At a glance
Going back to therapy after it failed once asks you to risk the same disappointment twice. You may have kept going for months out of hope, or stopped early and quietly decided it was your fault. This looks at what tends to go wrong when therapy does not work, and what to pay attention to before you try again.
Clinical insights from 22 years in psychotherapy
I’m Mark Colclough, MA, psychotherapist in Copenhagen. Qualified at the Psychosynthesis Education Trust and the University of East London. 22 years of full-time, face-to-face clinical practice.
- Effort was rarely what was missing. Clients who tell me therapy did not work have usually worked hard in it, and what was absent was a relationship in which that work could land.
- Stopping is often a late signal. When clients leave, they have frequently felt unmet for some weeks beforehand and had no way to say so in the room.
- The disappointment arrives before the second attempt does. Clients returning after a poor experience bring a watchfulness into the early sessions, and it helps more to name it than to work around it.
Clinical notes: My observations are anonymised and compounded from my session notes since 2004.
Why did nothing change, even though I kept going?
Turning up is not the same as being reached. You can attend for a year, answer every question honestly, do what is suggested between sessions, and still leave each week with the sense of having described your life rather than lived any of it in the room.
That gap is worth taking seriously rather than treating as a failure of commitment. Therapy works through something being felt while another person stays with you in it. When the hour stays at the level of report, the material never becomes present enough to move. You can be articulate about your anger and never once be angry in front of your therapist, and nothing shifts, because the thing you came to change has not actually been in the room.
Not improving in therapy is also more common than most people are told. In a pooled analysis of 29 trials of internet-delivered cognitive behavioural therapy, around 27 in 100 people who received treatment showed no reliable improvement on the strictest measure the authors used, and higher distress at the start made that more likely.1 Those were internet-delivered treatments rather than face-to-face work, so the figure does not transfer directly to a consulting room, but it does make one thing clear. A treatment that does not shift you is an ordinary outcome with reasons behind it, not evidence of something wrong in you.
Was it the therapist, the method, or me?
It is usually the fit between the 3, and that is harder to see from inside it. You want a single answer because a single answer tells you what to do differently. The honest position is that a therapy has several moving parts, and any of them can be the one that did not hold.
- The pace. A therapist who moves to technique before you feel safe can leave you compliant on the surface and withdrawn underneath.
- The focus. Work aimed at your thinking when the difficulty sits in what you feel, or aimed at your history when the pressure is in your marriage this month, can be careful and still miss.
- The timing. You may have gone when you had just enough stability to attend and not enough to let anything loosen.
- The person. Some pairings simply do not become a working relationship, and no amount of skill on either side makes them into one.
A small Norwegian interview study of 12 therapist and client pairs, in which both sides reviewed recordings of their own sessions, found that where therapists pressed on with their method before a sense of safety had formed, clients tended to withdraw or to push back, and the therapists often did not register it at the time.2 It is 12 pairs and it cannot tell us how often this happens. It does describe something I recognise from my own consulting room, which is how quietly a therapy can come apart while both people are still being perfectly polite.
What if I could not say that it wasn’t working?
Many people find it easier to leave a therapy than to complain inside one. You went for help with something difficult, your therapist was kind, and saying “this isn’t reaching me” felt both ungrateful and like one more thing you were getting wrong.
Look at what that silence was protecting and you often find the pattern you came in with. If you manage other people’s feelings for a living at home, you will manage your therapist’s too. If disappointment in your family was met with hurt or distance, you will not risk it with someone you have started to depend on. The difficulty does not wait outside the door while you discuss it. It comes in with you and shapes how you use the hour, which is exactly why it is worth saying out loud, and exactly why it is so hard to.
I would rather hear it badly phrased than not at all. A therapist who can take that well is giving you a better piece of evidence about the work than any description of their training.
Why does starting again feel worse than starting did?
The first time you only risked your money and your Tuesday evenings. This time you are risking the conclusion that nothing helps.
That is a real cost and I would not talk you out of feeling it. What I would question is the conclusion sitting underneath, which usually goes further than the evidence does. One therapy that did not work tells you about one therapy. It does not tell you that you are unreachable, too complicated, or beyond the kind of change other people manage, however much it feels like a verdict.
In Copenhagen there is often a second layer on top of it, particularly if you came here from somewhere else. You may have tried therapy in your own language and then in English, or in a system that worked differently from the one you grew up with, and you cannot easily tell what was the therapy, what was the language and what was the strain of the move itself. Keeping those apart is work worth doing early rather than carrying the whole thing as one bad experience.
What would I do differently this time?
Make the last therapy a subject in the new one, in the first session rather than the tenth. It is the most useful material you are bringing, and a therapist who treats it as information rather than as a complaint about the profession is showing you something.
- Say what you noticed, not what you concluded. “I talked for a year and never cried” gives a new therapist more to work with than “it didn’t work”.
- Ask how they work when a client feels stuck. The answer tells you whether stuckness is treated as part of the work or as a problem with you.
- Agree in advance how you will say it if this one starts to feel flat. Naming the route makes it possible to use it.
- Give it enough sessions to become a relationship, and notice what happens in them. Feeling slightly more known by the fourth or fifth session is a better sign than feeling better after the first.
None of this is sufficient on its own. If your circumstances are the active problem, a weekly hour will not outweigh them, and the work has to include what can actually be changed outside the room. If the previous therapy left you feeling harmed rather than disappointed, that belongs at the front of the new work and should not be folded into a general account of bad luck. And if you are unsure whether individual work or psychotherapy in Copenhagen with a different focus is the right shape this time, that is a reasonable thing to decide together in a first conversation rather than alone beforehand.
Questions people ask
Should I tell a new therapist that the last therapy failed?
Yes, and in the first session rather than once you have settled in. What you noticed going wrong is the clearest guidance a new therapist has about how to work with you.
How many sessions before I decide whether this one is working?
Look at whether you feel more known rather than at whether you feel better, and give it enough sessions for a relationship to form. Any fixed number would be a rule I cannot stand behind, so treat the question as something to review openly with your therapist instead.
Does a different type of therapy work better the second time?
Sometimes, though the change that matters more often is in the fit and the focus than in the label. It is worth asking a prospective therapist how they would approach what went flat last time.
Can I say in a session that I don’t think this is helping?
You can, and how a therapist receives it tells you a great deal about whether to continue. It does not need to be polished or fair to be useful.
Is it worth trying therapy in English if my first attempt was in my own language?
Often yes, because the language you live your current life in is frequently the one your present difficulty speaks. Some people find the reverse, and that is worth testing rather than assuming.
If therapy did not help before, emotion-focused psychotherapy may feel different, and I am glad to talk about what went wrong.
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Sources
- Rozental A, Andersson G, Carlbring P. In the absence of effects: an individual patient data meta-analysis of non-response and its predictors in internet-based cognitive behavior therapy. Frontiers in Psychology, 2019.
- Lavik KO, McAleavey AA, Kvendseth S, Moltu C. Relationship and alliance formation processes in psychotherapy: a dual-perspective qualitative study. Frontiers in Psychology, 2022.
How this article was written: I choose the subject and the angle. An AI assistant researches and drafts. I read the draft, correct and improve it and stand behind every clinical statement. The professional and clinical judgement is mine.
