HMN 2024: The One Ingredient That Dooms Therapy

Therapy’s success doesn’t depend on groundbreaking techniques or advanced theories. It depends on one simple yet essential factor: Willingness. As a therapist, I’ve seen this truth play out countless times—most vividly in one unforgettable couple I worked with.

When Resistance Turns to Regret

At their first session, the husband, a towering man with a commanding presence, crossed his arms, leaned back in his chair, and said, “Dr. Jeff, you’re a nice guy, but being here is bullsh*t. We don’t need therapy—she needs to learn to listen.” His wife sat beside him, tight-lipped and withdrawn. It was clear she’d dragged him to the session, and he had no intention of engaging.

Not surprisingly, progress was nonexistent. After a few tense sessions, they stopped coming. But a few months later, I received a frantic call from the same husband. His wife had told him she was done. This time, he begged for an appointment.

When they arrived, the dynamic was unrecognizable. The husband, once so confident and dismissive, now lay on my office floor in the fetal position, sobbing uncontrollably. His wife sat quietly, her decision firm. At that moment, his resistance had melted away, replaced by desperation and regret. He was finally willing to do the work—but it was too late for him.

Why Willingness Matters

Willingness is the foundation of a strong therapeutic alliance, which research shows accounts for 70 percent of success in therapy. Without it, even the most skilled therapist and practical tools fall short. Therapy isn’t something you can force; it’s a choice that must come from within.

Progress is nearly impossible when someone resists therapy—whether due to denial, pride, or external pressure. Conversely, when a person is genuinely ready, even the most challenging work becomes transformative.

The Problem with Forcing Therapy

Telling someone they “need therapy” often backfires. It can make them feel judged or defensive, creating resistance rather than openness. I’ve seen this dynamic with couples, families, and even individuals pushed into therapy by well-meaning loved ones.

When someone enters therapy unwillingly, they may go through the motions but remain emotionally closed off. This limits the formation of a trusting bond between therapist and client, preventing the deep work that leads to change.

How to Encourage Willingness

If someone you care about is struggling, you can encourage them to consider therapy without pushing them away:

Be sure to express concern, not criticism. Instead of saying, “You need therapy,” try, “I’m worried about how you’re feeling. Have you thought about talking to someone?”

Emphasize choice. Let them know therapy is their decision, and you’ll support them either way.

Share your own experiences. If you’ve benefited from therapy, share your story to normalize the process.

Be patient. Sometimes, people need time to reach their readiness.

Therapy can only work when someone is genuinely willing to be there. As difficult as it is to watch a loved one struggle, trust that their journey toward healing must start with their own choice.