Why Isn't Therapy Working?

We have a premium on efficiency in this country, so I can understand why people would be frantically searching for reasons why or what to do when therapy isn’t working. Is therapy for everyone? I do think there could be a form of therapy that works for different individuals, depending on their personal needs. Nevertheless, let’s take a look at some of the factors that may dictate what’s come to pass when ‘therapy isn’t working’.


Talk therapy

Psychotherapy doesn’t have to just be talk therapy. There’s creative arts therapy which incorporates visual arts, written expression, music, and dramatic arts. There’s equine assisted therapy, hypnotherapy, somatic experiencing, play therapy (for grown ups too!), wilderness therapy, and the list goes on. For the most part, there’s something for everyone, but it’s an experiment.


Time & Money

Therapy takes time. Both time out of your day, and lots of lots of patience. If you don’t have time, or can’t make time, maybe you’re “not ready yet” (as highlighted below).

At this point in economic evolution, therapy also costs money. You can acquire a therapist through your insurance and then the cost to you should be minimal. Many therapists do not accept insurance, and then you pay out of pocket. Therapy is 100% an investment, and you have to be pretty serious about it and able to make peace with the decision.


“Not ready yet”

It’s the therapist’s job to “meet you where you’re at.” If you’re a little resistant, it’s something to explore. However, sometimes you’re just not ready yet. Sometimes life is getting in the way and you just don’t have the energy to take the time for yourself. If you’re in a harrowing situation in your life, it may be important to keep all those defenses that you’ve been using since childhood. They may still serve you. This is especially true if you are going through crisis situations. It’s just not time to engage in a psychic shift. This isn’t a failure on your part or the therapist’s part. You can always return.


Discomfort with your therapist

One way to know therapy isn’t working is that you don’t want to go. It’s one thing to know that you have to talk about this really hard stuff and feeling some kind of anxiety about it. But every week, dreading seeing this practitioner probably means that you don’t have a good relationship. If you feel uncomfortable with the person you’re talking to, it’s most likely not going to work. And you’re going to feel badly. However, talk about this with your therapist-- it may be a pattern in your life that’s worth exploring.

Diagnoses

Personally, I lean away from diagnoses, so this is a theoretical discussion. Some psychiatric diagnoses do not respond well to talk therapy. Moderate to severe developmental disorders like Intellectual Disability or Autism (although both can respond well to different kinds of psychotherapies), severe schizophrenia, or even severe Bipolar Disorder may respond better to talk therapy following a combination of symptom management and intensive inpatient or outpatient treatment.


Medication

I don’t love the idea of throwing pills at a ‘problem.’ I struggle to take allergy medicine; instead wanting to make my environment more allergen free. Sometimes, though, medication can really help. Part of asking for help is asking for help (!) Talk therapy can absolutely move you to a place of increased well-being; however, at times, we can really be stuck in that neural rut that we’ve created after a lifetime of behavioral/emotional learning and meds can give you a better chance of allowing yourself to adapt to new ways of being.

Of course, they can also be useful for very severe mental health issues, especially when functioning is incredibly limited.


Expectations

What are your expectations of therapy? Did you talk about those expectations with your therapist? Depending on your therapist’s theoretical orientation, they may attempt to modulate your expectations around reasonable outcomes of your work together.

Have you ever seen one of those cartoons that say something like, “I’m a beautician, not a magician?” I've seen them for all types of service providers. It’s true, even though I talk about the magic of therapy, it’s true, “I’m a clinician, not a magician.” There’s no magic wand. There’s no magic wand in life or in therapy. It’s about doing the work. And often doing the work means being honest with yourself and letting that honesty have its effects on you instead of pushing it aside.


It gets worse before it gets better

If you’ve recently started therapy, and you just had a session in which you talked about a lot of bad things that happened in your childhood, you’re going to walk away from that session feeling a little prickly. Therapy digs up things that you would rather not have in your awareness. That’s why you pushed it aside, albeit unconsciously. It takes time to move through these challenges and get to the other side. It’s not a straight line. Patience and tolerance for yourself and your feelings is important.


Therapist’s role

As stated multiple times in this piece, if you’re feeling like something’s not working, it’s a good idea to talk to your therapist about it. Their job is to work that out with you and if need be, let you fly-fly to whatever will serve you best at that time.


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