During therapy

How will I know if my therapy is working?

This section has been written to help you think about the changes you may be expecting or experiencing as part of therapy and provide you with some suggestions about what you might do if they don’t happen 

What are the usual signs that therapy is working?
Therapy can result in significant changes in a person’s life. Often though these changes involve small steps; they don’t happen all at once. Sometimes it takes a few sessions to work out where you would like to be in the future. Given the large number of therapy approaches available and the varied reasons people seek therapy, it is impossible here to specify all of the areas in which people experience these changes. However, there are some broad areas in which people experience some positive change that can be taken as a sign that therapy is working: 

  • Mood/or emotion (such as more happiness, less anxiety)
  • Behaviours (decrease in unwanted habits, or increases in being assertive),
  • Thoughts (less negative thoughts, more realistic thoughts)
  • Relationships (getting on with a partner better, less arguments)
  • Diagnosis (no longer clinically depressed or phobic)
  • Life satisfaction (feeling like you’re getting more out of life)
  • Quality of life (better able to work, socialise) 

Sometimes greater clarity and understanding of your problems is sufficient. These changes may be discussed with you relatively informally in the therapy session, or they may also be assessed using rating scales and measurement tools. 

What is particularly important here, though, is whether therapy is working for you.

At the outset of therapy, your therapist may have talked to you about your goals (or ‘targets’) for therapy. These may change during the course of therapy, of course, but a good indication of whether therapy is working is whether you are getting what you wanted and is helping you move in the desired direction. 

The above can be described as the outcomes, or end resultsof therapy. Therapists sometimes make the distinction between these and the process of therapy, which describes the methods and techniques that therapists use and the client experiences that take place in therapy. 

As therapy is often about difficult emotions and events, some people experience their I felt worse as we started to explore the trauma I’d gone through but the therapist had explained this can happen. When it became too much for me, we had to focus on doing something else. feelings more intensely as part of the process of therapy, which can sometimes feel as though they are getting worse. This can be a usual and helpful part of how therapy works, but how can you tell if it is a temporary phase in a good therapy, or a sign that therapy is making you worse and is not going to help you?

From our current understanding, regardless of the therapy approach, any exacerbation or worsening of symptoms should only be short-term, be linked to exploring some difficult area that you were previously avoiding, and relate to the problem or experience that was the reason for entering therapy. If new emotions or problems arise, you should first discuss this with your therapist to explore how, or if, they may be understood as part of the therapy process and, whatever their origin, what measures can be taken to address them. (see ‘I am feeling worse’)

Questions to ask yourself

  • Is therapy helping me move towards my goals?
  • Are my symptoms getting better?
  • Is my life improving as a consequence of therapy?
  • Is my therapy making me worse?
  • Is my therapist helping me deal with the emotions that therapy generates? 

Questions to consider asking your therapist

  • What are the signs that indicate that therapy is working as it should?
  • What are the ways that this can be assessed?
  • What should I do if I experience any difficulties?
  • How does therapy work?

What are the signs that therapy isn’t working?
Not everyone who undertakes therapy has a successful outcome, with somewhere around 30 - 50% of people leaving therapy with their problems largely unresolved and their feelings largely the same. Also, the majority of people who change in a positive way make somewhere between a 30% and 80% improvement in a helpful direction. 

If you’ve been in therapy for the length of time that is usually recommended, and completed the therapy processes that are likely to help with your problem or situation but have not noticed any changes in a positive or helpful direction, it is possible that therapy isn’t working. This doesn’t necessarily mean that therapy won’t work, but is a good indication that you should review what’s happening with your therapist and then consider what can be done next. If you don’t feel able to discuss things with your therapist, or the nature of your relationship makes this difficult, this could be an indication of one of the barriers to your progress. 

Although people who experience some improvement early in therapy generally have better outcomes, it can take some time for the benefits of therapy to appear. However, you don’t have to continue with therapy that isn’t working, or continue working with a therapist with whom you feel you feel disempowered to speak up when things aren’t working.

What if therapy is making me worse?