I don't have the strength for therapy

Original text was published in Czech magazine Psychologie Dnes 11/24. Translation by AI.

In recent years, our mental resilience has been put to the test. Coping with the aftermath of COVID-19, witnessing the horrors of war, or dealing with economic struggles is exhausting. It’s no surprise that psychotherapy is increasingly seen as a magical solution that can fix everything. But is this really the case?

In their book We've Had a Hundred Years of Psychotherapy—and the World's Getting Worse, authors James Hillman and Michael Ventura criticized the lack of significant societal impact from psychotherapy on American culture over thirty years ago. They argued that psychotherapy internalizes the world’s problems within the individual’s psyche, attempting to heal them there, while the real illness remains “out there”—in the banking system, education, and society. While the book has no sequel, we can assume that neither today’s world nor the development of psychotherapy would impress its authors.

When Therapy May Not Work

Some individuals come to therapy in an advanced state of distress. Although they may not suffer from a diagnosed mental illness, they feel they’ve hit rock bottom and correctly recognize that their current life path is unsustainable. They see therapy as a last resort, placing all their hopes in professional help. However, even the best therapist cannot assist a client who lacks the strength to desire, imagine, and actively pursue change.

Clear contraindications for therapy include acute psychotic states or active addictions without motivation to change behavior. In such cases, pharmacological treatment and medical interventions are typically required. Even so, many patients struggling with addiction repeatedly leave treatment programs prematurely. Forcing someone who doesn’t want help is simply futile.

Lesser-known contraindications include social and systemic issues like poverty, lack of education, or other inequalities. Let’s examine a specific case to illustrate these limitations and possibilities within therapy.

A Mother of Three Facing Divorce

A woman in her thirties seeks psychotherapy during one of the most challenging periods of her life. Her problem isn’t medical, so she opts for private practice near her home, where she can get an appointment in just eight days. She has three children—the youngest still breastfeeding—and has recently learned that her husband is leaving the family.

Through tears, she explains her situation, describing how the children are managing and detailing her husband’s sudden behavioral changes. He has found another woman and says he can no longer tolerate “the constant mess and noise” of a home with young kids. She doesn’t understand—she thought they could handle it together but now feels she was wrong about him.

For weeks, she has received no financial support from her husband and is terrified that he plans to file for joint custody to avoid paying alimony. She seems less angry and more shaken, almost in shock.

The client doesn’t know what to expect from therapy; she just wishes her husband would “come to his senses.” However, such a request presents a significant challenge for therapy.

Overwhelming Demands

On one hand, the client clearly needs support to keep functioning during this difficult time. On the other, she seems so overwhelmed that asking her to reflect on her struggles, explore their origins, or connect them to her childhood seems unreasonable. Yet this kind of deep, reflective work is how much of therapy operates. Clients labor hard and painfully, uncovering problematic patterns, revisiting the past, and linking it to the present. For this, they need strength, determination, and endurance—qualities our client seems to have depleted.

To the mental burden of therapy, we must also add its financial demands. Even with health insurance contributions, private sessions cost roughly 500–1000 CZK each. In the context of this family’s situation and the likely lengthy divorce proceedings, this investment seems steep.

This raises a host of questions: Is this client the one who should be doing the therapeutic work? What support did she receive in motherhood? Should her husband also—or rather—be the one in therapy? What value does society place on marriage and family care? How do we ensure family systems are functional? And what role does the legal system play?

What Can Psychotherapy Offer?

Therapeutic approaches differ depending on the therapist’s training. Some schools focus on solutions, while others delve deeply into mapping connections. Some therapists are more directive and comfortable giving clients specific advice, but most schools remain cautious—advice-giving belongs to counseling disciplines and has a limited role in psychotherapy.

All approaches, however, should ideally address what the client needs and whether those needs can be met within therapeutic interventions.

Listening

When working with similar cases, I focus on attentive listening. I try to hear what remains unspoken, what may be lost amid daily worries and turbulent emotions. I bring controlled emotional responses into the session, react humanly to the gravity of the situation, and show empathy—sometimes even tearing up.

Calming

The second natural outcome of the session is calming. Clients often, for the first time, feel they can say everything without interruption. They are heard; no one counters with their own story or offers well-meaning advice on how to “get the partner back.” Physical relaxation is also essential, aided by the therapist’s deep, regular breathing and calm body language.

Impartiality

Finally, the impartiality of a listening professional provides a unique perspective. A therapist calmly and positively explores support options that the client may not have considered.

When There Are No Easy Solutions

A difficult truth I sometimes share with clients is that some situations have no easy or definitively good solutions. While I am a lifelong optimist, I find it more important to prepare clients for challenging times than to paint an unrealistically rosy picture.

Therapy cannot always change other people or entire situations. Instead, it can help us clarify what truly matters, identify what we can let go of, and focus on what we need to survive.

Life’s obstacles are unavoidable, but even the hardest periods are temporary. Psychotherapy can guide us in navigating these moments, restoring hope, and building the strength to endure—qualities we often need most.