9 Reasons Why Therapy Isn’t Helping and What to Do

You finally did it. You mustered the courage to ask for support, found a therapist you thought you’d vibe with, showed up for sessions, and… nothing really happened?

Well, maybe not nothing — but certainly not the progress you were hoping for. So, now what?

Before you throw in the towel or ghost your therapist, take a breath! It’s worth exploring some of the common reasons why progress is delayed in therapy, and what you can do about them.

While feeling stuck is a discouraging experience in therapy, it’s also a very normal one. Hold out hope, and remember that no matter what’s blocking you, there are resources out there to help you get your needs met.

1. You aren’t connecting with your therapist (yet).

It can take time to feel connected to your therapist! Particularly if you’ve experienced harm in other relationships, opening up to a stranger can feel intense, unfamiliar, wrong, and even dangerous.

Research has shown that the efficacy of therapy is impacted by the strength of the relationship you have with your therapist. If that relationship isn’t working, it’s unlikely that therapy will have the impact you were hoping for!

How do you know if you’ve connected with your therapist, though? Feelings of trust (even and especially when you’re being challenged), the ability to speak up when uncomfortable, and a sense of teamwork are all good signs.

Some questions to explore your feelings about your therapist:

How would I describe my therapist to a friend or trusted person? → Do I come across as enthusiastic and invested in the relationship? Or maybe apathetic, hesitant, and unsure?

How would I describe my therapist’s “style”? Are they insightful, warm, and encouraging, or maybe they’re a bit funny and more direct? → Do these descriptions align with what I need right now?

If my therapist went on vacation for a month… how would I feel? → Am I bummed? Annoyed? Unbothered? Relieved? What might that tell me?

How do I typically feel before, during, and after a session? → While not every therapy session will leave you feeling great, it’s important to notice if therapy is consistently unhelpful, stressful, or disappointing.

2. The issue or diagnosis you’re exploring has a better explanation.

Not all therapists utilize diagnoses the same way.

Some therapists use diagnoses as a framework for better understanding what you’re struggling with, and offering personalized support in light of what your challenges are.

Some therapists will use diagnoses to build out your entire treatment plan. Others utilize them only when absolutely necessary, like when accessing insurance benefits or for disability accommodations.

Some therapists, like those who use a neurodiversity-affirming approach, are largely opposed to diagnoses altogether!

If you aren’t sure what your therapist’s stance on diagnoses is, you should feel empowered to ask.

That said, therapists aren’t always right, and diagnoses aren’t as clear-cut as we might believe — there can be a lot of overlap between conditions!

I was misdiagnosed for several years with bipolar disorder, when in actuality, the highs and lows we were seeing had more to do with trauma and AuDHD rather than a mood disorder.

Because we were focusing on a different diagnosis that wasn’t really relevant, the therapies and medications I’d tried weren’t working. If you’ve been in therapy for quite some time, and you’re not seeing meaningful progress, you might ask your therapist if you can revisit your diagnoses.

3. The modality (or therapeutic approach) isn’t effective at this time.

Using myself as an example, I tried different types of cognitive and behavioral therapies for many years.

I noticed overtime that changing how I thought about things still wasn’t fully sinking in. There were plenty of things I knew cognitively, but they weren’t shifting how I felt.

This was a strong hint that I might need a different therapeutic approach altogether!

Personally, I’ve found that I need to rotate between conceptualization (the thinking and behavior stuff) and integration (the feeling and body-based stuff).

But everyone is different! If you’ve been doing a particular kind of therapy, and you’re not sure if it’s working, you might ask your therapist to talk to you about the modalities you’re using, and whether or not it’s worth switching things up.

4. There’s another issue “blocking” your progress that needs to be addressed first.

Sometimes it’s not just the relationship, modality, or diagnosis — it could be the “order of operations.”

Let’s say you’ve been working on perfectionism in therapy. Your impossibly high standards are making it difficult to complete assignments at school or work, and this performance anxiety is creating more and more stress in your life.

You and your therapist spend months making sense of why you developed these rigid ideas about what is and isn’t acceptable in your work, but you’re still struggling in your day-to-day life.

“I know my work doesn’t need to be perfect, in theory. But I can’t help but be frustrated when I keep making such careless mistakes! I know I’m capable of better, and I’m frustrated that I keep messing up,” you exclaim in therapy one day.

A light bulb finally goes off for your therapist. “Careless mistakes?” they repeat back. “Can you tell me more about what you mean by that?”

As you talk about the mistakes you keep making at work — mistakes that, despite your best efforts, keep slipping through the cracks, even when you’ve triple-checked your work — your therapist asks how well you've been managing your ADHD.

Even though you’ve unpacked your perfectionism, the mistakes you’re making at work still result in feeling frustrated every day! This is understandable, as careless mistakes with ADHD often don't represent what we know we're capable of.

This is different than simply being perfectionistic, which relies on an impossible standard rather than a reasonable one.

By figuring out better ways of managing ADHD, the work you're doing around perfectionism might feel more impactful because it's no longer being applied to situations where it isn't as supportive.

And this is just one example of where the "order of operations" may be mixed up!

This can also happen when we’re avoiding certain topics in therapy due to fear or shame, or because we're dismissing the significance of something else in favor of focusing on what we believe “should” be more important (or we believe is more interesting to our therapist).

5. Your goals and progress markers are unclear or need tweaking.

When’s the last time you spoke with your therapist about your goals for therapy? What about progress markers — or, put another way, what signs of change might reassure you that you’re actually seeing improvement?

This is discussed in a little more depth in our article on How to Tell if Therapy is Working. But suffice to say, if you haven’t had a recent conversation about your hopes for therapy, it can be helpful to revisit them.

6. You need some secondary support to “boost” your therapy.

Standard talk therapy by itself may not be the only thing you need, and that’s okay! There are plenty of other options you can add to your support system that can, in turn, make therapy more effective.

This doesn’t necessarily mean that therapy isn’t working for you or can’t work! You might think of these secondary supports as sunblock — they help you endure the heat so you can stay in the work a little longer without being harmed.

Is it possible that you need some sunscreen so that you can show up to the work of therapy without getting burned (or triggered, or fatigued)?

7. You need more practice outside of therapy sessions.

Therapy isn’t impactful just because we show up for our sessions. Attendance is the first step, but it’s not the only step! The magic often happens in the ways we show up for ourselves and in our relationships outside of therapy, too.

This means we’re “practicing” what we’ve learned in therapy, whether that’s using the coping tools we’ve been taught, initiating the vulnerable conversation with our spouse, or setting boundaries at work.

Think of yourself as a scientist, and your therapist as a fellow researcher and advisor. Your therapist is helping you identify opportunities to experiment in how you show up to your life. And your job, as the scientist, is to carry out the experiment and report back with the results.

It’s possible that therapy isn’t feeling helpful because those experiments aren’t happening, aren't safe for you to try on your own yet, or they simply aren’t working.

If you find there’s a disconnect between what you’re talking about in therapy, and the actions you’re taking outside of therapy, this could be a valuable observation to bring to your therapist.

8. There’s a lack of safety outside of therapy.

Safety is an important part of the healing puzzle.

While a therapist can help support and affirm you when you feel unsafe in your environment, it’s also important to keep in mind that an unsafe environment can exacerbate and trigger mental health struggles.

This could include a toxic workplace, an abusive relationship, an oppressive church community, and even political turmoil or violence in your local area.

That’s not to say that a therapist can’t be an invaluable resource when you’re struggling with these things! Rather, it means your therapist needs to be attuned to what you’re experiencing, so your goals for therapy can reflect the realities and challenges of your everyday life.

It’s also important to emphasize that an unsafe environment doesn’t mean therapy is useless or shouldn’t be pursued until your circumstances change.

In fact, therapy can be exactly what you need to stay afloat, and can help you explore paths and tools that you didn’t know were available to you, when you’re ready.

9. You need more time — or you need a break.

All of that said, therapy does take time. The results are rarely immediate, and you may not notice the progress you’re making at first.

My favorite healing analogy is of an ice cube melting. As you raise the temperature, you may not notice any changes in the ice cube at all. To you, the ice cube will still look identical at 30 degrees to how it looks at 10 degrees and even 0 degrees. It’s going to seem like nothing is happening.

But there’s actually a big difference — a difference of 20 or more degrees — for the ice cube itself, which will finally start to melt at 32 degrees fahrenheit.

Which is to say, you could be two degrees away from the big changes you want to see in therapy, but when things look the same as they did before, it can feel like nothing is actually happening.

There’s something to be said for giving the process some time. Just because you can’t recognize the shifts that are happening, it doesn’t mean that nothing is happening!

It may mean you can’t yet see what you’re building towards, and how close you actually are — and asking your therapist to help you identify your progress is a good starting point.

That doesn’t mean you should keep investing in therapy that doesn’t appear to be doing anything, though. It’s completely valid to feel impatient, or to outgrow your therapist or even therapy itself.

Remember, therapy is a collaboration — you don’t need to figure this out alone!

It’s great that you’re motivated enough to read through this resource and figure out why therapy isn’t helping. That tells me that there’s likely a part of you that really wants this to work.

But you don’t need to figure this out by yourself!

Your therapist’s role is to help you access what you need to feel better and meet your goals.

So if, after reading this article, you’re still not sure what’s going on (or maybe you figured it out but are feeling overwhelmed in addressing it), remember that it’s on your therapist to support you in figuring out any changes you might need.

You don’t have to become an expert on healing in order to heal. Part of what makes therapy so powerful is that you’re allowed to not have all the answers, and you’re allowed to be vulnerable and even overwhelmed in the process.

So if nothing else, I hope this article gives you permission to speak up for yourself, and begin naming what you need and want for your best possible life.