Are you too smart to be helped by therapy?

The short answer: probably not. Here’s why.

This might be hard for some folks to swallow, but sometimes a patient is smarter and more knowledgeable about the care they need than their doctor or other provider is. When that happens, it can be frustrating for both sides.

I’m transgender, and doctors very often just aren’t taught how to deal with people like me. That’s not because I’m too smart for them in general, but because I’ve spent a very long time studying what goes into trans healthcare, and it’s quite difficult to find a doctor who’s spent any time thinking about how to provide adequate care for someone like me. We’re used to doctors educating patients, giving them guidance on what to do and how to do it, but when I see a general practitioner, I often find myself educating THEM.

Therapists and their clients can run into similar issues, and as with what I described above, the best thing for everyone would likely be for the client to see a different provider who can meet their needs. That’s assuming the therapist in question doesn’t have the expertise required to help this particular client; for example, maybe your therapist works primarily with people who have garden variety depression and generalized anxiety disorder. But you come to them with something more complex, like schizophrenia or bipolar disorder.

Or, incidentally, gender identity difficulties: something they’re not familiar with, through no real fault of their own. It just isn’t taught regularly; if you want the information, you have to seek it out, and most people (including therapists and other professionals) just simply haven’t had any reason to make that effort.

In these cases, the best thing to do would be to refer the client to another therapist who can better fit their needs.

That’s assuming the therapist isn’t a good fit for the client. Another possibility is that the client is being manipulative (intentionally or not) and needs to be called out on that behavior, in a constructive manner, because if it’s happening in session, it’s probably happening in their day-to-day lives. They may not even realize they’re doing it, and if you call them out on it, you must do it tactfully. Even so, they may get angry and become totally noncompliant. But if you’re a therapist, you might already be expecting that.

Being “smart” doesn’t necessarily mean “difficult to help.” But if they think they have nothing to learn from ANYONE, because they think of themselves as being that much more intelligent than everyone else, there may be no way to help them.

One more thing. Therapy isn’t about establishing dominance, and it’s not a leader-follower situation, but more of a collaborative effort to help the client as much as possible, in whatever way is appropriate for the client. If your client views you (or therapists in general) as an adversary, the best thing you can do is attempt to communicate that you’re not on anyone’s side and that you’re certainly not THEIR enemy. Perhaps reminding them of the confidential nature of your sessions would help with that. You’re not here to judge them, but they may fear that you will. Try to assuage those fears.

Sadly, not everyone can be helped at just any given point. If you’re a therapist or other health professional, then you’ll have to confront that reality sooner or later. If you determine that the person won’t let themselves be helped, period, then you should probably cut them loose, explaining why you’ve chosen to do so.

Refer them to another therapist if you know of one that would be a better fit, that the client might be more receptive to. Make it clear that your door is always open, if they feel more receptive to change in the future, but don’t waste your time if you’ve tried and truly feel that they won’t let themselves be helped.

I’m not saying “won’t let themselves be helped” with any amount of judgment, by the way. The whole thing about getting help is that a client must be READY to be helped. They must be receptive. If they’re not able to be receptive, then there isn’t anything you can do. But at some point, they may be able to be receptive in therapy, and you don’t want them to feel like it’s no longer an option, if they do get to that point.

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