What if talk therapy isn’t working?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.


Photo courtesy of Pixabay.com

What should you do if counseling doesn’t seem to be helping?

Some people come to counseling for a couple of sessions and then drop out saying that counseling doesn’t work for them.

Other people come for therapy over a very long period, and while they feel counseling is helping them, other people don’t see any change. How do you evaluate the progress you’re making in therapy?

If you don’t feel you’re getting the results, you would like to see in therapy your progress, or lack of progress should be the primary topic you talk about with your therapist. Here are some questions to ask yourself and some of the factors that impact the effectiveness of therapy.

Is your problem acute or chronic?

Some problems are acute. Something has happened, and you can tell your counselor what happened and when. Treatment for acute problems can be very brief. You decide you need to change something in your life, or you may need to accept the change which has happened. What you may need is an empathetic person you can tell about what happened you.

The problem some more chronic you’ve always been common anxiety, or you don’t ever remember being happy. Treatment for these problems is like treatment for a chronic medical problem. Managing long-term mental health problems can be like managing high blood pressure or type II diabetes.

The professional may be able to help you initially, but a significant part of the process will be your learning life skills to manage your problem over the long term.

How long have you been in therapy?

When you’re in pain, whether it’s emotional or physical, you want it to stop. Go to the doctor he can give you pain meds, or he can look for an underlying cause and treat that issue. If you have gone to therapy for a while but aren’t feeling better discuss with your counselor how long treating your condition should take. Many people have unrealistic expectations for talk therapy.

Treating emotional problems is a process. How long this process will take depends on your specific diagnosis and your personal characteristics.

How good is your relationship with your therapist?

Most of talk therapy is done through conversation. The best predictor of success in treatment is the relationship you have with your counselor. If you feel uncomfortable discussing certain things with that therapist those unsaid things could be holding back your progress. Ask yourself if the problem is your difficulty in talking about what you need to deal with or in your lack of trust of the counselor. Not every counselor is a good fit for every client. If you have been working together for a long time and don’t see progress, you may need to try working with a different therapist.

Are there some problems you’ve avoided discussing?

The issues you don’t deal with are the ones likely to be keeping you sick. Sometimes people go to counseling and talk about the surface day-to-day events. Every time you go you feel a little better. But if you never get down to the real core of your issues, each session is like a Band-Aid placed on a deep wound.

Therapy can involve treating deep emotional pain. Looking at your core issues can be uncomfortable. The process can be like peeling an onion. You go as deep as you can and then you cry little. When you have process that material fully you go a little deeper. Over time you can heal all these deep wounds.

Are you working on your problem between sessions?

Your problems are with you between sessions. Talk therapy can be very instrumental in healing past wounds are in clarifying values and goals. For things to change in your life, you need to start making changes. For every one-hour a week of therapy, there will be 167 other hours when you’re not in therapy.

If your counselor is teaching new skills in session, you need to practice those skills outside of the therapy hour. The students who learn most in school not only attend class but also do homework outside of class. You can’t become a great musician by taking a weekly lesson. You need to practice your music between lessons. As you learn new emotional skills, you need to practice those skills between therapy sessions.

You’ll make more progress if you have clear therapy goals.

When reason people don’t make good progress in the therapy is fuzzy goals. Think about your goals for treatment. Discuss these goals with your counselor and make sure the counselor is working towards the same goals.

Consider adding medication to talk therapy.

Medication has not been shown to cure any mental or emotional illness, but medication can be very effective at managing symptoms so that you’re able to work on the causes. I’ve had lots of clients tell me they don’t want to take medication because they don’t want to become dependent on drugs. Unfortunately, many of those same clients are using alcohol, marijuana, gambling, or sexual addictions as ways to manage their problem. Newer psychiatric medications are much safer than the medicines that were available in the past. Discuss medication with your medical doctor and your mental health provider. Medication and therapy together are often more effective than either separately.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, Google Play, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.