How to tell your therapist something isn’t working

Therapists expect to be told when therapy isn’t working, and they’re trained for that conversation. Most people don’t have it anyway.

Why it’s hard to say

In a survey of 547 people in therapy, 93% said they had lied to their therapist at least once (Blanchard and Farber, 2016). Leaving things out was far more common than making things up.

Three of the most commonly concealed things were about the therapy itself: pretending to like what the therapist said, pretending it was helping, and not admitting to wanting to stop. The reasons people gave were shame and embarrassment, politeness, and not wanting to upset their therapist.

Asked what would make them more honest, the most common answer was that their therapist would ask them directly. The person across from you may be waiting for an opening too.

What happens when you do say it

Researchers call a strain in the working relationship a rupture, and sorting it out a repair.

Ruptures come in two shapes. One is saying you’re unhappy, or being openly annoyed. The other is quieter: agreeing when you don’t agree, keeping things light, cancelling a session, saying less than you meant to. The quiet kind is far more common, and it’s easy to miss that you’re doing it.

Pooling 11 studies covering 1,314 people, therapy where a rupture got repaired went moderately better than therapy where it was left unresolved (Eubanks and colleagues, 2018). The researchers go further, carefully: working through a problem in the relationship may be more useful than a course of therapy that never had one.

What to actually say

You don’t need a long speech, and the start of a session is the easiest place to put it.

• The approachApproach (modality) The kind of therapy someone uses, such as CBT or psychodynamic therapy. You'll also see it called a modality. More in the jargon decoder Close isn’t suiting you. “I don’t think this style of therapy is giving me what I need.”
• You felt misunderstood. “When we talked about my family last week, I felt like you missed what I was trying to say.”
• You’re not sure it’s helping. “I’ve noticed I’m not making progress on the things I came here for.”
• You want to try something different. “Can we focus less on the homeworkBetween-session tasks (homework) Things some therapists give you to practise between sessions, such as tracking when a mood shifts or trying a different response to a situation. You go through how they went at the next session. More in the jargon decoder Close tasks and spend more time talking through what happened this week?”
• You want to stop. “I want to pause our sessions for now and take some time to think.”

What your therapist will probably do

Therapists don’t always handle this well the first time.

When it goes well, they’ll name the problem and ask you to say more about it. They might change what you’re working on, or how. They’ll take their part in it rather than explaining it away. They may also link it to patterns that show up elsewhere in your life, if that seems useful to you.

Your therapist might say: “Thank you for telling me. Let’s talk about what hasn’t been working, and what we could do differently.”

If it doesn’t change anything

Raising it doesn’t always fix it. If your therapist brushes it off, or nothing shifts after you’ve said it plainly, you’re entitled to stop.

Why who you see matters more than what they do explains why the fit is worth changing for, and how to find a therapist covers where to look next. If you’re partway through a Mental Health Treatment PlanMental Health Treatment Plan A document your GP writes with you. It makes you eligible for a Medicare rebate on up to ten individual sessions a calendar year: six, then a review with your GP, then the remaining four. The plan itself isn't therapy. More in the jargon decoder Close, ask your GPGP (general practitioner) For most people, where getting help starts. A GP can write a Mental Health Treatment Plan, prescribe medication and refer you on, and some are trained to deliver a small number of structured therapy sessions themselves. More in the jargon decoder Close or the new practice how the referralReferral A letter from a GP, psychiatrist or paediatrician that you need for the Medicare rebate. You can see a psychologist without one if you pay the full fee. More in the jargon decoder Close transfers.

When to take it to someone else

A poor fit is one thing. Harm is another.

You don’t owe a therapist a conversation if they:

• touch you inappropriately
• contact you outside sessions for their own reasons
• pursue a sexual or romantic relationship
• pressure you, or shame you
• keep doing something after you’ve asked them to stop

You can stop attending, with no notice and no explanation.

PsychologistsPsychologist Someone trained to assess mental health problems and treat them with therapy. It takes at least six years of study and supervised practice, and they're registered with Ahpra, the national regulator. Psychologists can't prescribe medication. More in the jargon decoder Close, psychiatristsPsychiatrist A medical doctor who has specialised in mental health. Psychiatrists can diagnose, prescribe and do therapy, though many spend most of their time on medication and diagnosis rather than weekly sessions. More in the jargon decoder Close, occupational therapists and nurses are registeredRegistered For psychologists, psychiatrists and occupational therapists, registration with Ahpra is required, and using the title without it is an offence. Counsellors and psychotherapists can register with their national associations, which is voluntary. More in the jargon decoder Close with AhpraAhpra The national regulator for health practitioners, including psychologists and psychiatrists. Its public register shows whether someone is registered now, what kind of registration they hold, and whether any conditions have been put on their work. More in the jargon decoder Close, the national regulator. CounsellorsCounsellor Someone trained to help people talk through and work on difficulties. The title isn't protected in Australia, so it's worth checking a counsellor's training and registration. Medicare doesn't give a rebate for counsellors. More in the jargon decoder Close and psychotherapistsPsychotherapist Someone trained in therapy, often for longer-standing patterns. Like counsellor, the title isn't protected in Australia, and Medicare doesn't give a rebate for psychotherapists. More in the jargon decoder Close aren’t registered, and most belong to a professional association — either the Australian Counselling AssociationAustralian Counselling Association (ACA) One of the two national associations for counsellors and psychotherapists. It sets training and supervision standards, and takes complaints. More in the jargon decoder Close or the Psychotherapy and Counselling Federation of AustraliaPsychotherapy and Counselling Federation of Australia (PACFA) One of the two national associations for counsellors and psychotherapists. It sets training and supervision standards, and takes complaints. More in the jargon decoder Close. All of them take complaints. All the ways therapy can go wrong covers what that involves.

If things are difficult right now and you can’t wait for the next session, Lifeline is on 13 11 14, the Suicide Call Back Service is on 1300 659 467, and Kids Helpline is on 1800 55 1800 for anyone aged 5 to 25. In an emergency, call 000. Crisis and emergency support has the full list.

Where next

Does therapy actually work? sets out what the research says about how often it helps, how often it doesn’t, and how much the individual therapist matters.

What therapy actually is covers what a therapist will and won’t do. Worth a look if you’re weighing up whether what you’re getting is normal.