In Season 3, Episode 4 of Sex Education, Jakob Nyman tells therapist Jean Milburn, his soon-to-be co-parent, “I’m not saying that you’re not good at your job, but I’m not sure that talking can fix everyone!”
He wouldn’t be the first or only one to have reservations about therapy, even in 2021.
In 2020, the Women’s Care Centre at Association for Women for Action and Research (AWARE) saw almost 500 counselling clients, according to an AWARE spokesperson. About 4 in 5 reported functioning better at work and/or in their personal lives post-therapy, and around 9 in 10 were able to develop effective coping strategies to deal with the issues they faced.
But what about the plight of the remaining 15-21 per cent? Does therapy just not work for everyone? What are the factors that contribute to its failure for this group of people?
Common misconceptions about therapy
According to Mr John Shepherd Lim, Chief Wellbeing Officer of Singapore Counselling Centre (SCC), clients dropping out of therapy after the first session is common.
“Some may feel that the therapist is not a right fit for them, or that the therapy session is not aligned with their expectations,” he says.
This is why many therapists aim to make the most of the first session by getting to know the expectations of each client to manage them, set clear goals, and ensure therapy continuity, says an executive of Partnerships and Engagement of Samaritans of Singapore (SOS) Emily Tandar.
From their experiences, the few factors that contribute to the decision to stop counselling sessions include the following fallacies:
1. Going for therapy is a sign of weakness.
“It takes a lot of courage to acknowledge that one is struggling and in need of help,” says Ms Tandar. She cites the example of suicidal clients who might experience emotional barriers such as shame and fear of being judged.
In fact, many therapists, Ms Tandar included, believe that seeking help is more a sign of courage. “Taking the step to find support and hope when they are in a state of distress shows strength and resourcefulness,” she says.
2. Therapy is only for people with serious mental health issues.
There are many reasons why someone seeks help — from wanting to understand more about their relationship patterns, stressful home and work situations, to longstanding conditions such as depression, anxiety, or post-traumatic stress disorder (PTSD).
Instead of treating therapy as a judgement of how “serious” one’s problem is, Mr Lim encourages people to view it as “just another way to improve aspects of your life by learning more about yourself”.
“Typically, the longer people wait to start therapy, the worse the problem gets, and the longer it might take them to resolve the issues,” he adds.
3. Therapy is a one-stop shop for solving all your problems.
Contrary to popular belief, therapists do not have that magic wand to give advice or provide solutions that clients passively accept.
“Instead, we work collaboratively with the clients to explore different ways to manage and navigate their difficult situations, and come up with a safety plan,” says Ms Tandar.
It is through skilled questioning that a therapist eases through the thought processes and helps clients evaluate the resources that are already within their reach, adds Mr Lim.
Is it working or just a bunch of mumbo jumbos?
Due to the wide range of issues different clients face, mental health support organisations like the SCC often have specialists from various fields working with them. They include experts in depression, addiction, children and youth, family, and relationship counselling. his allows clients to pick counsellors who can best address their needs.
There are also centres that specialise in specific areas of help. AWARE, for example, provides trauma-informed, non-judgemental, gender-focused support for women. “AWARE’s sessions are safe spaces designed specifically for women to discuss their issues — including marital problems, abuse, and violence — and [they then] learn about the options available to them,” says its spokesperson.
“Therapy goals are usually set by the client themselves during the first session, and refined with the help of the counsellor to ensure that objectives are achievable,” says Mr Lim. These goals are centred around measurable and observable behaviour changes, which are constantly revisited and assessed periodically.
Another measure of success, he adds, is when clients is eventually weaned off their need for counselling altogether — of course, periodic check-ins would still have to be done. “This is one marker that can tell us that clients are more adept in self-management, and are not in need of our help,” he says.
Common pitfalls — when therapy might not work out
Mismatched expectations aside, there are also a few reasons that contribute to the high dropout rates among first-time therapy-goers. They become discouraged when they are unable to achieve their own set of goals within a certain timeframe, causing them to lose hope and to leave therapy altogether, says Ms Tandar.
Another reason is the level of readiness. “Some clients, who are still in the pre-contemplation stage, may be less motivated to follow up with counselling sessions, especially when they have yet to acknowledge a need for change,” she says.
A third reason is time. Some clients cannot make time for themselves to attend therapy sessions when they put work or family first.
In more dire cases like when clients are suicidal, Mr Lim says they also require other kinds of support that organisations like SOS are not equipped to provide.
“Suicidal thoughts are often a complex culmination of different factors,” he says. “When unemployment or financial struggles are contributing to a client’s feelings of hopelessness or helplessness, they require practical support beyond just counselling. … Such clients are usually referred to appropriate social service agencies for more holistic support.”
Even so, therapists do aim to make the most of each session by first exploring available positive coping skills and resources the clients can tap on, says Mr Lim.
Critical factors for success in therapy
While there is no hard and fast rule for therapy to work, there are a couple of key ingredients that have proven to be beneficial.
1. Having an open mind
While it may be beneficial, Ms Tandar says counselling can be difficult for someone to go through as it “not only exposes your vulnerability, but it also requires you to trust and be open to a total stranger”. “At the same time you need to be patient because the recovery journey is often non-linear,” she adds.
Having an open mind also means allowing yourself to be vulnerable, real, and willing to be taught — all of which facilitates the process of deep self-exploration.
“This will give the therapist more insight to work with, such as identifying existing beliefs, thoughts, and behaviours that could have contributed to the problems that you are currently facing,” says Mr Lim.
“Beyond the counselling sessions, having the openness to implement coping strategies that were discussed during the sessions also contribute largely to eventual client outcomes,” he adds.
2. Getting along, believing in one’s therapist
Mr Lim believes that the most important factor influencing a successful therapy outcome is being able to get along with the therapist. Termed as the therapeutic alliance, the bond between client and therapist is crucial, because “both parties need to work closely and collaboratively”.
“Compatibility can strengthen the connection and level of trust between client and the professional. Having a client feel safe and comfortable is important to having an honest working relationship which may influence the outcome of the therapy,” says Ms Tandar.
According to Mr Lim, honest communication regarding what works and what does not is key to helping the therapist identify coping strategies that suit the client’s personality and style.
“Should clients not find the sessions helpful, we would then encourage them to convey this directly to their counsellors and consider giving it a few more sessions,” he says. “Having said that, good ‘chemistry’ is critical, so do not be afraid to voice out should you want to change your therapist.”
Not every therapist may be right for you — while a friend may have positive experiences with a particular therapist, you may not necessarily have the same experience and that’s perfectly normal. Here are some red flags if a therapist is not a good fit, according to Mr Lim:
- You feel judged for the values you hold or the life experiences you have.
- You do not feel comfortable while being honest and authentic.
- The therapist is either too gentle or too assertive — these are neither good nor bad traits, but each person responds differently to the different personas and styles.
- You feel that your therapist talks too much about themselves without any therapeutic purpose.
- You leave the session feeling lousy about yourself, and there is no actionable direction or solution.
- When your therapist encourages you to rely on them to meet your needs, instead of guiding you to do so independently.
If any of these should happen, it is perfectly reasonable to request a change of therapists for the next session.
Ms Porsche Poh, Executive Director of Silver Ribbon (Singapore) (SRS), adds that it’s okay to try out different therapists, “as long as you don’t get confused”.
“It’s like finding a hairdresser. You’d often do trial-and-error until you find somebody you really like and who knows your style, and then you stick with him or her,” she says.
Importance of holistic support
Ms Poh left her previous role at the Institute of Mental Health (IMH) in 2006 to launch SRS after discovering that there was a lack in the accessibility of mental health support in Singapore.
She says then she had noticed that funding was pumped into making the institute look “like a beautiful resort”. “Yet, when I asked young people if they were willing to seek help here, they’d still say, ‘hell no, over my dead body’.”
She founded SRS to address the stigma surrounding mental health through workshops and peer helper programmes with the public. Her focus: mentally or emotionally troubled youths.
“Due to stigma, I’ve realised that many youths are not comfortable with seeking help from counsellors. It’s very important to understand the community’s needs, and craft our support methods accordingly,” she says.
Ms Poh and her team has reached out to a wide variety of groups, ranging from professors and student leaders to religious leaders and even the police, hoping to help those who want to be “helplines for the mentally troubled”, and teach them how to look out for warning signs and know the right advice to give.
“There are some who relate mental health issues to spiritual deficiencies, for example, and would advise those who seek help to pray more, rather than go to a therapist,” she says. “This happens across all religions in Singapore. We try to propose a concurrent treatment system, while respecting their religious views.”
She also says that it’s helpful for civil groups like the Singapore Police Force (SPF) to go through mental health workshops since the police are often the first point of contact when the mentally troubled face the risk of harming others or themselves.
“I have young people who tell me that when they have their outbursts, their parents would call the police. This makes them resent their parents even more. Sometimes, the police would handcuff them, and that never in their lives have they felt so ashamed,” Ms Poh says, adding that such traumatic experience will make then less likely to comply with a future treatment plan.
“A pleasant first experience with mental health support or management is therefore critical,” she says.
At times, SRS’s professional counsellors offer to mediate relationships between youths and their parents, advising parents on alternative approaches they can take to enhance their relationship with the children.
“Not all parents know how to be perfect parents,” she says. “Often, when youths seek help, it doesn’t mean that it’s necessarily a mental health issue or diagnosed condition, but something else going on in their lives.”
Ms Poh says the traditional treatment model is just a part of the mental health support puzzle. “Often, many of us may be concerned for our loved ones, but one key question to ask is, ‘are they ready to seek help?’,” she asks.
“If they’re not, they don’t have to speak to psychologists or psychiatrists. We can instead focus on getting them to speak to anyone for a more light-hearted intervention approach — such as the friends they trust, for a start.”
If you are looking for help, seeking for a loved one, or just interested in learning more about mental healthcare, check out this consolidated resource: tinyurl.com/gethelpsg.