Why is therapy not working?
Updated: Apr 11
"I've tried therapy; it didn't work".
I've heard that many times. Not just from clients, but from friends, family, partners, dates. Actually quite a few people have said that to me when I tell them I'm a Psychotherapist. I'm not sure if it's a posture, or a bit of a poke to the bear, but yep - sometimes therapy doesn't work.
Granted, I'm biased in my thinking in how transformative therapy can be, but yes; sometimes therapy doesn't work.
And there are fair and important reasons why that's happening.
1. The therapy isn't right for you.
There are a lot of therapeutic techniques and schools of therapy, and sometimes we don't get what we need. Someone with an acute phobia of spiders won't need the same therapy as someone with a history of trauma and abuse, and vice versa. It's unfair to assume one size fits all, and if you don't know the world of therapy you could easily, accidentally fall into a therapy school which isn't for you and what you need. Most therapists will offer a consultation where you can have their therapeutic approach explained to you, and you shouldn't be pressured into working with them if it doesn't feel right. Berating yourself that your 3 sessions of counselling didn't touch the surface of your suffering doesn't mean there's anything wrong with you, nor does it mean therapy as a concept doesn't work. It's also important to point out here that free therapy via charities and the NHS are sadly, disappointingly under-funded, so the therapy offered is probably going to be limited. Again, this doesn't mean there's anything wrong with you; it is a chronically under-funded service which needs a mass overhaul.
2. The therapist isn't right for you.
It's widely recognised in therapeutic training that the relationship between the therapist and their client is a huge factor in the process of change and healing. It's quite obvious really, but it can be overlooked easily.
You can't like everybody, and everybody can't like you - and it's exactly the same in this scenario. If you find a therapist you click with, who makes you feel safe and at home, welcomed and heard and important, then you have found the right therapist. If they don't or can't offer you that, you can change therapists.
There are several levels of therapy training, and it needs to be said that just because someone has many years and qualifications under their belt, it doesn't equal a brilliant therapist. I myself encountered a fully qualified Counselling Psychologist with a vast history of training, where I walked out halfway through the assessment because her inability to show empathy was too palpable for me to sit with for another half an hour. I imagine her way of being works for some people - but it didn't work for me. And the same goes for me as a therapist; there will have been clients who felt like we didn't click, and that's ok - it's just the way it is sometimes.
I'd also recommend finding your therapist via a directory such as the Counselling Directory or Psychology Today; these therapists not only have recognised qualifications and are part of a regulating body, but they are bound by ethical guidelines and have insurance, meaning they can be a part of the directory. It means they are vetted and are at a certain standard of recognition for their capabilities. It means you will be able to avoid people who have maybe only ever read one counselling book, did a 2 week online course in CBT and then set themselves up as a therapist with a fancy website. Don't be fooled. Sadly the term "therapist" isn't a protected term right now, so anyone can call themselves that.
3. It's not the right time.
I like to say that timing isn't a factor in important moments, but in therapy I think it is. Therapy is both a time for reflection and a time for action - and sometimes we aren't in a position to do either or both and that's ok. Sometimes we just need to get through some shit; get out of that relationship, move out of that house or toxic workplace, get our finances in order, and get to a place where we are at least a little less chaotic before we start to talk about our experiences and where we want to be.
4. You're not engaging in the process.
Ouch, I know. But, therapy is hard. When it gets to a place of it being easy, light-hearted, or you have absolutely no idea why you're still in therapy, then that's the time to stop. Until that time, it's fair to assume that your therapy sessions will vary in difficulty and emotional upheaval.
Change is really hard. We know something needs to change - we need to change, the environment, the family etc. etc., but we're stuck. The hardest truth in the therapeutic process is to admit that we want change but don't want to do any of the changing. This means we can get frustrated, withdrawn, avoidant, angry - all without actually changing anything. It is unfair on both you and your therapist to expect the hour a week of therapy (or fortnight, or month) is going to dramatically change your life for the better if you are not open to working with yourself the rest of the time. You have to be open and curious to the idea of trying something different, to allow change in. Nothing changes if nothing changes after all.
Your therapist shouldn't shame you for not being able to implement change in your life, but they should challenge you. Having repetitive, unhelpful, limiting patterns of behaviour and ways of thinking pointed out and brought into your awareness is a part of therapy, which can definitely feel scary if it's not something you're used to. But we're not out to get you.
5. You cancel your sessions/avoid them/accidentally forget you booked them.
Consistency is key in therapy, which means you have to actually attend your appointments, even when you don't feel like it. When I see a client sit down in front of me, fuming that they're there instead of sitting in a beer garden, they're tired, afraid, worn down, or maybe they are completely lost with what to talk about; I see a client who is engaging.
Even if you think you have nothing to say, you feel in a really good mood or you're just not feeling it that day; go to your therapy appointments. Work can still be done, even if you aren't in crisis.
6. You're not sure what therapy is.
I cringe watching therapists on TV shows or in films, because they are always shit. They cross ethical boundaries constantly, have unhealthy dynamics with clients, and I can never figure out what they're actually doing except handing over an eye watering invoice. They seem vacant, vapid, unenthused, dangerous, all the while sitting in ginormous rooms behind an oak desk and offering very little dialogue, and they always have a rude receptionist.
If you've never been to therapy, trained in it, learned about it, then it's very understandable you're not going to know what it is. The same way I have zero idea about mechanics, rocket science, and veterinary surgery because I never learned them, I would expect lots of people to feel similarly about therapy. Therapy is not you lying on a chaise longue while I sit behind you asking odd questions about your mother. It is a collaborative process and a conversation. We make eye contact, we discuss moments in your life, we both think pragmatically and with reflection, we might even laugh. If you find a therapist online and you want to have the process explained to you - ask away. They should be able to talk you through it, and to do so clearly and concisely.