How do you know if therapy is working?

Dear Alice,

I can't tell if, or when therapy is working. What are reliable signs of effective therapy?

Dear Reader,

Therapy can be extremely beneficial — and, for some, life changing — but often takes time and effort to work. If you're just getting started, it may be hard to determine how much progress is being made, particularly in the early stages when results aren’t so obvious. However, as you continue therapy, there are some general signs that may be indicative of effectiveness. These include the learning of new coping and problem-solving skills, increased self-awareness and insight into concerns (and factors that contribute to them), progress towards therapy goals, and the development of a positive, collaborative relationship with your therapist. Another sign may be that your symptoms lessen or dissipate (e.g., feeling less depressed or less anxious).

When you began therapy years ago, you may have set goals with your therapist that you'd like to accomplish during your time together. An individual’s goals and expectations of therapy, along with the severity of issues for which they’re seeking help, vary from person to person. With that in mind, reflecting upon your personal goals and expectations may help you come to a better understanding of your current progress. In terms of goal-setting, sometimes therapists and clients set goals together; other times, a client may come into the first session with a goal in mind. What progress do you feel you’ve made toward your goal(s)? Some other questions you may want to ask yourself as you assess the effectiveness of therapy include:

  • How do you feel about the relationship with your therapist overall? Do you feel that they listen to you, and that you have a collaborative partnership where your voice is valued? Do they seem judgmental?
  • Do you feel like you’re on the same page with your therapist about the core issues you're addressing in therapy, and the direction of therapy? 
  • How about any symptoms you’re experiencing — do you feel they’ve lessened? Have they increased or worsened?

Note that feeling negative emotions regarding therapy and your growth are expected at times. It’s very common to notice an increase in emotions such as anger, sadness, or feeling overwhelmed as you begin therapy, are prompted to address challenging topics, or make difficult changes in your life. Instead of indicating that your current therapy is ineffective, this uptick in emotion may be a sign of progress in such circumstances, even if they don’t feel great at the time!

After reflecting on your own, you may consider bringing up your concerns regarding progress with your therapist during your next session. Generally speaking, therapists are typically open to discussing what’s working and what isn’t to improve the therapeutic process. Doing so can help you both get on the same page and move forward together in a new direction or with a new strategy, as well as help you stay engaged and feel supported. In fact, research shows that people are more likely to achieve positive outcomes in therapy if they agree and contribute to their own therapy goals, and if they're given space by their therapist to provide direct feedback and thoughts about the direction of therapy.

Therapy may not fix all your problems, but, with time, it may provide you with tools to cope, problem-solve, and improve your daily life. Some tips for how to benefit most from therapy include:

  • View your relationship with your therapists as a partnership: Actively participate and collaborate in any decisions made about your course of treatment.
  • Be open and honest with your therapist.
  • Be patient – instant results are unlikely! 
  • Speak to your therapist immediately and directly if you notice frustrations about your progress or the direction of therapy.
  • Complete homework assignments and follow your agreed-upon treatment plan!

Adapted from Mayo Clinic.

If you have additional questions or concerns regarding your goals, progress, and expectations for therapy, try bringing up what’s on your mind during your next session. If you ultimately decide after this conversation that your current therapy isn’t as effective as you would like, consider speaking with your therapist or another mental health professional to discuss possible next steps and modes of treatment. It’s certainly possible that other types of therapy — and other therapists — may be a better fit.

Last updated Jan 31, 2020
Originally published Jun 25, 2015

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