I saw a couple for marriage counseling this week, and when I asked them if they had ever seen anyone else for counseling they said they had worked with two other therapists. They had seen one therapist on and off a few years back. They had seen the other one only a few times. They couldn't even remember her name.

I asked what they had gotten from counseling, and much to my chagrin, came a far too typical response: "Nothing." Why doesn't therapy make an impact? Why do people who see a counselor week after week continue to be bogged down with the problems they initially came in with?

Sometimes the therapist just isn't very good. She may be supportive and understanding of her clients' problems, but her skills don't go far enough. She's unable to confront the woman who talks on and on or to tell the man he's out of line with his anger. Or that he needs to stop drawing attention to himself by butting in. Sometimes, too, the therapist is good at helping to identify the problem but is not skilled in coming up with suggestions as to what the person can do to change.

Counseling may also fail because the person going may only be interested in proving it's someone else's fault. Once the therapist hones in on what the person is doing to cause part of the problem, the individual cancels all future therapy sessions. Later on she can be overheard at a party saying how therapy doesn't work.

Sometimes therapy is seen as ineffective because the original goal for going cannot be achieved. For example, a woman is involved in a terrible marriage. She and her husband fight constantly, he runs around on her, he won't come to therapy, and because of religious reasons she's unwilling to get a separation or divorce. In this case the therapist is limited. He can help the woman explore what she gets from fighting. Perhaps it's a pattern she learned in childhood or a fear of closeness. The therapist can teach the woman how to pick her fights instead of engaging in every fight that comes along. He can teach her how to stay on the topic when she and her husband have a disagreement, which will limit the length and intensity of their fighting. And he can help her learn to identify other areas of her life where she will find fulfillment. He can certainly help her cut down the arguments in her marriage. What he can't do is stop the husband from running around.

Sometimes therapy is ineffective because the person going is not willing to put in the energy to make needed changes. He may be willing to come talk about the problem - shyness, loneliness, anxiety, difficulty on the job - but he's unwilling to do what it takes outside of the therapy session to make therapy effective. He won't put himself in a situation where he can meet new people. He refuses to update his skills so he can find a different job. He won't explore other jobs, and he refuses to talk to his boss about his unhappiness.

Therapy is a little like going to the doctor. You want to choose a doctor that has a good reputation. Once you go, you explore your symptoms with the doctor - when they first appeared, how long you've had them, what you've tried in the past. The doctor makes a diagnosis and prescribes treatment. You follow the treatment plan and take your medication. If the medication doesn't work, you work on another course of action. You continue to consult the doctor for other treatment plans or you try a different doctor until you get the problem solved.

Doris Wild Helmering is a St. Louis psychotherapist in private practce. She has written eight books, numerous magazine and newspaper articles on the topics of marriage, relationships and families. Doris guides her clents with calm and sensitivity and solution directed action plans. Visit Doris at http://www.doriswildhelmering.com/blog She'll make you want to change.