1. Consumer model. Both clients and therapists often (consciously or unconsciously) fall back on the producer/consumer model, where the therapist is there to “provide” a solution that a client pays for and “consumes.” This ends up emphasizing external resources vs. internal solutions for both client and therapist, and creates an unhealthy, disempowering dynamic — even despite client-centered intentions and protocols — which often results in a lack of willingness to “do the work” that is required.
2. Incompetence or poor training. I often use the analogy of a violinist when describing good therapists: How many virtuoso violinists are there in the world? How many first and second chair violinists? And how many folks squeak away in their basement until a position opens up in the local community orchestra string section? Virtuosos are rare, and hacks are plentiful…so it can take a lot of effort, persistence and luck to find a really good therapist.
3. Lack of cultural integration/acceptance. Psychotherapy should be considered a normal, healthy, even prophylactic resource for well-being…like going to the gym, or going to an MD for a checkup. Unfortunately, it has been polluted with social stigma so that people who could benefit often don’t seek it out — or feel ashamed when they do. This leads to a disproportionate volume of psychotherapy engaging in: a) court-mandated treatment; b) “last ditch effort,” extremely acute, crisis intervention conditions; c) self-help hobbyists. This is not a great group of folks to work with, generally — not in terms of process, or in terms of outcomes — and IMO often results in excessive “lowest common denominator” practices.
4. **The profit motive. **Evidenced-based methods are great — but what if the latest “proven” approach for a given condition isn’t working for a particular client? Well, insurance companies don’t allow such variability; everything must be cookie-clutter compliant with their actuarial tables (i.e. clear diagnosis = rigid treatment protocol). At the other extreme, a provider receiving (uninsured) private pay may not be motivated to use some provenly efficacious, short-term approach, but instead be motivated to create a longer-term income stream. “Perverse incentives” all around….
5. Lack of holism/multidimensionality, and reliance on “silver bullet” modalities. Modern medicine is struggling to reverse over a century of hyperspecialization, where only the separate systems and components of a patient are considered, and not the whole. There are efforts to integrate different disciplines, engage in group consults and assessments across departments, and change this paradigm…but it has been slow, and frequently ineffective. And so modern medicine tends to treat symptoms, and ignore underlying causes. Psychotherapy has fallen into this habit as well — people are complex, and solutions to their problems may also require complexity. This takes time, and multiple perspectives, and acknowledgement that there is no “one size fits all” treatment that is appropriate for a given set of conditions.
FYI I have a guide intended to help folks find a good therapist, here: https://www.integrallifework.com/resources/How-to-Select-Mentor-Coach-Therapist.pdf
Also here is a free assessment process for a more holistic approach to well-being: https://www.integrallifework.com/resources/NourishmentAssessmentV2.pdf
My 2 cents.
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