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

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by Andrea M. Darcy

Therapy can be a life changing tool, but it is not a magic wand or a perfect science. Like anything, therapy can sometimes go wrong. When therapy doesn’t work, what is it really about? And what can you do next?

What is the issue when therapy doesn’t work?

When it comes to therapy, there are a number of ingredients to consider. There is you, the therapist, the relationship between you, the type of therapy, your different issues, and the length and format of your sessions (online therapy, in person, blended).

So what can go wrong with this combination of things that can mean therapy doesn’t work?

1. You are doing a type of therapy that doesn’t suit your personality.

Your personality can affect what therapy works best. For example, if you are naturally an over analyser, psychoanalysis could just keep you trapped in overthinking. A therapy that pulls you more into your feelings and body might be more effective, such as compassion-focussed therapy (CFT) or mindfulness-based CBT.

If you are too emotional, on the other hand, a very structured therapy might be best, such as CBT or dialectical behaviour therapy.

2. Your issues aren’t suited to the therapy you are doing. 

Unstable due to past trauma? Have c-PTSD? In some cases a therapy that immediately jumps into talking about your past, such as psychodynamic therapy, can leave you constantly triggered. 

If you have emotional dysregulation and impulsivity from trauma it can be a good idea to first do a therapy that helps you stabilise and get your stress response under control. (Our article on therapies that work for trauma can be a helpful read on this front).

And therapy format can come into play here. If you have social anxiety or phobias, online therapy might work better than in-person.

3. You are not being open and honest with your therapist.

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Many of us who come to therapy are lonely, and perhaps have never managed to have a healthy connection with someone. Our therapist can be the first time we feel seen and appreciated.

We go into pleasing mode to gain more attention, hiding things from our therapist or saying what we think they want to hear.

Of course a therapist can’t help troubleshoot our thinking and behaviours if we are lying about them. 

If you truly feel it’s gone too far and you can’t be honest with your current therapist, and decide you need a new therapist? Then in the very first session with the next therapist admit that you struggle to be honest as you want to please. Get the issue on the table immediately and go from there.

4. You don’t stick out therapy long enough or properly commit to the process.

Therapy does not provide instant results and it is not easy. It requires commitment and hard work.

If you keep hopping from one therapist to the next the second they say something you don’t like? You’ll never see results. 

And if you are showing up at therapy and being half-hearted, not in the present moment and not caring about the process? You are likely wasting your time. Therapy is best seen like a journey, not a destination. And you have to commit to being on that journey.

5. Therapy doesn’t work because you and your therapist are not a good match.

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Therapy is like dating. It can take several tries to get that ‘click’ and the first time might not work out. (But, again like dating, it can take a couple of sessions to be sure, don’t be too hasty). 

And don’t expect to immediately like and trust a therapist. It’s a working relationship, not a friendship. And most people who come to therapy have trust issues, which isn’t going to magically change with a therapist. 

Look for someone who you respect and feel you can grow to trust over time, and feel comfortable around.

6. There are boundary issues between you and your therapist.

Again, the therapy-client relationship is a working relationship. A good therapist should have clear working boundaries with you, and not bring their own life to the therapy room or contact you outside of therapy.

As for your side, if you can’t help but think your therapist is a friend, or that you are in love with them? Then you really need to talk to your therapist about this. ‘Transference’ means we move feelings for other people in our past or present onto our therapist, and talking about it can lead to breakthroughs.

Note that schema therapy has a different client therapist relationship than other talk therapies, and practices what is called ‘reparenting’. But even here the therapist works as a trusting parental figure, not a friend. And boundaries should be constantly discussed.

7. You have a treatment resistant issue or personality disorder that needs a specialised type of therapy.

Some of us have deeply entrenched trauma or what are rather horribly called ‘personality disorders’. A better way to put it would be ‘personality differences’. Our thinking and emotional responses can be very different or more extreme. So we can need a specialised therapy that suits us and creates a safe, strong container for us to grow within.

Schema therapy, for example, is created for treatment resistant issues and personality disorders. And dialectical behaviour therapy (DBT) was created to help those with borderline personality disorder (by someone who suffered with BPD herself). 

8. Your expectations are unrealistic.

Sometimes, therapy is working. It’s just not working as well as we want it to. We want to be ‘perfect’ or some version of ‘normal’ we have decided exists (it doesn’t).

The therapy industry could be held partially accountable here. Recent research does show, for example, that literature around how effective therapy is for depression was found to sometimes exaggerate the results. 

A good therapist is honest with you about results you can expect. And also will help you to recognise how things are improving and where you are comparing yourself to unrealistic ideals.

9. Your therapist is simply not a good therapist.

Not all therapists are created equal. Like in any profession, there are uncommitted sorts, those who are in it for wrong reasons, people just aren’t cut out for the job, and the occasional bad egg who crosses ethical boundaries.

It’s very important to educate yourself on what to look for in a therapist, and to assert your rights if any therapist is crossing professional boundaries, such as by calling the registrar they work under.

At Harley Therapy we take the stress out of finding a good therapist. Our therapists in London are rigorously selected for their passion and commitment, and all have at least 10 years of experience. On our sister site of therapy listings, you will find only registered therapists and can read client reviews before making a booking. 

Andrea M. Darcy is a mental health and wellbeing expert. She has some training in person centred therapy and coaching and now works helping others design their perfect therapy journey. Follow her on Instagram @am_darcy