What If Therapy Isn’t Working?

By Dan Zomerlei, PhD, LMFT | Alliance Counseling Group

I want to say something that might sound strange coming from a therapist who co-owns a counseling practice.

Therapy doesn’t always work.

Not “therapy in general doesn’t work” — the evidence for psychotherapy’s effectiveness is strong and I believe in it deeply. But specific therapy relationships, specific approaches, specific seasons of someone’s life — these sometimes produce very little. And I think the mental health field, collectively, is too slow to say that plainly.

So let me say it plainly: if therapy isn’t helping you, that’s important information. Not a reason to give up — information. And information points somewhere.

First, get specific about what “not working” means

Because it can mean several genuinely different things, and the right next step depends on which one is true.

“I don’t feel any different.” This might be expected — healing from some things is slow, and real change often precedes felt change. Or it might be a real signal that something in the approach or relationship is off. The length of time you’ve been in therapy matters here. Three sessions in? Probably too early to know. Six months in, working on something specific, with no movement? Worth examining.

“I feel worse than when I started.” Paradoxically, this can be a good sign — it can mean that important things are finally surfacing, that you’re touching something real rather than managing things on the surface. Or it can mean the approach isn’t right, or the relationship isn’t safe enough to do this work in. Feeling worse early in trauma work, for example, can be normal. Feeling consistently worse months in, with no felt sense of why or where it’s going — that’s different.

“I like my therapist, but nothing is actually changing.” This one is the one I want to flag most urgently, because it’s the most common and the most easily rationalized. A warm, comfortable therapeutic relationship that produces no real movement is something — it’s validation, it’s companionship in difficulty, and there’s genuine value in feeling heard. But it isn’t therapy in the full sense. Feeling supported and actually healing aren’t the same thing.

“I dread going. I feel judged. I don’t trust this person.” That’s not therapy not working. That’s the wrong therapist. Full stop.

Say something before you stop going

This is the step most people skip. They stop coming without ever telling their therapist why.

I understand the impulse. It feels confrontational. Awkward. Like criticizing someone who’s genuinely trying to help you. For people who struggle with conflict — which describes many people who find themselves in therapy — the path of least resistance is just to quietly fade out.

But naming it directly is one of the most valuable things you can do. Not just for this therapeutic relationship, but for yourself. Because learning to say “I don’t think this is working, and here’s what I’m noticing” to a person in a position of care is, for a lot of people, part of the actual work.

A good therapist receives that feedback as useful information. They want to know. They’ll either adjust — their approach, their focus, how they’re showing up — or they’ll acknowledge honestly that a different kind of support might serve you better. Either response is helpful.

A therapist who gets defensive when you raise this? Also useful information.

When to try a different therapist

Some situations genuinely call for a change. Specifically: you’ve raised the concern and nothing has shifted. The fit is wrong at the level of personality or communication style — something about this person, not the process. The approach doesn’t match the problem (individual talk therapy for a trauma that needs more specialized intervention, or individual work for something that’s fundamentally relational). Or you’ve simply run out of the goodwill and trust that effective therapy requires.

Changing therapists isn’t giving up. It’s making a responsible decision about where you invest your energy, your money, and your emotional risk.

When to try a different kind of support entirely

Sometimes the signal is that the type of support needs to change, not just the therapist. If you’re in individual therapy for something that’s primarily relational — a marriage in real trouble, a family pattern that’s stuck — individual work alone often can’t reach it. The system needs to be in the room. If your depression or anxiety is severe enough that it limits your ability to engage with the work, a medication evaluation might open a window that therapy alone can’t. If isolation is part of the picture, a structured group might address something one-on-one therapy isn’t built to reach.

These aren’t either/or decisions. They’re usually both/and.

The difference between slow and stuck

One distinction worth carrying with you: there’s a real difference between work that is slow — because growth is slow, because what you’re working on is layered, because real change takes time — and work that is stuck, where nothing is moving because something in the approach or relationship isn’t working.

Slow calls for patience and honest conversation about the timeline. Stuck calls for a change.

The hard part is that both can feel the same from the inside. Which is exactly why talking about it directly with your therapist is always the first move.

The bottom line

If therapy isn’t working, silence is the worst option. Silently enduring a process that isn’t helping you isn’t noble — it’s just costly. And quietly quitting without understanding why means you carry the same uncertainty into the next thing.

Name it. To your therapist first. Then, if you need to, make a change.

You deserve support that actually moves something. That’s not too much to ask, and it’s not too much to keep asking until you find it.

If you’ve had a therapy experience that left you discouraged and you’re wondering what might be different — we’d love to talk. Alliance Counseling Group serves clients across West Michigan and throughout Michigan via telehealth. Reach out.