'presenting concern') is not the real reason, or is only an aspect of it. That's not to say that it is irrelevant, or we are deliberately looking for things to be worse in order for someone to stay in therapy for longer (that would contravene the ethical code I abide by), but that there is a move from noticing the ripples that appear on the surface, to realising that the ripples have not caused themselves.
My experience cannot be understood
You may feel unable to reach an understanding of your own experience which feels satisfying and brings a resolution. That sense of not being able to change things by yourself could lead to feelings of frustration, or that you are somehow incapable. You may have experience of significant people in your life who were either unable, or unwilling to try and understand. We might consider your past experiences of attempting to seek support from others, and how this may have led to giving up on the idea that someone else could be interested enough to try.
It can be very tempting for both the client and the therapist to 'pretend to know'. As the client you may be feeling a genuine urgency for change which is why you have come to therapy, and as the therapist I may want to prove myself intelligent and worthy of your investment. Of course, both of these positions are understandable and even necessary to some extent, provided that we avoid the danger of claiming a 'premature understanding'. In Depth Psychotherapy we may need to work through periods of uncertainty or even confusion together.
It is a recognised stance for the therapist to adopt a position of 'not-knowing', the purpose of which is to allow the client something truly special which can be one of the most healing aspects of therapy, yet can be too easily taken away by a well-meaning but overzealous therapist. This is the sense of true self-discovery, rather than being given an understanding from someone else. It doesn't mean the therapist willfully withholds something at the expense of the client, but that they refrain from filling the gap of understanding with their own ideas about what would be best, or how life should be.
I recognise it is very important to have the sense that your therapist understands you. Based upon my experience I will of course have a certain understanding when you tell me about yourself, or if you mention a diagnostic term I will have a knowledge of what its meaning is in a clinical sense. But it is vital that I refrain from making assumptions about you. What I am mostly doing is thinking about what elements of my knowledge and experience might help you to explore what you are describing. To a large extent this can involve putting aside what I think I know about something, in order to be present with, and better understand the unique individual before me.
The purpose of your therapist's understanding is to help you understand yourself in new ways. For this reason it is very important that what we are doing is working towards a shared understanding, and towards the same purpose - the one you want to work towards. This means that I am not an expert on the subject of 'you', or a person with psychic abilities telling you about yourself as if I had access to your inner world.
Meaningful understanding in therapy emerges from the gradual process of interaction between us; exploring what you express in the sessions, my responses, and both of us reflecting upon this relationship. I think this is why depth psychotherapy can be powerful, because it is not simply a matter of figuring something out like an equation, it is participating in an experience.
In the present age of social media...
...I notice a whole variety of people (from qualified and unqualified therapists of various kinds, to coaches, healers, and wellness influencers) attempting to attract custom by claiming to understand exactly what the potential client is going through, and therefore what they need. At best I find this misleading, at worst it is exploiting the deeply held human desire to feel understood, and the instinctive hope that someone will intuitively understand and meet our needs without us having to verbalise them, as mothers do for infants (all being well).
The self-proclaimed expert will have experienced the 'same' situation, problem, or diagnosis, and make significant claims about how this will help the client. This person may well have their own experience of these matters, but that is still not meaningful knowledge of another individual's unique situation. That is only ever arrived at by a process of enquiry and finding out directly from the person concerned, and this is one of the elements that makes psychotherapy special.
Yes, some shared ground may help a person to relate or empathise with another, if it is applied with a sense of curiosity, and the expert may need to put aside their own experience for a while. But it can also have the opposite effect. Rather than greater empathy and being more attuned to the client, assumptions about something 'shared' might get in the way of really being receptive to what the client is communicating, because the expert so strongly identifies with their own experience of the issue at hand.
Rather than looking for a therapist who has the same life experience as you, I feel it can often be better to look for a (suitably qualified) therapist who has experience in working with a variety of people in different situations, and if necessary has specialist knowledge of the area that concerns you, that can build a meaningful working relationship with.
I've had therapy before, and I didn't like it / it didn't work
At the initial consultation I always enquire about whether there have been any past experiences of therapy. If so, what was it like? What was good about it, and what was not helpful? How did it end?
When we first meet I will be as clear as possible about how I work, and what it might have to offer you. We will reflect upon your hopes and expectations for therapy. If these are aligned then we can begin working together, and review how things are going at regular intervals. I suggest committing to 3 sessions at the start, to get a sense of what it is like, and the rhythm of the sessions within your life. You are always able to end therapy whenever you choose to.
There are so many different types of therapy, and even then so much comes down to the individual therapist, both in terms of who they are as a person, and also how they practice. For example, even within the Art Psychotherapy population of therapists there will be a range of different approaches, and different theories which underpin the practice of each individual. I appreciate that this does not make choosing a therapist simple for the prospective client.
Whilst the therapy sessions I provide are always different for each person according to their needs, I can't be all things for all people. I have my own approach, and in line with requirements set by the regulatory body (HCPC) I also have a 'scope of practice', which means that I don't work outside of my knowledge, skills, and experience.
It is important to remember that even when client and therapist are well matched at the beginning, what you need from therapy may change along the way, as you change and life goes on. There could come a time when we have travelled as far as we can together, and it would be more appropriate to see a professional who better meets your new requirements.
It's too late for me to change
To begin with, there may be questions around what it really means to change. One needs to be careful that the desire to become different is not in a direct that moves you away from who you truly are. Could the supposed necessity for change come from outside of you, perhaps messages from culture or society that you simply feel obliged to live up to?
Personally I feel a more appropriate word is 'transform.' 'Change' can mean replacement, something old for something new, like changing a tyre. Transforming implies the original element is still there, but something about its presence is different. It suggests going within, and being true to your Self. But let's keep the focus here on change in the context of it being 'too late.'
"It's never too late to change," says the chirpy popular phrase, but so often this contrasts with how people feel. I think there is no easy answer here, and this sense can be a fertile ground for personal exploration. This can sometimes be to do with age, but often it is in relation to a way of being, or situation, that seems so ingrained or permanent because it has been our experience for such a long time. Could it be more a question of having lost the sense that there is something else to change to - "Who am I, if I am not having this experience?"
The change that could be needed might be about realising more appropriate options. "It's too late to change" may only be an echo of a past version of oneself, and doesn't mean there isn't a whole range of future possibilities to work towards and realise. Often there is a part of us stuck in the past, whilst another part of ourselves really can imagine something new and desired. The pain caused by the conflict we experience could be seen as evidence for the existence of the aspect of ourselves which is still alive to new possibilities. The question might then be, "what prevents me from changing?"
Of course, it all depends on what the desired change is. There may be times where what's needed is to fully acknowledge what is not possible, that we cannot go back, and to mourn the loss of a path not taken - of which there will be many in every human life. Not in a self-absorbed way, but as a crucial act of bearing witness to our own life, and perhaps allows us to find greater meaning and purpose in what we have experienced.
In terms of age and 'too late', it seems to me that in our culture (by which I mean the dominant 'Western' one in which I live) there are a number of prevalent fantasies about how we live and what is possible, that influence our ideas about change. One of these is the desire for eternal youth, even an assumption that means 'I will always essentially be a young person, just in an older body'. If I don't really age, there can never be such a thing as 'too late'. In a spiritual sense we could take the view that our essence, what we truly are, is beyond time, ageless. I think there is a genuine reality to this. But to see human experience only in that way would bypass the limitations of physical existence. Something our culture does not attend to very well is aging and death.
Another possibility could be that the idea of 'too late' simply becomes a reason not to try, and a little encouragement with some first steps is enough to change one's mind. A story that one tells oneself, but really has its origin in powerful messages around what one is capable of that came from significant figures in your life personally, or societal expectations and stereotypes.
It will make me / the situation worse
It can be quite a common experience to feel a little 'worse' at the beginning of therapy. If this is the case it is important that client and therapist think together about what 'worse' is like, and what it means for the therapy. Whilst the aim is that therapy feels beneficial from the beginning, I think we need to make sure to dispel any ideas that coming to therapy automatically makes life 'better', ends all suffering, or instantly changes difficult situations. Or that the sessions themselves will be always be plain sailing.
It may sound paradoxical, but in order to benefit from Depth Psychotherapy an individual will first need to have sufficient ego strength to approach their difficulties, form a relationship with the therapist, and adopt an attitude of curiosity and enquiry.
Is the sense of 'getting worse' directly due to the therapy, or is there something going on in the client's life causing this, and therapy becomes a target for blame rather than attending to the real issue?
Sometimes people proceed in a self-sabotaging way, which could be why they have come to therapy, but we will only be able to work with this if the therapy can survive the attempts to undermine it.
I will do all I reasonably can to facilitate your self-expression during the therapy session, and the idea is that you feel relaxed and comfortable enough to do so. Although, it could be important that this is not so relaxed it's as if we are just meeting for a casual chat, and we both end up colluding in avoiding difficult subjects. It is crucial that we go at your pace, tread with care, and pay attention to any indications that working together may not be right for you at that time.
It could be that in coming to therapy the client is now facing the reality of communicating to another person what they are experiencing, and this could mean finding themselves on unfamiliar ground, feeling exposed and vulnerable. With this we need to find patience, compassion, and respect the courage that is being shown. We might notice whether the alliance between us is becoming stronger and gradually more trust can be placed in the therapist, or if that is not the case.
In successful therapy there will undoubtedly be occasions where difficult feelings - and even the sense that therapy isn't working - need to be tolerated, in order for them to be worked with. This can test the client, therapist, and the therapeutic relationship, but it is very much part of the work.
Is the mere presence of the therapist evoking something in the client which could be understood in terms of 'transference' (feelings directed towards the therapist which are more to do with other significant figures in the individuals life)? Again this is part of the therapy, but there will need to be a sufficient amount of positive feeling towards the therapist for it to begin well, and be sustained through difficult periods.
It's not a one way street, and feeling states are evoked in the therapist by the presence of the client and the 'material' they present, known as 'counter-transference'. As an experienced therapist who attends clinical supervision I am familiar with looking inwardly to consider how I am experiencing an individual, and reflect upon my responses and what may be influencing them. A therapist who doesn't make certain links about their own experience in relation to the client may unconsciously 'enact' something within the therapy which unsettles the client in some way. This can be very subtle, and unintentional, but can nevertheless jeopardise the therapy.
Sometimes there are instances where continuing would clearly not be in the clients best interests, and we aim to avoid that scenario where possible through the process of assessment in the beginning phase — Information provided at first contact, the initial consultation, and then the first 3 therapy sessions.
Other possibilities include....
The client and therapist are simply a poor 'match' for some reason.
The type of therapy and approach of the therapist is just not right for the individual.
Other interventions need to be in place before therapy can be effective — e.g. safe home environment, physical health, medication, other professional services involved.
If it doesn't work out I can help you to think about what might be more suitable.
Therapy is for 'other people'
Aside from an individual needing to find a type of therapy that suits them, there can be preconceptions about the 'type' of person that comes to therapy, and that these people are somehow fundamentally different as human beings.
Often pride around supposed self-sufficiency can be behind this attitude, with therapy seen as something that 'weak' people do. Does the person who says something like this truly believe it? Or could it indicate that such a person invests a great deal of effort in convincing themselves and others of their own strength - when deep down they feel differently? It might speak of a person who experiences the idea of exploring their inner world with another as an existential threat to their sense of self, due to core wounding in their own life. Perhaps at some point there has been a literal truth behind the need to appear strong and not show weakness; it may have been necessary for survival.
This kind of thinking may be due to how the individuals emotional life was responded to within the family. Or more generally, how certain emotions were welcomed and others were not between family members. It can take a great deal of courage and strength to begin therapy, and that is especially so for the person who feels they are too tough for it.
We are not islands, and cultural and social influences play a huge part in how therapy is perceived. Maybe it is only for the wealthy, those with time on their hands, self-absorbed people who love nothing more than to talk about themselves. Or more compassionately but no more accurate; only for the most 'unwell', the lost souls without hope, or the terminally confused.
In another way, there could be an undeserving attitude, or a deep sense of isolation and loneliness behind such a sentiment, where the 'other' people are seen as those worthy of care and affection when I am not, or for whom there is at least some hope; "No one cares about me", "No one would want to listen to me", "I've always been on my own, no one is ever there for me."
I don't deserve the attention
This might be the case for a person who is familiar with a sense of low self-worth or self-esteem. Presumably, the kind of attention that psychotherapy provides is essentially of a kind and loving nature. So we could say if that kind of attention is not felt to be deserved, maybe there's another kind of attention which is felt to be either deserved or inevitable, and this might be something more harsh, critical, and unkind. In exploring these feelings with you, I might not jump in to convince you that you do deserve kind attention, for a couple of reasons. Firstly because it might seem like I am simply denying the experience you are having, when we need to stay with the reality of where your are. And also because we need to find out what your experiences are of various types of attention.
Humans work in ways that can seem mysterious, and one consideration would be that for any persistent feeling state to be entertained, there must be some kind of pay-off for a part of the self. So that feeling of not deserving kindness and maybe deserving something else instead, could serve a purpose, perhaps something defensive, to protect against 'loving' attention, maybe for fear it is not genuine.
It might be something you have come to believe about yourself from early on in life. Perhaps you had a parent who did not feel worthy of kindness themselves, and you have internalised this message from them.
A different scenario would be someone who is in therapy due to feelings of shame or guilt around something that has involved them. Perhaps it is something they genuinely regret in relation to a choice freely made, or it could be a sense of shame that emerged out of a situation they were subject to.
Being afraid of attention makes it difficult to begin psychotherapy
This could be something like stage fright, where there is felt to be a pressure to perform. There might be worries about what you will say or express in artwork during the sessions. Sometimes this manifests as not knowing what to talk about, and at other times there is a fear of being judged for what is being expressed. People often feel that they need to satisfy an imagined set of expectations which they believe the therapist to hold, and this provides us with very useful things to consider. A client may believe they are somehow 'doing it wrong'.
Whatever happens in the therapy space is worthy of our attention. In some respects this may take the pressure off, but it may also increase a concern about being scrutinised. This is where the strength of the alliance between client and therapist is important, because we do look carefully at how you are experiencing the session. So the idea is that there can be a sense of trust which allows you to tell me about whatever you are noticing within yourself and what you notice about me. The trust means that although it may still feel difficult at times, there is still a sense of safety, and that I will never intentionally respond to you in a punitive way.
What happens next is that we think about it together, and explore your experience to see what meaning it may have for you. Whether it is a sense of not enjoying the attention, of being closely observed, or even that my attention has wandered and you feel like what you are saying is not interesting enough. Part of the reasons we look at what is occuring in the here-and-now between us, is because it can help us to see when particular feelings may be familiar from another time in your life.
Perhaps it might be true that I wasn't as present as I could have been at that moment, but the question is whether there is more to it than that. Is it merely a reminder for me to regain my focus on the client? Or, is there something pre-existing which leads this person to believe that at some point the other person will lose interest in them, that it is inevitable - "just like it always is!" The 'mistake' on the part of the therapist can often be the thing that allows for something really important to be explored, provided the therapist does not respond defensively and welcomes the clients comments.
It is not unusual for clients to assume that the therapist knows much more about them than they actually do, as if the therapist had psychic powers. Whilst it might be true that an experienced therapist is used to thinking about subtle forms of communication and symbolic language, the reality is much closer to only knowing what the client chooses to tell us about themselves.
There can be particular apprehension around using art materials during the session for these reasons. A client might wonder if the therapist will interpret images, and know things the client didn't want to reveal yet, or misinterpret something and get a completely wrong idea about them. Alternatively, the therapist might discover and then reveal to the client things that they didn't wish to know about themselves. These concerns are not entirely unfounded, because there are traditions of therapy, or healing which do operate in these ways.
However, I work very differently. The image is primarily used as way to explore your experience, and whilst I will offer my responses to it this is very much in relation to the specific context of that therapy session, and the relationship between us. I will not be telling what an image means, but will be assisting you to consider that for yourself. We also do not force an image to have a meaning, it is more like allowing meaning to form and emerge, which sometimes happens over time. "Ah, now I understand what this images means!", may be said several months after making it. We then have this visual expression of your psyche at that time, which helps us understand it when the time is right to do so.
You can find further information about 'art' in Psychotherapy on this page.
Will the Therapist Will Tell Me What to Do?
A key thing to remember is that Depth Psychotherapy is not a product that you buy and then use according to the instructions. What you are paying for is a relational experience in which you are a participant. This is not to say that I won't have any ideas about your situation and what might help, but that the crucial element is us thinking together about what you need.
No matter how well I get to know you, I will never know your inner world better than you do. So my approach is to support you in seeking the wisdom within. That's not to say nothing useful can come from outside you - far from it, but having a deeper contact with your own sense of what is best will help you to exercise discernment around what you absorb. This is particularly important with the prevalence of people giving 'advice' on social media platforms.
Recently I have noticed an increasing number of people requesting strategies. My work is all about helping you to reach an understanding of yourself which either enables you to devise your own effective strategies. Or perhaps to realise that sometimes strategies are simply another layer of defence to keep a problem at arms length, rather than getting to the roots of the issue and creating genuine change.
I appreciate that sometimes there will be a strongly felt desire for answers or guidance about your situation. That someone would go to see an expert because they are the one who knows what to do, and can tell the patient. Many other kinds of services in life are like this. An area of contention around 'mental health' treatment and particularly psychiatry, is that it stems from a medical model, which tends to see 'diseases of the mind' and treat them as if they were an isolated physical problem, rather than a person who has a multifaceted life, which needs to be examined as a whole to find the cause.
The Therapist Won't Say Anything
Sometimes people have in their mind the image of a distant, somewhat dismissive, silent person sitting on the chair opposite them. Behind this idea there are often a number of myths and clichés, but for these to have come about as popular thought there must be a certain truth to them somewhere. And no doubt there have been, and are now therapists who would fit this description, whether through personality, a deliberately cultivated approach to their practice, or a combination.
In the therapy session I aim to give you the time and space needed to express yourself, and also to be present in an attuned and responsive way. Sometimes this will mean I am mostly listening, and you are speaking. There may be occasional pauses or silences because each might need a moment to think, to reflect upon what has just been said or expressed before we respond.
An important and healing aspect of therapy is in the way it opens up a different kind of space for noticing what is happening. Sometimes the sessions are more conversational, but even then we must be careful not to crowd out the quiet voices from the parts of yourself that may struggle to find expression.
I have heard it said that the majority of what a Psychotherapist says is intended to show that they have been listening. When Freud referred to Psychoanalysis as "the talking cure," perhaps we might also understand it as "the listening cure."
The idea of the therapist as a 'blank canvas' is a popular misconception, among both patients and practitioners alike. My take on it is that the therapist is definitely not supposed to be an unknowable presence, void of personality or their own preferences. The idea of the therapist not revealing too much about their personal life, or even the full extent of their thoughts and emotional responses to the client during the session, does however serve a very important purpose. The idea is that a degree of 'neutrality' from the therapist allows the client to express more of themselves, and the therapists life should impinge upon the client as little as possible.
Think of the therapist as a surface for making an artwork on. You are definitely looking at something, rather than nothing, even before the painting has begun. It could be canvas - the weave might be coarse or tight. Linen is similar, but at the same time behaves differently. A wood panel could have visible grain or a flat appearance. Paper has very different qualities. The different surfaces may seem firmer, or more pliable. Now imagine the patient as being the art materials. Different people will have different materials and ways of applying them.
The question around whether client and therapist are a good 'fit' for working together could be thought about in this way. Whether the outcome of therapy is successful is not so much about the surface or the materials individually, but what the result is like when they are combined.
This means that depending on the inherent qualities of that surface (the therapist) which cannot be hidden or changed, the same words and expression from a client would create different results with different therapists. The surface can't help but be responsive to what the painter (the client) tries to apply to it, according its key characteristics— those that make the therapist who they are as a person.
A key element of being a Psychotherapist is that they have a good awareness of their own qualities in terms of how different people might perceive them, and what their responses to different material might be, so their own personality and experiences can be a help to the therapeutic process, rather than get in the way.
This is always a work in progress for each therapist with every client. It is a way of working developed through years of being a client in psychotherapy themselves, an immersive and thorough training, regular clinical supervision with a suitably qualified professional, and generally maintaining a sense of reflective self-awareness.
Andrew Phillips is a Visual Artist, Psychotherapist, and Soul-oriented Creative Mentor in south Wales.
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