Help! My Client Says ‘Therapy Isn’t Working’—Now What?
Dr. Lisa Marie Bobby is a licensed psychologist, licensed marriage and family therapist, board-certified coach, AAMFT clinical supervisor, host of the Love, Happiness, and Success Podcast and founder of Growing Self.
Therapists, let’s be real—hearing a client say, “I don’t think this is working,” is basically the therapist’s equivalent of “We need to talk.” It sends that little bolt of panic through your nervous system, doesn’t it? Your throat tightens, your mind races, and suddenly, you’re questioning everything: Am I actually helping my therapy clients? Am I even good at this? Should I just start an Etsy shop and sell candles instead?
If you’ve ever had a client express doubts about their progress in therapy (or worse, ghost you entirely), you’re not alone. And more importantly—this is not a bad thing. In fact, it’s an opportunity. Because when therapy isn’t working for a client, something is getting in the way—and if we get curious instead of defensive, we can actually do something about it.
In my latest episode of Love, Happiness, and Success for Therapists, I dove deep into why therapy sometimes stalls, the common mistakes we make as clinicians, and—most importantly—what we can do to transform the situation into an opportunity for professional growth as a therapist.
The Hard Truth: Sometimes, It’s Not Just the Client
Early in my career, when a client wasn’t making progress, I’d do what many therapists do—I’d start focusing on them.
- Maybe they’re resistant to change.
- Maybe they’re not really engaging in the process.
- Maybe they have unconscious blocks keeping them stuck.
And you know what? Sometimes, those things are true. But here’s the kicker: If that’s the only explanation we consider, we’re missing a huge part of the equation.
What I’ve learned after years of clinical work and supervising other therapists is that when a client says therapy isn’t working, there’s a good chance something in the therapy itself isn’t working for them. And that means we have some reflecting to do.
The Therapy “Whack-a-Mole” Trap
One of the biggest mistakes I see (and one I definitely made in my early days) is what I like to call Therapy Whack-a-Mole.
Picture this: A client expresses frustration that they’re not making progress, so we start throwing interventions at them like we’re trying to win a giant stuffed bear at the state fair.
One session, it’s a CBT worksheet. Next, we’re diving into mindfulness. Then, we pivot to psychodynamic interpretation. Oh wait! Let’s try an experiential enactment.
Before we know it, we’re just tossing techniques around, hoping something sticks. Meanwhile, the client is more confused than ever, and we’re exhausted from trying everything.
Here’s the hard truth: When we don’t have a clear, structured approach to therapy, our clients feel it. And when they can’t see a roadmap, they lose confidence in the process (and in us).
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The Key to Effective Therapy: A Clear Theory of Change
If we want to prevent clients from feeling lost (and prevent ourselves from flailing), we need more than just a collection of techniques. We need a structured approach—a theory of change.
A solid theory of change helps us answer critical questions:
What is the actual problem we’re solving? (Not just symptoms, but the deeper issue.)
What is the process this client needs to go through to create change?
What specific steps will help them move forward?
When we have a clear, evidence-based framework for understanding the client’s struggles and a step-by-step plan for working through them, therapy stops feeling vague and starts feeling purposeful.
Coaching vs. Therapy: Are You Using the Right Approach?
Here’s another truth bomb: Many therapists are using a therapy model for clients who would actually benefit from coaching psychology.
If you’re in private practice, you probably see a mix of clinical and non-clinical clients. And yet, therapy training programs don’t teach us how to work with non-clinical clients effectively.
If someone is struggling with general life satisfaction, career transitions, or goal-setting—but doesn’t meet diagnostic criteria for a mental health condition—traditional therapy might not be what they need. Instead, a structured coaching approach can help them develop clarity, motivation, and action-oriented change.
And no—this isn’t “woo-woo” life coaching from TikTok influencers. Coaching psychology is a real, evidence-based approach that therapists can (and should) be trained in. (If this piques your interest, check out my free training on The Therapist’s Guide to Coaching Masterclass.)
What To Do When a Client Says, “This Isn’t Working”
So, let’s talk about practical next steps. If a client tells you therapy isn’t working out, here’s how to handle it:
- Stay Curious, Not Defensive.
First, take a deep breath and set aside any initial panic. This isn’t a personal attack—it’s valuable feedback.
- Ask Open-Ended Questions.
Instead of jumping to conclusions, gently explore their experience:
“Can you tell me more about what you were hoping to get out of therapy?”
“What’s feeling stuck for you?”
“Have there been any moments that felt helpful?”
- Check for Clarity and Shared Understanding.
Are you and the client aligned on what the core issue is?
Have you clearly outlined how therapy is meant to help?
Does the client know what their role in the process is?
- Assess Your Approach.
Are you using a structured theory of change?
Is this client actually a good fit for traditional therapy—or would a coaching model be more effective?
Have you been transparent about what needs to happen for progress to occur?
- Track Progress More Explicitly.
Clients need to see movement. Consider using simple progress tracking methods so they can recognize their growth over time.
Growth is the Goal
Therapy is an evolving process—for our clients and for us. If a client isn’t making progress, it doesn’t mean you’re a bad therapist. It means there’s an opportunity to fine-tune your approach, clarify expectations, or expand your skill set.
If you’re curious about strengthening your ability to work with coaching clients—or just want to feel more confident when a client is struggling—check out my Therapist’s Guide to Coaching Masterclass. It’s free, packed with insights, and a game-changer for therapists in private practice.
And hey—let’s stay connected! Follow me on LinkedIn for more therapist tips, trainings, and professional support.
xoxo
Dr. Lisa Marie Bobby
P.S. If you found this helpful, think of one fellow therapist who could use this advice—then send this their way! Let’s support each other in making this work work. 💙
Resources:
Lai, Y. L., & McDowall, A. (2014). A systematic review (SR) of coaching psychology: Focusing on the attributes of effective coaching psychologists. International Coaching Psychology Review, 9(2), 118-134. https://eprints.bbk.ac.uk/id/eprint/51154/
Hart, V., Blattner, J., & Leipsic, S. (2001). Coaching versus therapy: A perspective. Consulting Psychology Journal: Practice and Research, 53(4), 229. https://psycnet.apa.org/fulltext/2002-00097-002.html
Worrell, M. (2014). What to do when CBT isn’t working?. How to Become a More Effective CBT Therapist: Mastering Metacompetence in Clinical Practice, 146-159. https://onlinelibrary.wiley.com/doi/abs/10.1002/9781394266487.ch10
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