You have been going to counselling for depression, you have shown up and done the work, and you still feel flat, heavy or stuck. That is discouraging, and it can feed the very thoughts depression already plants: "nothing works for me" or "I am doing this wrong". Neither is usually true. When therapy stalls, there is almost always something specific to look at, and there are several next steps you can take.
This guide covers how to tell whether therapy is helping, what to say to your counsellor, what might be in the way, and when to bring in your doctor.
If you are in crisis
Call or text 9-8-8 (Suicide Crisis Helpline, 24 hours). If you or someone else is in immediate danger, call 911. In BC you can also call 1-800-784-2433 (1-800-SUICIDE) any time, or 310-6789 (no area code) for mental health support. The Healing Oak is not an emergency service.
How can you tell whether therapy for depression is working?
Progress with depression is usually small and uneven, so it helps to look for specific changes rather than waiting to "feel better". Depression affects how you feel, think and handle daily activities such as sleeping, eating or working, as the US National Institute of Mental Health describes it (NIMH, Depression). Early signs that therapy is doing something often show up in those everyday areas first:
- You get out of bed or out of the house a little more often, even on bad days.
- You notice a harsh thought and can question it, even if it still hurts.
- A bad day stays a bad day instead of turning into a bad week.
- You can name what tends to pull you down, such as poor sleep, conflict or being alone too long.
Feeling a bit worse for a while when therapy touches painful material is common and does not on its own mean it is failing. What matters is the direction over several weeks.
A simple way to see the direction is to rate your mood, sleep and activity once a week on a 0 to 10 scale and bring the notes to your sessions. The UK's National Institute for Health and Care Excellence (NICE) recommends reviewing how well depression treatment is working between 2 and 4 weeks after it starts, and suggests considering routine outcome measures to track it (NICE guideline NG222, recommendation 1.4.3).
Is it too early to tell?
Sometimes it is simply early, but "give it more time" should not be the only answer you hear. Early sessions often go to goals and trust, and that groundwork matters. Session durations vary, and so does how long change takes, depending on what you are dealing with, your history and what is happening in your life.
Guidelines do give a sense of when to stop and take stock. NICE says that if depression has not responded at all after 4 to 6 weeks of psychological therapy, the person and their clinician should talk about what might explain it, including life circumstances, physical or other mental health conditions, and missed sessions (NICE NG222, recommendation 1.9.1). In plain terms: if a month or more has passed and nothing at all has shifted, it is reasonable to raise it rather than wait quietly.
Start by telling your counsellor
The most useful first step is to say it out loud in your next session. A good counsellor will not be offended. Feedback about what is and is not working is part of the job, and they cannot adjust what they do not know about.
If it feels awkward, you could open with one of these:
- "I don't feel like I'm getting better, and I'd like to look at that together."
- "Can we review my goals? I'm not sure we're working on the right thing."
- "I need more structure, like practical skills or things to try between sessions."
- "I think we're moving too fast. I'd like to slow down."
Then ask a few direct questions. What are we working toward, and how will we know it is happening? What approach are you using, and why? Would you suggest a different approach, or someone else, if this isn't helping?
What might be getting in the way?
When therapy stalls, something outside the room is often part of the reason. These are worth checking honestly, ideally with your counsellor and, for the medical ones, your doctor:
- Sleep. Ongoing poor sleep can drag mood down and make it hard to use new skills.
- Alcohol and other substances. These can blunt the effect of therapy or make low mood worse. Say so if this is part of your picture.
- Physical health. Some medical conditions and some medications can affect mood and energy. Only a physician or nurse practitioner can check this, so ask your doctor if you have not had a check-up recently.
- Life pressures. Money worries, caregiving, an unsafe relationship or a job that is wearing you down can keep pulling against the work you do in sessions.
- Other conditions. Anxiety, trauma, ADHD or grief can sit alongside depression and need attention in their own right. NICE advises reviewing the diagnosis and considering other conditions when depression is not responding (NICE NG222, 1.9.2).
- Gaps between sessions. Missing appointments or long breaks make it harder to build momentum. If cost or scheduling is the reason, say so. There may be options.
Is it the approach, or the fit?
If the basics are covered and you are still stuck, the next question is whether you need a different method, a different person, or both. NICE lists switching to another psychological therapy as one of the options when depression has not responded (NICE NG222, 1.9.6).
Different approaches work on depression from different angles. Cognitive behavioural therapy (CBT) looks at the links between thoughts, feelings and actions. Interpersonal psychotherapy (IPT) focuses on relationships, roles and life changes. Acceptance and commitment therapy (ACT) helps you make room for difficult feelings while acting on what you value. Psychodynamic therapy explores patterns that may have roots in earlier experience. If you have been doing one style for a while without movement, it is reasonable to ask whether another would suit you better.
Fit is just as important. Feeling safe, understood and able to be honest with your counsellor is a big part of what makes therapy work. Duncan White (CCC, M.Ed.), one of our Abbotsford counsellors, writes on his practitioner page that a common thing he hears from clients is that they tried many counsellors before finding the right fit. Changing counsellors is not a failure. Our guide on how to book a therapist in Abbotsford or Chilliwack covers how to switch without awkwardness.
When should you bring in your doctor or a psychiatrist?
Bring in your family doctor or nurse practitioner if your depression is getting worse, if it has not shifted despite changes to therapy, or if you want to talk about medication. Counsellors do not prescribe or diagnose, so questions about antidepressants, side effects or a physical cause belong with a physician. Many people do best with counselling and medical care working together.
A few routes in the Fraser Valley are worth knowing:
- Your family doctor or nurse practitioner can review your symptoms and medication and refer you to a psychiatrist. Psychiatrists are physicians, and seeing one with a referral is generally covered by MSP (HeretoHelp BC).
- Fraser Health's Rapid Access Clinic, run from the Chilliwack and Abbotsford Mental Health and Substance Use Centres, offers an appointment with a psychiatrist and nurse for adults 19 and over with mild to moderate conditions such as depression. It needs a referral from your family doctor or nurse practitioner, and the psychiatrist sends treatment recommendations back to them (Fraser Health, Rapid Access Clinic).
- No family doctor? You can register with the Health Connect Registry to be matched with one (HealthLink BC), and call 8-1-1 for health advice in the meantime.
- A psychologist can do a formal psychological assessment if the picture is unclear. At The Healing Oak, psychology is a separate service. See our psychology page, and our post on psychologists, counsellors and therapists in BC if you are unsure which you need.
What if you have already tried several things?
If you have tried more than one therapy, or therapy and medication, and still feel stuck, you are not out of options. NICE advises clinicians to reassure people that although a treatment has not worked, other treatments can be tried and may be effective (NICE NG222, 1.9.3). The US National Institute of Mental Health is funding research on treatment-resistant depression, its term for depression that has not improved after trying several options, so this is a recognized problem being actively studied (NIMH).
Practically, that usually means a fuller review with your doctor or a psychiatrist and perhaps a combination of approaches. Keep a short record of what you have tried, for how long, and what changed. It saves time with every new practitioner.
When you are doing better, it helps to plan for the dips. Our post on how CBT can help prevent relapse in depression covers warning signs and skills to keep using.
Looking for a different counsellor or approach?
If you would like to try a new counsellor, you can book directly at either clinic, and you do not need a doctor's referral to book counselling. These Healing Oak practitioners list depression on their profiles and show as accepting new patients (Healing Oak site, checked October 21, 2026):
- Abbotsford: Duncan White, CCC, M.Ed. (ACT, DBT, solution-focused), Jae Yoo, CCC-CCS (CBT, IPT and others) and Susan Doiron, MEd, CCC (psychotherapy, EMDR).
- Chilliwack: Jessy Parmar, RCC, BSW, MSW, RSW (ACT, DBT, narrative), Remi Wauthy, RCC (CBT, IFS and others) and Jen Larush, Psychologist (CBT, ACT and others).
Availability changes, so check each profile before you book. Some people also use massage or acupuncture alongside counselling for the physical side of low mood; that is a support, not a replacement for mental health care. Learn more about depression counselling in Abbotsford and Chilliwack, or see our guide to free and low-cost depression support in the Fraser Valley if cost is part of the problem.
Fees vary by practitioner. Confirm the fee when you book. MSP generally does not cover private counselling. Many extended health plans do, so check your plan. Direct billing depends on the practitioner. Ask when you book.
| Clinic | Address | Phone |
|---|---|---|
| The Healing Oak Chilliwack | #101-7408 Vedder Road, Chilliwack, BC V2R 4E6 | (604) 846-2999 |
| The Healing Oak Abbotsford | #111, 2632 Pauline Street, Abbotsford, BC V2S 0C9 | (604) 850-9097 |
This article is general information, not medical or psychological advice. For advice about your situation, talk to a qualified practitioner.
