A conversation with Dr. Amanda King of Psychiatry Connection
Therapy can be an important part of mental health care. But what happens when you have been going to therapy, doing the work, and still do not feel better?
That can be discouraging. Some people wonder whether they are doing therapy “wrong.” Parents may wonder why their child is still struggling after counseling or school-based support. Others may feel stuck between wanting more help and feeling nervous about seeing a psychiatrist.
Dr. Amanda King, a double board-certified psychiatrist in general psychiatry and child and adolescent psychiatry with Psychiatry Connection, said this is a common reason people come in for a psychiatric intake.
“A lot of patients who come to psychiatry for an intake assessment have been in therapy or counseling, either in the past or are currently in therapy or counseling,” King said.
Sometimes the next step is medication. Sometimes it is a different type of therapy, a more accurate diagnosis, a medical workup, or better coordination between providers.
The important thing to know is this: if therapy has not helped enough yet, it does not mean you failed. It may mean the care plan needs a closer look.
First, Make Sure the Diagnosis Is Right
“The first thing to do is, if you’re not finding that therapy is helping, is to make sure you’re diagnosed correctly,” King said.
That matters because symptoms can overlap. Anxiety, depression, ADHD, trauma, OCD, bipolar disorder, sleep problems, grief, major stress, and medical issues can sometimes look similar from the outside.
King said misdiagnosis can be a leading cause of what clinicians may call treatment failure. If the diagnosis is incomplete or inaccurate, the treatment plan may be aimed at the wrong problem.
A psychiatric evaluation can help clarify what is going on by looking at symptoms, timing, severity, functioning, family history, medical history, medications, sleep, substance use, and life context. If you are new to that process, Psychiatry Connection’s guide to what to expect at your first psychiatry appointment explains how that conversation typically begins.
Rule Out Medical Issues That Can Mimic Mental Health Symptoms
Psychiatrists are medical doctors, which means they are trained to think about both mental health conditions and medical factors that may affect mood, energy, sleep, and attention.
For example, King noted that hypothyroidism can cause fatigue, low energy, and low motivation that may look like depression. Anemia, vitamin B12 deficiency, and sleep apnea can also affect energy, mood, and concentration.
“These are all things you want to kind of look into and rule out first, that there’s not something medical going on that we could treat and then you would feel a lot better,” King said.
This does not mean every mental health symptom has a medical cause. It means a good evaluation should consider the full picture before deciding that therapy has simply “not worked.”
Make Sure You Are in the Right Type of Therapy
Another reason therapy may not be helping is that the type of therapy may not match the condition or the person’s needs.
“There are different types of therapy,” King said. “Not all therapy is the same.”
For depression and anxiety, King pointed to cognitive behavioral therapy, often called CBT. CBT can help people identify automatic thought patterns and cognitive distortions that may contribute to depression or anxiety.
For people who experience intense emotions, chronic suicidal thoughts, self-harm urges, or major difficulty with emotional regulation, King mentioned dialectical behavior therapy, or DBT. DBT can help people build skills for mindfulness, tolerating distress, regulating emotions, and communicating in difficult moments.
The right therapy depends on the person and the symptoms. If therapy has not helped, it may be worth asking: Am I in the right type of therapy for what I am dealing with?
When Medication May Be Worth Considering
For some people, therapy alone is not enough. Medication may be one part of the plan, especially when symptoms continue to interfere with daily life.
King said that for depression, combining psychotherapy and medication can be more effective than either treatment alone.
“The remission rates are much higher for people who do both therapy and medication,” she said.
That does not mean medication replaces therapy. In many cases, medication can reduce symptoms enough that therapy becomes more effective. For example, if depression is making it difficult to get out of bed, concentrate, or practice coping skills, medication may help create enough stability for therapy to work better.
Psychiatry Connection’s overview of psychiatric medication management explains how careful follow-up, dosage adjustment, side effect monitoring, and whole-person context all fit into the process.
Seeing a Psychiatrist Does Not Mean You Will Be Pushed Into Medication
One fear people have is that seeing a psychiatrist automatically means they will be pressured to take medication. King said that is not how thoughtful psychiatric care should work.
The first priority is understanding the diagnosis and the full context. In some conditions, medication may not be the first-line treatment. In others, therapy, skills-based support, lifestyle changes, family support, or treatment for related conditions may be part of the plan.
King said some patients have mild symptoms and want to start with therapy first. That can be reasonable.
“I’m totally fine with that,” King said. “I think it’s good to give therapy a good six to twelve week trial.”
In those cases, a psychiatrist may monitor progress, check in after a couple of months, coordinate with the therapist when appropriate, and revisit the plan if symptoms are not improving.
“We also want to collaborate with families and patients,” King said.
What If This Is About Your Child or Teen?
Parents often face a similar question: My child is in therapy or talking with a school counselor, but they still do not seem better. What now?
King said the general steps are similar for children and teens. The diagnosis should be reassessed, the type of therapy should match the symptoms, and medication may be considered when it is appropriate for the condition.
One difference is that children may not always notice or explain their symptoms clearly. Parents, caregivers, and teachers often see patterns across home, school, friendships, sleep, behavior, and emotional regulation.
Psychiatry Connection also has a broader guide to how psychiatrists support children, teens, and families if you are trying to understand what child and adolescent psychiatric care can involve.
When to Ask for a Psychiatric Evaluation
If you have tried therapy and still do not feel better, it may be time to consider a psychiatric evaluation if:
- Symptoms are still affecting work, school, relationships, parenting, sleep, appetite, or daily functioning.
- Therapy has helped somewhat, but symptoms are still getting in the way.
- You are not sure the diagnosis fully fits.
- You have tried counseling, but not a specific evidence-based therapy for your symptoms.
- A therapist, primary care provider, or school counselor suggested psychiatric care.
- You want to understand whether medication could be appropriate.
- You are worried there may be medical, sleep, or attention-related factors contributing to symptoms.
If you are having thoughts of suicide, self-harm, or harming someone else, seek urgent help now. Call or text 988, call 911, or go to the nearest emergency room.
You Have More Options Than “Keep Going” or “Give Up”
When therapy is not helping enough, it can feel like there are only two choices: keep doing the same thing or stop trying. There are more options than that.
You can reassess the diagnosis. You can look for medical contributors. You can ask whether CBT, DBT, trauma-focused therapy, family therapy, or another approach may fit better. You can consider whether medication may support the work you are already doing. You can ask your providers to coordinate.
At Psychiatry Connection, psychiatric care starts with a conversation. If you are already in therapy and still struggling, a provider can help you understand what may be missing and what next step makes sense for you.
Your mental health matters and getting help should not be complicated. Whether you are dealing with anxiety, depression, medication questions, a child who is not improving, or uncertainty about what to do next, Psychiatry Connection makes it easier to start care on your terms.
Compassionate providers, flexible options, and real support are just a conversation away.
