When Therapy Stops Working: Part 2

Healing Beyond Insight and the Therapy Room

1. When Insight Is Not the Destination

In Part 1, I left you with a question: perhaps before asking when therapy stops working, we first need to understand what we have been asking therapy to do

I want to stay with that question a little longer.

Many people come into therapy with a sense of curiosity to understand what happened to them and why they continue to react to life in the ways they do. Over time, as therapy progresses, they begin to recognize the connection between their childhood events and their adult relationships. They begin to recognize their triggers. They begin to learn why rejection affects them so deeply, why they become anxious when someone pulls away, why anger rises so quickly and unexpectedly, or why they continue to seek approval from those who cannot give it to them.

This understanding matters. I always acknowledge the importance of insight. For many, being able to name what has been happening internally can itself be deeply moving. Something that was previously experienced as shame or personal failure begins to make sense.

But there comes another question.

What happens when I understand why I am the way I am, but still struggle to live differently?

You may understand that your fear of abandonment has roots in an earlier relationship, but still experience overwhelming anxiety when your partner or anyone else close to you becomes emotionally distant. You may understand the origins of your anger and have learned ways to regulate yourself, yet find yourself losing your temper when life places you under immense pressure. You may recognize why you repeatedly enter relationships where you feel responsible for another person’s emotional wellbeing, yet find yourself doing it again.

Does this mean the therapy did not work? Or does it tell us something about the limits of understanding alone?

I have become increasingly interested in this space between knowing and living. We can know a great deal about ourselves and still discover that another part of us has not necessarily followed our understanding. Sometimes we can describe our patterns beautifully, recognize where they came from, and even know we may have to do things differently. Yet when an old wound is touched in the immediacy of a relationship, knowledge alone may not determine what happens in our decisions.

Perhaps this is where another dimension of therapeutic work begins. It’s not simply about whether I understand myself, but what happens inside me when my understanding is tested by life?

2. Emotional Safety , Trust and the Therapeutic Relationship

Understanding something intellectually is different from experiencing it within a relationship where it can be felt, explored, and challenged. Unlike any other work buildup, therapy is primarily experienced in relationship, and this relationship is between a client and a therapist. There is a lot of work required.

Sometimes I wonder, when clients reach out for an initial 15-minute call to get to know therapists, as is an ongoing customary practice for many. I know it’s a complex issue, but does the initial call clarify concerns about safety and trust?

Regardless of the modality, the comfort level is not merely a conscious-level experience for a client with a therapist. It’s an interaction that begins both consciously and unconsciously between two people. I sometimes refuse to get into an initial call. To this date, the majority of my long-term clients have not started with the initial call. I gather over a period of time that they have read about my nature of working, and something struck them while they were reviewing and considering settling down with me. They are preparing in their hearts to embark on their healing journey.

Trust is not something the therapist can request or assume, and trust can’t be taken for granted. A client enters the therapy room having experienced betrayal, abandonment, abuse, or relational instability, and they enter that space with caution. The caution carries its own meaning, purpose, and direction. Actually, two people enter the therapy room: besides the therapist, there is the person of the therapist.

Sometimes, it moves me to tears of gratitude that I held a safe place for many others without encountering any serious transferences, despite how I was embracing my own truth. In contrast, I encountered several segments of transference and countertransference, and I had to simply surrender as I sought help from my supervisors week after week so that I wouldn’t stand in the way of the therapeutic work of my clients. The therapist is also part of the therapeutic process.

I used to be overly cautious about the sense of ultimate separation between me and the one who was sitting in the room with me. I was very clear about walking in their shoes, and I nurtured that pure intention even though it raised a tension throughout my formative years. I believe it partially stemmed from subtle caution about overidentification from a clinical case seminar in New York, but I learned the hard way that the inner life of the clinician cannot and will not disappear, however hard one tries.

Perhaps most people are not familiar with the complexity of the therapeutic relationship and the perplexing context that shapes the process and how the relationship delivers the healing

Something deeply complex, but beautifully complex, happens in the therapy room. Therapy might start at the ego level of two people, but as the session begins and progresses, a slow but steady alignment brings the inner realms of the client and therapist into a deeper, accessible level.

The conscious level of the therapist starts with the conscious part of the client, and how long they remain there depends partially on both of them. It can move further without them knowing sometimes. Upon entry into the conscious part, the therapist begins to listen, and part of the listening is to access the unconscious. It’s a deeply powerful evolution that happens in psychotherapy, meaning that the unconscious can be accessed, and it’s not a one-way process.

While the conscious part of the therapist begins to access the unconscious of the client, the client’s conscious can return the favor to the therapist. The client’s conscious can access the unconscious of the therapist, and there can be a meeting point of the two unconscious parts.

This process is both rewarding and risky. While this complex, deeper meeting point of different parts can spearhead healing , it can also sabotage the therapeutic relationship because of the emerging transferences and countertransference the two unconscious parts witness.

THE THERAPEUTIC ENCOUNTER

A conceptual representation of conscious and unconscious relational processes

CLIENT

Conscious experience

↔

Conversation
Listening
Meaning

THERAPIST

Conscious presence

↓ ↓

CLIENT’S DEEPER EXPERIENCE

Implicit memories
Emotions
Relational patterns
Unconscious processes

↔

RELATIONAL
MEETING

THERAPIST’S DEEPER EXPERIENCE

Emotional responses
Personal history
Unconscious processes

THE THERAPEUTIC RELATIONSHIP

A shared relational field in which deeper patterns may become felt, recognized, and worked with

TRANSFERENCE

Earlier relational expectations and feelings may become activated in relation to the therapist

COUNTERTRANSFERENCE

The therapist’s emotional responses may become part of what requires awareness and reflection

Conceptual illustration. These processes are dynamic and reciprocal, not a fixed or literal sequence.

The framework offers deeper understanding of trauma work that unfolds in the context of holding that container for healing , a container of relationships.

A client who had spent a couple of hours in therapy complained that her partner was not expressive and that lately there had been a growing sense of disconnection between them. She had also been feeling that perhaps she needed a break from work, where she tended to feel stagnant. As the session progressed, the therapist suspected that she was suicidal and that they needed to work on a suicide contract.

The client was taken aback and refuted the therapist’s concern, but the therapist insisted on a suicide contract. The client stormed out of the session. Later, she reported this to my supervisor, saying that she had felt destabilized since she started her therapy.

3.When the Therapist Becomes Part of the Work

As a budding clinician, I even thought of changing my profession because it was a lot of inner work that I carried home from every clinical case. I started my trauma therapy at 19. I initially encountered two seemingly contradictory experiences. One was the unsettling feeling of all that I had experienced during my childhood. But on the other hand, I was curious and eager to learn about the connection between my nervousness and my earlier relationship with my father, the growing affinity toward older women and finding favor in their eyes, and the loss of a “good enough mother” that I carried with me to my school while forming some significant relationships as a young boy.

I was not really conscious of why I reacted in strange ways, why I felt trembling while dealing with authority figures. One of them happened to be my math teacher, whom I saw as an extension of my father in many ways. These images and imaginations of people continued to define my day-to-day relationships.

Remember, I did not know these older women were my transitional objects, but I never expected that I would have to encounter the loss of bonding with my mother in due course through my inner work in therapy.

4. What Supervision and further Therapy Taught Me

When I first joint the Psychoanalytical residency program in 2005 , having completed significant personal journey through therapy . I believed a carried insight and understanding about my lived past, but soon realized that my had only started with my previous therapy sessions . I would say the sooner it regular therapy and clinical supervisions blends well and sits deeper , the better it’s for the inner work , psychological growth of the clinicians and these will have to shape the person of therapist beyond ritualistic appeal of clinical education . I had to simply surrender as I sought help from my supervisors week after week so that I wouldn’t stand in the way of the therapeutic work of my clients.

And now retuning the therapist who sought suicidal contract from the client, the story was much more deeper than what one experiences in the room and when the deeper story becomes part of therapeutic relationship and interventions , the process of therapy can not help the therapist for the effective use of the self in therapy . Apparently, the therapist was going through her own breakdown. She had the power as the director of the program , what her trainees and clients saw was the competent person on the outside , but couldn’t easily see the person behind the powerful analytical role she projected from her couch . In the absence of social media her client became her sounding board in this case a punching bag . We are discussing a therapeutic , deep seated and unspoken problems here , what happens in these must be accorded utmost importance than labeling a person for broken boundaries in sacred work

Many of the legends suffered setbacks in their positions to hold a “safe place.” Around 1948–49, Rogers became deeply involved in treating a severely disturbed woman. He later acknowledged and recognized that he struggled to remain the accepting, empathic, congruent therapist his own theory called for. He described moving between warmth and a more professional distance when he felt threatened by the depth of her suffering. The therapeutic context contributed to a profound personal crisis in which Rogers questioned his competence as a therapist and his worth as a person.

However, Rogers did not run away from his existential crisis. He decided to enter therapy himself for roughly a year and later believed that the experience had a liberating effect on him, and his therapeutic work became freer, more spontaneous, and transformational.

Sándor Ferenczi

Ferenczi offers another powerful example of the complexity of transference and countertransference. He underwent analysis with Freud himself, but later believed that Freud had not adequately worked through Ferenczi’s negative transference. They shared a complex relationship and emotional ambiguity. Ferenczi identified his bonding with Freud as a father figure, while at the same time struggling for his own autonomy from him.

What strikes me more about Ferenczi is that he eventually challenged the idea of the emotionally detached analyst. In his Clinical Diary, he wrestled with the therapist’s emotional engagement, countertransference, trauma, and even experimented with what he called “mutual analysis.”

Perhaps one of the most critical aspects of Ferenczi’s work was his acceptance that some of his own therapeutic issues could unintentionally recreate aspects of his patients’ childhood trauma. Rather than simply defending his position as the analyst, he was willing to reconsider what was happening in the therapeutic alignment.

I find this particularly meaningful and enriching because it reminds us that the therapist can become a stumbling block rather than remaining simply the person who is treating it and a path toward recovery and restoration. The person of the therapist does not disappear behind training, theory, or the therapeutic role. I believe many sensible practitioners are aware of their “inner struggles” and remain attentive to their own contextual challenges, but at the same time remain humble and ready to grow so they can find themselves in the company of the most effective practitioners in the world.

5. Trauma-Informed Work Asks More of Us

Lived experience is valuable, but it is not clinical competence. I put on record the highest regard for those who have experienced trauma and undergone trauma therapy, and they are likely to deepen their sensitivity and compassion. However, your past work and training may not always prevent you from overidentifying with your client’s frame of reference, and no one is immune from encountering transference, dissociation, and attachment wounds in many unexpected moments. You’re walking into transference every day, but you’re caught off guard even if you believe you carry immense safeguards with you.

Our credentials are not our endpoint in our drive to become effective practitioners. Training gives us frameworks, ethics, skills, and responsibilities. Yet the Rogers and Ferenczi examples demonstrate that professional knowledge does not make the clinician psychologically invisible when a moment of risk unfolds in therapy.

6. When Therapy Has to Leave the Therapy Room

Insight is developed in therapy, but real healing is tested in life. While no one is expected to work with a therapist lifelong, those carrying trauma can learn in the therapy room, with an ongoing experience of emotional safety, that they are starting to work on a new regulatory system for their traumatized self. In the best possible way, before it’s late, both the therapist and client can lay the foundation to start a firm and stable therapeutic relationship, to work in collaboration for healing, recovery, and chalking out strategies to move forward from old patterns that keep coming into the present. However, reasonable and transparent initial work will determine a “misfit” in working together, and the client must be taken into consideration the moment clarification is sought from a mentor, peer, or clinical supervisor.

The objective cannot be to replicate or duplicate the safety of the therapy room everywhere in life. Life will not always provide emotional safety. Like any other relationship, therapeutic relationships can disappoint us. Clients can and will misunderstand us. Sometimes, as psychotherapy progresses, grief can arrive when we least expect it. Sometimes we will become dysregulated despite everything we have learned. I’ve learned to keep an open-mind, open-heart, and open-door approach.

The therapy room may provide the atmosphere in which something new can be learned, but life provides the platform and the conditions in which that learning becomes lived experience. One of the important questions in therapy is to explore what happens inside me when my understanding in therapy is tested by life. It’s important for clinicians to sit with their clients with safeguards that treatment was not delivering them from old patterns returning to them, but have they acquired greater capacity and psychological agency eventually when the old pattern knocks on the door again?

FROM SAFETY TO PSYCHOLOGICAL AGENCY

A simple view of how therapeutic learning moves into lived experience

WHAT CAN DEVELOP WITHIN THERAPY

Emotional Safety

↓

Therapeutic Relationship

↓

Regulation

↓

Collaboration

↓

Insight

WHAT BECOMES LIVED OUTSIDE THE THERAPY ROOM

Insight

↓

Lived Experience

↓

Setbacks

↓

Different Choices

↓

Repair

↓

Psychological Agency

The therapy room may provide the conditions in which something new can be learned,
but life provides the conditions in which that learning becomes lived.

Returning to my own grief about my mother, I’ve undergone hundreds of hours of therapy. I understood much of my history. Yet the loss of my mother awakened grief connected with her absence between the ages of 6 and 17, but I was not the same person meeting that grief.

The grief remained solid. The childhood history did not disappear. Therapy had not erased either, yet my capacity to recognize what was happening, receive support, pause my professional life, grieve, and continue engaging with the experience represented an inner resilience different from the younger version of me who once lived that loss without the same level of awareness, understanding, and clarity.

Final Reflection

I’ve realized therapy cannot and will not make us immune from our past. We cannot throw away our past. We will remember our history, or rather, be triggered by events. We know our patterns, learn to regulate ourselves, and still find that life has a way of touching places and parts of us we believed we had already won.

I have come to believe and appreciate that the memory of an old wound does not necessarily mean that therapy was not good enough. The more meaningful and relevant question may be how we meet that wound when it returns when we least expect it. We may not know, because the moment of encounter is mostly unconscious work. Can we hold ourselves without rushing immediately to self-condemnation? Can we seek help, consider more choices, repair what needs to be repaired, and take small steps to move forward?

Our healing process and recovery may not always be measured by what no longer hurts, but may be measured by who we have evolved into in relationship to what still hurts.

And perhaps that is one way of knowing and appreciating what it means for therapy to be a work in progress beyond the therapy room, long after I have left the therapy room. I admit that I’m still in therapy, and I can be available to many clients and patients to the extent that I make myself available for the work within.