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

A person lying in bed with their back against their wall, holding a coffee mug in one hand and a journal in the other, with their legs outstretched. They are surrounded by hanging plants, a nearby record player, and a mountain of pillows. They are staring in the direction of a window with a thoughtful expression.

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.

⚠️ Do you feel safe with your therapist?

Much of the advice outlined in this article encourages open communication between you and your therapist. However, if you're feeling unsafe with your therapist, this may not be appropriate for your situation.

If you have concerns that something unethical may be taking place, please consider reaching out to someone that you trust to talk through what's making you feel uneasy. You also have the right to report your therapist to their respective licensing board.

Should you want to find another therapist, you can use a directory service like Alma, even if you aren't sure yet about whether or not you'll continue seeing your current therapist (just aim to be transparent with any new clinicians, especially if insurance is being billed).

Remember: You are not required to continue seeing a therapist who is harming you or making you uncomfortable, and you can get a second opinion at any time.

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.

What to do if you’re not connecting with your therapist

Talk about it with your therapist.

Remember, therapy is for you. It’s your therapist’s job to take in your feedback and work with you to ensure you’re getting what you need.

A good therapist won’t be offended if you advocate for yourself — in fact, they should celebrate your courage!

You might try saying…

  • “I’ve noticed that I’m holding back in our sessions. Can we explore why that might be happening?”
  • “I’m feeling a disconnect in our relationship. It often comes up when…”
  • “I’ve been thinking about how therapy has been feeling. It’s helpful when you ___, but it’s not helpful when you ____. I think what I need is…”
  • “I’m trying to practice being more honest in therapy, which is hard for me. I’d like to share some feedback with you, if you’re open to that.”

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.

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.

What to do if you think you might be misdiagnosed

  1. Gut check it. While self-diagnosis is a very complex topic, a diagnosis is intended to capture your internal experience — something that only you can truly know and articulate. You might read up on the diagnoses you’ve been given, learn from folks with lived experience, and bring a list of questions to ask your therapist in your next session.
  2. Ask for clarification! A good therapist is going to honor your instincts, answer any points of confusion, and help you arrive at an answer that you’re comfortable with. You might also ask your therapist to walk you through the diagnostic criteria and assessments to help you better understand what different terms and questions actually mean.
  3. Request an outside assessment. Therapists aren’t the only ones who can conduct assessments! Ask your therapist if an external assessment from a psychiatrist or psychologist might be helpful.

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.

What to do if you might need to try a different type of therapy

1. Explore the idea of "top-down" versus "bottom-up" therapy. Top-down therapies focus on the cognitive/mental processing, whereas bottom-up therapies focus on moving through emotions and sensations within the body.

2. Reflect on what's been helpful (and what hasn't been!) so far. You don’t need to share this journal with your therapist, though I’d encourage you to consider sharing the highlights, so your therapist can better accommodate what you need in the future.

Consider some thought-starters like:

  • I feel seen when my therapist…
  • My biggest “aha!” moment in therapy so far has been…
  • One change I really wanted to see happen that I haven’t seen yet is…
  • I notice that when my therapist ____, I start checking out. That’s probably because…
  • Things were really clicking when ____, but that seemed to change when...

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).

What to do if you might be “blocked” in therapy by another concern or struggle

  1. Talk to your therapist about your goals, frustrations, and where you're feeling stuck. Ask questions about the focus of your work, and how you might shift gears. New insights could emerge simply by being honest about how you're feeling in therapy!
  2. Notice self-censorship and avoidance in the therapy room. If there’s a topic you’ve avoided bringing up because it doesn’t feel relevant or “important” enough — or if you’re too embarrassed or scared to disclose — consider sharing it (or writing it down on a piece of paper if it feels too terrifying to say aloud!).

Remember: A therapist isn’t here to judge you. Safely exploring what matters to you (even if you think you’re alone in it, should be ashamed, or are overreacting) can be incredibly healing.

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.

What to do if your goals or progress markers are unclear in therapy

Try exploring some of these conversation-starters with your therapist:

  • “I’m realizing that I’m not sure what we’re working towards in therapy anymore, and I feel really stuck. Can we talk about it?”
  • “I’m noticing that I’m struggling to recognize how therapy is actually helping me. Can you reflect back to me what progress you’ve seen in our work together so far?”
  • “Would you be open to checking in about our treatment plan for therapy? I’m feeling a little lost about what we’re working toward, and I’d love to get back on the same page.”

📧 Remember, it’s okay to kick off a conversation via email.

If you’re not sure that you feel empowered enough to start the conversation in-session, you can always email and express your intention to discuss these issues in your next session.

That way, you’re on the same page from the very beginning of your next session, with no awkward redirection required!

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)?

What to do if you need some secondary support while in therapy

Some examples of additional supports you may consider adding to your care:

  • MEDICATION: It might be worthwhile to add medications into the mix, which can in turn make therapy feel more approachable.
  • MULTIPLE THERAPISTS: There may be a case for having multiple therapists at once! For example, if you’d like to try different modalities together, but your current therapist doesn’t offer one of those modalities, bringing in another provider can be a great option. Sometimes insurance companies may even cover the cost for both.
  • PEER SUPPORT: Finding local support groups, online communities, and even reputable peer support mentors can be an invaluable addition to your care regimen.
  • SAFE AND SOUND PROTOCOL (SSP): A nervous system intervention like the SSP can help increase your emotional regulation, sense of connectedness and trust, and so much more, making your therapy more effective.

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.

What to do if you aren’t “practicing” enough outside of therapy

Let’s be clear about this: If you aren’t “doing the work” outside of therapy, that doesn’t mean you’re bad or that you’re doing something wrong!

If your therapist is giving you homework that doesn’t feel within the realm of what you can do right now, or they aren't giving you enough guidance to make any changes, it’s important that you let them know!

Your therapist should be meeting you where you’re at, and if you can’t follow through, work together to find small steps that feel more approachable.

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.

What to do if an unsafe environment may be blocking you in therapy

  1. Discuss with your therapist how your environment is impacting you. If you're nervous to disclose, you might pose it in hypothetical terms first, such as, "If a client were in a toxic workplace, how might you support them?"
  2. Assess cultural competence. If your therapist is unable to understand your unique challenges (for example, you are a refugee but your therapist hasn’t worked with refugee populations before), you can always ask for a referral to another provider. You might also familiarize yourself with critiques of more Western approaches to therapy, and seek out a therapist with a decolonizing approach.
  3. Don't abruptly stop therapy just because your circumstances aren't ideal, or initiate big changes without support! This might be destabilizing or even unsafe. If needed, ask your therapist to assist you with safety planning.

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.

What to do if you’re tired of waiting for therapy to “work”

Getting familiar with how to tell if therapy is working, and the benefits of therapy (even if you’re feeling “fine”), can help you make a decision about whether to wait, pause, or switch gears.

These resources can also be a helpful starting point in — you guessed it! — exploring these questions with your therapist as well.

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.

Explore your options!

If it’s clear to you that the relationship isn’t working, and you aren’t feeling up for discussing that at length with your therapist, that’s okay! You might consider finding a new therapist that’s a better fit.

You could ask for a referral from your current therapist, or you might use Alma’s directory to schedule free consultations with new providers who are more aligned with what you're looking for.

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Sam Dylan Finch
Sam Dylan Finch

About the Author

For nearly a decade, Sam has harnessed the power of digital media to empower readers, challenge stigma, and make mental health content accessible to all. He currently works as Content Marketing Manager for Alma; he previously worked as Content Marketing Director at Oar Health, as well as at Inflow – ADHD, Healthline, Psych Central, and Upworthy.

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