The Top Seven Reasons Why Therapy Fails

Therapy can be a transformational experience for many people, but sometimes it just doesn’t work out. Typically, therapy doesn’t work out because of something the therapist is doing (or not doing), something the client is doing (or not doing), or for some larger reason. In many of these cases, there are steps that the client can take to ensure a more successful therapeutic relationship, including finding a new therapist or approaching therapy differently.

Here are some of the biggest reasons that therapy doesn’t work out.

1. Bad fit between therapist and client

The quality of fit between therapist and client is one of the most significant determinations of how successful therapy will be. Several factors determine this fit, including openness to sharing, conversation style, expertise level, and personality.

For therapy to be successful, it's crucial to have a strong alliance between therapist and client. This therapeutic alliance helps to create a space where the client is open and feels comfortable sharing and processing with their therapist.

2. Therapist doesn't have the right training or subject expertise

Depending on the reason a person is seeking therapy, they might be interested in working with a therapist who has a specific kind of expertise. While many therapists and clinicians can help with general life struggles, such as depression, anxiety, and stress, a different degree of knowledge and treatment is sometimes required.

For example, clients might want support recovering from childhood trauma or managing their OCD. In this case, if a client is working with a therapist without expertise in childhood trauma or OCD, this can mean therapy is not as successful as it could be.

3. Client is resistant to change

An old joke goes, “How many therapists does it take to change a lightbulb?”

“Only one, but the light bulb has to want to change.”

Therapy can only be successful when clients are open to changing things about themselves. This might include trying out new coping strategies, practicing new ways of interacting with others, or changing the ways they think about themselves. If a client is resistant to this kind of change, it’s challenging to make progress in therapy.

4. Client isn’t as engaged as the therapist

As mentioned above, successful therapy is all about the partnership between the therapist and the client. While the therapist may be the expert in specific psychological techniques or modalities, the client is the expert in their own life. For therapy to be successful, the therapist and client must collaborate to change unhelpful patterns and alleviate the client’s distress.

A client must be as engaged in the therapeutic process as their therapist. This includes doing things like arriving to appointments on time, openly and authentically sharing during sessions, and being willing to try new coping strategies to see how they might work. If a client is not as engaged in the process as their therapist or expects that the therapist will do most of the work for them, therapy will not be successful.

5. Haven’t given it enough time

Sometimes in therapy, you will feel worse before you feel better. Being in therapy can involve reliving painful and even traumatic memories. Understandably, this can bring up a lot of complex emotions, including anxiety, distress, sadness, and overwhelm. It's common for clients to report that therapy makes them feel worse before it makes them feel better.

If a client comes to therapy expecting they will receive a quick fix or feel better very quickly, they may become frustrated or confused when those expectations are not met. In this case, it's not that therapy hasn’t been successful, but rather that the client needs to give it more time before they will see the benefits.

6. Systemic issues and things outside the client’s control

Life circumstances outside of the client's control can also create barriers to therapy success. Systemic problems like racism, income inequality, homophobia, and transphobia all impact a person’s well-being and quality of life.

For instance, if a therapist is working with a transgender teenager who is living with unsupportive parents, the client’s living situation presents a significant barrier to therapy's success. In this case, therapy may prove unsuccessful through no fault of the clients or the therapist. Because these issues are outside the client's and therapist’s control, they cannot be resolved by therapy alone.

7. Undetected or undiagnosed issues

People come to therapy for many different reasons, including treating conditions like anxiety, depression, ADHD, and others. However, other undetected issues or conditions can sometimes contribute to a person's mental state.

For example, some physical health conditions might cause a person to exhibit increased anxiety, including hyperthyroidism and diabetes. In other cases, a client may be struggling with an alcohol or substance abuse issue that is exacerbating their symptoms. In both of these cases, a client must focus on treating their health condition or substance abuse issues first before they can be successful in therapy.

What to do if therapy isn’t working

If you feel your therapy isn’t working, consider whether any of the factors on this list are relevant to your situation. You may have realized that by always running 5 or 10 minutes late to your therapy sessions, you're not as fully committed to therapy as your therapist. Or maybe you’ve realized that your therapist isn’t a good fit for what you need right now.

This can help explain why you do not see the success you would hope for. Use this information to make changes moving forward to ensure your therapy is successful.