You’ve been going to therapy for six months. Maybe a year. You show up every week, you pay your copay (or your $200 out-of-pocket because your insurance sucks), you talk about your feelings, and you leave feeling… exactly the same.
You’re starting to wonder: Is therapy a scam? Am I broken beyond repair? Is my therapist bad at their job? Am I bad at therapy?
Here’s the uncomfortable truth: therapy works for a lot of people. But it doesn’t work for everyone, and it doesn’t work all the time. And there are very real reasons why your therapy might not be helping—reasons your therapist probably isn’t addressing.
Let’s talk about the things your therapist won’t tell you about why therapy might not be working, and more importantly, what you can actually do about it.
Thing #1: Your Therapist Might Just Not Be Good
This is the nuclear option, but someone needs to say it: not all therapists are good at their jobs.
Just like there are bad doctors, bad lawyers, and bad teachers, there are bad therapists. Having a degree and a license doesn’t automatically make someone effective.
Signs your therapist might not be good:
- They talk more than you do. Therapy should center your experiences, not become your therapist’s podcast.
- They give generic advice. “Have you tried deep breathing?” “Maybe try a gratitude journal?” If their advice sounds like an Instagram infographic, they’re not engaging with your specific situation.
- They don’t remember basic details about your life. If you have to remind them every session that you have a sister or what your job is, they’re not paying attention.
- They seem checked out or distracted. Looking at the clock constantly, seeming bored, giving one-word responses while you pour your heart out.
- They violate boundaries. Talking about their own problems extensively, being late consistently, canceling frequently, or acting unprofessionally.
- You don’t feel heard or understood. If after months of therapy your therapist still doesn’t seem to “get” you, that’s a problem.
- No progress on your goals. If you came in with specific issues and nothing has improved after 6+ months of consistent work, something’s wrong.
What your therapist won’t say: “I’m not the right fit for you” or “I’m not equipped to handle your issues.”
What you should do: It’s okay to break up with your therapist. Seriously. You can say “I don’t think this is working for me, and I’m going to try working with someone else.” You don’t owe them loyalty. This is a professional service you’re paying for.
Thing #2: You’re Not Actually Doing the Work
Real talk: showing up and talking isn’t enough.
Therapy isn’t magic. It’s not like going to a massage where you lie there and someone fixes you. It’s more like going to a personal trainer—if you don’t do the workouts, you won’t see results.
What “doing the work” actually looks like:
- Homework assignments: If your therapist suggests exercises, journaling, or behavioral experiments, you need to actually do them
- Practicing new skills: Learning coping mechanisms in session but never using them in real life won’t create change
- Being honest: If you’re only telling your therapist the “acceptable” version of your thoughts and experiences, they can’t help you
- Sitting with discomfort: Growth happens when you address the hard stuff, not when you avoid it
Common avoidance tactics people use in therapy:
- Talking about surface-level issues instead of the deep stuff
- Changing the subject when conversations get uncomfortable
- Intellectualizing emotions instead of feeling them
- Focusing on other people’s problems instead of your own
- Making jokes or being self-deprecating to deflect
What your therapist won’t say: “You’re wasting your money if you’re not going to actually engage with this process.”
What you should ask yourself: Am I showing up to therapy hoping someone will fix me, or am I willing to do uncomfortable work to change?
Thing #3: Your Problem Isn’t Psychological—It’s Material
Here’s the thing nobody wants to admit: sometimes your problems aren’t about trauma or cognitive distortions. Sometimes your problems are about poverty, systemic injustice, or shitty life circumstances.
Examples:
- You’re depressed because you’re broke, not because of a chemical imbalance
- You’re anxious because your job is actually toxic, not because you’re catastrophizing
- You’re exhausted because you’re working three jobs, not because you’re not “resilient” enough
- You’re lonely because you live in a car-dependent suburb with no community, not because you’re socially incompetent
The reality: No amount of cognitive behavioral therapy will fix the fact that you can’t afford rent. No amount of mindfulness will make your abusive boss less abusive.
Therapy can help you cope with these circumstances and maybe develop strategies to change them, but it can’t solve systemic problems.
What your therapist won’t say: “Your problems are caused by capitalism/poverty/systemic racism, and therapy can’t fix that.”
What you might need instead:
- A higher-paying job
- Moving to a different city or neighborhood
- Leaving a bad relationship
- Political organizing or community building
- Debt relief or financial assistance
- Better healthcare access
Sometimes the best thing you can do for your mental health is improve your material conditions, not examine your childhood.
Thing #4: You’re In the Wrong Type of Therapy
Not all therapy is the same. Different approaches work for different issues and different people.
Common therapy types:
Cognitive Behavioral Therapy (CBT):
- Best for: Anxiety, depression, specific phobias
- Approach: Identifying and changing thought patterns
- Doesn’t work well for: Deep trauma, personality issues, relationship patterns
Psychodynamic/Psychoanalytic:
- Best for: Understanding patterns, childhood trauma, self-awareness
- Approach: Exploring unconscious patterns and past experiences
- Doesn’t work well for: People who want immediate practical tools, crisis situations
Dialectical Behavior Therapy (DBT):
- Best for: Emotional regulation, borderline personality disorder, self-harm
- Approach: Building specific skills for managing intense emotions
- Doesn’t work well for: People who don’t want structured homework
EMDR:
- Best for: PTSD, specific traumatic events
- Approach: Processing traumatic memories through bilateral stimulation
- Doesn’t work well for: Complex ongoing trauma, non-trauma issues
The problem: Most people get assigned CBT by default because it’s evidence-based and insurance likes it. But CBT doesn’t work for everyone or every problem.
What your therapist won’t say: “I only practice one modality, and it might not be right for you.”
What you should do: Research different therapy approaches. Ask potential therapists what methods they use and why they think it’s appropriate for your issues.
Thing #5: You Need Medication, Not Just Talk Therapy
This is controversial, but it needs to be said: sometimes brains need chemicals, not conversations.
Signs you might benefit from medication:
- You’ve done months of therapy with minimal improvement
- Your symptoms are severe and interfere with daily functioning
- You have diagnosed conditions that typically respond to medication (severe depression, bipolar disorder, schizophrenia, OCD)
- Your symptoms have a strong biological component (sleep disruption, appetite changes, physical anxiety symptoms)
- Talk therapy helps you understand your patterns but doesn’t reduce symptoms
The stigma problem: People feel like needing medication means they’re “really” sick or that they’ve failed at mental health. That’s bullshit.
Your brain is an organ. If it’s not producing the right chemicals or responding to them properly, sometimes you need pharmaceutical intervention—just like you’d need insulin if your pancreas wasn’t working properly.
What your therapist won’t say: “You should probably talk to a psychiatrist about medication.”
(Some therapists do suggest this, but many avoid it because they can’t prescribe and don’t want to seem like they’re admitting therapy isn’t enough.)
What you should do: If you’ve been in therapy for 6+ months with no improvement, schedule an evaluation with a psychiatrist. You can do both medication and therapy.
Thing #6: You’re Not Ready to Change
This is the hardest one to hear: sometimes therapy isn’t working because you don’t actually want to change.
Not consciously. Nobody wakes up and thinks “I want to stay miserable.” But unconsciously, change feels threatening.
Why people resist change (even when they’re suffering):
Change requires giving up familiar patterns:
- Your depression is horrible, but it’s also predictable and safe
- Your anxiety is exhausting, but it also protects you from taking risks
- Your relationship patterns suck, but they’re what you know
Change means uncertainty:
- Who will you be if you’re not anxious/depressed/angry?
- What if people react badly to the new version of you?
- What if you try to change and fail?
Change disrupts your identity:
- You’ve built a sense of self around your struggles
- Your relationships might be organized around your mental health issues
- You might get secondary benefits from your problems (attention, accommodation, excuses)
Signs you might be resisting change:
- You know what you should do but consistently don’t do it
- You complain about problems but reject every solution
- You’re more comfortable talking about problems than taking action
- You feel threatened when therapy challenges your worldview
- You’ve had the same complaints for years but nothing changes
What your therapist won’t say: “You’re not actually ready to do this work, and that’s why it’s not working.”
What you should ask yourself:
- What would I lose if I got better?
- What does staying the same protect me from?
- Am I coming to therapy to change or to be validated?
If you’re not ready to change, that’s okay. But therapy won’t be effective until you are.
So What Should You Actually Do?
If therapy isn’t working, you have options:
Option 1: Switch Therapists
Find someone who:
- Specializes in your specific issues
- Uses a therapeutic approach that fits your needs
- You actually connect with and feel understood by
- Comes recommended (ask for referrals from people you trust)
Option 2: Try a Different Type of Therapy
If you’ve been doing CBT for months with no results, try:
- Psychodynamic therapy
- EMDR for trauma
- DBT for emotional regulation
- Couples/family therapy if relationships are the issue
- Group therapy for connection and perspective
Option 3: Add Medication
See a psychiatrist for an evaluation. Medication + therapy is often more effective than either alone.
Option 4: Address Material Conditions
Before throwing more money at therapy:
- Can you change your job?
- Can you improve your living situation?
- Can you address financial stress?
- Can you build more community?
Option 5: Take a Break
Sometimes you need to step back and return to therapy later when you’re ready. That’s okay.
Option 6: Accept That Therapy Might Not Be for You
Some people genuinely don’t benefit from traditional talk therapy. Other things that might help:
- Physical exercise (genuinely effective for depression and anxiety)
- Creative pursuits
- Community involvement
- Spiritual practices
- Alternative treatments (acupuncture, massage, etc.)
- Books and self-directed learning
The Bottom Line
Therapy is a tool, not a magic cure. It works for many people but not everyone, and not working all the time.
If therapy isn’t helping you, that doesn’t mean:
- You’re broken
- You’re doing it wrong
- You’re beyond help
- You should give up on mental health
It might mean:
- You need a different therapist
- You need a different approach
- You need medication
- You need to change your circumstances
- You need to do more work outside of sessions
- You need something other than therapy
The mental health system wants you to believe that if therapy doesn’t work, it’s your fault—you’re “resistant” or “not ready.” Sometimes that’s true. But sometimes the system is failing you, not the other way around.
Trust your gut. If therapy has consistently not helped after genuine effort with multiple therapists, it’s okay to try something else.
Your mental health matters too much to keep doing something that isn’t working just because you’re “supposed” to be in therapy.
Find what actually helps you, even if it’s not what everyone else says should work.