What to do if therapy isn't working for you
(and what to do instead)
This is an old post I wrote for Reddit that I adapted in case it would be helpful. I started writing it before I started training to become a therapist. I am still not a licensed therapist. Additionally, my views are my own, and some therapists will disagree with me on some points.
I see many people talking about how they can’t go to therapy or that therapy isn’t helpful. I was in that boat for years. I started treatment and medication at age 14 and tried various therapists and pills unsuccessfully until my late 20s. I went to “specialists” who had no idea what to say to a suicidal teenager or said all the wrong things.
I then tried a bunch of unlicensed therapists/coaches/healers, who didn’t end up being much better, even going against the ethical codes that licensed therapists are bound to. Eventually, I went full circle and searched for a licensed therapist again, this time with a clearer idea of what I was looking for in terms of their training and personality.
Barriers to accessing therapy
Cost
Therapy can be downright expensive. Many people who struggle with mental health issues are working in low-paid jobs or struggle to hold on to a job. That can make the prospect of giving a day’s worth of money for an hour of telling someone how bad you feel seem quite daunting, especially since we have no guarantee that the therapy will help. It can also take time until you find a therapist you click with and find helpful, leading to stress every session and confusion regarding whether to stick it out or look for someone new.
Accessibility
It can be challenging to find qualified therapists in some areas. Note that by qualified, I’m not talking strictly about their license but someone empathetic, understanding, and up-to-date on the latest knowledge in mental health. You also want someone experienced in working with the issues you want help with. In some areas, it can take weeks or even months to see a qualified mental health professional.
Impatience with the process
We often go to therapy when we’re in a lot of pain, expecting it to make that pain go away quickly. We may expect the therapist to give advice or say something that will give us a breakthrough moment, some brilliant insight to help us turn our lives around.
The problem is that change through therapy takes time, and initial changes may be subtle and difficult to spot for those who don’t know what to look for or who are overwhelmed with pain. It can, therefore, be extremely difficult to know whether to keep going back to the same therapist or find someone who is a better fit.
Not finding a good fit/staying with a therapist who isn’t helping
While therapy can be difficult and take time to see changes, some therapists aren’t great at their job, or maybe great for someone else but not for you. The therapist-client relationship is the most important factor of therapy. Research “has consistently demonstrated that therapist empathy is one of the most potent predictors of client progress in psychotherapy across every therapeutic modality.”1
Alternatives to therapy (and things to do in addition to therapy)
Self-help and psychoeducation books
Books (and articles, podcasts, and YouTube channels) can provide a wealth of knowledge. I have a list of book recommendations for trauma recovery. You can find these books second-hand, in a library, or even free ebooks online (although if you can buy books, supporting authors is always welcome).
There are many good books out there. It helps to think about what issues specifically you want to work on. Motivation? Social skills? Setting boundaries? If there seem to be too many issues to work on, I recommend starting with self-compassion. Making healthier choices becomes easier when you’re doing it for someone you care about.
Support groups
ACA (adult children of alcoholics and other dysfunctional families) is a free online + in-person meeting for those who grew up in homes that were unsupportive or neglectful in any way. I’m generally not a fan of 12-Steps, and I’ve seen it cause harm to some (while others say it saved their lives). But it’s free and widely available, so even if you can’t find a meeting in your area, it should be easy to find an online meeting in a time zone that works for you. Refuge Recovery is a support group built on Buddhist principles instead of 12-steps.
There are also a host of support groups on social media and forums, such as the subreddits for emotional neglect or CPTSD, Focused Femmes (for women with ADHD) on Facebook, and more. Search for groups for the issues you’re struggling with. Like individual or group therapy, finding time for the right support group can be challenging but beneficial when you do.
Consider starting an in-person support group in your area.
Emotional regulation techniques
Learning how to recognize emotional flashbacks or dysregulation and how to deal with them can do wonders. Incorporating habits like yoga, body scans, or grounding exercises might be helpful for some. Keep in mind that for some people, bringing focus to the body through breathwork or meditation may feel threatening or dysregulating. That’s OK—there are more options out there. You aren’t broken. After experimenting with meditation retreats, breathwork, and yoga, I decided they weren’t my methods. Music, movement, writing, talking to a friend, cannabis, sauna/ice bath, and other things work better for me now - that may change in the future!
Psychedelics
You might have heard some people say that one psychedelic trip was like “years of therapy.” That has been my experience, as well. After taking mushrooms, it was as if some things just naturally shifted for me. This effect lasted for weeks, as I noticed I responded in ways and, for the first time, had a real sense of “Hey, I can choose to react differently.”
However, it’s important to stress that taking psychedelics shouldn’t be taken lightly. A trip can be a scary and anxiety-inducing experience if you’re unprepared. If you’re considering this, please read up about it first. Look at r/psychedelictherapy and the resources listed there. Read about harm reduction, how to use drugs safely, understand “set and setting,” and consider reading Michael Pollan’s book.
Community involvement
Getting involved in your community can help in several ways. First, it can give you a sense of purpose and agency. It can also be a great way to meet people and increase healthy connections.
Lifestyle changes
Diet, sleep, exercise—there’s much to say about their importance, but you already know. However, these are complicated topics, and it can be challenging to know which information to rely on. Wellness culture has become a whole thing in itself. If the supplements I take don’t work, is it because they don’t work or because I can’t even know I’m getting the dosage promised on the bottle?
Pay attention to your body. There are many considerations: stress, getting enough sleep, food intolerances. Don’t try to change everything about your life at once- small changes stick longer.
Creative outlets
Journaling, collage, painting, writing (fiction/poetry), dance, making music, etc., can be great ways to process emotions. Art can be used in many ways. We often get caught up in the product—creating art that looks a particular way instead of how it feels to make it.
I plan on writing a post on journaling and visual journaling. It’s on the list, OK? I can’t promise if and when it will be done.
Alternatives to in-person “talk therapy”
or: therapy can be many different things
One reason people dismiss therapy is that they can’t see how talking about their problems will help. I hear, “I already talk to my friends,” or “I’ve gone to therapy, but the therapist just nods and validates me, but it’s not helpful.” Others have had downright harmful experiences with therapists.
Often, people aren’t aware of the myriad options beyond “talk therapy” with a clinical psychologist or, in some countries, a social worker with a master’s degree, counselor, or marriage and family therapist. Regulation of psychotherapy varies by country and is in constant flux. Talk therapy with a licensed therapist can benefit if you’ve found the right person and modality. However, it’s not always easy and not the only option.
Online therapy
If you haven’t found a good therapist in person, try searching online. Some clinicians live in a low-cost country or work from home instead of renting an office, allowing them to provide cheaper sessions. I’m not a fan of BetterHelp - I think it’s better to find therapists through recommendations.
Somatic therapies
There are various forms of somatic or body-based therapies. Some people who practice somatic therapies are also trained in psychotherapy and/or have a master’s degree in one of the therapeutic professions. Some are trained only in a particular modality, such as Hakomi, without being licensed as a therapist. Body-based therapists may be beneficial in either case. My experience is that some (but not all) practitioners practice outside their scope, for example, providing psychotherapy without training or supervision.
Expressive arts therapy or creative arts therapy
While I recommend engaging in creative pursuits exclusive of therapy, I do make a distinction between using art in a therapeutic way and art therapy. As mentioned, a significant component of therapy is the relationship between the therapist and the client.
Whether you already feel a benefit from creative pursuits in your life or struggle to find an artistic outset, art therapy (or other types of creative therapies such as music therapy, psychodrama, drama therapy, bibliotherapy, dance and movement therapy)
The difference between creative and expressive art therapy is that a creative arts therapist specializes in one specific modality, such as visual art, writing, dance and movement, music, or drama. In contrast, an expressive arts therapist studies several modalities and may use several types of interventions in the therapy room.
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Online groups or courses
Several mental health professionals host online groups or courses. You can follow these “mental health influencers” for a while and see if you feel comfortable with their energy/message/if you get value from their free content.
Be wary of anyone who paints themselves too much as a guru or claims to have the one true formula or answer. I’ve written some tips about consuming online mental health content that will hopefully help you navigate the world of online mental health content.
Good luck!
Watson, J. C. (2016). The role of empathy in psychotherapy: Theory, research, and practice. In D. J. Cain, K. Keenan, & S. Rubin (Eds.), Humanistic psychotherapies: Handbook of research and practice (2nd ed., pp. 115–145). American Psychological Association. https://doi.org/10.1037/14775-005
Very insightful