For many people in therapy, it’s the first time they’ve let their guard down and trusted someone else to guide them through difficult emotions. You place trust in your therapist to make thoughtful decisions and create an effective mental health treatment plan that fits you. While letting your therapist practice their expertise is important, there are situations where it becomes necessary to speak up. If you feel as though therapy’s effectiveness is declining, or there are signs that treatment isn’t working, this is the right time to talk to your therapist about adjustments.
Noticing these signs, however, isn’t always as easy as it sounds. This article explains why open communication with your therapist is so important. It then covers ten warning signs therapy isn’t working, and explains when it may be time to re-evaluate your mental health care.
Founded in 2010, A Mission For Michael (AMFM) offers specialized mental health care across California, Minnesota, and Virginia. Our accredited facilities provide residential and outpatient programs, utilizing evidence-based therapies such as CBT, DBT, and EMDR.
Our dedicated team of licensed professionals ensures every client receives the best care possible, supported by accreditation from The Joint Commission. We are committed to safety and personalized treatment plans.
Why Communicating With Your Therapist Is Important
Feeling comfortable enough to communicate openly with your therapist is one of the most important parts of the therapy process.1 When you’re able to raise concerns or fears as they present themselves, it can play a meaningful role in supporting recovery. As valuable as a therapist’s work is, therapy relies on a back-and-forth and works best when sessions are shaped around you and your responses. This collaborative process also means you are more likely to discuss whether adjusting psychiatric treatment may be beneficial.
That said, speaking up is not always easy, especially when you’re unsure when to talk to your therapist about adjustments you may need.2 You may be in a vulnerable place, relying heavily on your therapist’s guidance, which can make it feel risky to question the process. If something feels uncomfortable, it may be because therapy is touching on emotionally charged areas, and that can make asking for a time-out feel frightening when you want the work to continue.
In other cases, you might feel unsure about the approach itself and worry that raising concerns could come across as critical or ungrateful.2 These are moments, however, when it is important to speak up and talk with your therapist about aspects of care that don’t feel right or aren’t working.
Sometimes, a therapist can explain that what you’re experiencing is an expected part of the process, which can be reassuring in itself. At other times, they need to know how you’re reacting to medication, or whether therapy is genuinely making day-to-day life feel more manageable.3 These are things they cannot always see from the outside, and sharing them gives your therapist the information they need. In some cases, it may highlight areas where your mental health treatment plan needs adjusting.
How to Know if Your Treatment Plan Needs Updating
Recognizing when treatment isn’t progressing as expected is a key part of evaluating your mental health care. Below are ten warning signs to watch for, along with guidance on what changes might help.
1. Daily Tasks Are Still Overwhelming
No matter your reasons for attending therapy, it should eventually improve your everyday life. Studies show that psychotherapy combined with medication tends to improve overall functioning.4 This means that if, after months of treatment, you are still struggling with day-to-day activities, your plan may not be helping with real-world functioning.
This is one of the key mental health treatment outcomes to monitor, but your therapist needs to know about these difficulties to reevaluate goals and strategies together.
2. Side Effects or Complications from Medication
In certain situations, medication is appropriate alongside therapy for managing or improving mental health symptoms. For some people, though, side effects or complications from medication can be strong enough to derail progress. For example, around 23-36% of patients on antidepressants in one study stopped their medication entirely because of the adverse effects they experienced.5
If you are experiencing nausea, dizziness, sexual dysfunction, or anything else that makes daily life difficult, let your therapist know. In many cases, adjusting the dosage or switching medications may help resolve the issue.
3. Emotional Blunting
Another well-known medication side effect is emotional blunting. In the early stages of use, many antidepressants have the potential to make you feel emotionally numb, meaning you might not initially experience emotions in the same way you used to. This emotional blunting occurs in around 40-60% of people taking SSRIs or SNRIs.6
If you suddenly find yourself unable to connect with your emotions at all, it may be a medication effect. Discussing this with your doctor can lead to dose adjustments or a different medication altogether.
4. Sleep or Energy Issues
Feeling excessively sleepy or being unable to sleep can also signal that medication issues are at play. This is a serious concern, with one review noting that side effects like severe drowsiness or insomnia can compromise quality of life.5
If you notice signs such as dozing off at unusual times or being unable to fall asleep at night, point this out to your therapist. They may adjust the timing of your medication or suggest trying a different type.
5. Weak or Broken Therapeutic Alliance
The bond and trust between you and your therapist, known as the therapeutic alliance, is a key factor in therapy success.7 If you feel misunderstood, unheard, unable to trust, or unable to be open with your therapist, progress is likely to stall.7
This is a clear sign that something within the therapeutic alliance needs to be adjusted. You and your therapist should talk about how to rebuild that trust, even if you’re not quite sure what’s driving the problem. Sometimes, an open conversation with your therapist can be enough to identify and fix the issues at hand.
6. No Discussion of Progress
Your treatment should always be a two-way dialogue, and research strongly supports this. One study found that patients who never reviewed their progress or goals with their therapist were much more likely to report lasting negative outcomes.8
If your sessions never include a check-in on how things are improving, or even how they are not, it is important to speak up. Tracking progress in mental health care is essential, as without it, necessary adjustments may be missed entirely.
7. You Feel Worse After Sessions, but It Is Ignored
It is normal to feel stirred up at times in therapy because certain forms or methods can be intense. However, if you consistently feel worse after sessions and this isn’t addressed by your therapist, it is a red flag. Experts note that feeling overwhelmed during or after sessions can be part of the process, but only if it is acknowledged and you get the necessary support.7
If your therapist ignores or dismisses your distress, let them know. Feeling heard about these emotions is critical for moving forward.
8. Therapy No Longer Feels Safe
Therapy should always feel like a safe space for you. If anything makes you feel frightened or pressured, therapy will not work as effectively as it would in a calmer environment. Experts emphasize that losing a sense of safety can stall progress and reduce the effectiveness of therapy.7
Speaking about these concerns is vital. Your therapist should be able to adjust aspects of your treatment that are causing stress so you can receive the best possible care.
9. Increases In Dangerous Thoughts
If thoughts of suicide or self-harm emerge or worsen during treatment, this is an urgent sign that your current plan may not be right for you. Research shows that a small percentage of patients can experience worsening symptoms if treatment is not well matched to their needs.9
Do not keep this to yourself, as your treatment plan may need significant adjustments or a more specialized level of care. Tell your therapist right away or seek immediate crisis support. In the United States, you can call or text 988 to reach the Suicide & Crisis Lifeline, or contact local emergency services if you are in immediate danger.
10. You Still Lack Coping Tools
A strong therapy plan should help you build coping skills through approaches such as cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT). If, after months of therapy, you feel like you have no new strategies for managing stress or anxiety, this is something that needs to be addressed.
It may also be worth considering whether comorbid conditions affecting treatment are playing a role, as conditions like ADHD, chronic pain, or substance use can all impact how well standard approaches work.
Whatever the case, your therapist can refocus on practical skills or assign exercises that better support you in real-life situations.
AMFM – Expert Mental Health Providers
If any of this feels familiar, it may be a sign that your current support could benefit from adjustments. Mental health care is never static, and recognizing when something no longer fits is a meaningful step forward.
But we also understand how difficult it can be to question a treatment plan you’ve placed trust and emotional energy into. This is why, at AMFM, our team offers a space where concerns can be explored openly, whether you’re unsure about therapy or the medication that is sometimes prescribed. Our therapists take the time to review what’s working, what isn’t working, and most importantly, consider adjustments that better support your needs.
If you’re feeling uncertain about your current care, reaching out could help bring clarity and direction.
References
- Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9–16. https://doi.org/10.1037/a0022186
- Mazor, K. M., Kamineni, A., Roblin, D. W., Anau, J., Robinson, B. E., Dunlap, B., Firneno, C., & Gallagher, T. H. (2018). Encouraging patients to speak up about problems in cancer care. Journal of Patient Safety, 14(4), e1–e7. https://doi.org/10.1097/PTS.0000000000000510
- de Jong, K., Conijn, J. M., Gallagher, R. A. V., Reshetnikova, A. S., Heij, M., & Lutz, M. C. (2021). Using progress feedback to improve outcomes and reduce drop-out, treatment duration, and deterioration: A multilevel meta-analysis. Clinical Psychology Review, 85, 102002. https://doi.org/10.1016/j.cpr.2021.102002
- Iliou, K., Balaris, D., Dokali, A. M., Fotopoulos, V., Kouletsos, A., & Katsiana, A. (2024). Exploring the effects of major depressive disorder on daily occupations and the impact of psychotherapy: A literature review. Cureus, 16(3), e55831. https://doi.org/10.7759/cureus.55831
- Kelly, K., Posternak, M., & Jonathan, E. A. (2008). Toward achieving optimal response: Understanding and managing antidepressant side effects. Dialogues in Clinical Neuroscience, 10(4), 409–418. https://doi.org/10.31887/DCNS.2008.10.4/kkelly
- Ma, H., Cai, M., & Wang, H. (2021). Emotional blunting in patients with major depressive disorder: A brief non-systematic review of current research. Frontiers in Psychiatry, 12, 792960. https://doi.org/10.3389/fpsyt.2021.792960
- Herzberg, B. (2025). What to do if therapy isn’t working. Psychology Today. https://www.psychologytoday.com/us/blog/the-psychology-of-relationships-and-emotional-intelligence/202503/what-to-do-if-therapy-isn’t
- McQuaid, A., Sanatinia, R., Farquharson, L., Shah, P., Quirk, A., Baldwin, D. S., & Crawford, M. (2021). Patient experience of lasting negative effects of psychological interventions for anxiety and depression in secondary mental health care services: A national cross-sectional study. BMC Psychiatry, 21(1), 455. https://doi.org/10.1186/s12888-021-03588-2
- Oasi, O., & Werbart, A. (2020). Editorial: Unsuccessful psychotherapies: When and how do treatments fail? Frontiers in Psychology, 11, 578997. https://doi.org/10.3389/fpsyg.2020.578997
