When Talk Therapy Doesn’t Work—What to Do Next

But what about the other 25% who find therapy not effective? For a number of reasons—such as misdiagnosis, one-size-fits-all treatments, or failing to recognize underlying medical conditions—a significant number of individuals are not getting the results they want from therapy. In some cases, therapy may even make things worse.

If you are struggling with talk therapy not working, you may be relieved to know there are reasons why traditional therapy may not be enough for you. Here’s how to recognize when therapy is not working, more information about why talk therapy doesn’t work for everyone, and what to do when therapy fails.

HOW DO YOU KNOW IF TALK THERAPY ISN’T HELPING?

Because talk therapy is a process, and progress is highly individual, it can be difficult to discern if it is working for some individuals. While some find relief upon their first appointment, others feel it after a few sessions.

Generally, treatment takes a few months. According to the APA, it takes about 15 to 20 sessions for 50% of trauma patients to improve, based on self-reported symptom measures. However, it also suggests that people with co-occurring conditions or certain personality issues may need longer treatment (perhaps 12-18 months) for therapy to work.

Regardless, there are markers of improvement that should be met, even in the early stages of therapy. Here are five signs that therapy is not working:

1. You’re not seeing improvement in your symptoms. If you started therapy because of depression or anxiety, are you feeling less depressed or anxious? Therapy should lead to progress over time.
2. You’re feeling worse over time. Therapy can cause some emotional discomfort when addressing tough topics during therapy. But when therapy makes things worse repeatedly over time, something is not working.
3. You’re not learning new coping strategies. Talk therapy should give you tools and methods for managing triggers, stress, and other symptoms. Examples might include setting boundaries, speaking up, stepping away, practicing a deep-breathing technique, or developing a supportive network of people/friends to reach out to.
4. You’re skipping therapy sessions or assignments. Dreading therapy sessions or failing to do assigned homework might suggest that the current therapeutic approach is not working for you.
5. You don’t have clear goals or are not meeting goals. Having goals is very important for effective mental health treatment. This is especially true for young people with anxiety and depression, research Setting goals helps to make the therapeutic process more manageable for young people, allowing them to take some responsibility in their own mental well-being, as well as enabling them to feel supported.

WHY TALK THERAPY DOESN’T WORK FOR EVERYONE

There are many explanations for therapy failure. Here are some of the top reasons why therapy is not effective for an estimated 25% of people who try it. 

1. Underlying Medical Issues Affecting Mental Health

Physical health and mental health are closely tied to each other. If treating the mental health condition with therapy is not working, it may be that you have an unaddressed medical condition.

For example, infections like Lyme disease are associated with mental disorders like depression and anxiety as are long-term physical illness (i.e., arthritis, asthma, cancer, chronic fatigue, diabetes, epilepsy, heart problems, and high blood pressure).

2. The Wrong Type of Therapy

Psychotherapy is not a one-size-fits-all solution for treating mental health disorders. There are many different types available, and for good reason. Not all mental health conditions are alike. Some require a specific approach.

For example, exposure and response prevention (ERP), a type of cognitive behavioral therapy, is the primary and most effective psychotherapeutic approach for treating obsessive-compulsive disorder (OCD), according to research. In fact, general talk therapy can make OCD worse. 

Additionally, talk therapy may be ineffective for some trauma survivors. Eye movement desensitization and reprocessing (EMDR) therapy has been shown to be effective in treating PTSD, according to research, which may be a better method for some. The temperament of some individuals may call for an entirely different approach like art therapy.

3. Poor Fit With Therapist

The quality of the alliance or connection between the client and therapist plays a major role in therapy outcomes, research shows. It should be characterized by empathy, a nonjudgmental attitude, and mutual respect. This creates a safe space for clients to discuss their concerns openly. If that is not happening, it may be a poor fit.

Perhaps the therapist doesn’t have experience with your issues, is culturally insensitive, or you simply don’t like their personality. While not the norm, there are poor therapists too.

They may fail in helping you to work towards a goal, break ethical boundaries, or talk too much about themselves. Think of finding the right therapist like trying to find the right medication. It may take a few tries to find the right one.

3. Misdiagnosis in Mental Health Treatment

Too often therapy fails because the patient has been misdiagnosed. Unfortunately, misdiagnosis is very common—particularly with primary care physicians.

One study found alarmingly high misdiagnosis rates from primary care physicians: 65.9% for major depressive disorder, 92.7% for bipolar disorder, 85.8% for panic disorder, 71.0% for generalized anxiety disorder, and 97.8% for social anxiety disorder. It’s critical to get an accurate diagnosis from a qualified mental health professional.