When therapy isn't working: When to switch therapists

A good therapy relationship is the cornerstone of treatment. Research shows the alliance between therapist and client is one of the strongest predictors of therapy outcome: often stronger than the therapy modality itself. When it doesn't work, therapy doesn't progress. According to a 2024 Yle report, getting stuck in unsuitable therapy can delay proper treatment by years (Yle 2024).

This article covers how to recognise that therapy isn't working, how to distinguish "a hard phase" from "wrong therapy", and how to switch within Kela rehabilitative psychotherapy.

How to recognise therapy isn't working

Lack of progress over time is the clearest sign. Although therapy doesn't always advance smoothly, you should at some point feel some development: new insights, symptom relief, or better coping. If you've had one session a week for two years and don't feel change, something needs reconsidering.

The therapist's approach doesn't fit you. Different therapists use different methods: psychodynamic explores the past, CBT changes thought patterns, solution-focused seeks practical solutions. If you're a CBT type but get only free association, or vice versa: fit needs assessment.

Concerns about the therapist's competence. If you feel the therapist doesn't understand your problem, pushes you in a particular direction, gives advice that seems wrong, or hasn't engaged with your specific issue (e.g. trauma, ADHD, OCD), it's worth raising the question.

Ethical issues. If the therapist crosses professional boundaries, makes inappropriate comments, or seems to exploit their position, ending immediately is justified. The matter should also be reported to Valvira.

Feeling unable to be honest. If you hide things from your therapist and don't feel you can be yourself, therapy can't produce results. A good therapist builds a space where honesty is possible.

What doesn't necessarily mean therapy isn't working

Some signs feel like therapy is going wrong but may actually indicate progress. Strong emotions during a session: anger, sadness, shame: are often a sign of working through something deep. Temporary symptom worsening can occur as defences are dismantled and difficult matters surface. Reluctance to attend isn't always a bad sign: avoidance may mean topics are getting close.

A good principle: before deciding to switch, discuss observations with your therapist. A good therapist takes feedback seriously, doesn't defend, and may adjust their approach. Sometimes the concern is part of the theme being worked on.

How to switch in practice

Switching from private therapy is simple: you announce ending, possibly hold a closing conversation, and find a new therapist. Cooperation ends without bureaucracy.

Within Kela rehabilitative psychotherapy, switching is possible but requires a few steps. Per Kela guidance, the situation is first discussed with the current therapist and the responsible care provider. The responsible provider is usually the psychiatrist who wrote the B-statement. The current therapist sends Kela feedback on the therapy. After this, you can start with the new therapist as long as they are a Kela-approved provider (Kela: Rehabilitative psychotherapy guide).

Ending doesn't mean the therapy "failed". It may be that you got the help you needed and the journey continues in a different context. Or that the situation has changed and a different approach serves better.

How to find a better-fitting therapist

Before choosing a new therapist, think about what you want differently. Did you want more structured work, practical tools, or conversely deeper exploration? Would chemistry be better with a therapist of a different gender? Do you need specific expertise (trauma, relationships, ADHD, eating disorders)?

A consultation call (often a free 15–30 min phone conversation) is a good way to assess fit before committing longer. Two or three consultation calls with different therapists can help.

The Finnish Psychological Association directory and Valitse terapia allow filtering by specialty and modality. Kela's provider registry lists Kela-reimbursed psychotherapists.

Where to get help

The responsible care provider (psychiatrist or doctor) helps with the Kela switching process. Finnish Psychological Association directory (psyli.fi). Kela's provider registry (asiointi.kela.fi). Valitse terapia (valitseterapia.fi). The Kysy Kelasta service (kysykelasta.kela.fi) helps with Kela process questions. In acute crises, MIELI crisis line 09 2525 0111 or 112.

Sources

• Yle: Psychotherapy can also be harmful
• Kela: Rehabilitative psychotherapy guide
• Kela: Procedural instructions for psychotherapists
• Kysy Kelasta: Switching therapists

Where to find a therapist

You can look for a therapist in several places:

• Search services run by the Finnish Psychological Association (Psykologiliitto) and professional bodies.
• Kela's service provider search, if you are applying for rehabilitative psychotherapy (only Kela-approved therapists qualify for reimbursement).
• The Valitse Terapia service and other directories.
• Your own health centre, occupational health service or student health service (YTHS), which can refer you onward.

You can contact several therapists and see with whom the collaboration feels natural.