What to Do if Therapy Isn’t Working

Laura Hans Therapy at her desk typing on a laptop

When someone begins their therapy journey, they’re usually hoping for some kind of change or transformation. At the very least, they probably want to feel better than they do right now. But what happens if therapy doesn’t seem to be moving them towards this goal?

Signs to Look Out For

Before we explore this topic, we need to know how we can tell whether therapy is working or not. One of the biggest signs therapy isn’t working is not feeling better, or much better, than you did when you first sought help. You may find the symptoms and problems you presented with haven’t improved or have only improved slightly.

However, it’s important to remember therapy isn’t a ‘quick fix’. Treatment can take time, so not feeling better straight away doesn’t mean therapy isn’t working or won’t work at all in the long run. The key is to notice how you feel before, during and after your therapy sessions. Notice how you feel in between sessions too.

If you’re working through difficult stuff, it’s quite normal and expected for you to feel a little bit worse, and even a lot worse, to begin with. Eventually, you should start to see an emotional shift, but if you’ve been in therapy for a long time and you’re still not really noticing a difference, this could be a warning sign.

Reasons Therapy Might Not Be Working

There are many reasons therapy might not work. Let’s look at three of them:

  1. The modality of therapy you have chosen may not be the best fit for your treatment needs and goals.

It’s crucial you receive the right kind of therapy. For example, if someone with a confirmed diagnosis of Post Traumatic Stress Disorder (PTSD) is given counselling, they may not see any improvement in their symptoms. According to the evidence base, this is not the recommended treatment for PTSD.

PTSD is a trauma related disorder. Talking about a traumatic memory may not help the brain process the experience because talking about things isn’t always enough to reach the part of the brain where the trauma is stored. Therefore, the person seeking help is unlikely to feel any benefits from this approach.

  1. The mode of delivery may not be right for you.

Since COVID19, there has been a huge increase in online therapy. While this is a proven and effective method of treatment delivery, some people simply prefer face-to-face appointments. If these are not available, it can understandably affect the client’s experience and perception of therapy.

There is nothing wrong with preferring a certain type of treatment delivery over another. Some people really need that in-person connection. For example, if you are experiencing depression, getting up and dressed and out of the house may be a mood boosting activity in itself.

  1. You may not have found the right therapist yet.

Research shows us over and over again that the relationship between the client and the therapist is one of the most important factors in effective psychotherapy. If you feel your therapist understands you and your problems, and are confident they can meet your needs, you are more likely to benefit from the therapy they provide.

It’s not as simple as picking the person who seems most qualified for the job. You could have the best trained psychotherapist or psychologist in the world, but if you don’t gel with their personality or therapeutic style, it’s unlikely you’ll fully benefit from the treatment they offer.

I would describe my therapy style as very gentle, warm and compassionate. This style clearly benefits lots of people, but there will always be some clients who need something different. This is why a lot of therapists, including myself, offer a free, no obligation consultation, giving potential clients the chance to decide whether they’re a good fit. It’s OK if you don’t gel with a particular therapist. They want what’s best for you, so please don’t feel you have to move forward with someone you don’t connect with.

What to Do if Therapy Isn’t Working

Please, please be assertive and tell your therapist. We rely on honest feedback, so if you think things aren’t working or things need to change, let your therapist know. When you raise these concerns, it gives your therapist a chance to revisit your goals for therapy and explore other ways they can help you work towards them. You may need to focus on another component of the problem or change therapy modality altogether.

As mentioned above, long-term emotional problems often need long-term psychological solutions. It’s important to maintain realistic expectations of what gains can be made and in what time frame. I’m often asked how many sessions will be needed and it’s hard to respond accurately. I’ve had clients who have come to me for one thing which we thought would be a short-term piece of work, but it turned out to be linked to something quite significant. In this respect, it’s important to keep an open mind. You may need 6-10 sessions for short-term problems and 16-20 sessions for medium to longer-term problems. There are exceptions. For example, a course of Schema Therapy can take much longer.

The Benefits of a Tiered Approach

As I am trained in CBT, EMDR Therapy and Schema Therapy, I can use each modality in a tiered way. This means, in most cases, there’s no need to lose hope if it feels like therapy isn’t working. There’s usually something else we can try.

For example, I would usually recommend CBT for a client who is new to therapy and whose problems have a relatively recent onset. I might do the same if they have had this problem for a while and haven’t sought help, or if they’ve had CBT before and feel the need for some booster sessions. If CBT isn’t having the desired effect, we would explore what might be stopping them from achieving a better result. My clinical experience tells me it may be connected to unprocessed past experiences affecting their belief system and causing them to become stuck in certain ways of thinking. CBT may not help with this, so a different approach is needed.

In this situation, as part of an assessment with the client, I would look at the experiences in their life, good and bad, from birth up until the present day, to try and identify things that may have led them to develop the problems they’re currently facing. If these problems are rooted in trauma, then I am much more likely to use EMDR Therapy.

If a client has a much more complex presentation, (for example, if they’ve been exposed to excessive amounts of trauma such as childhood abuse or neglect) EMDR Therapy may not be the most suitable treatment. This can be the case when someone has learned to detach from emotions because they were punished or shamed for showing them in their early life. Through this, they may have learned emotions are ‘bad’ or that you’re a bad person for feeling them and deserve to be punished. If they then come to therapy because they’re struggling emotionally, this belief can be a huge obstacle, preventing EMDR Therapy from running smoothly and acting as a barrier to effective processing.

In cases like this, I’m much more likely to use Schema Therapy as it’s designed for more complex, long-term emotional difficulties linked to unmet childhood needs. Clients in this group need a lot more time to gently work through and process the multiple traumas they’re likely to have experienced in their early years and throughout their lifetime. They also need lots of reassurance that their feelings are safe and that they’re not going to be judged or invalidated for sharing them with me as their therapist. Alongside this, they often need to work on some of the unhelpful coping strategies they developed to survive their early years. All these things can prevent EMDR Therapy from running smoothly, hence the need for an alternative approach.

Find Out More

Ultimately, I’m always focussed on improving your emotional wellness and overall wellbeing. It doesn’t matter what your journey looks like or how long it takes, as long as you reach a place where things feel better. If you’re unsure which therapy is right for you, contact me to arrange a free consultation. I’d love to discuss the options with you.

Useful Links

How to Get the Most Out of Therapy

What to Expect at Your First Therapy Session

How Effective is Online Therapy

I’ve Finished Therapy, What Happens Next?

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