Switching Therapists for Psychotherapy Offers No Advantage in MDD

A new study found that changing therapists or therapy approach does not offer additional benefit for adults with major depressive disorder (MDD) who do not respond to initial psychotherapy.1 Further psychotherapy after initial non-response produces modest reductions in depressive symptoms.

Only about 40% of people experience a significant response to psychotherapy. One solution may be to switch therapists altogether. The Associated Clinic of Psychology (ACP) lists 11 signs that it may be time to switch therapists: feeling a lack of progress, being unable to speak openly, feeling unheard or misunderstood, mismatched therapeutic styles, unresolved issues, a personality clash, discomfort during sessions, changing goals or focus, frequent scheduling problems, lack of engagement, and a gut feeling.2 Changing therapists may provide other benefits, such as accelerating recovery when a patient requires a different therapeutic approach, or shortening the duration of depression, which may help limit feelings of hopelessness.

However, whether changing therapists actually improves depressive symptoms remains an open question. Emerging data suggest the benefit may be limited.1

In this randomized controlled study, Maartje Miggiels, PhD candidate, from the Dimence Group and the department of psychiatry at Amsterdam UMC in the Netherlands, and colleagues, investigated whether continuing cognitive behavioral therapy (CBT) or short-term psychodynamic supportive therapy (SPSP) with the same therapist differs in effectiveness from 2 alternative strategies: switching therapists or switching both the therapist and the therapeutic approach.1 The primary outcome was depressive symptom severity, assessed via the Inventory of Depression Symptomatology-Self Report (IDS-SR).

This was the second phase of a randomized study published in 2021, which compared CBT with SPSP for MDD during the initial 16-session treatment phase. Participants were outpatients of 1 of 4 locations of Dimence, a specialized mental health care institution in the Netherlands.3

The first phase showed favorability of SPSP over CBT, with an estimated mean post-treatment difference of 2.54 (95% CI, -0.63 to 5.72). SPSP also showed favorable remission rates over CBT (9.0% vs 20.5%; P =.01). Response rates did not differ significantly between SPSP vs CBT (23.6% vs 20.7%; P =.59).3

This second phase randomized 163 non-responders 1:1:1 to either continue treatment with the same therapist, switch to a different therapist, or switch both therapist and treatment method.1 Participants were offered an additional 16 sessions over 8 weeks.

The study showed a modest but statistically significant reduction in depressive symptoms after continuing psychotherapy (mean change, -5.23; 95% CI, -7.27 to -3.12). However, investigators observed no significant differences in symptom reduction, response, or remission rates between the 3 treatment strategies.1

“Switching therapist or both therapist and method does not appear to offer additional benefit, but also does not hinder outcomes,” investigators concluded.1 “These findings suggest that there is no one-size-fits-all switching strategy that is suitable for all non-responders.”

About 2 years ago, HCPLive hosted a peer exchange with Andrew J. Cutler, MD, Sagar V. Parikh, MD, FRCPC, and Gregory Mattingly, MD, on switching treatment vs augmenting strategies in MDD.4 They discussed what point psychiatrists should start to think about switching or starting a new treatment and at what point you would augment.

“It’s one of the mysteries of what we do in clinical practice, and I don’t think there’s a right or a wrong answer,” Mattingly said.4 “If you’d asked me 20 years ago, I would’ve quite often started something new. I’ve become a fan of augmentation strategies more and more over the course of my practice.”

He described different augmentation strategies, such as adding a medicine or augmenting with psychotherapy or exercise.

“It’s important to know when you can augment and when you can start a new treatment option,” Mattingly continued.4 “If we see zero benefit, obviously we’re going to start something new. I think if we see an intolerable adverse effect, we’re going to start something new. It’s that group in the middle, they’re partially better, but not all the way better. And quite often I like that option of being able to augment something on top.”

References

1. Miggiels M, Ten Klooster P, Beekman A, et al. A randomized controlled trial testing the effects of sequential psychotherapy in depression: Changing therapist, or both therapist and method?. J Affect Disord. 2026;394(Pt A):120556. doi:10.1016/j.jad.2025.120556

2. Switching Therapists: 11 Signs It’s Time To Go. Associated Clinic of Psychology. Published on February 21, 2024. Accessed January 6, 2026. https://acp-mn.com/about-acp/blog/switching-therapists/

3. Miggiels M, Ten Klooster P, Beekman A, et al. The D*Phase-study: Comparing short-term psychodynamic psychotherapy and cognitive behavioural therapy for major depressive disorder in a randomised controlled non-inferiority trial. J Affect Disord. 2025;371:344-351. doi:10.1016/j.jad.2024.10.122

4. Cutler A, Mattingly G, and Parikh S. Switching Treatment vs Augmenting Strategies in MDD. HCPLive. Published on January 27, 2023. Accessed January 6, 2026. https://www.hcplive.com/view/switching-treatment-vs-augmenting-strategies-in-mdd