Family Therapy: When Counseling Doesn't Work

Carl Grody

Sometimes, despite everyone’s best efforts, family therapy doesn’t work.

It’s easy in those situations to blame people. The family might think the therapist doesn’t know what they’re doing or doesn’t understand what the family needs. The therapist might blame the family for “not doing the work” (good therapists won’t do this, by the way) or decide the family just wasn’t ready for change. Sometimes family members blame each other for undermining the process.

It’s likely, though, that nobody’s to blame. This happens with every therapist from time to time, and when it does, our job is to help the client move on rather than soothing our ego. But before you send the therapist on their not-so-merry way, there are a few things to consider.

Things often get worse before they get better. The therapy might actually be starting to work, but it triggered an “extinction burst” of negative behaviors. That’s fancy therapist talk that means whenever you change what you do, the kids have to test to see if you mean it. If that’s the phase you’re in, it’s important to stick with the therapy; eventually the kids will calm down and adapt to the change.

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Rapport with your clinician. The best predictor of positive therapeutic change is good rapport with a clinician who knows what they’re doing. That’s even more important than any approach or technique that your therapist might use. You don’t have to love everything about your therapist; you just need to respect them enough to consider what they say and follow through with the interventions.

Your therapist should meet you where you are. They should be working with you on your goals, not theirs. For example, I might think a family’s issues stem from an unspoken marital conflict, but the parents didn’t come to me for couples counseling; they came to change their child’s “terrible” behavior. It won’t help for me to say, “Of course Johnny’s acting out with the two of you yelling at each other all the time.” Instead, we explore how they work together parenting the kids, because that’s why they came to see me. The marital issues might eventually surface when the parents learn to trust me and start seeing improvement in the kids’ behaviors.

Openness with your clinician. Sometimes therapy feels stuck because you’re not ready to open up yet. That can feel like a therapy failure, but it just means you need more time to feel comfortable and connect with your clinician. I remember quite a few clients who agreed to therapy but didn’t agree to talk. If this happens, it’s OK to tell your therapist, “I’m not comfortable talking about that yet.” They’ll understand and work with you at your pace.

Positive change is scary. That sounds goofy, but it’s not. When things start getting better, anxiety increases because we expect everything to fall apart again. Sometimes that makes someone in the family sabotage the progress as a way to cope with the anxiety; the family might be back where they started, but it’s what they’re used to, so the anxiety fades. These relapses aren’t a sign that therapy isn’t working; they’re an expected part of the process. At that point, it’s important to explore what was making things better and keep building on those. I talk about this with families from the first session; the process of “two steps forward, one step back” is normal.

If you’ve considered all of that and still feel like it’s time for a switch, don’t feel guilty. Your therapist will be fine after you’ve left. But don’t just disappear, either. Have a final meeting with your clinician to explore what worked, what didn’t and what you think you need. Maybe they’ll offer a different approach that sounds worth trying for a few more sessions. And if not, your therapist should help you with referrals to respected colleagues who might be a better fit.

Carl Grody is a licensed independent social worker who works with families at Grody Online Family Counseling.

This story is from the Spring 2020 issue of Columbus Parent.