When Therapy Doesn’t Help

Diabetes is a condition that can make people feel like they have done something wrong even when they haven’t. The unpredictable fluctuations and frustrations that come with diabetes, even when you behave the way health-care professionals have suggested, can make you think that you messed up. For instance, when someone like me suggests that if you go to therapy you will feel better, and you follow my advice, you expect that you will feel better. However, sometimes that isn’t the outcome. So what might interfere with effective therapy, and who is at fault?


This is a complex question, and all of the people involved likely share some of the responsibility.

First, you must ask yourself the following questions: Why are you going to therapy, and what do you want to change? Most of us who seek therapy have some type of pain or problem that we can’t resolve on our own. We may be struggling with relationships, strong feelings that can get carried away, or some behavior we would like to alter. Clearly, we want help in moving ourselves or others from our current situation.

The more clear and specific you can be about what you want to change, the better your chances of finding a therapist who can be helpful. If you are uncertain about what issue you want help with, the therapist can help you identify it, but it might take a couple of sessions to figure that out. Once you have identified the “what,” the therapist will hopefully be able to identify the “how” part of the process. The therapist should be able to verbalize to you how he is going to be helpful and what part you will play in the process.

Now I’ll identify some of the issues that can interfere with good therapy. If you have further questions about these, I hope that you will leave a comment at the end of this blog entry.

  • A bad fit. This may sound simplistic, but I’m sure that you know when you feel a connection with someone and when you don’t. If you are not comfortable with a therapist, you are probably not going to trust them enough to risk very much. If it’s not working in the first couple of sessions, you will probably know. So trust your gut and ask for another referral. Most therapists will also understand this and be willing to help you find someone who may be a better fit.
  • The therapist is not trained in what you are seeking help for. If you already know what you want help with and the therapist has little or no experience or training in that area, don’t go to begin with. You do not have to be their training ground. I have always believed that a therapist needs to understand diabetes basics to work with people who live with diabetes. I really think that, even though many of the issues I help people address during therapy aren’t diabetes-related, diabetes is always in the background and I need to appreciate that. I believe that this is true for all issues you seek help with—the therapist must have some decent knowledge about such issues or they should say so and refer you to someone else.
  • You are not ready for therapy. While we all feel pain in our lives, the price we must pay, emotionally or relationship-wise, can prevent us from being willing to take action about our problems. In this case, the best therapist in the world can’t make change happen. They can help you discuss your ambivalence or confront your unwillingness to examine yourself, but therapy might not be helpful if you’re not ready for change.
  • The style of therapy doesn’t fit with how you process information. There are many different styles of psychotherapy. The therapist you seek will have been trained in various forms that he can describe for you. This is an opportunity for you to at least get a sense about how the therapist works and what he expects of you. You will also be able to have some appreciation about how you might do with this person and his approach. If it doesn’t fit for you and you don’t think you can adapt to his approach, seek someone who will fit better with how you think.
  • Lastly, sometimes therapy doesn’t work and no one is at fault. Sometimes the therapy works but the outcome isn’t what you intended, like the couple that seeks marriage counseling only to come to a decision to divorce. Sometimes therapy works to identify the issue, but you need to work on it on your own over time—or it might come back again, like recurrent depression.

    Tell me, what experiences have you had with therapy?

    Learn more about the health and medical experts who who provide you with the cutting-edge resources, tools, news, and more on Diabetes Self-Management.
    About Our Experts >>

  • Linda

    I would just like someone to hypnotize me into thinking ‘Sugar is poison.’ Then MAYBE I could avoid all of the goodies people bring into work for any occasion they can think of. .

  • Ephrenia

    Oh, but Linda, sugar isn’t poison. It is okay within limits to have sugar. I eat low carb (about 35 grams per meal) and I do sometimes have sugar. If I go to a birthday party, I want some cake, too. If I deny myself that, I feel bad about my diet. So… I eat a very low carb meal like chicken and broccolli, then have a small piece of cake (icing mostly removed) as my carb choice. No deprivation and still within my limits.

  • Burbot

    Therapy usually takes time. Don’t give up too soon. I have type 2 diabetes as well as schizoaffective disorder with clinical depression.
    I gave up on my psychotherapist after three months because we didn’t agree on certain concepts regarding alcohol abuse. But I returned a month later and am glad I did. He was willing to change his approach as so was I.
    Now, between my psychiatrist my psychotherapist my family doctor and a DBSA support group I can nearly live a normal life.
    Certainly, it is possible to get a bad match with any healthcare professional, but you should also ask yourself if maybe you might be part of the problem when this seems to happen.

  • Scott K. Johnson

    Hi Joe,

    I’m a big fan of yours – I was at one of the conferences that you spoke at (TCOYD a couple years ago maybe? Here in Mpls).

    I’m currently working with Kris in your office, and she’s really great too.

    I totally agree that for me, my therapist has to know diabetes. It’s such an integral part of my life. I have tried therapists not knowledgeable about diabetes, and it was no good for me.

    I found it very difficult through the insurance companies to find therapists who know about diabetes. The directories and staff they have there just don’t know enough about therapists specialties. More work needs to be done there to make it easier to find the help you need.

    I did a post on this back in February of 2005 (http://scotts-dblife.blogspot.com/2005/02/and-i-actually-pay-for-this.html).

    Thanks Joe, take care!

  • mindfuljoe

    Dear Scott K Johnson,
    Thanks for your comments. Insurance companies do not always share our philosophy of therapists needing to understand diabetes; I guess guys like us need to move in a different direction to improve this issue, maybe by training the insurance providers or at least the mental health case managers. This might open the door to improvement. After all, the DCCT did suggest that diabetes teams should consist of a mental health care provider in addition to a physician, nurse educator, and dietitian. Take care