What to do when therapy is not working

Six weeks in, and nothing has moved. You have been to every session, done the things in between, and you can hear what your therapist will say before they say it. The hardest part is not the lack of progress but not knowing what it means, and so not knowing whether to stay or stop.

The short version

• Therapy that feels harder for a while and therapy that has stalled look much the same from the inside, at least week to week. What separates them is a plan you can measure against.
• Of the referrals that completed a course of NHS talking therapies in 2024 to 2025, just over half were recorded as moving to recovery. Not getting there is common.
• Raise it with your therapist before you raise it with anyone else. The British Association for Counselling and Psychotherapy (BACP) says they should encourage you to tell them what is not helping.
• You have the right to stop, or to look for another therapist, at any time, and you do not owe anyone a reason.

Hard and wrong can look the same for a while

Therapy can go through a stretch where things feel harder instead of easier, because you are turning over material you have spent years avoiding. A course that has genuinely stalled produces much the same sensations though: dread beforehand, flatness afterwards, the sense of circling one loop. In any single week you cannot tell them apart. Over a run of sessions, with something to measure against, you usually can.

For context: NHS England Digital reports that 50.5 per cent of referrals completing a course of NHS talking therapies in 2024 to 2025 moved to recovery. That word is narrow. The Royal College of Psychiatrists explains it as having had symptoms severe enough to count as a clinical case at the start, and not at the end. The figure counts referrals rather than people, and only those who completed a course. I want to say plainly that not reaching that line is common, and it is not a verdict on you.

Three things that all feel like nothing is working

The approach may be wrong for you

The NHS treats a first attempt as a first attempt. Its talking therapies page says you may be offered guided self-help first, and another type of therapy if your symptoms do not improve, though what is available varies by area. Our post comparing cognitive behavioural therapy and acceptance and commitment therapy covers choosing at the start; this one is about the course you are already in.

The relationship may have a strain nobody has named

Therapists call this an alliance rupture: a breakdown in the agreement about what you are doing and why, or a strain in the bond itself. A 2026 meta-analysis in the Journal of Clinical Psychology found a small but consistent association between ruptures and poorer outcomes. Hold it lightly. It pooled four studies and 301 clients, it is correlational, and the samples were mostly personality disorder or forensic rather than anxiety.

What that paper describes is more useful than what it measures. A rupture can show up as withdrawal, as confrontation, or as both at once, and either of you can be the one doing it. Confrontation is moving against the other person or against the work. Withdrawal is moving away from it. In my experience withdrawal is the commoner one, and the harder to spot: you go quiet, agree with everything, bring the safe material and leave the real thing in the car. People assume a rupture looks like an argument. It far more often looks like a very polite session.

There may be no plan to measure against

BACP says you and your therapist should discuss a clear plan for what you want from therapy, even if the goals change, and that regular reviews of how it has progressed help you both judge when it should end. The sheet notes that not every type of therapy sets goals that way. But if you have never had that conversation, "it is not working" has nothing to sit against.

Saying it out loud, which is the last thing you want to do

BACP is direct about this: if you are not comfortable with something that has happened, it is important to try to speak to your therapist about it, and telling them how you feel can often help therapy get better. Your therapist should encourage that, should give you time to say which parts have helped and which have not, and should deal with it when it comes up.

If you have gone quiet, that is the thing to name rather than hide, and you do not need to have worked out what is wrong first. Try: "I do not think this is landing, and I have been polite about it for a month."

What a review should cover

The NHS builds this in. NHS England's service standards say stepped care rests on two principles, the second being a system of scheduled review to detect and act on non-improvement, so that people can be stepped up to something more intensive, stepped down to something lighter, or stepped out to a different treatment or none at all.

The review I would push for covers what you each thought you were working on, what has changed and what has not, what would look different in six weeks, and whether the approach still fits.

Add format to that list too, session length included. brightloaf sessions are 20 minutes long, and we have written about why. Whatever service you are with, it is worth knowing what can move and what cannot.

If you decide to change

BACP puts it plainly: the decision would preferably be made together, but ultimately it is your choice, your therapist should respect it, you can look for another therapist at any time, and whether you give a reason is up to you. The same sheet makes the other half of the case, which is worth hearing: it says that avoiding an ending, rather than having the conversation, can be a life pattern repeating itself, and that a therapist may appropriately challenge that. If that lands uncomfortably, we have written about why avoidance feeds anxiety.

So on the NHS, contact the service rather than simply not turning up, and a GP can advise on what else is available locally. Going privately, the NHS says to check your therapist is registered with a professional organisation accredited by the Professional Standards Authority. And if you cannot face raising any of this with your therapist, BACP runs a Get help with counselling concerns service, Monday to Thursday, 10am to 4pm, which you can use anonymously.

None of this is a substitute for personal medical advice, and a blog post cannot see what your sessions are actually like. Feeling worse for a stretch is one thing; becoming unwell is another. If you are having thoughts of harming yourself, or you do not feel you can keep yourself safe, do not wait for the next appointment: call 111 and choose the mental health option, use 111 online, or ask for an urgent GP appointment. If anyone's life is at risk, or you do not feel you can keep yourself or someone else safe, call 999 or go to A&E. Samaritans are on 116 123, and if you are under 19, Childline is on 0800 1111. brightloaf is not a crisis service.