You Don't Have to Feel Bad If Therapy Didn’t Help You

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I’ve been a psychotherapist for more than 20 years. I’ve seen how the power of therapy changes lives for the better. I’ve benefited from being in therapy myself.

And while I’ve touted the upsides of therapy, I’ve rarely addressed the ways in which it can disappoint. Therapy doesn't always work. While most people find it helpful, many do not. Even for those who improve in therapy, a large percentage will continue to struggle with difficult symptoms. For example, a large and rigorous clinical trial found that 60 percent of participants still met the criteria for depression after the treatment period.

What’s more, some people are even harmed by therapy. At times the harm comes from unethical or personality-disordered therapists. But even well-meaning therapists can accidentally offer the wrong treatment, or miss a crucial diagnosis. I’ve done it myself.

The equivocal effectiveness of therapy applies to the so-called “evidence-based treatments,” as well, such as cognitive behavioral therapy (CBT, my specialty). Just because a brand of therapy was found to be effective in multiple research trials doesn't mean it will help everyone.

Clinical research relies on averages across many participants. When psychotherapy such as CBT yields better results than a control condition (for example, placebo or waiting list), that simply means the average participant in the CBT group showed more improvement than the average score among the control group.

Some in the treatment group will always do better than the average, and some will do worse. The same goes for the comparison group. And some individuals in the treatment group might fare worse than those in the control group. In other words, they may have done better with a different treatment, or with no treatment at all.

Why Therapy Sometimes Doesn't Work

If you’ve had therapy and didn’t find it helpful, it’s nothing to feel bad about. It doesn't mean you did something wrong, or that it was your fault. There are many reasons for ineffective therapy that don’t lay the blame at your feet. These can include:

• An underlying medical condition. Physical and mental health are intimately connected. Many medical conditions can cause psychological struggles; for example, infections of the spirochete that causes Lyme disease have been linked to a wide range of neuropsychiatric conditions such as anxiety and depression.
• The wrong treatment. Not every type of therapy is helpful for every condition. For example, a specific treatment called exposure and response prevention tends to be more helpful in treating obsessive-compulsive disorder compared with more general talk therapy approaches.
• Misdiagnosis. Sometimes the wrong therapy is offered because the therapist doesn't realize their client has a certain condition. For example, they might be treating the person for anxiety without having identified their attention deficit hyperactivity disorder, which makes it hard for them to follow through on their work in therapy.
• Wrong time. Maybe therapy would have worked if the person’s life situation had been different. Therapy takes time and energy, and of course money, and it’s not always the right time for treatment. For example, people who are unemployed tend to get less benefit from depression treatment. Overwhelming deadlines, family crises, or any other conflict can get in the way.
• Poor fit with the therapist. One of the most consistent predictors of therapy outcome is the quality of the “therapeutic alliance”—in other words, how well you and your therapist work together. If for any reason you’re not on the same page, it can lead to a less effective course of therapy.
• Problems of living. It’s not uncommon for someone in therapy or their loved ones to expect therapy to do more than it can. For example, a spouse might think treatment can completely get rid of their partner's angry outbursts, or parents expect therapy to prevent their child from binging and purging ever again. But humans are fallible by nature, and even the best therapy won’t completely eliminate a person’s struggles.

What to Do If Therapy Didn’t Help

One of the downsides of unhelpful therapy is that it can make a person feel less hopeful that anything will help. However, a new treatment can be effective when a previous one wasn’t. For example, finding a better-matched therapist or one who specializes in treating the person’s condition can lead to a better outcome.

When you’re ready to try again, options can include:

• A new therapist with whom you have a better relationship
• A different therapy approach (for example, psychodynamic instead of CBT)
• Psychiatric medication
• An acceptance-based approach that focuses on living fully, even with symptoms
• Lifestyle modifications (for example, reduced work hours, consistent exercise, improved diet)

If you’re looking for a new therapist, you can search the Psychology Today directory.