Why Therapy Sometimes Doesn't Work

Therapy works. The research is consistent, and the effect sizes are meaningful. But it’s also true that therapy doesn't always work, and it definitely doesn’t work for all the people, all the time.

So, why doesn’t it work?

The Therapist

The most obvious answer, and the one most people start with, is that the therapist was bad. It’s true; not all therapists are equally “good.” Credentials and training don't guarantee quality. Some therapists are not going to work well with certain symptoms, issues, or presentations. Some are simply not going to be a good fit relationally, which, as we've discussed, is the part that matters most.

If you’ve been to one therapist, and it was a bad experience, it may just be that particular therapist was bad. That's not to assign blame, but to recognize that not all therapists are equal, and that one bad experience is not a referendum on therapy itself.

The Fit

Even a good therapist can be the wrong therapist for a particular person. The research on the therapeutic alliance suggests that the relationship is the engine of therapy. If that relationship doesn't develop, if you can't be honest, if you don't feel understood, if something about the dynamic is consistently off, then the therapy won't work regardless of the approach or the therapist's competence.

Fit is somewhat unpredictable. You can show up, be honest and vulnerable, and still not click with a therapist. In fact, this can actually help the process. If the relationship doesn’t seem to be working - tell your therapist directly! How the two of you respond can open up communication and change the nature of the relationship.

The Timing

Sometimes therapy doesn't work because the person isn't ready. That may sound judgmental, but it really isn’t meant to be. “Readiness” isn’t a moral quality. It also isn’t an either/or. You can be anywhere on a spectrum of readiness, and that position can change instantly. You can be “ready” one minute, and not ready the next. Great therapy happens when you are open to it.

Therapy requires a willingness to look at things directly, to sit with discomfort, and to consider that some of what isn't working in your life might be connected to patterns you're carrying. That's hard. Some people arrive at therapy hoping to feel better without that part. Sometimes, current life circumstances make that kind of openness genuinely difficult, and we have to work through these immediate concerns to get somewhere deeper. Sometimes, the real issue isn’t a therapy issue. In those cases, therapy may need to be paired with other support, or the timing may simply not be right.

This is not a reason to avoid therapy. It is a reason to be honest with yourself and your therapist about where you actually are.

The Expectations

Therapy is not a fix. It is a process. People who arrive expecting to be cured of something in a defined number of sessions often find that the reality doesn't match that idea. This mismatch between what therapy is and what someone expects it to be isn’t anyone’s fault. Media has shaped people’s expectations. We live in a medicalized society that expects “fixes.”

On a related note, some things that bring people to therapy are not problems to be solved. Grief, for instance, is not a disorder. Loss doesn't resolve on a timeline. The goal of therapy in those cases isn't to eliminate the feeling but to develop the capacity to carry it. Sometimes these processes can be hard to recognize as progress.

The Approach

For most presenting concerns, the modality doesn't matter much. But for some specific conditions, especially around certain trauma presentations, OCD, and eating disorders, there is evidence that particular approaches outperform others. If you've been in therapy for one of those conditions and haven't improved, it's worth asking whether the approach being used has good evidence behind it for your specific situation.

One More Thing

If therapy hasn't worked for you, it doesn’t mean therapy will never be useful. It doesn’t mean that you can’t be helped. It probably means one or more of the above was true at the time. Being interested in why it didn’t work is a great sign that you might have a better experience in the future.

Mike O'Rourke is available for in-person and telehealth therapy. Book a session or consultation.