For some people, psychotherapy is a life changing experience. For others, it is a complete waste of energy. What really determines the nature of the experience you or your loved ones have is how able you and they are to really take a step back to examine themselves with a very deep, yet compassionate lens.
What is so hard about this for many people is that so often the underlying issues they are really in therapy to work on are completely terrifying. For example, it is a very delicate thing to help someone work on their fears of intimacy, commitment, abandonment, etc. that are so clearly connected to their anxieties and depressive symptoms when they are presenting as overwhelmingly guarded with their therapist or loved ones. This is especially true for the acutely self-critical because they can easily put themselves down in these moments, which thereby reinforces their instincts to keep their defenses up so as to avoid the pain.
Couples, for example, are notorious for this sort of dynamic because of how much our fears and shame can be most present and challenging in our intimate relationships. For example, as a male therapist, I frequently attract one of two pretty standard kinds of couples in my practice. The first is where the female partner in the relationship will call to schedule an appointment and then have to drag their male partner in kicking and screaming. The female partner’s intention is that they think having a male therapist will make it easier for their male partner, or that I as a man will be able to “talk some sense” into the male partner. The second most common case is when both members of a couple claim to be on the same page, but then they get to my office and they are both very on guard. The male partner explains that the real problem of the relationship is that he wants her to work a full time job, pay all the bills, cook, clean, and happily have sex with him at the end of the night (or some loose variation of those expectations). Not to mention he expects me as the clinician convince her to fall in line because he feels like she is clearly at fault. In both situations, one partner is looking externally and wanting the other person to change (making their partner the “identified patient”) because it is far more convenient than having to look at themselves to see how they are showing up in the relationship. Individuals do this as well, but can instead look to medication, fads, relationships, etc. to fill the void rather than having to face themselves. Again, looking externally rather than internally.
To avoid this, you can do two main things. First, enter therapy with the understanding that you can only change yourself. Secondly, allow yourself the time and patience to find the right therapist for you. You can only change when you are able to feel vulnerable so you feel safe enough to look internally and face the fear. Having a therapist who does not create the feel of that opportunity will likely not be able to help you.