If you have had counselling before and come away feeling much the same, there are usually two conclusions people draw. Either therapy does not work, or there is something wrong with them.
In my experience, neither is usually true.
Many of the people who contact me have already worked hard at this. They have seen one or two counsellors, or completed a course of CBT through the NHS, and they can describe their own history clearly. They know where the patterns come from.
And still, when the trigger arrives, the body does what it has always done.
That gap between understanding something and being free of it is worth taking seriously. It is information, not failure.
Insight and change are not the same thing
Most talking therapy works through understanding. You put words to what happened, you make sense of it, and the meaning shifts. For a great many difficulties that is enough, and it is often exactly what someone needs.
But understanding lives in one part of the brain. The threat response lives somewhere older and faster, and it does not wait to be consulted.
This is why you can hold a completely accurate account of your own history and still find your chest tightening when someone raises their voice. The part of you that reacts was never persuaded by the explanation.
When people tell me they know exactly why they feel this way and it has changed nothing, they are usually describing this precise problem.
Four reasons therapy sometimes does not reach it
There is rarely one answer. These are the four I come across most often.
The relationship was not the right one
Research consistently finds that the relationship between client and therapist predicts outcome more reliably than the particular model used. That is not always a comfortable thing for the profession to sit with, but it is well established.
A therapist can be skilled, experienced, and simply not the right person for you. That is not a criticism of either of you.
If you spent your sessions managing how you came across, or found yourself quietly reassuring your therapist, the work was probably not able to go where it needed to go.
The processing started before there was ground to stand on
With trauma, and particularly with trauma that was ongoing or began in childhood, preparation is not a warm-up. It is a substantial part of the work.
If someone begins processing difficult material before they have reliable ways to settle themselves, the experience can be overwhelming rather than useful. People often stop at that point, and understandably conclude that therapy made things worse.
In my experience this is the most common way trauma work goes wrong, and it is a problem of sequence rather than a problem with the person.
The work stayed with the story
Some difficulties are held in the narrative, and talking changes them.
Others are held in the body: the bracing, the flatness, the reaction that arrives before any thought does. You can talk about those at length without ever reaching them.
Approaches like EMDR and Deep Brain Reorienting exist because of that distinction. They work with the response itself rather than with your account of it.
The approach did not match the problem
A structured, short-term approach aimed at present-day thinking can work very well for a specific and contained difficulty.
Applied to complex trauma, dissociation, or long-standing relational patterns, it can feel like being handed tools for a job you are not actually doing.
That is a mismatch, not a failure on anyone’s part.
What this does not mean
It does not mean the therapy you had was wasted. A great deal of the understanding people arrive with was built in earlier work, and it often makes the next stage possible rather than redundant.
It also does not mean a different method is guaranteed to work. I would not promise that, and I would be cautious of anyone who did.
What it means is that “therapy did not work” is usually too broad a conclusion to be useful. Which therapy, aimed at what, at what point, and with whom.
Where I would start
If you contacted me having already tried therapy, the first thing I would want to know is what kind it was and what happened.
Not to critique it, but because the answer usually points somewhere. If the fit was the issue, that is one conversation. If the material was there but the work only ever reached the narrative, that is a different one.
Sometimes the honest answer is that what you had was appropriate and the timing was wrong. Sometimes it is that nobody addressed the nervous system at all.
I work with trauma, complex trauma, and dissociation, and I am trained in EMDR, attachment-focused EMDR, and Deep Brain Reorienting. Which of those I would suggest, if any, depends entirely on what you tell me.
A conversation before you commit to anything
Everything starts with a free 20 minute phone call. There is no charge for it and no expectation that you book afterwards.
It is a chance for you to say what has happened so far and to ask whatever you want to ask, including whether I think I am the right person. If I do not think I am, I will say so and try to point you somewhere more useful.
If you have been through this before and are wary of starting again, that is a perfectly reasonable place to begin from.
If you would like to talk it through, get in touch to arrange the free 20 minute call, or ring 07470 514551.
