Therapy Isn’t Helping. Is My Therapist Stringing Me Along?

Dear GoodTherapy.org,

I am hoping you can give me an honest answer here. I have been seeing a therapist for nearly three years now and I just don’t feel like it’s working for me. I don’t feel any different than when I started. In some ways, I feel even worse, because I am discouraged about therapy not helping. It makes me wonder what is wrong with me that I can’t get better. I have read that it is highly unusual for someone to be in therapy as long as I have.

I guess I should provide some background about my “issues.” As a kid, I was molested for years by an uncle, saw my parents die, and was bullied incessantly. I have been told I have major depression and have tried about half a dozen kinds of medication, none of which have made a shred of difference. I have self-esteem problems. I can’t seem to hold down a job. I haven’t been in a relationship for five years; women won’t even look at me, and I don’t blame them. I hate my life and I have no friends. Yes, I have considered suicide. No, I am not currently suicidal. I know that distinction is important to people who do what you do.

Because therapy isn’t helping me and hasn’t helped in all the time I’ve been in it, I want to stop. I feel like I am throwing away money. I feel un-helpable. I must be one of the few cases out there for whom there is no relief, whose problems are just too many and too major. I might be a lost cause. But I do not want to be a fool. My therapist has encouraged me to continue with therapy and to not give up hope. She says she has seen signs of progress but cannot seem to articulate them in a way that allows me to see them too. Maybe that is my failing, but I am starting to feel like maybe I’m just a paycheck for her. I don’t think she is necessarily a bad therapist. She is a nice person and she tries. She seems to truly care. I just think she isn’t helping me, I think she knows she’s not helping me, and I no longer really think anyone can.

What are your thoughts? Is she just stringing me along? Are there other people like me who don’t seem to get any better, and if so, what do you recommend in those cases? Please answer these questions. Thank you. —Lost Cause

Dear Lost,

What a great question regarding a terribly painful situation. I’m glad to hear from you about this, while so sorry to hear about all you have endured. Let me first give you my impressions in a way that “cuts to the chase,” then flesh things out a bit.

First, it is not unusual for it to take a while to find the right medication or combination of medications. (For instance, some people respond better to an older generation of medications, while others respond to SSRIs.) Have you tried more than one psychiatrist? I would encourage you to keep trying, discouraging as it has been. I have worked with a few people in therapy who were as discouraged as you, but managed to find an effective medication plan that helped them enormously.

You have been through hell and back. The fact you are still standing says something about your resilience. You have suffered enough trauma for several lifetimes, so it’s understandable you would feel this way. Your life experience has, I sadly observe, given you no tangible reason to hold onto hope. It does not mean there is none to be found, however; in fact, your letter indicates you are searching for it, itself is a glimmer of something positive.

As to your therapy question: Any therapist worth their salt would welcome any and all the feedback you have put forth here. My impression is it is time to have a blunt and honest conversation with your therapist regarding your feelings; if you’re still dissatisfied afterward, it may well be time to seek out someone new.

I would guess you had no source of true comfort after seeing your parents die. How unspeakably sad! I can hardly imagine a more hellish experience, in that the people you may have relied on most for comfort are the ones you lost. This, in addition to the other psychological injuries you experienced, leads to my amazement at your resilience. My great hope is you find, sooner rather than later, the kind of therapeutic “holding” and healing you deserve.

In the meantime, you seem to know intuitively you’re not getting what you need. I would be curious to know what keeps you in therapy with your current therapist. Have you tried telling her directly what you say in your letter? If not, why not? Is it possible she has helped as much as she can and now it’s time for a new approach? It is not uncommon, after all, to seek a second opinion medically; I believe this applies to psychotherapy also.

Sometimes people in therapy are afraid that, because they are not the “authority,” they do not have the last word on their own experience. You sound almost convinced it’s time to move on or ask directly that your therapist change her approach; I encourage you to follow your intuition. Whether or not it’s worth one last conversation with your therapist is obviously your call. Such a conversation could prove healing or just add fuel to frustration. If you feel you would benefit somehow from clearing the air, it’s worth a try. If, however, you feel it’s a foregone conclusion, you might want to move on.

Is it possible you doubt your own perceptions (not unusual with depression) in that she sees progress while you don’t, leading you to wonder if she is “right”? If the latter is true, she needs to find a way to convey her observations in a way that is meaningful to you. If your therapist insists you “hang in there” for no reason that feels solid, that’s simply not good enough; the direct experience of the person in therapy is, in my view, always front and center in therapeutic inquiry and exploration.

I don’t expect the people I work with in therapy to understand everything that flows from my lips. I have to learn a person’s language—and, to paraphrase Carl Jung, each of us speaks differently. I cannot insist on calling anything “progress” if the person in therapy feels or perceives otherwise. In the absence of mutual resonance regarding progress and therapeutic aims, the person in therapy feels dangerously alone.

Given your dwindling (or absent) faith in the process, it makes sense you are feeling alone in this relationship. It almost seems this alone-ness may even echo or parallel earlier suffering with the traumatic isolation and self-doubt you describe. I can’t shake the feeling you sense painful distance or discrepancy between you and your therapist, that she is missing something essential. I am not blaming her—nor you, for that matter. Do you somehow feel pressured to “live up to” her seeing progress? Are you concerned that if she feels disappointed or anxious about “progress,” it could be a bad sign?

Therapists seek a tricky balance between instilling hope and validating a person’s pain—mostly because, in so many cases, the latter has never been permitted or acknowledged by caregivers. Strangely, the more a pain is accepted as valid in the context of a person’s experience—with a safe other who can stay with you during and through that pain—the more healing the process becomes.

Therapists seek a tricky balance between instilling hope and validating a person’s pain—mostly because, in so many cases, the latter has never been permitted or acknowledged by caregivers. Strangely, the more a pain is accepted as valid in the context of a person’s experience—with a safe other who can stay with you during and through that pain—the more healing the process becomes. It’s when we begin to fear that emotional pain is “too much” for us or the other, or that it’s a sign of weakness on our part—that we need to “get over it already,” etc.—that it lingers like an unwelcome guest.

I believe people are entitled to all of their feelings, including and especially about therapy, because no one knows your experience better than you. I can’t imagine anything more important in your therapy than what you have bravely expressed in your letter. I am grateful you are not suicidal, but it sounds bad enough that an adjustment needs to happen, either within the current therapy or with someone new. (If thoughts of hurting yourself do resurface, please call 911 go to your nearest emergency room immediately.)

You sound very certain your therapist “knows she’s not helping me,” though I would urge you to not jump to the conclusion that no one can. The latter can be a hallmark or emotional symptom of depression—the sense one is cosmically alone in the universe, unable to connect with anyone. This feeling is, sadly, more common than many people realize. But this feeling is not objective “truth.” Your situation is not hopeless, and the fact you wrote your letter suggests you may leave room for hope, too. It is vital your therapist help you believe this more expansively.

When it comes to feedback, vital in any therapy, I try my best to listen nondefensively to where a person is or is not happy with me or how things are going with the two of us. My aim is to do no harm and be as helpful as possible. I do not assume I am always on the right track, or that no feedback means everything is fine and dandy.

There needs to be, more often than not, some mutually understood “map” of where we are going, and why—in your case, that would plainly include relief from traumatic anguish. The work can be difficult, even painful, at times, but for the sake of a treatment plan (ethically required), the “plan” needs to be something the person in therapy understands, endorses, and trusts as desirable.

Once a person begins to feel overly “protective” of the therapist’s feelings, which the therapist might tacitly encourage, the process is in danger of shutting down or becoming overly burdensome to the person, adding to their trauma and emotional isolation. Maybe the person has never had a chance to be fully honest with another, which can feel scary or even risky. The very act of sharing this disappointment can be healing, which is why I do my best to encourage it.

I would be curious to know if you are getting help with managing painful or traumatic emotions or emotional states between sessions. Do you need concrete help dealing with feelings of despair or low self-worth? There are cognitive behavioral approaches, dialectical behavior therapy (DBT), mindfulness, and other techniques to help with such moments.

Please do not give up. I wish you the best of luck in your pursuit of much-deserved relief.

Warmly,

Darren Haber, MA, MFT

Darren Haber

Darren Haber, PsyD, MFT is a psychotherapist specializing in treating alcoholism and drug addiction as well as co-occurring issues such as anxiety, depression, relationship concerns, secondary addictions (especially sex addiction), and trauma (both single-incident and repetitive). He works in a variety of modalities, primarily cognitive behavioral, spiritual/recovery-based, and psychodynamic. He is certified in eye movement desensitization and reprocessing (EMDR) therapy, and continues to receive psychodynamic training in treating relational trauma, including emotional abuse/neglect and physical and sexual abuse.