for your question about therapy: studies show that the main factor that determines whether therapy works is the quality of the therapeutic relationship between the therapist and the client. if you don't really connect with the therapist, if you don't feel understood by the therapist, or if you don't trust the therapist, it'll be more difficult to see improvement. the therapeutic relationship is a two way street, both you and the therapist are responsible for it.
in your first few sessions with the therapist, i recommend asking them directly about what things they keep confidential, and what things they are required to report, and what things trigger involuntary commitment. ask them what they do when a client is in distress. ask them what their typical strategy/treatment plan is for clients with your conditions, and ask them if they have experience treating clients with similar conditions/issues. tell them your concerns about therapy. if you're skeptical that therapy won't work, be honest with them about that. try to be honest about the main issues you've been dealing with, even if you don't feel comfortable going into a lot of personal detail yet. and try to keep an open mind.
you're also responsible for practicing skills and coping mechanisms outside of therapy. most people see their therapist for one hour a week. if you only dedicate one hour a week to improving your mental health, progress will be pretty slow! so try to set aside a little bit of time every day to practice the skills you learned, do worksheets if the therapist gave them to you, journal, reflect on what you talked about last session, etc.
it takes time for progress to happen and for trust to be built. but if it's been a while and you don't feel like things are getting better, or you don't trust or connect with your therapist, tell them directly. maybe they need to try a different approach. or maybe they aren't the right fit, and they can refer you to a different therapist who might work better with you.
i did therapy years ago, it improved my mental health maybe 20%, but not as much as i would have liked. looking back, i recognize that i kept my biggest problems to myself, because i didn't feel comfortable talking about it. of course my therapist couldn't help me with that stuff, because i didn't tell them about it! and i didn't really work on therapy skills outside of therapy, so that made my progress slower too. knowing what i do now, i think i would have benefitted a lot more had i done things differently.
your other question was about if psychiatry works: you'll get different answers depending on who you ask. meds made me much more functional, but it took some time to find the right ones, and even then, there are some side effects. if a psychiatrist wants to prescribe you something, look into the pros and cons, read up on how that med helps and why it works, and read up on the side effects too. ask your psychiatrist why they want you to try that specific med instead of a different one. if you have concerns about certain side effects, tell them about it. it might take some trial and error, but most people find something that helps. for some people, certain types of meds just have too many side effects, but others work well.
the most important thing to remember is: you have autonomy. you are not just a participant in this process--you are in the driver's seat. if something doesn't feel like it's helping or working, tell your therapist or psychiatrist. if you are uncomfortable with something, say no to it.
