Summary
On Outreach With Reggie, Dr. Stacey Krauss, CEO of Transitions Counseling and Consulting, spoke with host Reggie Holloway about what to do when therapy doesn't seem to be helping. She shared what she saw change during her years as an active-duty U.S. Army psychologist, what being stuck in therapy can look like, why the frequency of sessions matters, how to tell a therapist the fit isn't right and how intensive outpatient and partial hospitalization programs differ from weekly therapy.
Key Takeaways
- According to Dr. Krauss, studies found most people in the United States thought it would take one or two therapy sessions to start feeling much better, but progress usually takes much longer.
- According to Dr. Krauss, feeling stuck can look like relief after a session that fades by the end of the week, or several tries at therapy without a lasting result.
- Frequency matters. Dr. Krauss says the research shows most people get a better result when they come in weekly, especially at the start, than when they come every other week.
- It is okay to tell a therapist directly that something isn't working. In Dr. Krauss's experience, most therapists want to know and will not be offended.
- According to Dr. Krauss, you don't have to be in crisis to deserve care, and asking for more support can be a sign of progress rather than failure.
Listen to Dr. Stacey Krauss's full Outreach With Reggie interview:
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What should you do when you're doing the work in therapy and still don't feel better?
Many people decide therapy must not be for them and stop going. But according to Dr. Krauss, feeling stuck is not a reason to give up. It can be a sign that something about the care may need to change, whether that's the type of therapy, how often you go, the fit with your therapist or the level of support.
Dr. Stacey Krauss, Psy.D., ABPP, CEO of Transitions Counseling and Consulting, recently joined Reggie Holloway on Outreach With Reggie for a thoughtful conversation about that experience.
The episode, “The Wrong Dose of Therapy,” explores what it means to feel stuck in therapy and what people can do about it. The conversation covers expectations, session frequency, therapist fit, intensive outpatient and partial hospitalization programs, practical barriers to care, stigma and what getting better really looks like.
From Army Psychologist to Mental Health Leader
Dr. Krauss's path into mental health care was an unusual one. She went to college on an Army ROTC scholarship in 2000, planning to become a traditional military officer. Then, at a training event, she happened to meet a military psychologist, and the idea struck her like a bolt of lightning. With the Army's support, she completed her master's and doctoral degrees in psychology and served for 10 years on active duty as a psychologist.
Her service also showed her how attitudes can change. Early on, some people wouldn't meet her for lunch at her office because they didn't want to be seen walking into a mental health clinic. Years later, a senior leader in a combat unit loudly greeted her as his doctor in a dining facility, showing his unit it was okay to be seen getting care. Dr. Krauss calls it “such a fantastic show of bravery and leadership.”
What Does It Mean to Be Stuck in Therapy?
Asked what she wants someone who is still struggling in therapy to understand, Dr. Krauss says her first message is simple: things can be better and different, so don't give up. She knows how frustrating it can be to find the right combination of mental health care. “But you're worth figuring that out,” she says.
According to Dr. Krauss, feeling stuck can look a couple of different ways:
- Trying therapy several times without a meaningful result that lasts.
- Feeling some relief during a session and for a day or two afterward, only to find that by the end of the week you're right back where you were, rather than seeing gradual, steady improvement.
Sometimes, she explains, being stuck means there has been a misunderstanding about what's going on or what could help, or that the type of therapy hasn't been a good fit for the person's needs.
Why Therapy Takes Longer Than Most People Expect
Part of the problem is expectations. According to Dr. Krauss, when people across the United States have been asked how many therapy sessions they think it will take to start feeling much better, most guess one or two. Research on how much therapy people typically need points to a longer timeline: a widely cited review found that roughly 13 to 18 sessions are typically needed for about half of people in therapy to improve (Hansen, Lambert and Forman, 2002).
“We're on a collision course here,” she says. After one or two sessions without feeling much better, people start to worry that therapy isn't for them or that they're doing something wrong. In reality, she explains, it takes a lot longer, and because progress happens gradually, it can be hard to notice.
Progress isn't always linear, either. Many people do focused work in therapy for weeks or months, take a break to apply what they've learned and return at a new stage of life. She says that is especially true with grief.
TV doesn't help. Real therapy, she says, is usually a peaceful and slowly paced experience without the drama of television. That's why she believes part of a therapist's job is to explain what therapy will be like, since for many people, walking into a mental health clinic is a completely new experience with no frame of reference.
Making Time for Therapy When Life Is Busy
Between work, school and family, many people struggle to fit therapy in consistently. Dr. Krauss suggests asking yourself what may be the most important question: how much of your precious time are mental health symptoms disrupting, interfering with or taking away?
She notes that people can get used to feeling bad very quickly, to the point that it starts to feel normal. Taking a step back can help put the time investment in perspective.
She compares it to physical therapy after an injury to your Achilles or ACL. As she puts it, “you can't just walk it off.” You need focused support on a schedule. In the same way, investing consistent time in therapy now may benefit your quality of life in the long term.
What Is the Wrong Dose of Therapy?
The idea behind the episode's title is about how often someone goes to therapy. As Dr. Krauss explains, therapy needs to happen at a certain frequency for people to get the most out of it.
That can be as simple as the difference between coming in once a week and coming in every other week. She says the research shows most people improve faster when they come in weekly, especially at the beginning. One large study in a real-world counseling setting found that clients seen weekly improved more quickly than those seen every other week (Erekson, Lambert and Eggett, 2015).
Dr. Krauss believes it is part of the therapist's job to explain the trade-offs of different schedules. If weekly sessions aren't possible, she says coming every other week is still worthwhile, but people should make that choice with their eyes open, knowing the trade-offs.
How to Tell a Therapist It Isn't Working
Sometimes the issue isn't frequency but fit. Dr. Krauss believes many people are so polite that telling a therapist directly that something isn't working feels deeply rude and confrontational. So they stay in a situation that isn't as helpful as it could be, or they stop going without saying anything and end up with no care at all.
Her message is clear: it's okay to speak up. A therapist's job is to help you connect with the right care, even if it's not with them, and in her experience most therapists want to know, won't be offended and can help you find a better fit.
“You have the permission of therapists everywhere to just tell us directly when it's not working, because then we can actually be helpful to you.”
Dr. Krauss shared a few practical ways to start that conversation:
- Write down what you want to say beforehand, then bring it with you and read it.
- Bring a support person with you if you want help telling the therapist.
- Remember that you're not a bad person for wanting a different fit.
IOP vs. PHP: What’s the Difference?
Some people do everything their therapist suggests and still don't see results in their real life, and they often blame themselves. For some of them, a higher level of support may help. Dr. Krauss describes intensive outpatient programs (IOP) and partial hospitalization programs (PHP), which she calls the most misunderstood type of mental health care.
She describes them as a continuum of intensity:
- Weekly therapy: The lowest intensity.
- Intensive outpatient program (IOP): Group sessions that typically meet a few days a week for two to three hours at a time.
- Partial hospitalization program (PHP): The highest intensity of outpatient care, meeting five days a week for about 20 or more hours a week.
Despite the name, there's no hospital involved in PHP, and people go home at night.
Dr. Krauss compares these programs to working with a personal trainer for a period of time. In terms of hours, she notes, eight weeks of IOP adds up to about the same as a year of weekly therapy. The groups focus on learning and practicing coping skills to use for the rest of your life, and many people come to IOP to strengthen those skills before starting trauma-focused therapy.
The groups are led by a professional therapist, and Dr. Krauss describes them as a supportive experience where people realize they are not alone. Often, people begin by helping someone else in the group. As she puts it, “You're part of the solution too.”
Transitions offers intensive outpatient programs for teens and adults and a partial hospitalization program for teens, as well as group therapy and individual counseling and therapy. Availability depends on location and individual needs.
For more, read Transitions’ guides on how to know if therapy is actually working and why to choose an intensive outpatient program over standard outpatient therapy.
Talking About Practical Barriers to Care
Even when people know they need more help, practical barriers like cost, insurance, transportation and schedules can get in the way.
Talking about money or transportation in a health care setting can feel uncomfortable, but Dr. Krauss's advice is to tell your provider simply what your limitations are. A big part of what mental health providers do, she explains, is build deep knowledge of community resources. If they can't provide the care someone needs, their next job is helping that person connect to care that fits, or something as close to it as possible.
Meeting someone where they are, in Dr. Krauss's view, starts with respecting the client's right to make their own choices, explaining options in plain language and checking in regularly with questions like:
- Does this make sense to you?
- Is it helping?
- Are we going too fast or too slow?
Why Asking for More Help Can Be a Sign of Progress
Why do so many people see needing more support as a personal failure? Dr. Krauss points to social comparison: we judge other people's insides by their outsides and assume everyone else has it all together.
She sees changing therapists, trying a new approach or stepping up to a higher level of care as a real sign of progress. It takes guts, and it models for the people in your life how to take care of yourself when things aren't feeling right.
Dr. Krauss also reflected on her years as an Army psychologist, when nearly all of her clients were men. Many grew up hearing messages like “boys don't cry,” and therapy often started with learning the words to describe what they felt. Many of them, she says, wanted their own kids to know that talking about feelings is okay.
For families, she recommends making emotions a frequent, low-pressure topic and looking for developmentally appropriate conversation starters for kids and teens.
You Don't Have to Be in Crisis to Deserve Care
Dr. Krauss would like to see mental health viewed as part of overall health rather than something separate. We check in on our physical health routinely, she points out, and mental health deserves the same kind of regular maintenance.
Finding care has also become easier. People can search for therapists online and access care through telehealth, which she calls a game changer for people who live far from qualified providers or lack transportation.
Still, many people delay getting help because they know someone who has it worse. Dr. Krauss encourages listeners to remember:
“You don't have to experience a personal tragedy. It doesn't have to be an emergency. You deserve healthcare.”
If you or someone you love is in crisis or having thoughts of suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline, or call 911 in an emergency.
Dr. Krauss's Closing Advice on Getting Better
The episode closes with a few personal questions. Dr. Krauss's answers include:
- For anyone who feels they've tried everything: Sticking with it, even through many tries, is an act of human resilience and bravery, and they're worth it.
- What keeps her going: Knowing that part of her job is to be “a source of hope.”
- How she takes care of herself: Exercising on most days is part of her self-care plan, even though she doesn't love it.
- What getting better means to her: Getting much clearer on the things that make your life feel worth living, then spending more of your time and energy on activities that line up with those values.
Frequently Asked Questions
Who is Dr. Stacey Krauss?
Dr. Stacey Krauss, Psy.D., ABPP, is CEO of Transitions Counseling and Consulting. She served for 10 years as an active-duty U.S. Army psychologist and has led Transitions since 2021.
What does it mean to feel stuck in therapy?
According to Dr. Krauss, it can mean feeling better after a session only to be back where you started by the end of the week, or trying therapy several times without a lasting result.
Does it matter how often you go to therapy?
Dr. Krauss says the research shows most people get a better result when they come in weekly, especially at the beginning, than when they come every other week.
What is the difference between IOP and PHP?
IOP stands for intensive outpatient program and PHP stands for partial hospitalization program. As Dr. Krauss describes them, IOP typically meets a few days a week for two to three hours at a time, while PHP meets five days a week for about 20 or more hours a week. At Transitions, PHP is available only for teens.
What services does Transitions Counseling and Consulting provide?
Transitions Counseling and Consulting offers mental health services for people of all ages in Arizona and Texas. Services include individual counseling and therapy, group therapy, relationship and couples counseling, psychiatry and medication management, intensive outpatient programs for teens and adults and a partial hospitalization program for teens, with telehealth available when appropriate. Availability depends on location and individual needs.
Listen to Dr. Stacey Krauss on Outreach With Reggie
The full Outreach With Reggie conversation goes deeper into Dr. Krauss's path into psychology and her years as an Army psychologist, what feeling stuck in therapy can look like, how IOP and PHP work and why mental health care is something for everyone.
Listen to the full interview with Dr. Stacey Krauss
About Dr. Stacey Krauss
Stacey Krauss, Psy.D., ABPP, is CEO of Transitions Counseling and Consulting. She served for 10 years as an active-duty U.S. Army psychologist and is board certified in both Clinical Psychology and Business and Organizational Consulting Psychology.
Learn more about Dr. Stacey Krauss and her background.
Her professional experience includes executive-level roles leading behavioral health teams for the Department of Defense and designing and directing nationally accredited training programs for future psychologists. She is licensed to practice in Arizona and Texas.
Today, she leads Transitions Counseling and Consulting's work to expand access to mental health care for children, teens, adults and families in Arizona and Texas.
Find Mental Health Support for Your Family
Transitions Counseling and Consulting offers mental health services for children, teens, adults, couples and families in Arizona and Texas, with telehealth available when appropriate. Contact Transitions or call (602) 363-0629 to schedule an appointment or ask which services fit your needs.
At Transitions Counseling and Consulting, we provide compassionate, evidence-based mental health care for children, teens, and adults. Our personalized treatment options help individuals and families find the support they need to improve their mental health and move forward with confidence. Explore our services to learn how we can help.
