does therapy just not work on some people?

by A.
(New England, United States)

Hi I have been going to therapy on and off for a couple years and I am no better for it. To summarize the issue: I cut myself so bad can never wear short sleeves again cause of how bad the scars are, am miserable/sad, have a lot of anxiety, a lot of times I want to die but am also very afraid to die at the same time. my growing up situation was a nightmare, but im 30 now and cant seem to move forward. the last couple years I have had this overwhelming sense I am supposed to be dead, not that I am going to commit suicide, just this feeling and kind of reasoning im so sad cause im not supposed to be here I say it to myself in my head when I feel sad as some kind of way you know that explains it why I am the way I am. well in june I choked on some food and developed a swallowing anxiety. I have lost around 40 pounds since then from very limited eating, I am afraid to eat most things, I have finally worked myself up to certain things but even those things I can get myself to eat I am afraid when I eat so it makes the experience not enjoyable. well I forced myself to see a nurse who prescribes psych meds and after taking them for a month she tells me oh they can take 4-6 months to work when I question that its not working so I stopped taking them. I made an apt with my old therapist cause I requested his notes from our past sessions to try to figure whats wrong with m as nothing has helped me but when I asked him if some people just don't get better he says usually they do and he isn't sure why im not. well this puts me in a situation where im like okay so I tried to get help but nothings working even after a couple years so is it just that this is how I will always feel as long as im alive? I never expected to have a happy outcome or life, I just wanted to feel like okay and not think or imagine my death every single day, so im wondering like for some people like me is it possible no one will ever know why I am like I am or be able to help me. im just wondering if ive tried the drugs, ive tried the therapy, what else can I do? or should I stop wasting my time trying to understand something beyond what will be understood? Are some people like me just not able to feel anything but this?

Ben's Reply:

These are good questions, but not simple. I wish I could say that psychotherapy is always sure to help any person within a specific period of time, but we are each different. Not all issues are the same, and some are not quick to change. To add to the confusion, there are many different schools of thought, theoretical orientations to therapy, that look at the process in different ways. Some issues, like phobias, or anxiety, or trauma can often be resolved within a shorter time (for most people) using specific techniques, like CBT, EMDR, EFT (Tapping) to name a few. But complex traumas, early traumas, attachment issues (related to early traumas), or "personality disorders" can take much longer. Some people would consider 2 years of therapy to be a relatively short time to address some of those issues. I know people, including other therapists, psychology professors and people I have great respect for, who are very self-aware and wise, who have gone through many years of therapy themselves and even return to do therapy for periods of time throughout their lives. It's not a mark of failure, but a dedication to continual growth and self-discovery.

I guess my main point is, don't be so hard on yourself and don't consider it a failure. Sometimes a new approach is needed, a new model of therapy, or a different therapist (or a different healing modality altogether). Or coming up with a new plan with the therapist that you have (if you feel a good connection and trust with them). Some forms of depression (like Dysthymia - chronic depression) can be more difficult to change since it can become such a "normal" part of one's identity over time. Sometimes there are old traumas that haven't fully been resolved in therapy and until they are released, the depression and anxiety continue. For some people with these long standing issues, DBT can be a very effective model to use (Often done in more intensive programs, but there are also therapists who use this in their individual therapy practices). Mindfulness based practices can be very good in general (and are a part of DBT too).

As for the swallowing phobia you developed, using a technique like EFT/Tapping would probably be one of the best things to try. That kind of specific phobia, based on a specific traumatic event (choking) is often quickly resolvable with techniques like EFT or EMDR.

Don't give up on yourself. Life is change, and change is always possible if you don't give up. There is always something new to learn and nobody is a hopeless case.

Wishing you the best,
Ben