Starting psychotherapy can feel like a brave first step toward change—especially when you’re struggling with something as painful and persistent as OCD, intrusive thoughts, or low self-esteem. Often, there’s a strong and understandable hope: that therapy will bring relief, clarity, or even resolution. And while psychotherapy can be life-changing, the reality of the process is often more complex and slower than many expect.
It’s not uncommon for people to start feeling stuck in therapy. They may question why they’re not “better” yet, wonder why their intrusive thoughts still come, or feel disheartened that certain patterns haven’t disappeared. Sometimes, this sense of stuckness is a sign that it’s time to rethink expectations—and consider what kind of work needs to be done outside of sessions.
Let’s explore what realistic expectations for therapy look like, why progress isn’t always obvious, and how you can engage with the process in a way that supports real, lasting change.
Progress in Psychotherapy
One of the most common therapy myths is that it leads to steady, upward improvement. In reality, mental health progress is rarely linear. You might feel great one week, only to feel stuck or overwhelmed the next. Sometimes, you may even feel worse before you feel better—because therapy for anxiety, OCD, or trauma often involves confronting difficult emotions or memories that have long been avoided.
Plateaus and setbacks don’t mean failure; they’re often signs that you’re doing meaningful, deep therapeutic work. Progress may be invisible at times, taking the form of new insights, increased awareness, or the ability to sit with discomfort without reacting.
Recognising Therapy Progress
When you’re immersed in the hard parts of therapy, it’s easy to forget how far you’ve already travelled. Many clients overlook the growth they’ve made—like being more self-aware, more assertive, or more compassionate toward themselves—because they’re focused on what’s still not “fixed.”
That’s why tracking therapy progress is so important. Looking back at journal entries, therapy notes, or past situations can offer a clearer picture of your development. Mental health progress often looks like subtle shifts: fewer compulsions, more emotional regulation, or moments of self-compassion.
Doing the Work Between Therapy Sessions
If you’re feeling stuck in therapy, it’s worth asking whether you’ve been doing the work between sessions. While talking with your therapist is important, much of the transformation happens outside of the therapy room—through CBT homework, exposure exercises, and daily habits.
This is especially true for issues like OCD and self-esteem. With OCD, for example, real change often comes from consistently doing exposure work, resisting compulsions, and learning to sit with uncertainty. With self-esteem, it’s about challenging critical inner voices, setting boundaries, and showing up differently in relationships.
Rethinking expectations means recognising that insight alone rarely leads to change. It’s the application of that insight—often repeatedly and imperfectly—that creates real growth. This work is not easy. It requires effort, courage, and a willingness to be uncomfortable.
Understanding OCD, Intrusive Thoughts, and Self-Esteem Issues
These struggles are persistent because they are reinforced by avoidance, mental compulsions, and self-critical thinking. Therapy can’t simply eliminate intrusive thoughts or instantly improve self-esteem. But it can help you build a different relationship with your thoughts and experiences—one rooted in acceptance, resilience, and behavioral flexibility.
Why Change Feels Hard: Resistance in Therapy
Even when something feels painful, it can still feel safer than change. Familiar patterns—even if uncomfortable—are predictable. Real change involves stepping into the unknown, which can bring up fear and resistance.
This resistance is normal. In psychotherapy, noticing your resistance can be a powerful part of the process. It allows you to name what feels threatening about getting better—and decide whether you’re ready to keep going anyway.
Real-Life Examples from Therapy
A Client With Autism Learning to Trust Himself
One client with autism began therapy by asking if I was an expert in the condition. While I knew a fair amount, I explained that I wasn’t a specialist. We explored why he felt he needed one. What emerged was the belief that someone else needed to “fix” things for him.
Over time, he came to understand that he was the expert in his own experience. By communicating his challenges, we could work together to find solutions. Some of the most meaningful progress came when he rethought his expectations of what therapy should offer and took ownership of what he wanted to work on. Sometimes the most helpful approach was to accept his limitations while also supporting his desire to grow and move toward his goals.
A Young Woman with OCD and Health Anxiety
Another client, a young woman dealing with OCD and health anxiety, felt deeply ashamed of her intrusive thoughts. While she initially engaged in therapy, she struggled to do the exposure and response prevention (ERP) work required to reduce her symptoms.
She took a break, returned several months later, and once again found the process too uncomfortable to continue. Her journey reminds us that OCD therapy is demanding—and that it’s okay to need more than one attempt. It also shows how important it is to engage in the work consistently for therapy to be effective.
Setting Realistic Expectations for Therapy
Psychotherapy is not a quick fix. It’s a process—sometimes a slow and challenging one—that unfolds over time. Rethinking your expectations doesn’t mean expecting less—it means understanding more about what therapy involves, and recognising your own role in the process.
You may begin therapy seeking symptom relief, and over time, find yourself developing self-awareness, resilience, and deeper relationships. This is therapy doing what it’s meant to do: not just treat the surface, but support you in becoming who you want to be.
Feeling Stuck in Therapy? Here’s What to Do
If you’re feeling stuck in therapy, talk about it. Stuckness is not unusual, and it often leads to important breakthroughs. You might:
Revisit your goals
Explore any avoidance or fear
Look at whether you’re engaging between sessions
Talk to your therapist about pacing or approach
Sometimes the stuck point is where the real work begins.
In Conclusion: Keep Going
Therapy works—but it takes time, persistence, and a willingness to sit with discomfort. Real change comes from the inside out, not just from insight but from the work you do between sessions, the risks you take emotionally, and the new habits you build over time.
If you’re feeling stuck in therapy, you’re not alone—and you’re not failing. Take a breath. Reflect on your expectations. And when you’re ready, recommit to the work. You’ve already come further than you think.
The holiday season is a time of mixed emotions, and it’s okay to experience loneliness or sadness alongside moments of joy. By understanding your feelings and taking steps to connect with yourself and others, you can create a meaningful holiday experience. Remember, you are not alone—support is always available to help you through challenging times. The holidays can be an opportunity for growth, healing, and discovering new ways to celebrate life.