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Key points
- Psychotherapy requires a big investment of time, effort, and money.
- Knowing if you are making progress is important so that you don't waste precious resources.
- Too often patients assume that therapy is headed in the right direction, even when they don't feel better.
- There is a simple way to clear up the confusion and make sure your time and effort in therapy are well spent.
Working with a psychotherapist requires a significant investment of time, energy, and money. Knowing that your efforts in counseling are leading to success is important. But sometimes it is difficult to judge whether progress is being made. This is particularly true if you have no previous experience with psychotherapy.
Sometimes those who have never worked with a counselor harbor mistaken beliefs regarding how progress takes place. For example, although they may feel better after each visit for having "gotten things off their chest," anxiety or depression returns as strong as ever the next day. Or they may gain new insights into the problems that initially led them to seek counseling but find this does nothing to improve their mood or alter the destructive relationships that weigh them down.
Patients with these experiences may believe that therapy is not working and prematurely end their efforts. Others may think that this is the normal course of counseling and that if they simply persist in seeing their therapist great changes will eventually take root.
Neither of these reactions is helpful because both are based on the patient having only a vague notion of what progress should look like when working toward their specific goals.
Progress in Therapy: Goals and Strategies
To accurately judge whether progress is being made in therapy requires two things. One is that you are clear about the goals you are working on in therapy. Put another way, how will life be different if therapy is successful?
If you enter therapy with the goal of becoming more assertive, progress looks very different than if your goal was to develop better control over your angry outbursts.
Secondly, you need to understand how therapy will work to help you reach your goals. For example, if you enter therapy in order to reduce anxiety, most therapists will respond by teaching a variety of coping skills. In this case, progress will be measured by the number of coping skills you have learned and how much your stress/anxiety has diminished.
But if you enter therapy because you find yourself generally dissatisfied with life and repeatedly getting involved in romantic relationships that end up with your feeling misunderstood and neglected, therapy will likely involve gaining insight and teaching new skills that help you change the trajectory of your relationships. Obviously, progress will look different in this circumstance.
In these situations insight is often needed in order to effectively employ new skills. Developing new insights into your fears, conflicts, and motivations can be uncomfortable. Consequently you may wonder if therapy is working.
This situation is somewhat like going to a physical therapist after sustaining a serious injury. At first the prescribed exercises are painful, and only after consistently performing them do you begin to feel the strength return and the limitation give way to better health.
The bottom line? How you judge whether progress is being made will differ depending upon the problem that is being resolved and the therapeutic strategy employed to resolve the issue.
Things Are Often a Bit Complex
The main takeaway from what has been discussed so far is that judging whether therapy is working requires that you be very clear about what you wish to accomplish in counseling and that the therapist be equally clear about the strategy being employed in helping you succeed.
If you are unclear about either of these points, then the first thing to do is to speak with your therapist. Get very clear on your goals and have the therapist tell you in plain English how their approach is supposed to help you reach that goal.
This is all very straightforward, but, as you would expect, things can still get a little confusing, or messy, when judging progress. One thing that adds to this confusion is that people seldom enter counseling with a single issue to solve. This is true even when they initially believe there really is only one thing to focus upon.
Anxiety is a good example. Let’s imagine that someone enters therapy because they are tired of how worry and fear restrict their life. The therapist does a thorough assessment and concludes that this patient’s coping skills are underdeveloped. Terrific. The solution is to teach the patient effective coping skills.
But…the assessment also finds that due to growing up in a highly dysfunctional family, the patient learned to assume the worst about anyone and any situation. Assuming the worst about people has kept the patient from being taken advantage of by others as they navigated a childhood filled with untrustworthy people. So this was a good and effective skill the patient developed as a child.
The problem is (and this happens frequently) that as an adult the patient continues to assume the worst. It’s become a habit, automatic, and most often unconscious.
Now we are dealing with something that’s a little more complex than simple anxiety caused by a lack of coping skills. Instead, we have an ingrained way of looking at the world that the patient counted on for survival in his or her early childhood. Changing that perspective will take time. It will also require more than teaching a handful of new skills.
If this patient asks, “Is therapy progressing?” the answer will be more complex than in the example with uncomplicated anxiety. That’s because it is no longer just a matter of judging whether new skills are being developed. A full answer requires assessing whether the patient’s automatic distrust of others is also changing. And if it is undergoing a modification, is it accurate? That is, does the patient now trust those who deserve trust and remain cautious about those who have not earned trust?
The Solution for Judging If Progress Is Being Made
We’ve seen that answering the question of whether therapy is working can be easy or difficult. Not surprisingly it depends upon the goals of therapy and the obstacles that stand in the way of reaching those goals.
The best way to get an answer is to talk with your therapist. Be direct. Raise your questions and concerns. Accept that there may be times when progress is difficult to assess, but this state of affairs should be temporary rather than the norm.
Most therapists will be grateful for your candor in asking about progress. Ideally their response would show curiosity as to why you are concerned, followed by an earnest effort to provide a clear answer.
If, however, your therapist responds defensively and fails to engage you in that discussion, then it’s time to consider finding someone new with whom to work. The time, energy, and money you’ve invested in therapy needs to be respected, and this occurs when your question is met with a straightforward response.
If that’s not what you get, then it’s likely you are not working with a therapist who can help you make the changes you desire.
In that case, the solution is to “saddle up” and look for another therapist who is a better fit.
To find a therapist near you, visit the Psychology Today Therapy Directory.
