I have heard countless times, “I just don’t think therapy would work for me.”  I acknowledge that therapy may not be the key for everyone and we all have our own unique needs. At the same time, I do believe that anyone can benefit from therapy in some way, shape, or form. As human beings we all have the universal need to feel connected, supported, and validated. Those factors in therapy in and of themselves can be incredibly healing.  My hope is that speaking to some of the common factors that impact the effectiveness of therapy will help inspire people to be open to this way of healing or to make adaptations to enhance their current experience.  So let’s explore the question: Why isn’t therapy working?


Change is hard and can be scary. Motivation fluctuates which can absolutely impact how we show up or engage in the therapy process. Feeling ambivalent about change is very normal. This is something to be transparent about in therapy. While we have reasons to change, it is important to acknowledge the reasons you don’t want to change. Therapy can help explore these barriers and figure out how to navigate them. Therapy can support us in engaging with the change process even when motivation is lower. 

The Therapeutic Relationship 

When it comes to finding the right therapist, one size does not fit all. Therapists have different training and specialties, backgrounds, personalities, cultural identifiers, and styles in how they do their work that impact the client experience. The therapeutic relationship and rapport is fundamental in most types of talk therapy. It is important to have trust and for you to feel safe and supported. Consider if there are any barriers that need to be addressed relationally or brought into the room to create a stronger rapport. Maybe you need someone who is more direct, or teaches more skills, or is more your age, etc. 

The Approach or framework 

There are many different theoretical frameworks that therapists utilize.There are many types of therapy modalities and approaches that can meet the needs of people of all different ages, developmental levels, abilities, interests, strengths, and diverse cultural backgrounds and identities.  If one approach does not seem to be clicking for you that does not mean you are hopeless. Not only are there many different theoretical frameworks within the realm of talk therapy, but there are a host of different mind/body and holistic approaches, somatic therapies, as well as creative arts therapies to consider that may be a better fit for your needs, or can serve to enhance your care.  The options are endless and can help you work with your provider to customize care to best meet your goals and accommodate your unique needs. Don’t be afraid to consult your therapist or a professional about all of these options!

Goals and Expectations 

Having clear goals for therapy is key. Goals should feel tangible and specific. This helps give a sense of direction in what you would like to get out of therapy, as well as a way to track that you are moving towards those goals and making progress over time.  

Expectations should be discussed on both ends. Oftentimes clients come in with time expectations. The reality is that some therapy goals are achieved quicker than others. Many times this is not predictable or a protocol with a set amount of sessions,  and it is important to be patient and be willing to give yourself grace as you embark on this journey. Change takes time and practice. While meeting weekly can absolutely be enough for some, if you are looking for skills and techniques, these will need to be practiced and implemented outside of the therapy space as well in order to work most effectively and become more integrated into your daily life. 

Level of Support 

Many people have only heard of outpatient therapy where you meet with a therapist weekly, biweekly, or even on an as-needed basis. However, for many people this is not enough support to adequately meet their needs. Maybe you are someone who is really struggling or feels constantly in crisis, or even just feeling defeated and unable to make progress. This is not a failure on your part. Rather it may be a signal that outpatient therapy is not enough support for you. 

This may mean it is time to meet more frequently with your provider or consider treatment. There are outpatient therapy groups that can be additional support. There are also treatment centers that exist to support people in need of more frequent and intensive care. It is important to note that treatment centers have several levels of care. This includes intensive outpatient programs, partial hospitalization, and residential to accommodate all different levels of acuity. 

In Need of Additional Providers and Adjunct Services 

It is useful to consider other additional services and providers that can enhance the effectiveness of your healing. Many people find that their symptoms are best alleviated through a combination of medication and therapy. Having a psychiatrist on board to help assess the need for medication and monitor medications is a very helpful additional support. For clients with eating disorders, I find including an eating disorder-informed dietitian as part of the treatment team to address nutrition is incredibly useful. When providers are able to collaborate and coordinate care it can be hugely beneficial for recovery. 

You are not hopeless if past therapy attempts have not gone well for you. It is normal for it to take some time to find a therapist you connect with. This includes someone who has an approach that feels effective for you.  We are all unique beings with different backgrounds and needs, so one size does not fit all! We are complex individuals and we are capable of healing.  Explore your options and consider what methods and services appeal to your wants and needs. 

Looking to try therapy? Book a session with one of our wonderful therapists.

Article written by Dani Parmacek, LCPC, R-DMT

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