Talk therapy is one of the most valuable tools in mental health care. Different forms of psychotherapy can help people understand difficult emotions, change unhelpful patterns, develop coping skills, improve relationships, and reduce symptoms.
But therapy does not produce the same outcome for everyone. Some people make meaningful progress while continuing to experience depression, obsessive-compulsive symptoms, anxiety, sleep disruption, physical tension, or difficulty functioning. Others begin to wonder whether they are doing therapy incorrectly because improvement has been slower or less complete than expected.
When talk therapy has not been enough, it does not mean the work was wasted. It may mean the diagnosis, therapy approach, treatment intensity, medical factors, medication plan, or broader combination of care needs to be reassessed.
At WHOA Wellness in Richmond, VA, we offer FDA-cleared TMS for specific conditions alongside complementary wellness services. Our role is not to replace an established therapist or promise that adding more services will solve every problem. We help each person consider whether another evidence-informed option belongs in the care plan.
Progress That Stalls Is Not a Personal Failure
Mental health conditions develop through complex interactions among biology, learning, relationships, environment, health, stress, and personal history. No single treatment can be expected to work equally well for every person or every diagnosis.
A person may also receive a form of therapy that is not well matched to the condition. Exposure and response prevention has a specific role in treating OCD. Trauma-focused therapies are central to PTSD care. Behavioral activation, cognitive behavioral therapy, interpersonal therapy, and other approaches may be used for depression depending on the individual’s needs.
The therapeutic relationship matters, too. A person may need a different clinician, level of care, session frequency, or treatment structure. Progress can also be affected by sleep disorders, chronic pain, medication effects, substance use, medical conditions, trauma exposure, financial strain, or an unsafe environment.
Before concluding that “therapy does not work,” it can be helpful to ask:
- Has the diagnosis been carefully evaluated?
- Is the therapy designed for the condition being treated?
- Has there been enough time and consistency to assess the response?
- Are symptoms improving in some areas but not others?
- Are medication effects or medical concerns complicating treatment?
- Does the current level of care match the severity of the symptoms?
- Would another evidence-based treatment be appropriate alongside therapy?
Our overview of mental health treatment options in Richmond explains how psychotherapy, medication, TMS, and wellness services can serve different purposes.
Therapy and TMS Do Not Work on Separate “Layers”
It can be tempting to describe psychotherapy as working only on a cognitive surface while TMS reaches a deeper biological cause. That explanation creates a false divide.
Psychotherapy can affect thoughts, emotions, behaviors, relationships, avoidance patterns, and physical responses. TMS uses a different method: magnetic pulses delivered through a coil near the scalp induce electrical activity in targeted brain tissue.
Both approaches interact with a living, adaptable nervous system. The meaningful distinction is not that one is psychological and the other is biological. It is that they use different treatment processes, have different indications, and require different forms of clinical expertise.
TMS may be considered after previous treatment has not produced satisfactory improvement for an eligible condition. It should not be presented as proof that therapy failed or as a procedure that makes psychological work unnecessary. Our post on TMS vs medication for depression explores how these different treatment approaches compare in practice.
Where TMS Fits at WHOA Wellness
WHOA Wellness uses BrainsWay Deep TMS technology. The treatment is noninvasive and does not require anesthesia, but it is still a medical procedure that requires an individualized evaluation.
The FDA-cleared indications relevant to our current services include:
- Major depressive disorder: Treatment of depressive episodes in adults who did not achieve satisfactory improvement from antidepressant medication during the current episode
- Comorbid anxiety symptoms in major depressive disorder: Decreasing anxiety symptoms in eligible adults whose anxiety occurs within the major-depression indication
- Obsessive-compulsive disorder: Adjunctive treatment for adults with OCD using the applicable Deep TMS protocol
Those boundaries are important. The device’s anxiety clearance does not apply to every standalone anxiety disorder. TMS should also not be described as FDA-cleared for PTSD.
Someone interested in the depression pathway can read our guide to TMS therapy for depression. We also provide an overview of FDA-cleared TMS for OCD.
What Happens During TMS?
During TMS, a coil positioned near the scalp produces brief magnetic pulses. These pulses induce an electric field in the underlying brain tissue and stimulate targeted neural structures.
The treatment protocol depends on the condition and device indication. A course generally involves repeated appointments across several weeks rather than a single procedure.
TMS does not require sedation, and people can usually return to ordinary activities after a session. Possible effects include scalp discomfort, headache, tingling, facial-muscle movement, or lightheadedness. Seizure is a rare but serious potential risk.
Screening may include questions about:
- The current diagnosis and symptom severity
- Previous medication and psychotherapy
- Seizure history and neurological conditions
- Current medications and substance use
- Metal or electronic implants in or near the head
- Other medical and psychiatric conditions
- Immediate safety concerns
Our article on who may be a candidate for TMS provides general information, but only a clinical evaluation can determine whether treatment is appropriate.
TMS Can Accompany Therapy Without Replacing It
Many people continue psychotherapy while receiving TMS. Others return to therapy, adjust the frequency of sessions, or begin a condition-specific approach as part of a revised treatment plan.
TMS should not be promoted as making therapy automatically more effective. Research has not established that every person experiences that interaction in the same way. However, continuing appropriate psychotherapy may help someone work on behaviors, relationships, coping strategies, avoidance, relapse prevention, or other concerns that TMS does not address by itself.
The same principle applies to medication. Some patients continue medication during TMS. Any decision to change or discontinue a psychiatric medication belongs with the prescribing clinician. Medication should not be stopped abruptly because TMS has begun or symptoms appear to be improving.
With the patient’s permission, communication among clinicians may help clarify:
- Which condition each treatment is intended to address
- How progress will be monitored
- Whether symptoms or side effects are changing
- Who is responsible for medication decisions
- What support is needed after the TMS course
- When a higher level of care or referral is appropriate
Integrated care works best when each provider’s role is clear. If you are wondering whether depression has not responded adequately to prior treatment, our post on depression not improving with medication outlines what that pattern can look like and what options may be worth exploring.
Whole-Person Care Should Be Selective, Not Automatic
At WHOA Wellness, our services also include acupuncture, massage therapy, nutritional counseling, and Reiki. These options have different purposes and very different levels of supporting evidence.
Whole-person care does not mean adding every available modality to every treatment plan. It means considering the person’s symptoms, physical health, routines, preferences, resources, treatment history, and goals.
Complementary services may support relaxation, physical comfort, nutrition habits, or general well-being. They should not be presented as replacements for psychotherapy, medication, TMS, medical evaluation, or crisis care.
A responsible plan may involve TMS and continued therapy, one wellness service alongside outside clinical care, or a referral to a provider whose services better match the person’s needs. You can review our full range of offerings on our acupuncture, massage, TMS, and medication services page.
Acupuncture as Complementary Support
Acupuncture may appeal to people who experience physical tension, stress, pain, sleep disruption, or other concerns alongside mental health treatment.
Research examining acupuncture for depression has found possible modest benefits, but the studies vary in quality and design. The evidence does not establish acupuncture as a replacement for psychotherapy, medication, or TMS when those treatments are indicated.
Claims that acupuncture reliably resets the nervous system, corrects a specific mental health circuit, or activates a predictable healing response are stronger than current evidence supports.
We offer acupuncture as complementary care. Some people may experience a subjective sense of calm, reduced tension, or improved physical comfort. Others may not experience the same response.
Our article on acupuncture and mental health recovery explains this supportive role in greater detail.
Patients should share relevant medical conditions, medications, pregnancy status, bleeding concerns, and other safety information with their healthcare providers and acupuncturist.
Massage Therapy for Tension and Rest
Depression, anxiety, trauma-related symptoms, and ongoing stress can coincide with headaches, jaw tension, neck or shoulder discomfort, poor sleep, or a sense of being physically unable to settle.
Massage may offer short-term relaxation and help address muscular tension. Evidence regarding massage as a treatment for psychiatric disorders remains limited and varies considerably across conditions and study populations.
We do not need to claim that massage permanently changes neurotransmitters, lowers cortisol in every client, or releases emotions stored in the muscles to recognize its potential value as a wellness service.
Our massage therapy services are customized around the client’s health history, comfort, preferences, and areas of tension.
Touch-based care should always involve consent and control. Clients can discuss pressure, positioning, clothing, draping, conversation, and areas they do not want touched. Massage may also require modification or medical guidance for certain injuries, infections, clotting concerns, recent procedures, pregnancy, or other health conditions.
Nutrition Without Assuming a Deficiency
Nutrition can influence physical health, energy, daily functioning, and the practical experience of managing a mental health condition. Depression or anxiety may also make it harder to shop, prepare meals, eat consistently, or notice hunger.
Research suggests that improving overall dietary patterns may reduce depressive symptoms for some people. The same evidence has not demonstrated a clear overall benefit for anxiety symptoms, and nutrition should not be presented as a cure for a psychiatric disorder.
We also avoid assuming that everyone who is struggling has a deficiency in magnesium, vitamin D, B vitamins, zinc, omega-3 fatty acids, or another nutrient. A deficiency is a clinical question, not a conclusion that can be drawn from mood symptoms alone.
Our nutritional counseling may help someone explore:
- Irregular meals or appetite changes
- Barriers to grocery shopping or food preparation
- Caffeine or alcohol use
- Medication-related appetite or weight changes
- Cultural food preferences
- Digestive or medical concerns
- Questions about supplements and medication interactions
- Sustainable habits that fit the person’s resources
Supplements can cause side effects or interact with medication. Testing, supplementation, and substantial dietary changes should be discussed with an appropriate healthcare professional. For a deeper look at how diet intersects with mood, see our post on the role of nutrition in depression treatment.
Reiki Within Clear Evidence-Based Boundaries
Reiki involves a practitioner placing their hands lightly on or just above the body with the intention of directing energy.
Some people describe Reiki sessions as peaceful, grounding, or personally meaningful. However, Reiki has not been clearly shown to treat depression, anxiety, OCD, PTSD, or another health condition. Scientific evidence has also not established the existence of the energy field traditionally proposed to explain the practice.
At WHOA Wellness, Reiki should therefore be understood as an optional wellness experience rather than a psychiatric treatment. A person can value quiet time, focused attention, ritual, or a subjective sense of relaxation without being told that Reiki is correcting an energetic cause of mental illness.
Reiki should never delay necessary medical or mental health care.
How to Decide Whether the Current Plan Needs to Change
Feeling discouraged after months or years of therapy is understandable. It is also important not to make major treatment decisions based only on frustration in a difficult moment.
A useful next step may be a structured review with the therapist, prescriber, or another qualified clinician. Questions might include:
- What diagnosis are we treating, and is it still the best explanation?
- What improvements have occurred, even if they feel incomplete?
- Which symptoms remain most disruptive?
- Is the current psychotherapy evidence-based for this condition?
- Would changing the therapy approach or level of care make sense?
- Are medication changes worth considering?
- Does the person meet criteria for TMS?
- Are wellness services being considered for realistic, clearly defined goals?
- How will progress and safety be monitored?
At WHOA Wellness, we begin with an evaluation rather than assuming TMS or a package of integrative services is the answer.
The consultation may identify a possible fit for TMS, a complementary wellness option, a need to continue current treatment, or a reason to seek care outside our scope. Honest guidance is more useful than promising that one additional modality will become the missing piece.
Frequently Asked Questions
How does TMS differ from talk therapy?
Psychotherapy uses a structured therapeutic process to address thoughts, emotions, behaviors, relationships, avoidance patterns, coping skills, and other concerns.
TMS uses magnetic pulses to stimulate targeted brain tissue. It is delivered as a medical procedure under a condition-specific protocol.
The treatments work differently, but it is misleading to say that therapy affects only a superficial cognitive layer while TMS reaches the “real” biological problem. Mental health is not divided that neatly.
Can I continue seeing my therapist while receiving TMS?
Generally, yes. Many people continue appropriate psychotherapy during and after a TMS course.
The TMS clinician and therapist should understand their respective roles. Information may be shared with the patient’s authorization when coordination would support safe, consistent care.
What conditions does WHOA Wellness use TMS to address?
WHOA Wellness offers BrainsWay Deep TMS within applicable FDA-cleared pathways for eligible adults with major depressive disorder, including comorbid anxiety symptoms within that depression indication, and as an adjunctive treatment for adults with OCD.
TMS should not be described as FDA-cleared for standalone anxiety disorders or PTSD.
What does WHOA Wellness offer beyond TMS?
Our complementary services include acupuncture, massage therapy, nutritional counseling, and Reiki.
These services are not interchangeable, and they do not all treat psychiatric disorders. Recommendations should be based on the person’s individual needs, preferences, health history, and care plan.
Is there evidence for combining therapy with integrative care?
There is strong evidence for several forms of psychotherapy and for TMS within specific cleared indications. The evidence for complementary services varies.
Acupuncture has shown possible modest benefits for depression, but study quality is mixed. Massage may support relaxation and physical comfort, although evidence for psychiatric treatment is limited. Dietary improvement may help depressive symptoms for some people. Reiki has not been clearly shown to treat a health condition.
Using services together does not guarantee a stronger result. Each service should have a clear purpose.
How do I know whether TMS is appropriate for me?
A TMS consultation reviews the diagnosis, current symptoms, prior treatments, medical and psychiatric history, medications, implants, seizure risk, and other safety considerations.
Being in therapy without complete improvement does not automatically qualify someone for TMS. Candidacy depends on the specific condition and the applicable clinical criteria.
Key Takeaways
- An incomplete response to therapy is not a failure by the patient or therapist.
- Before changing treatment, it may be necessary to reassess the diagnosis, therapy approach, medical factors, medication plan, and level of care.
- Psychotherapy and TMS use different methods; they should not be described as working on separate superficial and biological layers.
- BrainsWay Deep TMS has specific FDA-cleared pathways for major depressive disorder, comorbid anxiety symptoms within MDD, and adjunctive treatment of OCD.
- TMS is not FDA-cleared for standalone anxiety disorders or PTSD.
- Many people continue psychotherapy or medication during TMS under appropriate clinical guidance.
- Acupuncture, massage, nutritional counseling, and Reiki have different purposes and evidence bases.
- Whole-person care should match services to the individual rather than automatically combining every available modality.
More Than One Path Forward in Richmond
When talk therapy has not provided enough relief, the answer is not necessarily to abandon it. The next step may involve a more condition-specific form of therapy, medication review, medical evaluation, a different level of care, TMS, or carefully selected complementary support.
At WHOA Wellness in Richmond, VA, we offer FDA-cleared TMS within its appropriate indications and complementary wellness services within clear boundaries. We do not assume that every person needs every service, and we do not present wellness care as a substitute for established mental health treatment.
We begin by listening to what you have tried, what has helped, what remains difficult, and what you hope will change. From there, we can help determine whether our services fit into a broader, realistic path forward. To take that first step, schedule a consultation with our team and we will work with you to identify the most appropriate next steps.
About the WHOA Wellness Team
At WHOA Wellness in Richmond, VA, our team brings clinical treatment and complementary wellness services together in an appointment-only environment.
We recognize that mental health concerns can affect thoughts, emotions, behaviors, relationships, physical comfort, and daily routines. Our approach respects the distinct roles of TMS, psychotherapy, medication, acupuncture, massage therapy, nutritional counseling, Reiki, medical care, and community support.
We are committed to meeting each person where they are while providing accurate information, individualized screening, and realistic expectations.
Works Cited
National Institute of Mental Health. (n.d.). https://www.nimh.nih.gov/health/topics/psychotherapies. National Institutes of Health.
National Institute of Mental Health. (n.d.). https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies. National Institutes of Health.
U.S. Food and Drug Administration. (2024). https://www.accessdata.fda.gov/cdrh_docs/pdf22/K222196.pdf.
U.S. Food and Drug Administration. (2019). https://www.accessdata.fda.gov/cdrh_docs/pdf18/K183303.pdf.
U.S. Department of Veterans Affairs & U.S. Department of Defense. (2022). https://www.healthquality.va.gov/guidelines/MH/mdd/VADODMDDCPGFinal508.pdf.
Smith, C. A., Armour, M., Lee, M. S., Wang, L.-Q., & Hay, P. J. (2018). https://pubmed.ncbi.nlm.nih.gov/29502347/. Cochrane Database of Systematic Reviews, 2018(3), CD004046.
National Center for Complementary and Integrative Health. (n.d.). https://www.nccih.nih.gov/health/massage-therapy-what-you-need-to-know. National Institutes of Health.
Firth, J., Marx, W., Dash, S., Carney, R., Teasdale, S. B., Solmi, M., Stubbs, B., Schuch, F. B., Carvalho, A. F., Jacka, F., & Sarris, J. (2019). https://pubmed.ncbi.nlm.nih.gov/30720698/. Psychosomatic Medicine, 81(3), 265–280.
National Center for Complementary and Integrative Health. (n.d.). https://www.nccih.nih.gov/health/reiki. National Institutes of Health.
Medical Disclaimer
The information provided in this blog is for educational purposes only and does not constitute medical advice, diagnosis, or a treatment recommendation. Do not begin, stop, or change psychotherapy, medication, TMS, supplements, nutrition plans, or complementary services without consulting an appropriate healthcare professional. Treatment outcomes vary, and no specific result is guaranteed.