15 May 2017

When Therapy Doesn’t Work

What to do next


Joel L. Young, M.D.

For many people, therapy is a treatment of last resort. A depressed person, for instance, might delay therapy for months or even years, only to give in when his symptoms become so terrible that anything seems preferable to living another day with depression.  Because therapy patients often view therapy as a panacea—and one which they’ll only try when life gets impossible—the disappointment you feel when therapy doesn’t work can be deep, cutting, and profoundly demoralizing.

Mental illness is just like any other health condition, though. Whether it’s difficulty coping with stress or something more serious, such as post-traumatic stress disorder, the first treatment doesn’t always work. If you had heart disease, you wouldn’t throw up your hands and give up if your first medication didn’t yield results, so don’t do the same with therapy! If therapy has failed you, you still have plenty of options for feeling better.

Ask Your Therapist About Next Steps

If therapy isn’t working, the first person you should talk to is your therapist. She may opt to change her approach to treatment, pursue more “homework” options for you, or even refer you to another therapist.


Be sure to ask the following questions:

  • How long should it take for me to see results?
  • What treatment method are we using, and is it too early to try a different approach?
  • Is there anything I can do to increase the efficacy of therapy?
  • Could medication help? What about lifestyle changes?

Pursue Lifestyle Changes

Therapy is just one step in your treatment journey, not the whole journey. One of the greatest benefits of therapy is that your therapist can give you the confidence and strength you need to pursue lifestyle treatments. A good therapist can also recommend changes you can make that might improve your prognosis. Every person is different, and every mental health condition demands slightly different treatment. Generally speaking, though, the following lifestyle changes can often help you combat mental illnesses:

  • Developing a regular schedule and taking time each day to plan your day. Remember, time is exactly like money, and by budgeting your time, you may find you have more of it—not to mention less stress.
  • Take steps to ensure your lifestyle and environment are healthy. If you are in an abusive relationship, leave. If conflict with loved ones is an ongoing problem, work to resolve these conflicts.
  • Eat a balanced, healthy diet rich in lean proteins, fruits, and veggies.
  • Get at least 150 minutes of cardiovascular activity each week.
  • Commit to a regular sleep schedule, getting up and going to bed at the same time each night. Aim for seven to eight hours of sleep.
  • Start meditating. If meditation is not your style, try another activity that forces you to slow down and focus on your breathing, such as yoga or mindfulness-based cognitive therapy.

Do Your Homework

Therapy isn’t brain magic. There’s nothing your therapist can say that will mysteriously re-scramble things in your brain, immediately making your life better. Instead, therapy is hard work. Just as you’ll never learn algebra if you don’t do your math homework, you’ll never learn to better manage your emotions and life if you don’t do your therapy homework. By following your therapist’s assignments, you enable yourself to adopt new coping mechanisms and move beyond the struggles of the past.

But what if your therapist doesn’t give you homework? Homework doesn’t have to be specific or involve paper. Instead, it’s simply a matter of doing the things your therapist suggests with an open mind. If he asks you to focus on saying no less, give it a shot before rejecting it out of hand. And if your therapist doesn’t give you homework, it’s time to start asking for some—or begin working with a therapist who is a bit more proactive.


Try a New Therapist

The single best predictor of whether therapy will work is whether you and your therapist is a good fit. A therapist who accepts your values, understands your emotions, and who makes you feel accepted and heard is key to therapy. If your therapist isn’t offering you this, it’s time to try someone else.

What if you like your therapist but therapy’s just not going where you want it? It’s not enough to like your therapist, and there’s huge differences in competence from therapist to therapist. If therapy’s not working, consider whether your therapist is the right one for you. If your therapist hasn’t done at least the following, it’s time to move on:

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  • Talked with you about treatment options and advised on what you can do to increase the effectiveness of therapy.
  • Set specific treatment goals and given you a timetable for when you can see results
  • Talked to you about medication for your mental health condition.
  • Given you a diagnosis or a clear picture of what you’re in therapy to work on.
  • Given you clear, specific recommendations for homework and other activities you can do to build upon what you’re learning in therapy.


Talk to Your Doctor

Research suggests that, for many mental health conditions, combining therapy with medication is the single most effective way to see results. If therapy’s not working, it’s time to consider taking medication. But medication is not the only thing your doctor can help you with. Health problems can interfere with your progress, and some physical health problems masquerade as mental health problems. The sluggishness some people experience with hypothyroidism, for example, can mimic common symptoms of depression. It could be that you’re struggling with an easily treated health problem, so ask for blood work and give your doctor a specific, detailed list of your symptoms and health history.

It can be deeply frustrating when therapy doesn’t work, but this is just the beginning of the journey, not the end. If you’re willing to research your condition, be a good advocate for yourself, and keep trying until something works, you can feel better sooner than you expect.

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