When You Feel Like A Mental Health Treatment Or Therapist Is Your Last Hope

Sometimes when someone is about to begin a new mental health treatment, or start working with a new therapist, they'll say, "This is my last hope" or "You're my last hope."

I know when someone talks like that it can feel very true as they're saying it. They may have suffered from difficult, painful emotional symptoms for years or decades. They may have already tried all kinds of treatment methods, some standard, and others more alternative, intensive, or experimental. They may have worked with a number of therapists over many years. Their issues may not be much better, or even feel like they've been getting worse lately, and there's a sense the next thing they're about to try is their last shot.

I totally grasp why people can think this way, but it can interfere with their potential to recover. If you believe something is truly your last hope you can put too much pressure on it to fix you. You may quit too quickly if it doesn't seem to work right away. If it doesn't pan out you may feel so discouraged you're not willing to try anything else, and fall even deeper into hopelessness.

I think that however true it feels on an emotional level that a treatment is your last hope, it's rarely the case that it's literally your final shot:

There are always new treatments to try

It may seem like you've been through everything, but I almost guarantee there are more methods you haven't come across yet. They may not even be obscure, kooky, fringe, questionably effective modalities either. They may be some pretty common, effective types of therapy you just didn't learn about so far for whatever reason.

In mental health it's also possible for a more basic therapy method to start creating progress on a treatment resistant condition. It's not the case that once you've had to try some more exotic, extreme second or third line treatments those are your only options going forward. There are clients who have tried several modalities, and they didn't make much difference, then later on they tried another one and it had whatever special ingredient was needed to finally start moving the needle in a positive direction.

There are always new therapists to work with

Even if your new therapist is a renowned expert in their sub-speciality, it doesn't mean if things don't work with them nothing else will. Every therapist is different, even ones who practice the same model. You might not gel with an expensive, well-regarded counselor, but hit it off and do great work with someone who's less pricey or impressive on paper.

You can always go back and give a treatment that didn't work out another shot

Sometimes a method has the potential to work, but the first time you did it you weren't in the headspace to give it a proper try. You didn't do anything wrong, but it wasn't the right time for you (for example, you attempted to face your fears with Exposure Therapy, but weren't motivated to put in the uncomfortable work). Maybe you were missing some prerequisite skills to get the most out of it (e.g., you hadn't learned the emotion regulation tools to ride out the anxiety exposure brings up). Or maybe you got a watered down, less-effective version of a treatment, but didn't realize it at the time, like an intern counselor said they were doing Cognitive Behavioral Therapy with you, but they were really just letting you talk about whatever you wanted, and occasionally tried reframing one of your thoughts. If you go back to a previous treatment with new skills, motivation, life experience, or a better sense of what you need, you may get way more out of it than the first time.

Sometimes a previous treatment didn't work out, not in the sense that it was a total dud, but you had some progress, maybe even made some reasonable improvements, but then things stalled out or slowed down, and you switched to something else. If you go back to it and put in more time you may eke out more healing, even if it's not as fast as you'd prefer.

There are always new treatment methods coming down the pipeline

There are new types of therapies being developed as our understanding of things like trauma and neurodivergence improve. Older, established modalities are still being refined and updated, and their new versions can be noticeably different from their classic forms. Innovative methods that have languished in obscurity for years, and may as well have not existed to the average client, can finally catch on and become more widely available. It doesn't happen as often as with talk therapy methods, but new medications can also come onto the market, or psychiatrists will discover existing medicines also have uses in mental health. There are so many treatment methods out there it's unlikely someone's tried every last one of them. But even if they have, in another year or two a bunch of new stuff may be available.

Some shift may happen in your life that expands the range of options you have

You may feel a treatment is your last hope not because you've tried every last thing, but because your circumstances prevented you from trying much at all, and this is the final one you have access to. However, it's possible something could change that increases your choices:

Again, I understand that when you're feeling really low and discouraged it can feel like if this next treatment doesn't work you don't know how you'll be able to go on. I really do think there's always another chance. I hope this article can help take away some of that sense of being backed into a corner.

I don't want to be overly optimistic and cheery, or seem like I'm casually dismissing anyone's concerns. I realize not literally everyone gets a happy ending. But I know of people who have struggled with serious mood disorders for most of their life, and maybe felt several things they tried were their last hope, but they kept going, and then in their sixties they found something that actually brought them significant, lasting healing.