Why So Much Psychotherapy Fails — When the Word "Therapy" Makes Things Worse

Psychotherapy is supposed to help. So why do some people come out of therapy worse than when they went in?

Research has already given the answer: the problem may not lie in the "method" of therapy, but in the "therapy" framework itself.

🏥 The "therapy" framework turns people into "patients"

When a person walks into a counselling room, is called a "patient", and is "diagnosed" with "depression", their subconscious receives one message: "I am sick."

Psychologist Becker (1963) showed in labelling theory that labels reshape a person's identity. When someone believes they are a "depressed patient", they unconsciously begin to "perform" the behaviour expected of a depressed patient — this is the self-fulfilling prophecy of labels.

Rosenthal and Jacobson (1968) further showed in the Pygmalion effect that expectations become reality. When a teacher expects a student to be bright, the student genuinely does better — and conversely, when a person is expected to be "sick", they may genuinely become so.

😔 The therapists themselves are struggling

Ironically, many psychotherapists themselves suffer from depression and stress.

Research shows that 21% to 61% of mental health practitioners experience burnout (Morse et al., 2012); a 2023 study found that more than half of therapists have experienced burnout (Canady, 2023). Simionato et al. (2019) also identified psychotherapists as a high-risk group for developing depression and other psychological difficulties.

Why? Because when a therapist frames their work day after day inside "therapy", "patient" and "diagnosis", they themselves find it hard to escape that heavy suggestion.

🕯️ A heartbreaking example

The late superstar Leslie Cheung left us in 2003. Before his passing, he was diagnosed with depression.

Leslie Cheung had abundant resources, wealth and connections — he was certainly not someone "unable to seek help". He was, moreover, a brilliant actor.

Here is the crux: he was "diagnosed" with depression — and that very "diagnosis" did not help him; it made things worse. Because Leslie Cheung was a superb actor: any role "imposed" on him, he would unconsciously "perform" to the fullest. When the role of "depression" was imposed on him by a "diagnosis", he — a genius-level performer — took it on and brought it to life.

And more cruelly still: he was clever and sensitive. A clever person "absorbs" suggestion far more deeply than an ordinary one. A duller person might hear "you have depression" and brush it off; but a clever, sensitive person with a vivid imagination will absorb that "definition" deep inside, internalising it as part of himself.

And that is precisely why we must ask: when a person with ample resources, extraordinary talent and, on top of that, sharp intelligence and sensitivity is given the label of "depression", could it be that he unconsciously acted the role of "depression" until it became real?

The label of "depression" was, indeed, one of the reasons he left us.

This is not to blame anyone, but to point to a crueller truth: labels are a form of invisible "killing". Not with a knife, but with a "definition" — once the definition of "depression" is attached, it is a hundred times harder to shake off than before it was applied.

Why is a label especially lethal to a "performer"? Because an actor's gift is precisely "becoming the role". When a genius-level performer is given the label of "depression", he may unconsciously inhabit the role of "depression" down to the bone — until, in the end, even he can no longer tell which is his true self and which is "depression".

And "invisible killing" is the most terrifying of all — because it uses no knife, no violence, only a "definition". A single definition of "you have depression" is enough to make a living person slowly believe he is "hopeless" and "cannot escape". This collapse from the inside is deadlier than any external harm.

(If you are in pain, please remember: you are not your label. Helplines are at the bottom of this article.)

🌱 Our choice

This is why we use "coaching" and not "therapy", and why we call you a "client" and not a "patient".

Because we deeply believe: the right frame is itself a form of healing; the wrong frame is itself a form of harm.

📞 24-hour helplines

• The Samaritans (multilingual): 2896 0000
• Suicide Prevention Services: 2382 0000
• The Samaritan Befrienders Hong Kong: 2389 2222
• Caritas Family Crisis Support Centre: 18288