What Type of Person Does Therapy *Not* Work On?

Gizelle Bryant and Karen Huger are at it again. The Real Housewives of Potomac ladies are often fighting, and Gizelle thinks that's just part of their dysfunctional friendship. When she stopped by Watch What Happens Live with Andy Cohen in July, she opened up about the way she and Karen understand one another, kind of. 

"I think it's mutual [sabotage] — and it's just how me and Karen love each other," she said. "Nice, good old fun, shady fights," she added laughing. 

Well, Karen doesn't see it that way, FYI. She now says she's fallen for Gizelle's drama too many times and thinks even therapy won't help her on-again/off-again friend. 

Dr. Elizabeth Lasky, Ph.D., LCSW, told Personal Space that actually, therapy isn't always the answer.

"Therapy is not always a good fit," she said. "A lot of factors have to align to make for a constructive and healthy therapeutic relationship and therapy experience. For example, the therapeutic alliance has to be strong. The therapist has to know how to deal with the problems being discussed. The patient also has to be open to being challenged in the room."

Therapy doing its job also depends on the therapist.

"Not every therapist is a perfect match for each patient. The therapeutic relationship has to come first, before degrees, before credentials, and before modalities," Lasky added. 

Most importantly, "someone has to be ready to engage in therapy," she said. "It can be demanding and if someone is not motivated to change, he or she may have a very hard time in therapy."

Ultimately, some people will never be a good fit for therapy.

"Some people with severe and persistent mental illness, or people with some personality disorders will not respond to talk therapy," Lasky said. "A person needs to decide for him or herself if therapy is going to work or is working. Neither a friend nor an acquaintance should even be commenting if therapy is working for anyone besides themselves."

Psychology Today explains, "There is no doubt that psychotherapy works for most of the mental disorders," with some exceptions.

"If the interventions used are potent enough to create positive change, it should not come as a surprise that they are potent enough to damage people as well. It is estimated that as many as 15 percent of patients get worse following treatment. Negative effects come in two major forms: 1) worsening of problems already present, such as hopelessness or depression and 2) new problems might emerge, such as becoming dependent on the therapist, marriage issues, or reduced self-image.

"Therapists need to ask patients for feedback and be self-critical about their own performance."