COVID-19 Update: I'm continuing to provide therapy via secure video conference.
Therapy Isn’t Working. What Should I Do?

Sadly, I hear this a lot. It’s a delicate topic for sure.

I hear stories of people who’ve been with the same therapist for years. They either still feel stuck or think this is as good as it gets (and it’s not so good). They feel guilty about it.

I’ve talked to colleagues who have expressed frustration, feeling like they’re not able to truly help someone. They, too, feel guilty.

Remember, the therapist-client relationship is like any other relationship: sometimes there are obvious reasons why it’s not working and sometimes there aren’t. What’s important is that we know what to do next. If you’re feeling like you’re not meeting your goals, have a conversation with your therapist about it. Just like any other relationship, personal or professional, clear and honest communication is key.

As a therapist, I know one of the hardest conversations I have to have is when I don’t think therapy is working. I hate having it! But I owe it to my clients to get them the care they need. I also owe it to myself to live in my truth. Not every relationship is meant to be, and I’m not the right fit for everyone.

Sometimes, you may feel that your therapy is finished. This is a different situation but can still be uncomfortable to talk about. I’ve written about this, too, to help you know when therapy is done.

Therapist Factors: Training + Expertise

One of the best ways to set yourself up for a positive therapy experience is to ensure you’re seeing someone specialized to meet your needs. If you’re seeking therapy for something specific like depression, generalized anxiety, an eating disorder, PTSD, etc, chances are there are evidence-informed models that should guide treatment. For these things, you’ll want to make sure you’re seeing someone who has specific training and experience treating what you have. The IOCDF has a list of great questions to ask a potential therapist. You could modify these questions for your specific needs, and it would be a great place to start the conversation.

I want to suggest that we think of mental health the same way we do our physical health. If you needed a hip replacement, you wouldn’t go to a general practitioner even though they did a rotation in orthopedic surgery, would you? Probably not.

You Factors: Treatment Interfering Behaviors

There are many factors that go into a positive and effective therapy experience. Having a productive therapy experience isn’t just about making sure you click with your therapist, though that is important. Certainly, you’ll want to find someone with whom you feel safe and who has the requisite skills to treat your condition. If you’re in a type of therapy where the change happens between sessions, like CBT, you’ll want to be mindful of anything you may be doing, or not doing, that could be interfering. We call these “treatment interfering behaviors.”

When discussing treatment interfering behaviors, it’s important to highlight that while the intent of the behavior is not to undermine treatment, that’s the outcome. I learned about this from Alec Pollard, PhD many years ago. Such behaviors may include:

  • Not doing the between session work
  • Avoiding opportunities to practice skills
  • Doing the bare minimum for exposures
  • Not participating in session
  • Showing up late

In addition to behavior that might unintentionally interfere with your therapy, there’s one key element I always want to remind us of — willingness. The willingness to be uncomfortable and uncertain is the secret sauce to so much of the work I do and to a meaningful life. Willingness is truly the essential ingredient to learning new behaviors.

Us Factors: Finding the Therapist Right for You

Learning new behaviors, going through exposures, and looking at things differently can all be scary stuff, so finding someone you click with is important. This isn’t necessarily something that neither the therapist nor the client can control. Some of it is just chemistry, but there are some guidelines you can keep in mind:

  • Feeling heard by your therapist is important because it helps develop that trust
  • You’ll want to feel you can communicate openly and honestly at all times, but especially around stuck points
  • Therapy is a partnership, so being able to collaborate around next steps helps keep you active in your progress

What If My Child’s Therapy Isn’t Working?

If you’re a parent reading this, the same principles apply to your child’s therapy. You’ll want to find someone with the training and experience in treating your child’s condition. Looking at ways your child may be interfering with their treatment can be helpful. Are there issues between the therapist and child that may prevent progress?

It’s also okay to contact your child’s therapist, even if it’s an adult child. (You’ll just need to make sure you have the proper release once they’re over 18.) Ask questions if you think your child is stuck. Just because they’re technically an adult doesn’t mean they’re functioning like one and/or that you couldn’t be doing things differently.

A conversation with their therapist could be very helpful and, possibly, the catalyst that shifts things in a more positive direction.

Looking for a therapist? If you live in Ohio, please reach out. If you’re out of state, check out the IOCDF or ADAA websites for providers in your area.

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