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Four Reasons Why Therapy May Not be Working Out So Well

Updated: Oct 11

by Shaina Gonzales, LCSW


I often hear from clients, friends, and family some version of "I tried therapy and it didn't work." When I hear these words, I cringe inside.



Don't get me wrong! I've had my fair share of terrible therapy experiences, too. One time, about two years ago, I showed up for an initial assessment and told the therapist my presenting concerns only to feel like a freak. The #therapist did not do a good job of creating a safe, judgment-free environment. Instead, I half-expected her to grab a bag of popcorn as I “entertained” her with my story!


So I get it. I know bad experiences in therapy happen. But I believe strongly in #therapy and its power to help heal people. And I worry that giving up on therapy because of one bad experience – or even a few – furthers the #stigma in our society around seeking mental health treatment.


Here’s the bottom line: Therapy is far too important and far too transformative to give up after a few bad experiences.


The truth is, there are many reasons why therapy might not be effective the first time, or even the second or third. And if you understand those reasons, you’ll be better equipped to find success next time around. So, if therapy hasn't worked out for you yet, here are some things to consider before you give up.


1) The Therapeutic Relationship


The therapeutic relationship refers to the connection that a person has with their therapist. This relationship is so important in fact, that clinicians in-training are taught to think about it when they are learning how to be more effective with clients. If you are like most clients, you probably have sought therapy with a desire to heal from relationships that were harmful or traumatic, whether you are aware of this or not. Psychodynamic theorists such as Freud, Ainsworth, and Bowlby believed that the therapeutic relationship can be healing and reparative in and of itself. Research has shown that the relationship an individual has with their therapist can account for up to 34% of successful therapy outcomes.


Therapy requires that you be open and vulnerable. It is a scary situation to be in, as many of us live our lives in protective shields, careful of who we allow to bear witness to our pain. A therapist's job is to ask questions to get at the origin of psychosocial distress, and this can feel unsettling, especially if it is your first time in therapy. You are much more likely to open up, be vulnerable and look at yourself in the mirror if you have a human connection that is safe and nurturing.


If you do not feel comfortable with your therapist or do not feel safe enough to be open and vulnerable, therapy likely won't work.


2) The Treatment Modality

There are many different types of therapy approaches that therapists use with clients. Not all of them work the same for everyone. Your therapist should mold therapy to your unique personality and situation. The goal of many of these approaches will be to help you to retrain how you think about, approach, and cope with your problems. Other approaches will focus on helping you to process traumatic memories so that they no longer feel as upsetting as they once did. Common types of therapy include Cognitive Behavioral Therapy (CBT), Solution Focused Therapy (SFT), Dialectical Behavioral Therapy (DBT), Narrative Therapy, Eye Movement and Desensitization and Reprocessing (EMDR) Therapy, among many others.


Ask your therapist about the approaches they are using and explore other ones that may work better. If you understand the purpose behind the chosen approach, you are likely to get more out of it.


3) Homework

Attending sessions is just a small part of the work of therapy. The real work occurs in between sessions. Therapists often assign homework to help clients reflect upon topics and practice skills learned in a session. Homework can include journaling, worksheets, reflection, and conversations with loved ones.


Remember, the goal of therapy is to help you retrain how you think about your problems. You have had a whole lifetime of experience thinking about your problems in very specific ways. In fact, many of us don’t even know we can change our thinking! It’s not easy work though. Getting your brain used to thinking in new ways requires practice outside of sessions in order to be successful. Much like going to the gym to lose weight or tone muscles, homework is mental exercise that is necessary to strengthen your brain's muscles to think in new and healthier ways.


You may find that you are having trouble staying motivated to do your homework or you may find that the homework doesn’t feel like it’s sticking. If that is the case you should consider talking to your primary care doctor and your therapist about medications. It is common for clients to need medication to help them be better able to engage in homework and consistent mental exercise.


Ultimately, you don’t need to complete your therapy homework. However, not doing so will likely mean that your progress will move at a slower pace.


4) You may not be ready for change.

Change is hard. Even when it is needed, it is still an adjustment and that can be uncomfortable. Change can also be scary because it can feel like a shock to your identity. It is normal for your identity to become intertwined with your challenges, your struggles, or even your diagnosis. Being without these things can feel like unsteady and new territory. Whether you are conscious of it or not, you may be afraid of what life will look like when our problems no longer exist. Will you know how to act? How to be? How to navigate relationships? These are big questions that feel hard to answer when you don’t know who you will be once a change is made. You may feel that you are ready to make big changes in your life, but when it comes down to it, you may find that you simply can’t seem to take the steps necessary to achieve the change.


Don’t worry! There's an explanation for this. Research on The Stages of Change has shown that in order to make changes in our lives, humans pass through various stages before actually being successful. The stages of change are precontemplation, contemplation, preparation, action and maintenance. Precontemplation is the first stage where you probably aren’t aware that a change is needed. Contemplation is the stage where you begin to become aware that there is a problem and you are starting to think about making a change. Next comes the preparation stage where you begin to take action steps to help you achieve change. After preparation comes the action stage in which you begin to actually take steps to make change. The final stage is maintenance. In this stage you have already made change and are actively taking measures to sustain it. If you find yourself stuck in a change rut, consider which stage you may be in and what you might need to help you move on to the next stage.


Even good change comes with uncomfortable emotions. Be kind and patient with yourself in the process while also examining what may be holding you back.

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