Previous therapy didn't help enough. How do I choose differently this time?
/Perhaps you have attended therapy before and found parts of the experience helpful. You may have developed a better understanding of yourself, recognised patterns in your relationships, or made connections between past experiences and present difficulties.
You may even have appreciated your therapist and found the conversations meaningful.
And yet, something you hoped would change has remained much the same.
Or perhaps the therapeutic relationship never quite worked for you. You struggled to feel understood, found it difficult to engage in the way you wanted, or felt that something important remained unexplored.
If you are considering therapy again, you may now have a clearer idea of what you are looking for. Perhaps you want a different way of working, a particular therapeutic approach, or a relationship in which you can explore aspects of yourself that were difficult to address previously.
Your earlier experience may help you make a more informed choice.
What did you learn from your previous therapy?
An experience of therapy does not have to be entirely successful to have been useful.
You might have gained valuable understanding without experiencing the changes you hoped for. This distinction is explored in two earlier articles: Why insight alone is not always enough and If insight is not enough, what then?.
But previous therapy can also teach you something about the kind of help that suits you.
Perhaps you wanted your therapist to engage more actively, or you needed more time to establish trust. Perhaps the conversations focused on understanding your difficulties when you wanted to explore how those difficulties were experienced emotionally or physically.
You may have discovered that certain ways of working were helpful, while others did not seem to reach what mattered most.
These observations can be useful when considering another therapist.
When the previous therapeutic relationship did not quite work
Sometimes what brings someone back to therapy is not only that their original difficulties remain, but also that something about the relationship with their previous therapist feels unresolved.
Perhaps you struggled to feel understood, found it difficult to express disagreement, or experienced moments of tension that were never fully explored. You may have felt that something was missing in the relationship without being able to identify exactly what it was.
For some people, these experiences remain important after therapy has ended. They may raise questions about what happened, what each person brought to the relationship, and why it became difficult to work together.
Exploring this with another therapist can sometimes be valuable in its own right.
It may help you understand more about the previous relationship, recognise what you need from a therapeutic relationship, or explore whether similar difficulties arise elsewhere in your life.
This does not mean assuming that the difficulty was caused by you, or that your previous therapist was necessarily responsible for it. Sometimes two people, despite their best efforts, do not find a way of working together that is sufficiently helpful.
A new therapeutic relationship can offer an opportunity to explore these experiences without having to reach a definitive judgement about the previous one.
You may already know what kind of work you want
People return to therapy with different expectations and degrees of clarity about their needs.
Some are looking primarily for a particular kind of therapeutic relationship. They may want to explore what happens when they become emotionally close to another person, feel misunderstood, fear rejection, withdraw, or become angry.
For them, an important part of therapy may be experiencing these difficulties within a relationship where strong feelings, disagreement and vulnerability can be recognised and explored. They may be looking for a relationship that can remain engaged through difficult moments, where misunderstandings can be addressed and connections repaired when possible.
Others have identified a therapeutic approach they wish to explore. They may be interested in Deep Brain Reorienting (DBR), Transactional Analysis (TA), EMDR or another form of psychotherapy, perhaps following their own reading, a recommendation or an earlier therapeutic experience.
Others may be looking for more attention to bodily experience, emotional processing or unresolved traumatic experiences.
These interests need not compete with one another.
Some people want a combination of relational and experiential work. They may need a therapeutic relationship in which difficult feelings and relational experiences can be explored, alongside opportunities to address trauma and work with bodily responses.
In such cases, the relationship is not simply a safe setting in which a therapeutic technique is applied. It can be an important part of the work itself.
The question is not only which techniques a therapist uses, but how the different aspects of the work can be brought together in a way that is appropriate for that person.
What if you are still unsure what you need?
Not everyone returns to therapy with a clear preference.
You may simply recognise that certain difficulties continue to affect your life. These might include persistent anxiety, repetitive thinking, relationship difficulties, emotional disconnection, low mood, exhaustion or difficulty managing everyday demands.
Perhaps you find yourself becoming overwhelmed in situations that others seem to manage comfortably. You may struggle to express your needs in relationships, withdraw when emotions become intense, or continue to experience physical reactions that are difficult to understand.
Some people recognise themselves in several of these experiences without knowing how they fit together.
If you would like to explore what you are experiencing, my What I Help With page describes a wider range of difficulties that might resonate with you.
Recognising yourself in a description does not establish the cause of your difficulties or indicate which therapy you need. It may, however, help you find the words to explain what you would like support with.
You do not have to arrive at therapy knowing which approach is most suitable. Exploring that question is also part of the therapist's professional responsibility.
Choosing the therapist you want to work with
Choosing a therapist involves more than selecting a therapeutic modality.
Professional training, registration and relevant clinical experience matter. So does the way a therapist understands difficulties, participates in sessions and develops a working relationship with clients.
If you are interested in a particular approach, you may want to establish whether the therapist has appropriate training and experience in using it, and whether they consider it suitable for the difficulties you are bringing.
If you want a combination of relational and trauma-focused or body-oriented work, it may be useful to ask how the therapist brings these different elements together, rather than simply whether they offer them.
And if the therapeutic relationship itself is particularly important to you, you might want to explore how the therapist responds to disagreement, emotional intensity, withdrawal or moments of misunderstanding.
A good working relationship does not necessarily mean feeling comfortable all the time. Some therapeutic experiences are challenging. What matters is whether there is sufficient trust, responsiveness and collaboration to explore what happens, while respecting your boundaries and pace.
It is also worth recognising that a therapist who offers an approach you are interested in may not necessarily be the person you want to work with. Conversely, a promising personal connection does not automatically establish that the therapist has the expertise your difficulties require.
Both considerations matter.
Using an initial consultation to explore your options
An initial consultation offers an opportunity to discuss what you are looking for and how a prospective therapist might work with you.
If you have attended therapy before, you can explain what was helpful, what seemed to be missing and what you would like to approach differently.
Depending on what matters to you, some questions worth exploring might be:
The approach: How does the therapist understand difficulties like yours, and what ways of working might they consider?
The relationship: How do they approach disagreement, difficult feelings, misunderstandings or periods when the therapeutic relationship feels strained?
The combination of methods: If you are interested in relational, somatic and trauma-focused work, how might these be integrated?
Reviewing progress: How would you and the therapist recognise whether the work is useful, and what would happen if it seemed to be making little difference?
You do not need to ask all these questions, or approach the consultation as an interview with a fixed checklist.
The conversation itself may give you a sense of how the therapist listens, responds and engages with you.
Do you feel able to ask questions? Is there room for uncertainty or disagreement? Does the therapist seem interested in understanding your particular experience rather than immediately fitting it into an established explanation?
The therapist also has a responsibility to assess whether the work they offer is appropriate. This may involve exploring aspects of your difficulties that you had not considered, discussing limitations or suggesting another form of support when indicated.
An initial consultation cannot guarantee that the relationship will work or that therapy will produce the changes you hope for. It can, however, help both of you consider whether there is a reasonable basis for working together.
A more informed beginning
Returning to therapy does not necessarily mean starting again from the beginning.
You bring what you have learned about yourself, your previous therapeutic experiences and perhaps a clearer understanding of the kind of help you are seeking.
Sometimes that understanding will be quite specific. Sometimes it will remain uncertain.
Either is a reasonable place to begin.
The aim is not to find a perfect therapist or identify a method guaranteed to work. It is to make a more informed choice about the person you want to work with, the possibilities they can offer and how you might explore together what is needed.
That understanding can continue to develop once therapy begins.
You and your therapist can revisit what you are working towards, how you are working together and whether something needs to change.
Choosing a therapist is an important decision, but it does not mean giving up your ability to question, reconsider or influence the work once it has started.
Considering therapy again?
If you have previously attended therapy and are considering a different approach or therapeutic relationship, I offer a free 20-minute initial consultation.
We can discuss what you are looking for, what you found helpful or less helpful previously, and whether my way of working might be suitable for you.
There is no obligation to continue.