“I am now in therapy for a few months now, but I don’t feel I get better. It just feels that the things we discuss are not related to my problems and don’t really help me. What should I do? Quit? Discuss it with her? Switch to medication?”
The quiet assumption that therapy always works
Many people suffering from mental health problems think that therapies should work. The same is true for therapists. If a therapy is ‘evidence-based’ then it should work, they assume. There is, after all, research showing that it works, right?
Unfortunately, that is not always the case. The outcomes of therapy are clearly better than doing nothing, but that does not mean that everyone gets better. For example, in depression it has been estimated that 42% of people receiving therapy improve substantially (their symptoms are half of what they were at the start of therapy), while only 16 to 17 percent improve when they don’t get this therapy. In anxiety disorders, PTSD and OCD between 30 and 40% of people improve substantially in therapy.
That means that many people receiving therapy do not improve substantially. And if you are in therapy, but you do not improve substantially, you are certainly not an exception.
So what can you do?
Be realistic — and go easy on yourself
First of all it is important to be realistic about what you can expect from therapies. The therapist should inform you about the chances of getting better when you get the therapy, but therapists are also often not aware that therapies have limited effects. Therefore it is important as a client that you do not expect automatically that it will work for you. If you are lucky it does work right away, but there is a considerable chance that it will not work.
When you are in therapy and after a while you don’t think you are improving enough, it is also important to remember that this is not caused by you. It is also not related to the complexity of your problems or your ability to improve. It is just a logical consequence of the limited effects of therapies, and it is not known why some people respond right away and others don’t.
Talk to your therapist
But if you do not improve enough it is important to discuss this with your therapist. In many therapies a discussion of how things are going is built in at several points during the therapy, but that is not always the case. So if you feel things are not getting better, you should take the initiative to talk about this with your therapist.
This may be difficult and often you don’t want to disappoint the therapist, who is also doing the best they can, or you may feel they will be angry with you. But therapists are trained for this work, including the handling of complications like this. You may expect a professional and constructive attitude from them.
You can then discuss with your therapist about the goals you have for your therapy, what has been working and what not.
What can change?
Maybe you can continue with the current therapy, but change the focus. Or maybe you should get another type of therapy (there are countless types of therapy), maybe you should get another therapist, or maybe you should add medications to the treatment. Maybe the therapist may want to have another diagnostic interview with you, to get a better picture of what exactly is going on.
You are not alone
When you feel that therapy is not working good enough, you are certainly not alone. Many people who recover say afterwards that it took quite a search to find the right treatment by the right person. It is important to keep an open mind when going into therapy, but also to keep a focus on what you need and what is best for you to recover.
Read an interview with me about this subject on the website of Success.
Pim Cuijpers is professor emeritus of clinical psychology and scientific director of Metapsy. He has been involved in more than 1,100 scientific studies, mostly on psychological treatments of mental health problems. This is one of a series of evidence summaries in which Prof. Cuijpers tries to answer questions from patients and clinicians, based on what is known in science about treatments. The knowledge is mostly drawn from collective work of the Metapsy collaboration of at least 15 years. Do you have other questions you would like Prof. Cuijpers to discuss? Feel free to contact us.