What To Do When Therapy Doesn’t Help


Therapy doesn’t always help. That doesn’t mean that it can’t help and that a second chance isn’t indicated. But, it does mean that you will need to ask yourself a few questions about what is going wrong.

There are several possibilities:

1. Misdiagnosis. If, for example, you have an alcohol or drug problem, but the therapist wasn’t told about it or didn’t realize its significance, treatment is almost certain to fail. Similarly, if you have a Bipolar (manic-depressive) Disorder that goes untreated (these can be difficult to diagnose), it will be hard to profit from therapy. I have seen many adults, for example, who have the inattentive form of ADHD and have never been diagnosed and treated for the condition, even though they have seen more than one therapist.

2. Insufficient motivation. Have you been giving therapy your best effort? Do you go to sessions religiously? Do you follow through on any “homework” assignments that you and the therapist discuss? If you are not adequately open and dedicated to getting better, then treatment is likely to fail. Defensiveness in the treatment process and inconsistent attendance are major problems. With respect to lack of effort, the old joke goes: “How many therapists does it take to change a light bulb?” Answer: “One, but the light bulb has to want to be changed.”

3. The therapist/patient match. Do you feel comfortable with the counselor? That doesn’t mean that therapy will never make you uncomfortable (change isn’t easy and it is often painful), but it does mean that the therapist is someone you can trust, who is sincere, and who is competent. Does the therapist have sufficient understanding of your life circumstances? This doesn’t necessarily mean that he has lived through a similar situation or has an identical background, gender, age, or religion; but he will need to understand where you are coming from.

4. The tempo of therapy. Does the therapist push too hard? Do you find yourself too often overwhelmed by the issues and feelings being stirred up in your sessions? Or perhaps, do things seem to go too slow? Are the sessions becoming boring and unproductive?

5. Activity level of the therapist. Is the counselor too active and probing for you? Does he seem to have a plan and a direction for your treatment (he should)? Is he too controlling, seeming to follow an agenda that is inflexible and ignores what you need? Or, alternatively, is he too passive, simply waiting for you to talk about whatever you want, regardless of how far afield this might lead the treatment?

6. Is the therapist too friendly? Does he want (or is he open to) a friendship or anything other than a therapeutic relationship (he shouldn’t be). Or, is he too distant and uninvolved?

7. Type of therapy. Therapists are not all equally comfortable and competent at the multiple types of treatment available. Some problems have been subjected to well-documented and researched treatments (Obsessive Compulsive Disorder, for example). If your therapist is using the wrong treatment approach, you are not likely to benefit as much as you could.

8. Medication. Would you do better if you were on medication? If you are on medication, might you improve more with a different medication?

9. The therapist’s problems. Does the therapist seem stable? Does he act in an inappropriate way in the sessions? Does he become angry and critical? Is he judgmental rather than supportive? Does he talk about his own current problems?

If you are still in therapy and you have concerns about its effectiveness or any of the issues mentioned above, it is usually best to voice those issues to your counselor. He should not only be open to hearing what you have to say, but want to be responsive.

Therapists are not mind readers and won’t always figure out what you are thinking or worried about unless you say it. Do your homework and try to find out what therapeutic approaches might be more appropriate for you (your therapist should be able to describe at least some alternatives).

If he cannot provide you with the kind of treatment you are asking for, he should be able to come up with some very good reasons for what he is doing. Should those reasons be unconvincing, perhaps a second opinion is indicated and he should be open to this idea, as well. If you remain sure that this therapist is not the right one for you, getting a referral from him to someone else is entirely appropriate.

If, on the other hand, you have had unsatisfying experiences in therapy before and are not now in treatment, but are thinking of trying again, make sure that you have attempted to investigate your potential new therapist’s background and experience. Also, when you talk to him on the phone, ask about his therapeutic approach. If you do decide to see him, talk about the things that didn’t work in previous therapy attempts, as well as those that did.

Be as informed as you can be. Unlike brain surgery, you aren’t going to be passive and unconscious during treatment. You are going to participate and interact with someone who, you hope, is well-trained and dedicated and compassionate. Evaluate what is going on in treatment in an open and thoughtful way; collaborate with the therapist.

You will be glad you did.

The Red Woman by Neuthaler is the name of the above image, sourced from Wikimedia Commons.

11 thoughts on “What To Do When Therapy Doesn’t Help

  1. A comment concerning the type of therapy treatment, which is very pertinent to me. I went to therapy after 3 years of abuse, manipulation emotional blackmail, harassment at my work place. My manager was NPD for sure, which did trigger anxiety, depression and haunting of my emotional abandonment from childhood. Not to mention hours upon hours of research trying to understand what was this I had to contend with. But unfortunately my therapist neglected to want to understand my situation at the present day level. The exposure of the characteristic that my manager displayed affected me greatly, most of which I had never ever had to contend with, even via my childhood. I was able to escape the abuse of my family however the therapist failed to understand that I couldn’t escape the workplace toxic environment because my commitment to have a roof over my head. CBT therapy I now understand has only a one in three possibility to help, I do understand that connection between past traumas and current coping styles, I can NOW easily identify NPD individuals and try my upmost to stay clear. However, when they have got you at their disposal, you put up and shut up till your health declines and the coping mechanisms you employ are redundant. NPD individuals are exhausting to try to adapt to, forever changing their motive and mode of operation . Believe me I tried everything .My point is that CBT therapy is confrontational and tries to pin point faulty thinking in the client. A therapist worth their salt surely could understand playing the devils advocate while actually dealing with a devil day in day out is counter productive to helping someone in the midst of my symptoms and diagnosis and being around someone who is so tormented that you question everything and anything. Being labelled resistant to treatment i think is an easy flexible solution to a therapist who is failing to grasp the present predicament and not invested into the patient, but rather can only follow guidelines of a preferred treatment course. Trust can’t be gained which is important, if a therapist is not able to adjust to the patients requirements. I now understand that I need counselling for both my harassment at work and my childhood abuse, neglect and abandonment.
    But they must both be separate so as not to confuse the therapist. CBT therapy is not for me, can you please advise me of other treatments.


    • Thank you for your comment. I am very sorry to hear of the pain you have been suffering. I will answer the question you asked at the end of your comment privately.


  2. Oh, please. If I’m going to therapy because I’m trying to figure out why I’m not motivated, how am I supposed to be pre-motivated. It’s articles like these that sap my faith in professionals. Really, there are reasons therapy doesn’t work? I’m sick–I need help. I don’t have the capacity to determine whether therapy works–that’s why I’m seeking help.

    I don’t need to “want” to get better for a doctor to perform effective surgery on me, so why should a competent therapist need my pre-motivation?


    • Sorry to hear that your faith in professionals has been sapped. Surgery and therapy are very different things, one done with words, one with a scalpel, often while unconscious. Therapists can try to help improve your motivation by such things as recommending medication that might reduce depression or asking you what your inaction costs you, thus getting you to motivate yourself more. They can inquire as to whether there is something you are afraid of that causes you to prefer not to take risks — not to try things that might cause you disappointment, which translates into an attitude that looks like a lack of motivation. Therapists can try to find out if you have some unresolved grief that might be sucking the energy out of you. In these ways and many others, a decent counselor can try to get under the surface to what could possibly be reducing your motivation. But imagine a world in which a class of people (therapists) would easily persuade others to act and feel the way that they (the therapists) wished them to. Such a class would be hired by advertisers and politicians to influence the masses to get behind some pretty scary ideas, I suspect. You are right, therapy isn’t easy. It must be very frustrating to be without motivation and the capacity to know how to change that. Nonetheless, a good therapist still needs your effort. It is not something that the counselors of the world decided to impose of others, it is simply the way that things are. All that said, many people still do benefit from counseling. Best wishes.


  3. concerned step mom

    What if the child isnt willing to open up to the therapist? What if the abuse was not only emotional and physical in nature, but sexual as well? All by her biological mother, who she is terrified of. Suggestions??


    • As you probably gathered, my essay was aimed at those old enough to make their own decisions — therefore older teens or adults. What I’m about to say can’t be specific to your situation, since I’ve never evaluated the child and know only the details you’ve supplied. Much depends on whether the abuse is ongoing or old. If it is ongoing, effort must be made to intervene, as the law allows or requires. If she has tried treatment, it is possible that the treatment has not gone on long enough for her to feel safe with the therapist. If that trust seems unlikely even with more time, it is possible another counselor might do better. You might wish to consult whatever child welfare organizations exist in your community. I’m sorry I can’t offer more in the way of suggestions, but I hope you can help her or assist her in getting help. Best wishes.


  4. I have a bit of a different problem. I’ve suffered from depression suicidal thoughts and tendencies all my life. My first attempt was at age 12 (I’m 54 now) I’ve also suffered from fits. The last one was 4 months ago. They are like fits of rage and I end up hurting myself by banging my head or punching a wall. I have no memory of these fits and cannot find what triggers them. My pcp swears they are “behavioral” my therapist is not so sure. I also feel depressed all the time for no reason am lethargic and seem to have developed movement disorders. I am unable to tolerate antidepressants they cause siezures. I’ve been in therapy for almost 4 years now,taking all the different classes and such with no improvement. This is not my first round with therapy, I’ve been in and out of it all my life. I am terrified of having one of these fits in public,or seriously hurting myself or Lord forbid someone else. Just how do you stop a “behavioral” problem when you’re not aware of it? My therapist thinks I should get a complete psychiatric work up by a psychiatrist that’s an m.d. but I’m finding it hard to find one. Any suggestions?


    • I’d be inclined to go to a major medical center that specializes in diagnosing complex problems. Something like the Mayo Clinic in Rochester, MN comes to mind. I’m sure there are others elsewhere. The advantage of such a place is that you would benefit from a team of experts who have experience in working together. Best of luck with this.


  5. I agree with your statement, “If he cannot provide you with the kind of treatment you are asking for, he should be able to come up with some very good reasons for what he is doing.” But in my experience, therapists rarely (if ever) give reasons for what they are doing, and usually respond uninformatively to questions about why they are doing what they are doing. Responses I got from one therapist to questions about why she was doing something have included, “Are you sure you’re not second guessing me?”, “Do you realize you are asking me to give up my control?”, and “Because that’s what you need.” Once she said, “Consider me to be something like a computer: what you say goes in, mixes around with my training and experience, and out comes a response.” I once asked her if she could explain the theory behind what she was doing; she responded, “Oh, I love to talk about my theories,” which seemed doubly inappropriate. I finally quit her, and tried another therapist. I asked her before making an appointment, “Do you let your patients know what you’re doing?’ and she assured me that she did — that she even gave them things to read. She did give me one thing to read, that just described policies about cancelled appointments, etc. At first she answered some questions, but then started giving responses like, “I have my reasons,” so I quit her, too. A few years later, I tried another therapist. Again, no information offered about what she was doing and why — and when I finally asked point blank, “What do you have to give?’ she said, “I believe I have something to give but don’t know how to articulate it.”


    • drgeraldstein

      Thank you, Mary. Yes, I can’t say I’m surprised and your reasons for leaving them to themselves sound well-founded. I can only say that they disqualified themselves. They ought to have been able to do better. Some counselors can. Your comment is much appreciated.


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