Why Therapy Fails Without a Trauma-Informed Approach

Young depressed woman during her therapy session

People who are experiencing extreme stress or anxiety often seek help from a therapist, hoping they will have the cure or at least some way to lessen distressing symptoms. Of course in this time of a pandemic along with all the unrest in our culture, extreme stress or anxiety is becoming more commonplace.

Going to a therapist does not guarantee that they will have answers and approaches to alleviate your stress and fear symptoms. Scott Miller, PhD, in his blog entitled The Failure Rate of Psychotherapy: What It Is and What We Can Do? shares what his research on the ineffectiveness of psychotherapy.

He states that 50% of people who go into therapy are helped. “Even in studies where carefully selected therapists who receive copious amounts of training, support, and supervision, and treat clients with a single diagnosis or problem, between 5 and 10% get worse and 35-40% experience no benefit whatsoever! That’s half, or more. In fact there have been studies that show that therapy is only considered effective for about 30% of clients.”

Man talking and waving hands in therapy session with psychiatrist/ psychologist.

I think it can be helpful to factor in trauma when we consider why therapy might fail. Peter Levine in his book In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness provides the following insight: Many therapists hold to the hope that they can somehow provide their clients with the positive, affirmative relationship that will assuage a client’s fractured psyche and restore his or her wounded soul to wholeness. However, what often happens is that a client’s dependency upon the therapist escalates and gets entirely out of hand.… Traumatized individuals are not made whole through the therapeutic relationship alone. Even with the best of intentions, and highly developed empathic skills, the therapist often misses the mark here.”

Levine goes on to give a deeper explanation of possible dynamics in therapeutic interactions when therapists are unaware of the complexity a traumatized patient brings into the relationship. Trauma can influence a person’s abilities to engage in therapeutic processes. However, most of the people who seek therapy have a trauma history. What a dilemma!

Young woman discussing her problems with female psychologist

So in thinking about today’s stressors where so many people are overloaded with stress and fear and who might also have unresolved trauma, it makes sense that therapy is so often ineffective and even unhealthy if therapists are not highly trained to understand how trauma affects the brain, mind and body and do not have a trauma-informed approach to therapy. If you have not had a good experience in therapy, please know that it is not your fault and maybe is not even the fault of your therapist. It is an important awareness to first find out the degrees to which that therapist is trauma-informed, trauma-sensitive and trauma-competent.

This article offers some suggestions in that regard. Unfortunately, there’s no official database of “trauma-informed therapists.” But I’d like to share some tips for when you’re seeking a trauma informed therapist. Pay attention to a how a therapist describes themselves on their website; listen to how they talk to you on the phone.

When a therapist has an authentically trauma-informed approach, they will:

  • Highlight safety from the beginning: physical safety, emotional safety, and creating a safe environment where healing can occur.
  • Emphasize self-care, boundaries, grounding and resourcing.
  • Their approach will recognize that your behavior isn’t who you are—rather that it makes sense based on your history. It is what happened to you, not who you are!
  • They will work to understand your coping skills, how you survived your experiences, and help you build new healthy coping skills.
  • They will  move at a pace you’re comfortable with, collaborating with you along the way, and help to keep you within your window of tolerance of emotions.
African american man feeling sad and rejected.

Don’t be afraid to ask what a trauma-informed approach means to them. In addition, pay attention to how you feel in the initial meetings with a new therapist. You should feel respected, comfortable and allowed to slowly build a relationship. There should be a sense of safety in the therapy room before ever sharing deeper information about your trauma history. My hope is that you will also feel compassion, warmth and kindness. And they note that of most importance, if the therapist asks for all the details of your trauma upon the first visit, definitely consider another therapist!

Invitation for Reflection:

  1. Have you sought out therapy only to be disappointed or even wounded as a result? To what extent did you feel that this failure was your fault or at least your responsibility?
  2. How do you feel about the statistics of how successful therapy seems to be?
  3. Do you feel better equipped now to help yourself interview a potential therapist?

Diane Wagnehals, Director, Lakeside Global Institute