Say it plainly and early, in a sentence or two: "Something about our sessions is not working for me, and I would like to talk about it." You do not need to have the perfect words or be sure you are right. You can raise it at the start of a session, or send a short message ahead of time if saying it aloud feels too hard.
Part of our guide: Which Type of Therapy Is Right for You?
A good therapist should treat this as useful information. It may feel rude or risky, but telling your therapist is part of the work. NIMH's own advice is that if you are not getting better after what feels like a reasonable time, talk to your therapist, and then consider other professionals or approaches if needed.
Why speaking up is worth the awkwardness
The research does not directly test "speaking up in session," so it is fair to be cautious. Several related findings do point in the same direction:
- The relationship is linked with results. A meta-analysis of 295 studies with more than 30,000 patients found a consistent, moderate link between the therapy alliance and outcomes. This does not prove the alliance causes improvement, since people who are improving may also feel better about their therapist.
- Repairing strains is linked with better outcomes. Researchers call a strain in the relationship, such as disagreeing about goals or tasks, a "rupture." In a meta-analysis of 11 studies, repairing ruptures was moderately associated with better results. It is a small body of research, and this is an association as well.
- Tracking progress can help. Some therapists use brief questionnaires to monitor progress. A 2021 meta-analysis of 58 studies found a small benefit for symptoms and dropout, and an earlier review found the clearest benefit in people who were predicted to have poor outcomes. A 2016 Cochrane review found insufficient evidence that routine monitoring improves outcomes, with considerable uncertainty, so the picture is not settled.
- People do leave quietly. About 1 in 5 clients drop out of therapy early, according to a meta-analysis of 669 studies. Some of them may have been happy to stop, and others may have left with a fixable problem that was never named.
- Your preferences count. In a meta-analysis of 53 studies, getting the kind of therapy they preferred was linked with fewer dropouts and somewhat better outcomes. Your therapist cannot adjust to a preference they do not know about.
For more on the relationship itself, see why a strong therapeutic alliance matters.
What is worth bringing up
Almost anything that affects the work is fair to raise, including:
- Pace. Too fast, too slow, or moving into painful material before you feel ready
- Method. Too much structure, too little, too much homework or not enough tools
- Direction. Sessions feel like weekly catch-up, or you cannot tell what you are working toward
- Something that was said. A comment that stung, felt judgmental or missed the point
- Identity and culture. Moments when you felt misunderstood, or when you had to do the explaining
- Something you have been hiding. Skipped homework, substance use, or stopping a medication
- Logistics. Lateness, cancellations, costs or how often you meet
- Your doubts. Wondering whether this therapy or this therapist is right for you
If the concern is about medication, such as side effects or wanting to stop, tell your prescriber as well. Please do not stop or change a medication on your own.
How to say it: sample wording
A useful formula has three parts: what you noticed, how it affected you, and what you would like. These examples are starting points, so change them to sound like you.
| Situation | You might say |
|---|---|
| Feeling stuck | "We seem to talk about the same things each week. Can we look at whether this is helping and what we are working toward?" |
| Too fast | "When we went into that memory last week, I felt shaky for days. I would like to slow down and talk about how we pace this." |
| Need more tools | "I understand my patterns better now, but I would like some concrete things to try between sessions." |
| A comment hurt | "When you said that last week, I felt judged. I have been thinking about it, and I would like to go back to it." |
| Hidden information | "I have not been fully honest about how much I am drinking. I was worried about what you would think." |
| Doubting the fit | "I am not sure this is the right fit. I would like your honest view, and to talk about whether another approach might work better." |
If saying it aloud feels impossible
- Write it down. Read from your phone, or hand over a note.
- Open with the hard part. "This is hard to say" is a perfectly good first sentence.
- Raise it at the start of the session. Waiting until the last five minutes leaves no time to talk it through.
- Use any check-in forms. If your therapist uses questionnaires, answer them honestly and do not soften the numbers.
- Message ahead. Ask how your therapist prefers to handle this kind of message, then send a short note that you would like to discuss something next time.
If you tend to please people or avoid conflict, you may find that this conversation is useful in itself. Practicing a difficult conversation with someone whose job is to listen can carry over to the rest of your life.
What a good response looks like
Therapists are people, and they may feel surprised. Most should still be able to do some version of the following:
- listen without rushing to defend themselves
- ask questions to understand what you experienced
- acknowledge their part, including apologizing if appropriate
- be open about what they can and cannot change, and why
- suggest a concrete change, then check back on how it is going
Sometimes a therapist may have a good reason for what they are doing. For example, exposure work is uncomfortable by design, so a therapist might explain why and offer to adjust the pacing. That is a fair response if they explain it clearly and you still have a say. They may also ask whether this pattern comes up elsewhere in your life. That is fine as long as it does not replace taking your concern seriously.
When the conversation does not help
Watch for these signs:
- your feedback is dismissed or treated purely as a symptom
- you are blamed or made to feel guilty for raising it
- nothing changes after you have raised it more than once
- you feel less safe or more hesitant to tell the truth afterward
You are allowed to change therapists, and you do not need anyone's permission. If you can, one closing conversation helps, and it is reasonable to ask for referrals and for records to be shared with your next clinician. Our articles on what to do if you do not click with your clinician and what to do if therapy is not working cover the next steps.
When feedback is not the right tool
Some problems are not a matter of fit. A sexual relationship or sexual contact with a therapist is never part of treatment. New York's rules on unprofessional conduct count any physical contact of a sexual nature between a psychologist and client, or between a physician and patient in psychiatry, as immoral conduct. State law on physicians also lists it as professional misconduct in the practice of psychiatry. State guidance for mental health practitioners lists forming a sexual relationship with a current or former patient among situations that may lead to problems. Other serious concerns include threats, harassment or billing fraud.
You do not have to raise these with the therapist first. In New York, you can file a written complaint with the State Education Department's Office of Professional Discipline about a licensed professional, and you do not need to be sure the professional is guilty. Complaints about physicians, including psychiatrists, go instead to the state Department of Health's Office of Professional Medical Conduct. Rules vary by profession and state, and this is general information rather than legal advice.
A note for parents and teens
Teens can give feedback too, and a parent can help them plan what to say. Parents who have concerns can also ask for time with the therapist, keeping in mind that some of what a teen shares is usually kept private. Ask how the therapist handles this at the start.
If you are looking for a new start or a second opinion, individual therapy describes how Mind Body Seven works with clients, and fees and insurance explains costs.
FAQs
Will my therapist be offended?
They may feel something, since therapists are human, but handling this kind of conversation is part of their job. Your care should not suffer because you raised a concern. If it does, that tells you something useful.
Should I give feedback even when things are going well?
Yes. Knowing what is helping lets your therapist do more of it. A sentence such as "that exercise really helped last week" is useful information.
How long should I wait before raising a concern?
There is no need to wait. Small concerns are often easier to discuss early, before they build up. For a concern about whether therapy is working overall, it may help to raise it even if you are only a few sessions in.
Is it okay to tell my therapist I saw someone else or want a second opinion?
Yes. Many clinicians welcome that, and it can help them coordinate your care. Ask for a release form if you want the two clinicians to talk.
