Thank you for the question. Please keep in mind with my answer that I am from the United States and I don’t have a lot of knowledge about how mental health care works where you live. But some things are pretty much universal and applicable to anyone.

One of those things is that at 13 sessions, you should definitely have a working alliance established by now. The working alliance is also called the therapeutic alliance or just the therapeutic relationship. It basically means the bond that you have with your therapist. Research shows that stronger alliances between therapist and patient lead to better outcomes in therapy. The research also varies about how many sessions it takes to develop a working alliance, but as I said, at 13 sessions you should definitely have one by now. The things that should be present in a good working alliance are an emotional bond with the therapist, agreed-upon treatment goals, and an understanding of the work and tasks necessary to more forward. You are not in the introductory phases with this person anymore and you should be able to work well together at this point.

I will say that there are different therapeutic approaches that people can have. It may be that your therapist is more psychodynamic or psychoanalytic in their orientation. That would potentially lead them to be more of a “blank slate” in therapy where they are not leading you a whole lot. Rather, they are passive and let you explore on your own, sometimes bringing in their own interpretations. This is in contrast to an approach like mine that is a lot more solution-focused and active. I am always making sure that there is a plan, a direction, and work to be done. You are allowed to like whatever approaches resonate with you and dislike whichever don’t.

The fact that you brought up her not following up on things from previous sessions could be concerning. It really depends on why that is happening. It could be that she is just following your lead wherever you go and not forcefully integrating any particular topics. It could also be that she is forgetting from session to session. I’m not sure. But if you get the sense that she is not giving you the sort of care that you deserve, you are allowed to feel that way. You could be right about that and you are allowed to be concerned. I’m not sure how easy it is for you to change providers in your healthcare situation, but at this point you would be well within your rights to switch to another therapist. You definitely have given this course of therapy a fair try. You have been consistent for quite a few sessions, and it’s obvious that you care about getting better.

You could bring these concerns up with her if you’d like. Sometimes that is a helpful and constructive thing to do. You can bring up that you feel like you aren’t getting where you should be and that you aren’t feeling totally comfortable with the approach you are using. This is a common thing to be talked about in therapy. In fact, talking about therapy and the relationship between you and the therapist IN therapy is a very powerful tool and one of the things that I suggest doing to take therapy to the next level.

At this point though, if your gut is telling you that you just need to find someone else and that this part of your mental health journey has run its course, then you could also just send an email saying that you’d like to discontinue and find another provider. I understand that there could be a little guilt involved or concern about “sunken cost.” That’s valid – she has gotten to know you and it’s hard to start from scratch with new providers, but in the end, this is an investment in yourself. Sometimes, even if you really like the therapist, it’s important to get a new set of eyes and a fresh perspective. There’s nothing wrong with that and it does not indicate a failure on either of your parts.

If you’d like, you can try bringing up the issues we are talking about here to see if some progress can be made in the approach and if it seems that nothing is going to move forward, then you can find someone else to work with. Alternatively, if you want to take matters into your own hands a bit more, you could bring a notebook and take notes during session, so you know what you would like to follow up on in later sessions. You could also talk with her about the approach and ask what her theoretical framework is to see if that leads to a helpful discussion about your work together.

Thank you for writing in. I think your concerns are totally valid and you deserve to be getting good care