When therapy isn’t working

Stalls and dropout

What helps

Discussions in therapy are deeply personal, and looking at painful things can be uncomfortable. Progress is rarely a straight line. A tough session, or a few slow weeks, doesn’t mean therapy is failing.

NIMH’s advice: if you’ve been in therapy for what feels like a reasonable amount of time and you’re not feeling better, talk to your therapist. You can also consider a different professional or approach.

It can feel awkward, even rude, to tell a therapist it isn’t working. But good therapists want to know. Research shows that working through strains together is linked with better results.

Ways to start

• “I want to check in about how therapy’s going for me.”
• “I’m not sure we’re working on what matters most to me.”
• “When you said…, I felt brushed off.”
• “I’d like more practical tools,” or “I’d like more time to talk.”
• “I’m thinking about whether this is the right fit.”

Counselors are expected to involve clients in planning their care, and clients have the right to refuse changes they don’t want. You’re a partner in therapy, not a passenger.

Some therapists ask clients to fill in a short questionnaire every session or so, and look at the results together. This is called progress feedback or routine outcome monitoring.

A review of 58 studies with 21,699 patients found progress feedback slightly improved results and reduced dropout. For people who weren’t on track, feedback nearly doubled the rate of meaningful improvement and reduced how many got worse.

Ways to track, even without a formal tool

• Rate how you feel (0 to 10) at the start of each session
• Look back at your first goals every month or so
• Note one thing you’re doing differently since you started
• Ask your therapist: “What changes do you notice in me?”

You are free to choose whether to stay in therapy. Switching isn’t failure, and it isn’t rude. NIMH says there’s no one-size-fits-all treatment.

A smooth switch

1. Start looking for a new therapist before you stop, if you can
2. Tell your current therapist you plan to move on (in person, by message, or in a final session)
3. Ask for names of other professionals who might suit you
4. Ask how to have your records sent, and sign a release if you want them shared
5. Tell your new therapist what helped, and what didn’t, last time

Counselors are expected to help with a transfer of care and to recommend other providers when needed. You generally have the right to a copy of your health record, though a therapist’s separate private notes are treated differently.

Therapy should end when you no longer need it, when it isn’t helping, or when it’s causing harm. Counselors are expected to talk the ending through with you and suggest other services if needed.

Good things to cover in a last session

• What’s changed since you started, and what helped most
• Early warning signs to watch for
• What you’ll do if things get hard again
• Whether you can come back for a “top-up” session later

If your therapist has to stop seeing you, they shouldn’t just disappear. Counselors are expected not to abandon clients, and to help arrange continued care.

Most stalls are about fit or approach. But sometimes a therapist crosses professional lines. Ethics codes set clear rules to protect clients.

Serious red flags

• Any romantic or sexual contact, in person or online
• Pressuring you toward their own beliefs or values
• Sharing your information without consent, outside the legal limits they explained
• Starting a business deal or friendship with you
• Not explaining fees, or changing them without warning

Professional ethics codes ban sexual or romantic relationships with current clients. If this happens, it is never the client’s fault.

If someone you love says therapy isn’t helping, it’s tempting to tell them to quit or to push them to keep going. Usually the most helpful thing is to listen and encourage them to speak up.

Helpful things to say

• “Have you been able to tell your therapist how you feel about it?”
• “It’s okay to look for someone else. Want help searching?”
• “What’s one thing you wish was different in your sessions?”
• “I’m proud of you for sticking with it this far.”

If you’re feeling much worse, or having thoughts of suicide, reach out now: to a crisis line, your therapist’s emergency contact, or emergency services.