“Therapy Didn’t Work for Me”: What Survivors & Therapists Need to Know

When a survivor of sexual violence says, “Therapy didn’t work for me,” it’s not a refusal to heal; instead, it’s often a reflection of a process that didn’t feel safe, empowering, or effective.

To explore what can make therapy more helpful and supportive for survivors, RAINN connected with Niya McCray-Brown, director of community engagement and partnerships at Mental Health America (MHA). Her insights can help survivors and mental health professionals create therapeutic spaces that are healing-centered, trauma-informed, and genuinely helpful.

When Therapy Doesn’t Help

RAINN: Many survivors share that therapy hasn’t helped them—or even made them feel worse. Why is that?

McCray-Brown: “For survivors who’ve experienced betrayal, mistrust, and invalidation from others, therapy can feel like more of the same—especially if a provider doesn’t build trust from the very first session. Survivors may be expected to open up too quickly—without the chance to establish safety or control. That’s a missed opportunity to build rapport, which is the foundation of any successful therapeutic relationship.”

Therapy Vs. Trauma

RAINN: So, what does make therapy effective for survivors of sexual trauma?

McCray-Brown: “It starts with affirming the survivor’s autonomy. Survivors have already had their control taken away from them, so therapy should be a space where that control is restored. That means inviting their voice into the process early and often: asking about their needs, respecting their boundaries, and offering them choices for how they want to share and heal.”

Finding the Right Therapist 

RAINN: What advice would you give to survivors who want to try therapy again—but they’re hesitant?

McCray-Brown: “Know that it’s okay to take your time. Many therapists offer a 10–15 minute consultation call before intake. Use that time to ask whatever you need to feel safe. For example:

• ‘Have you worked with survivors before?’
• ‘What happens if I get emotional during a session?’
• ‘Do you have trauma-informed training or experience?’

“Survivors can also speak up about how they prefer to communicate. Maybe talking is too overwhelming, and you’d rather write or draw. That’s valid. Therapy doesn’t have to look one way. 

“Let your therapist know what helps you feel grounded—like bringing a fidget toy, essential oil, or soft hoodie—and share why it matters to your comfort. These aren’t small things. They’re powerful tools for safety and self-regulation.”

Building Better Therapy

RAINN: That’s great advice for survivors. What about therapists? How can they do better for survivors?

McCray-Brown: “One of the first things that therapists can do to set the foundation of a healthy therapeutic environment is explain what to expect. Let the survivor know what kinds of questions might come up in the intake and why. If you’re going to ask about distressing experiences, be sure to offer a way to skip or delay those discussions, and let them know how you’ll support them after they share. For example: ‘We’ll pause, do some breathing together, and revisit this if and when you’re ready.’ That builds trust.”

“It’s also best practice to give survivors options. Maybe they’re not ready to speak about something, but they are open to writing it down or identifying it from a checklist. Every opportunity for choice strengthens their sense of control—and that’s where healing begins.”

Getting Validation

RAINN: Survivors often worry that they’ll be judged—or that their experiences will be minimized. How can providers respond in ways that feel validating?

McCray-Brown: “Say thank you. When a survivor opens up, even a little, because that takes courage. A simple, sincere ‘Thank you for sharing that with me’ goes a long way. It tells the survivor: You matter. I believe you. I honor what it took to say that out loud. Gratitude builds connection—and connection is how we heal.”

Taking the Next Step

RAINN: What’s your biggest takeaway for survivors who had a negative therapy experience?

McCray-Brown: “Your healing is yours to define. You get to decide what works for you, what doesn’t, and when you’re ready to take the next step. And if a provider doesn’t make you feel seen or heard, it’s okay to try someone else. 

 “You deserve a clinician who knows how to hold space for you as you move toward healing”

Turning Awareness Into Action

At both RAINN and Mental Health America, we know that healing from sexual violence isn’t linear, and a single bad experience in therapy doesn’t mean all hope is lost. We encourage every survivor to advocate for their needs and to trust that healing is possible—on their terms.

MHA’s theme for the year is “Turn Awareness into Action”, focused on equipping everyone with the practical steps and tools they need to drive meaningful change for their mental health. Together, we can turn awareness into action by centering survivors’ voices in every therapeutic space. Whether you’re a survivor looking for support or a clinician offering care, compassion and empowerment must come first.

Taking steps to understand and care for your mental health isn’t just self-care – it’s an investment in your future. Take the first step with a free, anonymous online mental health screen at mhascreening.org.