You do what you can to help someone.

That's the job of many therapists, hoping to held lead their patient down the path of self-help and rehabilitation. No matter what difficulties arise, you stay the course, helping them find the answers and providing possible solutions they need.

Sometimes, however, that path gets cut short when the therapist realizes their patient is beyond help. What can you do when there's literally nothing to do?

*The following article contains discussion of suicide/self-harm.


Reddit user, dreawithlove, wanted to know when all hope seemed lost when they asked:

"Therapists of Reddit, What was the moment you realized your client couldn't be helped?"

Maybe there's a bit of self-realization, the moment you notice your therapist has decided to no longer see you.

Yay, America...

"My therapist had to let me go because my insurance decided my mental health wasn't worth paying for and I couldn't afford her rate. I miss her sometimes she was my first therapist and I enjoyed talking with her."

Amethoran

But...Why?

"When I was 12 I saw a therapist with my Mother in the room. This 70 year old therapist started the session with basic questions. One question was, “what is a similarity between and peach and a pear?” My response, “they both start with P. He said he had never heard that answer and that nearly everyone says they’re both fruit. Then he ended the session and dropped me"

folkyall

Obviously, Go To One Who Works For You Within Your Budget

"My last therapist decided that if I can't come in twice a week, due to financial reasons, that she stopped letting me schedule appointments."

BloodPactScout

Always Be Aware When You're Not Getting What You Need

"For the most part, I've had the opposite as a client. Where the therapist sessions become mundane and unhelpful but the therapist doesn't let go - the client (me in this case) ends the relationship. It makes sense. It's that whole it's easier to keep an existing customer than recruit new ones. Sometimes the relationship just isn't working but I've never had the therapist recognise that they're not helping me. Whether it's genuine ignorance on their part or not is of course my own speculation but that point about customer acquisition does stick with me."

lifeinwentworth

You can't help someone unless they want to help themselves. Any self-help professional will tell you that, and live by that, as evidenced by some of these dropped cases where it was apparent no desire for improvement was to be found.

It's Not The Kids Fault

"When the child is younger than 8-9 yrs old and the parents want me to only work with the kid to change the kid’s behavior. Ain’t gonna happen. You change the environment and parenting and THEN you see changes in the kid’s behavior."

"Edit: point of clarification. I AM NOT saying it is the parents’ fault or that they are the cause. I AM saying that to work with kids who are young, you need to change the parenting and environment."

"Examples: Autism and ADHD, not caused by the parents, but effective therapy requires changes to the environment, increases in prompts, forewarning, cues, help with regulating emotional and sensory responses. After the brain matures some, kids can better take perspective and think socially with help, a little later they can better plan ahead for contingencies, though the frontal lobes won’t fully mature until a much later point In development than that which I was referring."

odd-42

Perfect Example, Right There

"One month in with this couple, a wife had just spent 5 minutes explaining the impact of her husband's language on her, and how devalued, disregarded, and unimportant she felt in the relationship. His response to her was to, verbatim, use the exact language she had just described to respond to her. She collapsed into sobs, and he sat back, sighed, rolled his eyes, and gestured vaguely to her, as if I would agree that she's the problem. I told him exactly the opposite. He stormed out. She went to the lawyer I recommended and cleaned him out. Full custody too. It was truly a happy ending."

mahoagie

Their Heart Isn't In To It

"The moment I realize they don't want to be helped. It is usually with the cases that are bullied into therapy by loved ones. Of course, most of them at least become curious of the process and start being a part of it, but there are the few that just won't stop resisting no matter how many sessions."

melhamb

So Far Gone They Can Never Come Back

"I am a therapist for sex offenders. One particular client was a drug user, but thus far it did not seem to interfere with the therapy (it was in no way related to his criminal acts). Until one day he showed up for his appointment completely high on hard drugs, he had already been awake for 48+ hours. Turned out his drug abuse was way way way worse then he'd make it seem. He also severely damaged his penis while high (he told us) . We immediately referred him to a rehab and never heard from him since."

OGveer

"I usually can tell in the first two-three sessions. Mostly narcissistic individuals who are brought to treatment by their SO or a relative desperately hoping for change. It never works."

CloudLizard911

Help They're Unable To Provide

"I'm a therapist for individuals with severe and persistent mental illness, as part of a team that does a lot of mobile and intensive services. As a result I've worked with a lot of people for years that I've realized I can't really help much with my skill set."

"Most commonly this is folks who are elderly and start experiencing a lot of cognitive decline. I eventually really don't do much beyond giving them some socialization and more case management to get them appropriate services. Therapeutically I'm not doing much to help them. Eventually they go to a nursing home with a dementia unit and I never see them again."

"The other scenario is when someone is actively invested against therapy (e.g. court mandated, when legal guardians are forcing therapy, or when payee services refuse to contact their clients except through us, county forces clients on us). In those cases I try to build common ground, develop as much rapport as possible, meet them where they're at, and be as radically open as I can. Unfortunately in some cases there's just so much grievances between us to be able to help them, which doesn't help when it's mandatory and insurance won't allow a switch (yay managed care . . . ). It's not so much that they can't be helped - it's just I or my team can't help them because of all these environmental factors interfering."

"I've dealt with a lot of serious cases (significant psychosis and/or personality disorders, etc.) and I don't think I've ever met anyone that I've felt was truly beyond any sort of help from anybody. Just a lot of cases of I'm not the right person in the right environment."

Darklight161

Then there's these, sad tales of therapists who realized their patient was far beyond their help, and perhaps far beyond anyone's help.

Not Understanding The Treatment

"my client told me that despite the promise from her psychiatrist that trying an anti-anxiety prescription might help ease the symptoms of her complex PTSD, it would only be treating a symptom and not the cause of the anxiety. I wish she had been able to understand that in order to move forward she would’ve needed to get out of her “fight or flight” mode, which was why finding the right anti-anxiety prescription was a good start."

"edit for clarity: the anxiety was fueled by her fear of an abusive ex"

hopelesslydevoided

Putting Them In The Right Place With The Wrong Head Space

"I’ve been a youth mental health therapist for 7 years, and I’ve not had that issue yet in mental health work. And honestly I don’t think I ever will"

"But previously I did family therapy and general social work, and had a client that had a drug problem, he was homeless and I did everything in my power to help him get work and shelter. He would always quit after 2-3 days citing that he couldn’t get along with the boss. And he would consistently lie about health problems or call me in the middle of the night to try to get money, or for me to sign off financial aid to him (I already got him monthly financial support prior - it was just going to more drugs)"

"Finally I managed to get him a place in a halfway house - the workers were kind, the other guys living there seemed really easygoing. It came with immediate employment and a place to stay for a year, and he’d be coming out with enough money to get by for awhile."

"He quit after a month…"

"It’s been years since then, and from what I know, he’s still in the system"

musicmonkay

No, It's Not That Kind Of Relationship

"He kept hitting on me. I had brought it up for reflection in context of his functioning and history. Lots of attempts to deepen insight and hold a boundary. At some point the boundary needed to get bigger . So I ended our therapeutic relationship.

jbuam

Worldwide Pandemic Can Do That To People

"They had an advanced extreme case of antisocial personality disorder, too agitated, too aggressive, with substance abuse. After months in therapy at a hospital, there was no progress whatsoever and nothing to be done, their family didn’t want them, neither did the police, nor the hospital and after setting their bed on fire and harming the other patients, i was just too scared to work with them so i closed the file and spoke to the doctor to find another solution. Sadly covid happened and they had to lay off a huge majority of the staff in the hospital, since i was still new, i was let go. I still don’t know what happened with the patient."

skypotato98

"When she committed suicide."

"It might sound harsh, but she was one of my very first patients as a doctor. Had several sessions with her together with colleagues. She was a very nice person."

"She will be forever stuck in my mind."

Dysp-_-

A very sobering read.

If you or someone you know is struggling, you can contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

To find help outside the United States, the International Association for Suicide Prevention has resources available at https://www.iasp.info/resources/Crisis_Centres/

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