When Therapy Doesn’t Help: How to Tell If You’re in the Wrong Kind of Support (and What to Do Next)

Lisa Marie Bobby, PhD, LMFT, BCC

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.

When Therapy Doesn’t Help

If you’ve been in talk-therapy for months… maybe years… and thinking “Why am I still stuck?” or “Why do I understand myself more but nothing is changing in my life?”… I want you to take a slow breath with me. If therapy feels like talking in circles, that doesn’t automatically mean you’re “doing it wrong.” It may mean you’re using the wrong kind of help for the result you want. And here’s the compassionate reframe I hope lands in your bones: you’re not failing therapy; it might be failing you.

Quick Answer

When therapy doesn’t help, it’s often because the type of support you’re getting doesn’t match your goal. Some therapy is designed for clinical symptom relief with progress tracking (evidence-based treatment), some is designed for insight and exploration (which can become circular if you want outcomes), and some support is coaching (skills + accountability, powerful but unregulated).

But here’s the tricky thing about coaching: most people calling themselves “coaches” have no training or credentialing at all. It is easy to get mixed up with a random person who may not be able to help you. (More on therapy vs. coaching)

In contrast, a licensed mental health professional who is a highly effective therapist but also a legitimately trained and certified coach—that is rocket fuel. They bring the best of both. The challenge is that only 3% of licensed therapists are also certified coaches.

How do I know this?

Here at Growing Self, part of what we do is run a training program accredited by the National Board for Certified Counselors that supports licensed therapists in becoming board-certified coaches.

If you’re a therapist reading this, feeling curious and wanting to know more, here’s the link to the Coaching Certification for Therapists program site.

If you are a person who’s been in therapy, and are now thinking that coaching might be a better fit for you…. but want to work with a therapist who is a truly qualified professional, we have an amazing opportunity for you to connect with one of the therapists in our coach training program at a deeply discounted rate.

Learn more about how to get eight sessions of coaching with a therapist at a fraction of their usual cost, right here.

The fastest path forward is to identify which “lane” you need—and then interview your provider so you can see the plan, the goals, and how progress is measured (APA Presidential Task Force, 2006; Wampold, 2015; Flückiger et al., 2018). I’ll be breaking down those three lanes for you a little further on in this article.

Why therapy can feel like it’s not working

Let me say something gently, but clearly: the word “therapy” means one thing to you… and often something totally different to the mental health professional sitting across from you. That mismatch alone can cost people months—sometimes years—of time and money.

You might walk into therapy thinking:

“Help me grow.”
“Help me change.”
“Help me build a better relationship.”
“Help me stop repeating this pattern.”

Totally reasonable. That’s how our culture uses the word.

But in the professional world, “therapy” often means clinical behavioral healthcare: assessment, diagnosis, and treatment designed to reduce symptoms and improve functioning (APA Presidential Task Force, 2006). That can be life-changing and life-saving when it’s the right lane.

And sometimes… it’s just not the right lane.

“Therapy isn’t one thing—it’s different models with different goals.”

You might be reading this thinking, “Yeah, but my therapy is different. I’m not getting clinical mental health treatment; instead, I’m talking to my therapist about how I feel and the things that are going on in my life.

Know this: if your provider is submitting health insurance claims to have a third-party payer foot the bill for the services they’re providing you, They have diagnosed you with a clinical mental health condition and they are telling your insurance company that they are providing you with medically necessary treatment to reduce your symptoms.

If that’s not what you have signed up for, there’s a disconnect between what you have consented to and what your provider is doing in practice.

If you’re reading this and connecting the dots, let me just say it out loud: Your provider may be committing insurance fraud to “make this work.” This is a known problem in the mental health industry.

“Why do I understand myself more but nothing is changing in my life?”

This is one of the most painful experiences—because insight can feel like progress. You’re connecting dots. You’re naming your childhood stuff. You’re seeing patterns. You feel emotionally lighter after a session.

And then… your real life stays the same.

That’s not a character flaw. That’s often a lane mismatch: insight-oriented work can be deeply meaningful, but if your goal is tangible outcomes, you may need a different structure—skills, practice, accountability, and tracking (APA Presidential Task Force, 2006).

“Insight without action can feel good, but it doesn’t necessarily create change.”

Also: therapy isn’t risk-free. Research has documented that some people do deteriorate during psychotherapy, and iatrogenic harm is a real topic in the field—especially when the approach doesn’t fit the person or the problem (Cuijpers et al., 2018; Parry et al., 2016).

The Clarity Model: 3 Lanes of Help

I’m going to give you a simple decision framework I use constantly.

The Clarity Model: 3 Lanes of Help

Lane 1: Clinical mental health treatment

Symptoms + impairment + diagnosis (when applicable) + evidence-based protocols + progress tracking. This is where clinical therapy shines (APA Presidential Task Force, 2006).

Lane 2: Insight-oriented talk therapy

Exploration, meaning-making, self-awareness, self-compassion. Powerful in the right season. But it can become circular if what you want is outcomes.

Lane 3: Evidence-based coaching

Skills + goals + accountability + behavior change. Can be rocket fuel. But it’s largely unregulated—so you must vet carefully (ProPublica, 2024).

“A good provider can explain the plan, the goal, and how progress is measured.”

If you take nothing else from this article, take this: when therapy doesn’t help, it’s often a mismatch—not a personal failure.

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The Clarity Model: 3 Lanes of Help

I’m going to give you a simple decision framework I use constantly.

The Clarity Model: 3 Lanes of Help

Lane 1: Clinical mental health treatment

Symptoms + impairment + diagnosis (when applicable) + evidence-based protocols + progress tracking. This is where clinical therapy shines (APA Presidential Task Force, 2006).

Lane 2: Insight-oriented talk therapy

Exploration, meaning-making, self-awareness, self-compassion. Powerful in the right season. But it can become circular if what you want is outcomes.

Lane 3: Evidence-based coaching

Skills + goals + accountability + behavior change. Can be rocket fuel. But it’s largely unregulated—so you must vet carefully (ProPublica, 2024).

“A good provider can explain the plan, the goal, and how progress is measured.”

If you take nothing else from this article, take this: when therapy doesn’t help, it’s often a mismatch—not a personal failure.

Lane 1: Clinical mental health treatment

This lane is for when symptoms are impairing your ability to function—panic attacks, trauma symptoms, severe depression, substance use, eating disorders, bipolar symptoms, etc. In this lane, “support” isn’t just a warm conversation. It’s structured treatment.

What you should expect here:

Lane 1: Clinical mental health treatment

What you should expect here:

Assessment and a clear working formulation (APA Presidential Task Force, 2006)
Evidence-based therapy vs supportive counseling as the core distinction (APA Presidential Task Force, 2006)
A treatment plan with goals
Progress tracking over time

If you want a deeper primer on what “evidence-based” actually means in therapy (and what it doesn’t mean), this is worth reading: evidence-based care explained in plain English.

And if you’re curious about one of the most common evidence-based approaches, you can explore: what cognitive behavioral therapy is (and when it’s useful).

“Good therapy isn’t just supportive—it’s intentional.”

Micro-exercise: “What lane am I actually in?”

Write down, in one sentence:

“I want help with ___.”
Then add:
“The change I want to see is ___.”

If your answer is primarily symptom relief and functioning, that’s usually Lane 1 (APA Presidential Task Force, 2006).

Lane 2: Insight-oriented talk therapy

This is the “let’s explore” lane. And I want to be very respectful of it—because it can be beautiful work.

In this lane you might:

understand your feelings more clearly
make meaning of your past
increase self-compassion
see patterns you couldn’t see before

If you want a clearer description of what this kind of therapy is, here’s a helpful explainer: what talk therapy is.

“What should I do if therapy feels like the same conversation every week?”

If you’re in Lane 2 and you keep revisiting the same pain without a bridge to action, it can start to feel like… a loop. A weekly emotional debrief. Relief without transformation.

Sometimes the answer is: Lane 2 is still right, but you need more structure inside it—clear goals, tracking, and intentional skill-building (APA Presidential Task Force, 2006). Then the new question becomes, is that something that my treating provider does? Unless your therapist has coaching competencies, they may not know how to do that.

And sometimes the answer is: you actually want Lane 3.

“Insight without a bridge to action can become a very expensive journal.”

Real-world example: individual growth

Let’s say you’re unpacking why you procrastinate. You understand it now: fear of failure, perfectionism, old messages about performance. You cry. You feel seen. You leave feeling lighter.

But your week looks identical.

A therapist might stop there, or focus on helping you be more compassionate with yourself. (And hey, nothing wrong with that!)

But as a therapist who is a coach, and who has a responsibility to help my clients make the changes they are hiring me for, I’m going to handle this moment differently.

That’s when I start thinking: “Okay—what’s the skill we practice? What’s the plan? How do we measure progress?”

Lane 3: Evidence-based coaching

Coaching can be incredibly effective for functional, capable people who want outcomes:

direction
relationship skill-building
confidence and follow-through
life design and purpose
accountability for change

But here’s the big, non-negotiable reality:

“Coaching can be powerful—and risky—because it’s largely unregulated.” (ProPublica, 2024)

If you want a clean overview of the differences, start here: life coach vs therapist: what’s the difference?
And if you’re sorting out adjacent forms of support, this can help too: coaching vs counseling—what changes, what doesn’t

“Do I need therapy or coaching for personal growth?”

Here’s my honest answer: it depends on the lane.

If you need symptom reduction and clinical treatment: Lane 1
If you need meaning-making and emotional integration: Lane 2.
If you need insight, but also skills, goals, accountability, and traction: Lane 3.

If you want a fast starting point, you can use this: therapy vs life coaching quiz.

Reflection question

When you imagine the help you want, what are you longing for most?

relief
understanding
change
direction
repair
accountability

Your answer is a compass.

“How do I tell if my therapist has a plan?”

I love this question because it’s so practical.

Ask yourself:

Can I clearly name what we’re working on?
Do we have goals we revisit?
Do I understand how progress is measured?
Do we ever talk about outcomes, not just feelings?

This isn’t about turning therapy into a corporate KPI meeting. It’s about making sure your care is intentional and not drifting.

The research on the therapeutic alliance is clear: the relationship matters (Flückiger et al., 2018; Wampold, 2015). But warmth alone isn’t the whole deal. A strong alliance paired with an intentional approach is where people tend to do better.

“A good provider can explain the plan, the goal, and how progress is measured.”

Furthermore, this is true for effective therapy and also for effective coaching. The difference is that in a coaching relationship, this is expected (it is what coaching provides). That is not always the case with therapy.

Questions to ask a therapist (and how to interview them)

You’re allowed to interview your provider. Truly.

“You’re allowed to interview your provider—this is healthcare, not a blind date.”

If you want a complete list you can bring to a consultation, start here: the best therapy questions to ask.

First and foremost, you must get clear on why you’re there and what you want to get out of this.

Let’s think about whether psychotherapy would be beneficial for you. Ask yourself this question: Are you looking to connect with a therapist because you are having difficulty functioning day-to-day?

Do you feel paralyzed by anxiety? Are you routinely plagued by scary thoughts about worst-case scenarios? The clinical term for that is generalized anxiety disorder, which is very real and is a treatable condition.

Are you having trouble getting out of bed, feeling exhausted, and feeling like everything in your life is horrible (including you)? There’s a good chance you might be struggling with a major depressive episode that requires treatment.

Have you lived through horrible things and now you’re having scary intrusive thoughts, dealing with a lot of emotional reactivity, or avoiding things to the degree that it is creating problems in your life? The clinical term for that is post-traumatic stress disorder, and you might have it.

But if you are doing okay, and the reason that you’re feeling motivated to work with a therapist is because you want to work on yourself, you want to feel happier, more confident, you want to have a better relationship, you want to figure out your career, or you want to get support as you navigate a difficult life transition, coaching may actually be a much more productive approach for you.

Step one is to connect with a provider who does what you want them to do.

Scenario 1: If you are looking for clinical mental health treatment to help you recover from a trauma, you should read bios carefully. Your provider should have specialized training and experience in an evidence-based treatment approach that has been shown to be effective in resolving symptoms of PTSD.

Scenario 2: If you are looking for a provider who can help you and your partner communicate more effectively and get on the same page about finances, you would be much better served by working with a licensed marriage and family therapist who is a credentialed coach offering relationship coaching with a subspecialty in financial coaching for couples.

Imagine for a moment what might happen to the couple in Scenario 2 if they connect with a therapist who specializes in trauma treatment, but has no specialized skills or competencies in:

1. Relational dynamics

2. Coaching psychology

3. Financial coaching for couples

If you’re thinking, “Wow, the experience of that would be very different and the outcomes would be very different too,” you are absolutely right.

Unfortunately, that happens all the time.

After You Identify a Therapist Who Has The Right Training & Experience…

Interview them! What most people do not understand is that not all therapists are the same. Not all approaches will be effective for you. It’s important for you to be an empowered and informed consumer in this space, coming into a relationship with a prospective therapist prepared to ask the right questions in order to understand whether or not hiring this person to help you is going to get you the outcomes you want.

Here are the core questions I want you to actually use:

Do you have experience in helping people with [this specific thing?]
If so, what methods do you use in order to help people get from A to Z?
“How do you typically structure your work?”
You’re listening for a process, not improvisation.
“How will we define success?”
Then: “How do you know if therapy is working?”
You deserve clarity.
“What would you expect to see change in the first 10-12 sessions?”
That’s not you demanding instant results. That’s you asking for markers.
“How do you help clients translate insight into behavior change?”
Because insight alone may not create movement
“If I use insurance, what will you diagnose me with, and what will my treatment plan be?”
If you’re there for “couples therapy” be sure to ask: “Will it be me or my partner who will be the identified patient? What will you diagnose them with, and on what basis? What will the treatment plan be?” Remember: If you’re using health insurance in therapy, your therapist is claiming that this is medically necessary treatment and all sessions must be focused on the symptom reduction of the identified patient.

“Should therapy feel hard or just comforting?”

Sometimes therapy is comforting. Sometimes it’s challenging. Either can be appropriate depending on the goal and the lane.

But if therapy is always soothing and never translates into new actions, new skills, or measurable shifts—and you’ve been there a while—listen to that data.

If you’re worried you’re seeing therapist red flags, this can help you name them: signs of a bad therapist (and what to do next).

Therapy vs coaching: how to choose without guessing

Let’s make this simple.

Skills-based therapy vs talk therapy

Skills-based therapy often includes structured practice and progress tracking (APA Presidential Task Force, 2006).
Insight-oriented talk therapy is often exploration-focused and may not prioritize outcomes in the same way.

Insight-oriented therapy vs CBT

CBT is typically more structured and skills-based, with clearer mechanisms for change and tracking. Insight-oriented therapy can be more exploratory.

Coaching vs psychotherapy differences

Psychotherapy is a regulated healthcare practice. Coaching is not regulated in the same way (ProPublica, 2024). That doesn’t mean coaching is “bad.” It means you need to vet carefully.

Always try to work with a licensed mental health professional who is also a board-certified coach. (BCC)

Insurance-driven therapy realities (what you deserve to know)

Let’s talk consumer rights.

“Insurance reimburses medically necessary treatment, not personal growth.”

In the U.S., insurance and Medicaid documentation standards commonly require clinicians to document medical necessity and treatment progress, which shapes how sessions are framed and recorded .That reality can be fine—if you’re truly in Lane 1. But if what you want is personal growth or relationship skill-building, insurance-driven structures can create pressure toward a medical model.

“If I use insurance, do I have to be diagnosed?”

Often, when insurance is billed, a diagnosis (or diagnostic framing) is commonly part of the documentation that supports medical necessity. This isn’t about you being “broken.” It’s about how the system works.

If you want a detailed walk-through, here’s a resource that breaks it down: using insurance for therapy (what to expect).

And if cost is part of your decision-making (it usually is), you might also want: how much therapy costs (and what influences price).

“The system can shape the frame—even when your real need is different.”

Coaching safety (because life coaching is unregulated)

Let’s be real: there are wonderful coaches… and there are people doing work they are not qualified to do.

“Coaching can be powerful—and risky—because it’s largely unregulated.” (ProPublica, 2024)

“What qualifications should a coach have if they work with anxiety or trauma?”

If someone is claiming to “treat” trauma or anxiety through coaching, that’s a red light warning sign. Those are clinical domains with real risk if mishandled (Parry et al., 2016; Cuijpers et al., 2018). Coaching is not regulated in the same way as psychotherapy. If you are encountering any coach claiming that coaching is appropriate to help you with a mental health condition or trauma, that is a sign that they are an unqualified provider. Run away fast.

If you want to revisit the differences again, this is a solid reference: life coach vs therapist.

Summary + key takeaways

If you’ve been thinking “therapy not working” or “therapy feels like talking in circles,” please hear me: you’re not broken. You may be in the wrong lane.

Key takeaways:

Therapy isn’t one thing—it’s different models with different goals.
Lane 1: clinical treatment = symptoms + impairment + evidence-based care + tracking
Lane 2: insight-oriented talk therapy can be meaningful but may feel circular if you want outcomes.
Lane 3: coaching can drive change through skills and accountability, but it’s largely unregulated—vet carefully
The relationship with your therapist matters, and so does the approach
Therapy can sometimes have negative effects, especially when there’s a mismatch or a harmful frame
You’re allowed to interview your provider—this is healthcare, not a blind date.

I hope this conversation helps you make informed choices about the path that is genuinely best for you.

I will also add that the very best possible place for you to go, if you’re unsure about what type of support you need, is to a therapist. This should be a fully licensed mental health professional who is also a board-certified coach. You can speak with them about your hopes and goals and then get their informed recommendations about what type of process would be most helpful and appropriate for you.

That is what we do here at Growing Self. Schedule a free consultation with one of our coaching therapists to discuss your hopes and goals, and the best path forward.

Your partner in growth,

Dr. Lisa Marie Bobby

P.S. Curious about coaching? Want results at a truly affordable rate? How does $49 per session sound? Growing Self offers a unique opportunity to work with an exper tlicensed therapist going through our Coaching Certification Program For Therapists. Learn more at https://www.GrowingSelf.com/grow Not sure if coaching or therapy is right for you? Our intake process is designed to help you find your best fit, so you can be confident you’re getting the right type of support.

References

American Psychological Association Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271–285. https://www.apa.org/pubs/journals/features/evidence-based-statement.pdf

Centers for Medicare & Medicaid Services. (n.d.). Medicaid documentation for behavioral health practitioners (Fact Sheet). https://www.cms.gov/medicare-medicaid-coordination/fraud-prevention/medicaid-integrity-education/downloads/docmatters-behavioralhealth-factsheet.pdf

Cuijpers, P., Reijnders, M., Karyotaki, E., de Wit, L., & Ebert, D. D. (2018). Negative effects of psychotherapies for adult depression: A meta-analysis of deterioration rates. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2018.05.050

Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. https://doi.org/10.1037/pst0000172

Parry, G. D., Crawford, M. J., & Duggan, C. (2016). Iatrogenic harm from psychological therapies—time to move on. The British Journal of Psychiatry, 208(3), 210–212. https://doi.org/10.1192/bjp.bp.115.163618

ProPublica. (2024). Utah life coaches aren’t licensed. Should they be regulated? https://www.propublica.org/article/utah-therapists-life-coaches-regulation

Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270–277. https://doi.org/10.1002/wps.20238

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When Therapy Doesn’t Help: How to Tell If You’re in the Wrong Kind of Support (and What to Do Next)

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