So you took the plunge, found a therapist, and starting talking about those difficulties you had been dealing with on your own for long enough.
The sessions ended, and you are left wondering – why didn’t therapy work for me?
You might be worried that things will never change, that it is your fault, and that you just cannot be helped. In fact, there are lots of different factors that may have contributed and it is not a sign that things cannot change or that you did something wrong.
Issues in your relationship with the therapist
The best predictor of therapeutic outcomes is a positive relationship between client and therapist. If you do not feel safe enough or free of judgement in that relationship, it will prevent you from being truly open to understand the cause of your difficulties and what needs to change. The therapist should hold appropriate boundaries and provide a compassionate but professional relationship.
Signs this was a problem for you: You did not feel any warmth or compassion from your therapist, you felt judged and criticised, the therapist did not remember really key things you had shared with them previously, they seemed distracted or bored in your sessions or you generally felt you could not be honest with them. They treated you like a friend, shared a lot of their own experiences with you or were otherwise unprofessional.
Issues with the therapist’s skills or experience
Perhaps your therapist did not have the right training, experience and knowledge to help you. When selecting a therapist think carefully about who they are accredited with and the length of training they have received. No matter how great the training, developing the skills to help people with their mental health takes time and cannot be achieved quickly.
Clinical Psychologists are required to have extensive mental health experience prior to undertaking a three-year doctorate that involves teaching and clinical work. Not everyone needs to see a Clinical Psychologist, but many concerns have been raised about low cost, instant access therapy platforms that do not appropriately vet their counsellors. Do lots of research and speak to different providers to carefully select a qualified therapist for the difficulties you are dealing with.
Signs this was a problem for you: Your therapist seemed well intentioned, but lacked confidence or expressed anxiety during the session. They gave advice that was unhelpful and seemed stuck when you reported this back. They were unable to work flexibly with what you discussed, taking a manual and generic approach rather than understanding your unique experiences.
Psychological barriers got in the way of your recovery
Logically, we might want to make changes in our mental health, but there may be a part of us (that we are often not even aware of) that does not want that change to happen. This is usually because there is a fear, that if you do change or are able to react differently, there will be some negative consequence. You may also find yourself drawn into pleasing your therapist and wanting to say the right thing, or be a good client, that prevents you from being honest and getting to the root of your difficulties. These psychological beliefs or blocks can get in the way of reaching your goals. An experienced therapist should notice these, be able to bring them into your conscious awareness and identify their origins, so that you might be able to move past them.
Signs this was a problem for you: You noticed a resistance to putting the strategies you discussed in the session into place. You found yourself engaging in behaviours that sabotaged or prevented any progress you were making. You really wanted to please your therapist and were motivated by their praise.
You engaged in a cognitive, rational, analytical process but did not address the problem on an emotional, felt sense level
We believe that most of our behaviours, reasoning and actions in the world are under our conscious control. We can rationalise why we did or did not do certain things, and why we felt a certain way. Just because we do that, it does not mean we are right. So many of our emotions and behaviours are controlled by implicit, unconscious drivers out of reach if you engage in a purely rational, logical process. These usually link to our childhood and past experiences that shape our automatic and emotional responses in the here and now. You may need support with processing some past experiences, or just getting in touch and working with emotions as they are experienced in your body, to see any meaningful change. Somatic approaches, EMDR and body-based work like breath work can address your difficulties on a felt-sense, not just cognitive level.
Signs this was a problem for you: You developed an understanding of your difficulties but that led to no meaningful change. You felt no moderate or strong emotions at any point during the therapeutic process. You had a very here-and-now approach dealing with current difficulties, but did not talk about where those difficulties came from, or how earlier experiences might have shaped them.
You came to a therapy session once a week, but otherwise did not make any other changes in your life
Psychological therapy is a bit like personal training. If you see your trainer for an hour once a week, you don’t do any other exercise the rest of the week and eat unhealthily, you are very unlikely to see the change you are hoping for. May be when you took on therapy you were not prepared to make lifestyle changes and on some level hoped that the therapist could ‘make’ you better. That one hour a week needs to impact the rest of your week. This could be in the form of reflecting on the content from the session, trying out different coping strategies or behavioural responses, removing or limiting contact with negative influences, environments or relationships, or engaging in positive activities like hobbies, exercise or mindfulness, meditation or breathing practices.
Signs this was a problem for you: You did not think about the session much between appointments, you did not do any of the agreed tasks set out in therapy, you engaged in activities or with people you had identified as very negative for you, you did not create other reflective spaces and practices in your week.
If any of these fit for you, do not give up on change. It was not the right time or right person for you. The things you can do to have a different experience in future are:
- Do you research on a therapist’s training and experience. Check their accreditation and consider what you might need.
- Speak to a few therapists on the phone first. Most will offer a free brief phone consultation to see if you are a good fit. Ask the questions you need to know, but also use this as an opportunity to see how you feel talking to them. Do they sound warm and compassionate? Do you feel they are listening and being upfront? Pick the therapist you feel the most affinity with, provided they have the right qualifications.
- Be prepared to get in touch with your emotions in therapy. If you noticed yourself thinking and analysing a lot in previous therapy and not seeing improvements, discuss this with a potential new therapist. Consider approaches that are attentive to emotions and how past experiences can drive our behaviour, such as EMDR or somatic approaches.
- If you noticed resistance to change or a need to please a therapist previously, share that with a new therapist to address this early on.
- Make sure it is the right time to engage. Consider your readiness to engage in this process, and potentially make some changes in your life. Be ready to attend weekly sessions, but also to reflect outside of sessions and include other positive activities in your life.
Dr Madeleine Jago is the Principal Clinical Psychologist and founder of Seven Lion Yard. Seven Lion Yard is a holistic health and wellbeing centre in Clapham offering psychological therapies to children, families and individuals and group classes in mindfulness, meditation and breath work.