You’ve been in therapy for a while, and you’ve been doing everything that’s been asked of you. You’ve shown up to every session and meticulously followed the plan that was put together when you started treatment. Yet, something about where you are doesn’t match where you expected or hoped to be by this point.
Mental health treatment should be a moving target, and one that adjusts as you and your situation change. But in reality, treatment plans can stay fixed long after your circumstances have changed. Knowing when to change your mental health treatment plan is key to better outcomes, as it can help realign your care with where you are now.
To help you, this page will cover:
Adjusting a therapy plan as an adult starts with recognizing the specific indicators that could mean the care plan you’re involved in may need revisiting. Some of them can be obvious, but others can be easier to miss.
Understanding the signs that treatment isn’t working can help you advocate for the care you need.
This one depends a lot on what type of treatment you’re in. Studies on early response in therapy found that meaningful improvement in the first four weeks is one of the strongest predictors of overall treatment outcomes.[1]
If you’re several months into therapy without meaningful improvement, evidence suggests the treatment plan should be reassessed rather than continuing as you are, hoping for change.
If you’re on medication, that timeline can be a little tighter. One study that tracked adults on antidepressants found that people who showed even slight improvement by four weeks were around twice as likely to reach remission later.[2]
Clinical guidelines generally recommend that if there’s been little to no change after four to six weeks at an adequate dose, the plan should be reassessed.[2] If you’re past these windows and nothing has changed, your treatment plan may benefit from a rethink.
This is slightly different from the last point. In this case, you may feel better than you did when you started treatment, but feel stalled at a point where symptoms are still interfering with your daily life.Â
For example, you might be sleeping slightly better but still struggling with motivation. Perhaps the worst of your anxiety has been dealt with, but you’re still avoiding things you want to be doing.
A study on partial remission in depression shows that this is one of the most common outcomes in treatment, with roughly a third of people improving without reaching full remission.[3]Â
Those residual symptoms are one of the strongest predictors of relapse, so it’s important to take them seriously. The study showed that relapse rates can be three to six times higher in people who partially improve, compared to those who fully remit.[3]
Partial improvement over a long period of time is a sign to optimize your mental health care plan, not a reason to accept where things are right now.Â
Medication is a complicated part of recovery, and its role in your progress or lack of progress can be significant. Technically, medication can still be working while the side effects make your quality of life worse in other ways.Â
A review found that side effects are one of the most reported reasons people stop taking their medications, with discontinuation rates as high as 60% in some studies.[4] Weight gain, emotional blunting, sexual dysfunction, and fatigue aren’t minor inconveniences if they’re affecting how you feel about yourself and how you function day to day.
If you’ve started skipping doses, or even just considered it, because the side effects are too much to handle, you must speak with your prescriber. There may be alternatives you can try before giving up on medication altogether, and your treatment team can help you understand each one. Changing medications for mental health is a common and often necessary part of optimizing mental health care.
Many things in your life can change while you’re in treatment, and those changes need to be considered. For example, you might have started treatment during a crisis that has since passed, or a new stressor may have entered the picture that your original plan wasn’t designed for.
Treatment that was right for your life six months ago may not be right for the life you’re living now. If this sounds like your situation, you should discuss it with your therapist. A treatment plan reassessment can help ensure your care matches your current reality.
A large depression study followed more than 4,000 adults through as many as four sequential treatment stages.[5] The key finding was that people who didn’t respond to the first approach could still reach remission by moving to a second or third option. But the gains were largest in the first two well-delivered steps, and remission rates dropped at steps three and four.[5]
These findings suggest that the specific treatment may matter less than how quickly the plan adapts when something isn’t working. If you’re in a plan that stopped helping months ago, it can cost you time that could have been spent finding the right one.
Another trial found that matching people to the right level and type of treatment from the get-go produced much better outcomes than the standard approach of starting low and escalating after failures.[6]
Treatment matching, whether it happens at the start or during treatment, is crucial. Personalized treatment plans in psychiatry consistently produce better outcomes than standardized approaches, which is why a regular mental health care plan evaluation is so important.
If your therapy plan is not working and you’re unsure what to do, bringing a specific set of questions to your next appointment can give the conversation a clear direction toward improving treatment outcomes for mental health.
This is a question that many people wouldn’t think to ask, especially if you’re not comfortable with the psychology behind your treatment. Even so, research suggests it’s one of the most important things to ask if you feel treatment isn’t quite meeting you where you’re at.
Studies on treatment-resistant depression found that a huge portion of cases labeled as ‘treatment-resistant’ involved missed or incorrect diagnoses.[7]
Bipolar disorder is the most commonly missed condition, with some estimates suggesting that up to 69% of people with bipolar depression are initially misdiagnosed as having unipolar depression.[8]
If your treatment hasn’t been working, even with multiple attempts, asking whether the underlying diagnosis has been fully explored is a reasonable and important step. This is especially true in complex mental health cases.
If you’re currently on medication, and it has produced only a slight improvement over a long period of time, it’s worth bringing this up with your prescriber.
Even slight improvements may be a real positive, but guidelines generally recommend augmentation when you’re in this position. If there’s been no major improvement or side effects are starting to cause obvious problems in your life, having this conversation can be really important.
Second-line treatment options, including another medication, may also be appropriate. One clinical trial found that some augmentation strategies led to higher remission rates than simply switching antidepressants.[9] This is a key part of revising psychiatric treatment when first-line options fall short.
In some cases, the environment in which you’re receiving treatment could also be affecting your progress.
For example, if you’re in an outpatient treatment program and it’s not producing enough change, moving into a more intensive program could be a legitimate next step.Â
Intensive outpatient programs (IOPs), partial hospitalization programs (PHPs), and residential treatment provide greater structure and more therapeutic contact than standard outpatient programs. Stepping up your level of care can be a positive mental health decision, and this decision shouldn’t be seen as a failure.
The reverse is also true: if you’re already in a higher level of care and feel ready for more independence, it can be something to discuss with your treatment team.Â
A good therapist should certainly be doing this, and in most cases, they will be, but it can help to ask the question so that it’s explained clearly to you.
Improving treatment outcomes in mental health can start with something as simple as tracking progress. Research found that regularly tracking progress and sharing the results with your clinician nearly doubled improvement rates in clients who were off-track.[10]Â
If you feel that your provider isn’t using any kind of structured measure to track how you’re doing over time, it’s worth raising the point.
AMFM is here to help you or your loved one take the next steps towards an improved mental well-being.
If you’ve never been through a formal mental health care plan evaluation, asking for one can feel a little daunting. In reality, though, it’s a relatively straightforward and usually welcome conversation.
A treatment plan reassessment is a conversation between you and your provider where everything currently in place gets reviewed against where you are currently. This chat usually covers whether:
Your therapist may use standardized progress measures as part of a mental health progress review to compare where you are now against where you were when treatment started.
The goal is to make sure that every part of your plan is still working toward the same outcome you are. If something has drifted or stopped producing results, the reassessment is where that gets identified and corrected.
We understand that it can be a tough conversation to have, but a good therapist will welcome the conversation and be more than happy to take over from there.
This can feel like taking a step back, but this isn’t the case. A readjustment or possibly even a complete rethink can sometimes be necessary.
The necessary adjustment depends on what’s not working. For example, if the relationship with your provider is strong but the medication or therapeutic approach isn’t producing results, adjusting within the current setup makes sense.
A good clinician can adjust the medication you’re on or perhaps refer you for a diagnostic reassessment without you needing to start over again with a new therapist. If the relationship itself feels like part of the problem, if you consistently feel misunderstood, a fresh start with a different provider may be what’s needed.
The work you’ve already done carries forward regardless, and everything you’ve learned about yourself doesn’t change.Â
If any of what you’ve read here has struck a chord with you, it may be the moment to rethink your treatment. Remaining in a mental health care plan that has stopped helping you costs you the time that could be spent finding the right one.
AMFM (A Mission For Michael) Mental Health Treatment provides mental health care for adults that goes beyond traditional care by offering a more personalized and deeply compassionate healing experience. Our expert clinical team works across multiple evidence-based approaches, including:
We offer residential programs across the U.S. for those who need space from daily life, as well as outpatient options with support for your current situation. AMFM Mental Health Treatment accepts insurance and is in-network with most major providers. Simply complete our confidential, free online verification form to check your insurance coverage for mental health care.Â
If you’re looking for a full diagnostic reassessment or just a second opinion on your current plan, our team can help you work out what the right next step looks like. Call us at 866-478-4383, and a member of our team will be more than happy to guide you on the next move.Â
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