You’ve been in therapy for a while, but the sessions have started to feel a little different. You can’t quite put your finger on why, but something has changed. This might be what’s known as therapy stagnation. If you’re in mental health treatment, it is important to understand what is happening and how to get back on track.
This page aims to explore why therapy might stall and what can be done to fix the problem. We’ll cover:
You used to leave your sessions feeling as though something special had happened in that room. You couldn’t put a name on it, but you knew deep down that real progress had been made.
But recently, you’ve noticed that you’re leaving the sessions with the same feelings you walked in with, and in some cases, feeling worse than before. This kind of experience is far more common than people realize, and research supports this. One meta-analysis found that 41% of clients showed a meaningful response within the first two months of treatment, and a third never showed improvement at all.[1]
Although these findings may seem discouraging, they illustrate that periods of stalled progress are common in therapy. This means that a stall is not usually a sign of a huge crisis, or that nothing can be done to start seeing real changes again.Â
What matters is understanding what is behind the stall and how it can be addressed. Recognizing ineffective therapy signs early allows you to take action before the problem becomes entrenched.
There are various reasons why therapy can stop producing the changes it was producing before, and many of them are due to mechanical rather than personal factors. The reasons therapy fails for adults are usually identifiable, and understanding which one applies to your situation can help you overcome the difficulties you may be having.
A classic model in psychotherapy estimated that around 50% of clients show improvements by around 8 sessions, with 75% improving by session 26.[2]
Each session after that produces a smaller increment of change, and understanding therapy plateaus can stop you from blaming yourself for something that is usually just part of the process. A recent meta-analysis supports this trajectory, and it holds across different types of treatment settings.[3]
What this means is that the first few weeks of therapy tend to produce the most noticeable results. It makes sense, as for some people just starting therapy, it’s the first time they’ve been able to speak to another person about what’s truly going on inside their minds.Â
In many cases, it may also be the first time they’ve experienced successful initial coping methods, which have made their day-to-day life noticeably better.
Once those gains start to level out and slow down, it can feel as though therapy isn’t working anymore or that they might be doing something wrong.
One study found a consistent relationship between the quality of the therapeutic alliance and treatment outcomes.[4] This means the relationship between you and your therapist can be one of the biggest factors in whether or not therapy works.
When the alliance weakens, losing progress in therapy becomes more likely, but it doesn’t mean that either party is necessarily doing something wrong. For example, a therapist who was the right fit during a crisis period might not be the right person for the deeper work that comes after.
The connection can weaken slowly, too, especially if you’ve built a positive relationship with your therapist. You might be so grateful for their initial work that it could mask therapist mismatch symptoms.
It’s important to remember that different types of therapies were developed to deal with different types of problems. In your case, a type of therapy that may have worked at one stage of your treatment might not be as effective now.
For example, research on cognitive behavioral therapy (CBT) for different types of anxiety disorders found that it produces positive outcomes for conditions like panic disorder and social anxiety.[5]
 But if the anxiety is being driven by something deeper, such as unresolved trauma, CBT alone might not be enough.[5]Â
Your therapist could start you on CBT to manage the anxiety, only for symptoms to emerge or worsen weeks or months later when it becomes clear that trauma is the real driver. At that point, the therapy has to change to match what’s actually going on.
This reason is uncomfortable to consider, but it’s important to look honestly at what is going on. The goal of many forms of therapy is to reach a point where it moves from understanding the underlying factors to changing the patterns that fuel it.Â
This switch comes with a level of discomfort that can trigger avoidance thinking or behaviors. For example, you might notice that you’ve been avoiding certain conversations that are uncomfortable because they’re not something you want to address.Â
Reviews have found that experiential avoidance, which is the tendency to push away uncomfortable internal experiences, is heavily linked to conditions like:[6]
If you’re dealing with these types of mental health conditions, that kind of avoidance can appear in the therapy room, too. This can keep you where you are rather than moving forward.
Mental health treatment failure in therapy often has more to do with external circumstances than with the therapy itself. If the issue that led you to therapy in the first place, be it a relationship problem or a stressful job, hasn’t changed, then therapy may be fighting against the current.
An hour a week with your therapist is being asked to absorb the shocks that the other 167 hours keep delivering to you. The therapy itself might be perfectly sound, but the conditions around it aren’t allowing the work to take hold as well as it could if the stressors were removed.
If this is where you are, the therapy hasn’t necessarily failed. In this case, it may need to account for what’s happening outside the room.
AMFM is here to help you or your loved one take the next steps towards an improved mental well-being.
If your counseling is not working and you’re unsure what to do about it, the decision doesn’t have to be one you reach on your own.
There are things that both you and your therapist can do together to work out what’s going on and whether something about the current setup needs to change.
Telling your therapist that you feel stuck is one of the most important things you can do, but it’s one that many people avoid. A good therapist will welcome your concerns because improving therapy results depends on having the clinical information they may not have had access to before.
Research on something known as alliance rupture, where the therapist and client relationship experiences issues, found that addressing these difficulties is very important. The study found that when they were identified, this predicted better outcomes than if no rupture had occurred at all.[7]
You don’t need to have the perfect words when you discuss this with your therapist. A simple, “I’ve felt like we’ve been going over the same ground for a few weeks, and I’m not sure it’s moving,” gives your therapist something concrete to respond to.
If you’re not sure what the goals are anymore, ask. Fixing therapy that’s not working can start with getting clarity on whether it’s still on track and where you are in the process right now.
Research on routine outcome monitoring found that regularly tracking progress and sharing feedback nearly doubled improvement rates in clients who were off-track.[8]
If your therapist isn’t using any kind of structured progress measure, asking for one is one of the most evidence-based requests you can make.
Staying in one modality for months without movement is one of the most common reasons for stalling, and asking about alternatives is a reasonable conversation to have.
A trial comparing stratified care to standard stepped care found that matching patients to the right type of treatment from the start produced better outcomes for depression than the standard approach of starting low and escalating.[9]Â
If your therapy is not improving your depression, this suggests that integrating or switching to a different form of therapy may be more effective than continuing with the same approach.
Sometimes the reason therapy isn’t working is that the original diagnosis didn’t capture the full picture of what’s really going on.
If your therapy is not improving your depression, for example, it’s worth knowing that at least 30% of people with the condition also met the criteria for treatment resistance.[10]
Bipolar disorder is a commonly missed condition, with some reviews estimating that 26-47% of people labelled as ‘treatment resistant’ actually have an underlying bipolar spectrum condition.[10]
This doesn’t automatically mean that if you experience a stall, it’s because of a misdiagnosis. But what it does is open the door to a conversation with your therapist, so it can be explored.Â
A good therapist will know this, so it may be something they are already looking at. But knowing about this possibility can give you reasons why a stall may happen, so you don’t feel too hard on yourself.
That said, if you’ve been in treatment for a year or longer and not seen any meaningful movement, you have the right to bring this up with your therapist. What feels like therapy failure may actually be a signal that something important was missed from the start, and identifying it can change the entire direction of your treatment.
If you’ve read this far and you’re still unsure whether what you’re experiencing is normal or something that needs to change, reaching out for a second perspective can help.
Deciding to switch therapists or seek a second opinion can feel uncomfortable, but it doesn’t mean you’re going behind your therapist’s back. People seek second opinions across every area of healthcare, and mental health treatment is no different.Â
A fresh set of clinical eyes can help you work out whether the current approach is still the right fit, or whether something about the setup needs adjusting.
You don’t have to have made any decisions before picking up the phone. Just talking it through with someone who doesn’t know the history of your current therapeutic relationship is enough to bring some clarity to where things stand. Understanding therapy stagnation in mental health requires perspective, and sometimes that perspective needs to come from outside your current treatment.
If therapy has stalled and the strategies you’ve tried haven’t worked, it may be time to consider a different level or type of support. Feeling stuck doesn’t mean you’ve failed the process or that the process doesn’t work for you.
AMFM (A Mission For Michael) Mental Health Treatment provides integrative mental health care programs for adults with various conditions.
Our expert clinical team uses evidence-based approaches, including CBT, dialectical behavior therapy (DBT), Eye Movement Desensitization and Reprocessing (EMDR), and psychodynamic therapy. This means the work can be matched to what you need rather than being limited to a single modality.
We offer residential treatment for those who need the structure of a full-time therapeutic environment in locations across the U.S. For those stepping down or looking for support that fits around daily life, we also provide flexible outpatient programs.Â
We understand the emotional and financial challenges that can come with finding new treatment options. AMFM Mental Health Treatment accepts health insurance and is in-network with most major providers.
If you’d like to talk through whether a change in your treatment setup could help, call us at 866-478-4383 or learn about our admissions process online.
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