April 12, 2023

How can you tell if therapy is really working?

It’s not always obvious whether therapy is actually improving your life. The thing about therapy is, it doesn’t work the way a medication might, where you have symptoms, you take a drug targeting those symptoms, and hopefully after some time, those symptoms go away.

Therapy is more about taking the time to look for and treat the source of the wound.

It can be hard to understand what therapy is targeting, or how it is doing so. Therapy comes with a pretty strong sense of the unknown for a lot of people, and it can be uncomfortable to put your trust in a seemingly vague, nonlinear process.

So, what does success look like in therapy?

Part of what makes success in therapy so difficult to measure—or even explain—is the fact that success means different things to different providers, in different kinds of therapy, and for different conditions or purposes.

To break that down a bit, the “how to know if therapy is working” answer for any one person greatly depends on what they sought treatment for (their health and personal history, symptoms, goals for treatment, background) and who they are receiving treatment from (how they were trained, what kind of therapy they practice, and what they might look for in a patient for improvement).

Goals and successes in psychotherapy can also change over time, as therapy itself is a very dynamic process.

Like the conversations in any relationship, what you discuss initially might be more general until you get more comfortable. Your goals might also start off as more surface level (e.g., “I want to sleep better”). But what comes out over time through your work together could be a deeper, causal understanding of these symptoms (think: I’m not sleeping because I experienced a trauma and am having nightmares from it), which in turn, could alter the goals for therapy, what improvement would look like, and might even change the type of therapy someone receives.

Your therapist also learns a lot about you from the behaviors, patterns, and thoughts you exhibit in session, which can help dictate what “success” looks like. By observing you over time, and coming to know you, a therapist will only better be able to point out what they witness or make interpretations of what these behaviors or thoughts might mean.

For instance, a therapist might notice you change the topic every time your partner is mentioned. After seeing this a few times, a therapist might say, “I notice that every time I ask about your partner, you change the topic,” which can open the conversation up for discussion on the meaning behind this and might, in the future, allow for greater awareness or understanding. You may have previously been completely unaware of these behaviors, thoughts, or interpersonal patterns—so this type of awareness or insight, that might be considered a “success” in therapy would be kind of unexpected and hard to predict upfront.

There are a few common ways to assess your progress in therapy.

Ultimately, successful therapy means that your symptoms seem better managed or are decreasing, and you feel like you’re accomplishing your current goal(s) or raising your self-awareness outside of therapy. But let’s unpack this some more.

If you went into therapy symptomatic of a mental health issue, like anxiety issues, you can look at whether your symptoms have decreased (or are gone completely), or if they are interfering with your day-to-day activities less frequently. For example, you might feel less anxious, you might have less frequent panic attacks, or you might be sleeping more hours a night.

Keep in mind that this will not be perfectly linear, and sometimes you can have bad days or even weeks. The dips or plateaus you might witness as you track your symptoms do not mean your progress has stalled or therapy is not working. It’s more important to pay attention to the greater trends and try not to worry over the details of the day-to-day changes.

But keep in mind that not all progress will be obvious and tangible.

Other therapy success “metrics”—like developing your self-awareness and insight—are measures that often perplex patients the most because they feel less tangible. Say you’re receiving therapy that’s insight-oriented: Success would mean that your insight has deepened. In other words, you understand yourself, your feelings, and your behaviors more than you did before therapy started.

Additionally, therapy may be working if you feel you do not need to be seen as regularly, your problems do not feel as urgent, or you generally feel better able to cope on your own. But it’s important to realize that it can take a long time to get to this point, and that’s okay. You may not reach that goal right away, but if you feel that you are making progress toward it, that is a good sign.

And, surprisingly, sometimes feeling worse is actually a measure of success.

Without sounding cliché, you will often feel worse before you feel better. Change is hard and can hurt. Good therapy doesn’t always feel good because it often requires patients to look at and change long-standing patterns of behavior. Therapy also requires patients to deal with a lot of things they have been avoiding (topics, emotions, people), and that can cause a “spike in painful emotions”. You shouldn’t let this discourage you from continuing treatment.

The end goal for therapy is also not simply to “be happy” and never experience other emotions, like sadness or anger. Progress in therapy loosely means you are allowing yourself to observe and experience all your emotions. Getting to a perpetual state of happiness is not reality. Happiness is one emotion of many. You also can’t feel happiness and not feel pain.

Finally, therapy takes time and requires a lot of patience. In the end, if you are able to understand yourself much better, to set healthy-enough boundaries for yourself and others, to love and find enjoyment in what you do in your life…then therapy was all worth it.