Therapy doesn't always work (and other things I wish people had told me)

Everything I've learned from dumping eleven therapists - and how to find help that works for you

I’m about to say something controversial. So controversial, in fact, that I’ve started writing this piece about 15 times and keep deleting it for fear of saying the wrong thing - or saying the right thing in the wrong way. Honestly, it’s getting a bit tedious. I have other stuff I need to do - life admin is a bitch. And sadly my bathroom is not yet self-cleaning. So here goes - deep breath…

Sometimes therapy doesn’t work. There. I said it. And I think it’s something we need to acknowledge more. In fact, I think normalising ‘therapy not working’ would be a seriously helpful thing for a lot of people.

What qualifies me to say this? I’m glad you asked. Over the last 20 years I have sought help from, and broken up with, eleven - yes eleven - therapists. Some have helped me and some have… very much not. But questioning therapy feels like the ultimate taboo. Like saying Santa doesn’t exist, or you don’t actually like chocolate. Or dogs.

Much is made of therapy success stories and I applaud this. But I want to discuss the darker side - the times it doesn’t work. The times I’ve ploughed ahead with something that’s not helping while thinking the problem is me not doing it right. The thousands of pounds I’ve sunk into the hope and belief that therapy will always work. This is not a topic that’s often talked about - frankly because it’s a bit depressing.

But here’s the truth; if therapy isn’t working for you, it’s not because you’re beyond help. It’s not because you’re doing it wrong. It’s not even because your therapist is shite. It’s because the alchemy you need in any successful relationship is not there. And that’s ok.

The magical therapy bullet myth

Before I expand, may I say firmly for the record that therapy is a brilliant and wonderful thing. It can literally save lives and I encourage everyone to invest in it as and when needed.

But I worry we’re not honest enough about the fact that therapy is not always a perfect fix.

For most of my life I’ve viewed therapy as a magic bullet - largely because I’m highly suggestible and this is the prevalent narrative I see everywhere. Read any story about someone who has dealt with a difficult life event and thrived afterwards and you’ll find talk of therapists. Go onto any medical website for help with depression and therapy is your answer. Go to your friends when your mind is going to dark places and (unless they’re assholes) they’ll likely suggest you speak to a therapist.

As a result I’ve developed a reverence for therapists as God-like healers, great sages, oracles and people-whisperers. They are Iron Man, Jed Bartlett in The West Wing, Mary Poppins - people you can rely on to make things ok.

So what happens when… it doesn’t work? As a long-time people pleaser, the natural thing to do is turn this on myself. Much like Taylor Swift, I’m the problem… it’s me. This is at best de-moralising and at worst damaging.

In recent years I’ve slowly realised I’m looking for a cure that might not actually exist. I’ve experienced serious bouts of depression and anxiety since childhood - and I am still not ‘cured’. I always thought it was just me. I’d see friends start therapy, evangelise about its impact on their lives, then happily move on.

Then I read Matthew Perry’s heartbreaking book Friends, Lovers and The Big Terrible Thing and it changed my perspective. Perry went to re-hab 15 times. He spent an estimated $9 million on treatment and attending over 6000 AA meetings. There were periods in which he got clean - but the monster was always there. He threw everything he could at it - and the devastating toxicology report from his death shows he lost in the end.

Similarly Alastair Campbell’s refreshingly honest Living Better: How I Learned to Survive Depression explores the idea that his depression will never be cured - and looks at ways he’s learned to manage it better and how to “live with the enemy”. All while also holding down seriously heavyweight roles in UK politics. Big respect.

The notion that some mental health challenges cannot be cured is - perversely - immensely freeing to me. It takes the pressure off the ceaseless hunt for the one perfect cure. If there is no one big cure - no perfect treatment that will rid me of depression forever - I can look at the smaller things that just help me manage things a bit better. And by moving the judgemental finger of blame off myself, I can take a more objective view about what kind of therapies work for me - and which do not.

Great Expectations; My Life in Therapy

A few years ago I did what I still consider to be the most absurdly British thing I’ve ever done. I faked a miraculous turn around while on the phone to The Samaritans (a UK charity helpline for people feeling suicidal). That’s right - rather than continue to explain how awful I felt and that, yes, ending it all was by far the most appealing option at the time, I faked it. I just felt too damn awkward doing anything else.

After a brief stint of me sobbing and ineptly trying to explain the thoughts in my head, punctuated with the odd sympathetic “mmmm” and long silences from the volunteer at the end of the phone, I didn’t feel I was getting anywhere and felt so embarrassed by my clearly self-obsessed ramblings that I just wanted it over.

“Wow you’ve been so helpful”, I lied. “I feel much better now - thank you soooo much for your time! Bu-bye now!” I said cheerfully.

I hung up, slid down onto my cold wooden floor feeling like even more of a failure. I couldn’t even do depression right.

With hindsight this was because this was not the interaction I needed. Speaking things out loud is one thing - but to do this to a human equivalent of a brick wall is not, for me, particularly helpful.

One of my first therapists operated like this. She worked from a basement room in her house in a very inconvenient part of South London, and after work every Tuesday I would make the tediously complex journey to her. She would sit in a corner and stare at me until I said something. It was the easiest £70 an hour anyone could make. While I appreciate the whole point of therapy is to help you solve things yourself rather than telling you the answers, she took this to the extreme and barely spoke. This process did not help me at all. In fact it made me annoyed - something that she would have doubtless found ‘interesting’.

Since then I have enjoyed the following highlights:

The One With the Form

Cognitive Behavioural Therapy (CBT) is often lauded as the best cure of anxiety there is. I tried it years ago with a lovely woman who equipped me with a notebook and series of printed forms. The concept was simple enough - when you’re having a negative thought, you write it down then work through a series of questions about the thought to help you challenge your thinking and help you re-frame into a less damaging thought. The process of doing this repeatedly re-wires the neural pathways in your brain until ta-dah! Those nasty thoughts are gone. Only they didn’t go. And the whole process made me want to punch people in the face.

I tried it again recently in app form. Same result. Something about the basic formula of this was - and is - irritating to me in a way I cannot put my finger on. Life is too hard already to layer on extra stress.

The One Who Got Weird About Money

One of my longer therapy relationships was with a woman who operated out of a building near my office in London and had a penchant for brightly coloured trainers. I went every week for about two years - prompted by my small post-divorce breakdown. I continued to see her as my mental health at work deteriorated and I ended up with extreme burnout and had to stop work for a while. A while later a friend pulled me up on this.

“Wait” she said “You were seeing a therapist the whole time that was happening?”

“Yes!” I said, feeling proud of my proactivity.

“Do you think maybe she was… not a very good therapist?” she enquired gently.

It was a real penny drop moment. Although it was only when my therapist suddenly, out of the blue, started aggressively demanding payments up front for a month in advance that I decided to let her go. Something felt off - alarm bells finally rang.

My time with this woman was not wasted - with her I started to understand the impact my early years had on my ways of thinking. But just understanding this didn’t seem to actually change anything.

The One With The Portal

Having thoroughly explored my childhood and uncovered - but apparently not solved - my many issues, I sought out someone who could offer me more practical help. I found a coach/therapist hybrid who claimed she never gave more than 6 sessions as that’s all she needed to change your habits. She was trained in neurolinguistic programming, havening, tapping (or emotional freedom technique), EMDR (eye movement desensitisation and reprocessing) and a whole raft of other neuro-science led practices. She was frighteningly and reassuringly expensive.

But something didn’t quite gel. For starters, after every session I would walk away with extensive and confusing homework via her online ‘portal’. This involved battling a clunky online system to try and find the right pdf document and then practising about 8 different things at home. It all got overwhelming, and I began to dread my sessions for fear of not having done it well enough. It felt like my childhood piano lessons when I knew I hadn’t practised. While evidence shows benefits to all her practices, trying to do them all at once in a clusterfuck of neuroscience, didn’t really work for me.

My relationship with her ended when I went to her with intrusive suicidal thoughts after my mother’s death - only for her to tell me I was fine and this was just grief. Ho hum.

The One Who Told Me How Hard I Made Things

After Portal Woman, I found solace with one of the few male therapists I’ve worked with. We worked well together and his approach covered both practical exercises and a lot of good ol’ fashioned talking. Although there was one bit where I had to talk to my inner critic as if they were sitting in a chair that I still squirm at the thought of. After a productive few months we agreed we’d gone as far as we could - and he kindly invited me to reach out in the future if I ever needed a one-off top up. Something I did every few months.

Until one day half-way through a top-up he stopped me.

“I just need to say, Annie, that I find this very difficult. I don’t hear from you for ages and then you come to me with a problem and it’s just a lot for me to deal with”.

Because I was clearly not cured this sent me into a spiral of guilt and failure. And we never spoke again.

The One Who Is Kind And Accepting

In recent years I’ve found a woman who is kindness personified - and realised perhaps that this is what I need. Again we saw each other intensely for a while and she is now (seemingly genuinely) happy for me to check in when I need to speak to her.

She is interactive, chatty, explains how she sees my mind working, highly empathetic and kind. So, so kind. Talking to her makes me feel I might not be such a freak anymore. She’s taught me to challenge my thoughts in a way that doesn’t involve vast quantities of paperwork and to cut myself some slack. Which I mostly fail at doing but continue to try. Like all of us, I am a work in progress.

How to do therapy

This is all to say that therapy is a vast and complicated landscape that the troubled must traverse, often without a map, in the dark and without a torch. So don’t beat yourself up if you get a bit lost, or end up getting side-tracked by some well-meaning bandits.

The imperfect world of therapists and clients is like Tetrus; to work, the right shaped block needs to find its perfect resting place. Of course this is blindingly obvious when I write it down - and perhaps I’m the only person in the world to have swallowed the overly simplified story of girl-meets-therapist-and-lives-healthily-ever-after.

But I rarely see therapy mis-fires written about or discussed, and I can’t help feeling this leads to an unhealthy shroud of silence around the topic. For me, it makes me feel ashamed. I’ve been working on getting well for a long time and sometimes it feels like walking up the down escalator.

For anyone else who feels this - maybe it’s time to change the narrative. Because therapists are human and as flawed as the rest of us. And because we are all unique and complex, what we need to help us will likely be unique and complex. As much as the idea of a quick fix is alluring, therapy is more likely to feel like a long and expensive game of trial and error. But that doesn’t mean you’re broken and it doesn’t mean you should give up looking.

As for me, my time with eleven therapists has not cured me - but I manage things much better now. I do the practical things I can - eat well, sleep, drink minimally, walk my dog, exercise, sing loudly in the car to showtunes (don’t tell anyone this). I try to do more things that have meaning for me and fewer things that feel like a bullshit waste of time. And I’m getting better at seeing when a bad patch is appearing and knowing what to do about it.

If you’re struggling this week and feeling like the therapy isn’t working, here are my reflections on two decades of therapy. I hope they might help:

• Therapists are human too. They might just not be your person. Like dating or friendships, you’re not going to gel with everyone.

• CBT doesn’t work for everyone. I’ve met quite a few people like me and discussed this with numerous therapists. If you hate it, try something else.

• If you’re not feeling it, move on. Do not, as they say, throw good money after bad. Just because the neuro-hypnotherapist worked wonders for your best friend, does not mean they’re the one for you.

• Understanding things doesn’t always make them better. I now know why my mind works in unhelpful ways - but this knowledge doesn’t stop it happening. Sometimes practical methods work really well alongside talk therapy.

• There won’t always be a cure - but you can still make things better. Don’t despair if it seems you’re not cured by therapy. Everything you do helps makes things a little bit better - and this adds up.

• Don’t fake it - trust how you feel and if a certain therapy isn’t helping just say so. Nobody wants to be the person cheerfully faking a re-birth to The Samaritans. Trust me. It’s not a vibe.

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Hello team! If you’ve made it here to the end, my hearty thanks and congratulations. I’ve really struggled with this one - it’s another one I’ve agonised over the publish button on. But in my quest to write things I would find helpful to read, here we are - it felt like an important topic to tackle. Please do not take this piece as throwing shade at therapists - most people working in this space are heroes and work hard to make life better for their fellow humans. This is an extraordinary quest and one I respect and admire. Therapy is awesome - you just need to find the right fit.

If you’re a well-adjusted human who’s never had the need or desire to engage with therapy, I salute you (and, dare I say it, envy you!). This might not resonate. But for my people who’ve jumped aboard the therapy train and are happy to talk about it, I’d love to know your thoughts. Have you tried a form of therapy that didn’t work for you? Were you happy to move on - or did you worry you were the issue? Or does this simply sound familiar to you? I’d love to know if it’s not just me…