When Therapy Doesn’t Work – Why it Happens and What to Do Now

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Therapy can be a life-changing tool, but it isn’t a magic wand or a perfect science. Like anything, it can sometimes fall short of what you’d hoped for. When that happens, what’s really going on, and what can you do next?

What’s really going on when therapy isn’t working

There are a number of ingredients that make up any therapy experience: you, your therapist, the relationship between you, the type of therapy, the issues you’re working through, and the format of your sessions (online, in person, or blended)

So what can affect this combination of things and mean therapy isn’t landing the way you’d hoped?

1. The type of therapy may not suit your personality

Your personality can affect what therapy works best for you. If you’re naturally an over-analyser, for example, psychoanalysis may keep you stuck in your head. A therapy that draws you more into your feelings and body may work better, such as compassion-focused therapy (CFT) or mindfulness-based CBT.

If big emotions tend to take over, a more structured therapy may suit you better, such as CBT or dialectical behaviour therapy (DBT).

2. The therapy may not be suited to your particular issues

Living with the effects of past trauma, or complex PTSD? In some cases, a therapy that moves quickly into talking about the past, such as psychodynamic therapy, can leave you feeling constantly triggered.

If trauma has left you with emotional dysregulation or impulsivity, it can help to first work with a therapy that supports you to stabilise and get your stress response under control. Our article on therapies that work for trauma is a helpful read on this front.

Format matters too. If you experience social anxiety or phobias, online therapy may suit you better than in-person sessions.

3. It can be hard to be fully open with your therapist

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Many people come to therapy feeling lonely, and may never have had the chance to build a fully honest, trusting connection with someone. A therapist can be the first person who really sees and appreciates you – and that can make it tempting to want to please them, or to hold back the parts of your story you think they won’t want to hear.

This is a completely understandable response. But a therapist can only help you work through your thinking and behaviour with the full picture in front of them.

If you find you can’t yet be fully open with your current therapist and are considering a change, try naming this early with a new therapist – for example, letting them know that being fully honest is something you find hard. Getting it on the table from the start gives you both something real to work with.

4. Therapy needs time and commitment to show results

Therapy doesn’t provide instant results, and it isn’t always easy. It asks for patience and genuine engagement with the process.

If you move on from a therapist the moment they say something you don’t want to hear, it can be hard to get far enough in to see change. And if sessions start to feel like something to get through rather than to be present in, it may be worth pausing to notice what’s making it hard to engage – that in itself can be useful material to bring to your therapist.

Therapy tends to work best when you think of it as a journey rather than a single destination.

5. You and your therapist may not be the right match

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Finding the right therapist can be a bit like dating – it can take a few tries to find that sense of connection, and the first match may not be the one. As with dating, it’s worth giving it a couple of sessions before deciding, rather than judging too quickly.

It’s also normal not to feel instant trust or liking. Therapy is a working relationship, not a friendship, and many people who come to therapy are working through trust issues in the first place – these won’t necessarily shift overnight just because you’re in the room with a therapist.

Look for someone you respect, feel safe with, and can imagine growing to trust over time.

6. There may be boundary issues in the therapeutic relationship

The client–therapist relationship is a working one. A good therapist holds clear boundaries – they shouldn’t bring their own personal life into the room, or be in contact with you outside of sessions.

On your side, if you notice yourself thinking of your therapist as a friend, or developing romantic feelings towards them, it’s worth raising this directly with them. This is a recognised part of therapy called transference – when feelings connected to other relationships, past or present, get placed onto the therapist – and talking about it openly can lead to real breakthroughs.

Schema therapy works a little differently, using an approach called reparenting, where the therapist takes on a trusted, parental-style role. Even here, the relationship isn’t a friendship, and clear boundaries should still be discussed regularly.

7. A treatment-resistant issue or complex diagnosis may need a specialised approach

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Some people are living with deeply entrenched trauma responses or what are clinically termed personality disorders – though many now prefer softer language, such as personality differences, since these experiences can simply reflect a different way of thinking and feeling rather than something “disordered.” Whatever the language, these experiences may call for a specialised therapy that builds a strong, safe structure to grow within.

Schema therapy, for instance, was designed for treatment-resistant issues and personality disorder diagnoses. Dialectical behaviour therapy (DBT) was developed specifically to support people with borderline personality disorder (BPD).

8. Your expectations of therapy may not match what’s realistic

Sometimes therapy is working – it’s just not moving as fast, or getting you as far, as you’d hoped. It’s natural to want to feel “fixed,” or to reach some idea of “normal” that, in truth, doesn’t really exist.

Some research has found that studies on how effective therapy can be for conditions like depression have, at times, overstated the results.

A good therapist will be honest with you about what to realistically expect, and will help you notice genuine progress rather than let you measure yourself against an unrealistic ideal.

9. Sometimes, the fit comes down to the therapist’s own skill or approach

Therapists, like professionals in any field, vary. Some may not yet have found their strengths, some may not be the right fit for a particular client, and – rarely – some cross ethical lines they shouldn’t.

It’s worth knowing what to look for in a good therapist, and knowing your rights if a therapist crosses professional boundaries, including how to raise a concern with the registering body they work under.

At Harley Therapy, we aim to take the stress out of finding the right therapist for you. Our therapists are rigorously selected for their passion and commitment, and all have at least 10 years of experience. On our sister platform of therapy listings, you’ll find only registered practitioners, along with client reviews, so you can make an informed choice before booking.