Karen Tells Other People That She Gets Lots Out of the Many

Karen tells other people that she gets lots out of the many sessions she's had with her therapist. However, her friends can't help but notice the fact that the problems which motivated her to seek help in the first place never seem to get any better. When they ask her for some examples of how what she learns in her sessions gets applied to her everyday life, she can't think of any. What factor could be reducing the chances that her therapy will have a successful outcome?

A) her lack of openness
B) her lack of self-relatedness
C) a lack of competence on the part of the therapist
D) the fact that her friends question the value of her therapy
E) none of these factors would reduce Karen's chances of a successful therapeutic outcome