When Therapy Doesn’t Work: Understanding Nonresponse and Adherence in Fertility-Related CBT
Navigating Therapy Challenges During Infertility
Seeking therapy during infertility can feel like a lifeline—something to help you stay afloat when the process gets emotionally overwhelming. Cognitive Behavioral Therapy (CBT) is often recommended to help with the anxiety, depression, and hopelessness that can show up during fertility treatment. It’s structured, skills-based, and can be delivered in person or online. But what happens when it doesn’t seem to work?
A recent study published in BMC Psychiatry explored this exact question: why some women don’t respond to CBT during fertility treatment, and what factors might predict whether someone benefits from therapy—or drops out early. Their findings offer a much-needed look at the emotional realities behind the numbers, and how we can better support people when standard therapy approaches fall short.
Key Findings
Higher distress = lower response: Women with elevated anxiety and depression scores before starting therapy were 1.4 to 2 times more likely to not improve, whether they did online or in-person CBT.
Some factors were protective: Lower education level, longer marriage duration, having a dual infertility diagnosis (both male and female factors), and a diagnosis of mixed anxiety/depression reduced the risk of nonresponse.
Adherence was mixed: Some participants dropped out early—defined as attending fewer than 4 of 8 sessions—but the study couldn’t pinpoint specific predictors for dropout.
Why This Matters
In my work with clients navigating infertility, I know that therapy isn’t one-size-fits-all. Some clients find relief through CBT’s structure and coping tools. Others need something gentler, more relational, or more focused on grief, trauma, or body-based work.
That’s why I don’t just rely on one model. I use a variety of approaches—sometimes integrating CBT, other times using narrative therapy, mindfulness-based interventions, or just providing a steady, nonjudgmental space to fall apart. The key is finding what works for that particular moment in someone’s fertility journey.
This study is an important reminder that when therapy doesn’t seem to “work,” it’s not a personal failure. It’s often about timing, emotional readiness, or the need for something different. The more we understand these dynamics, the more we can adjust and support people where they truly are.
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