Erin Smith, 27, a publicist in Upper Marlboro, MD., struggles with anxiety. She can tell therapy is working well since she now implements some of the coping mechanisms she’s learned there. “I catastrophize and go down a rabbit hole when bad things happen,” says Smith. But because of therapy she’s able to interrupt those thoughts with constructive alternatives.

“I brainstorm positive outcomes of the situation. I write down what I would like to see happen and follow with positive affirmations,” says Smith. “It has created a dramatic improvement in the way I deal with high-stress situations.”

In Smith’s case, clearly something is working. She learned tools to cope with high stress situations and they’re working.

But is it always this simple? Not exactly, according to the experts. Figuring out if therapy is working can be complicated and the clues are sometimes subtle. Therapy doesn’t work like taking an aspirin, it can be much harder to quantify and define success when it may seem subjective.

So, how do you tell? Is it because your therapist says you’re making progress? Maybe it’s working since you feel better after a session. How about if you feel less depressed, anxious or communicate better?

“Therapy is a serious investment and an important endeavor. That’s why it’s so important to consider carefully who you chose to work with,” says Lisa Wolcott, LCSW, at Wolcott Counseling & Wellness, LLC in Gainesville, Fla.

Laying The Foundation For Therapy To Work

Your therapist should be someone who “gets” you, makes you feel profoundly understood, yet also challenges you effectively.

Plus, you need to trust your therapist not to judge you. “Liking your therapist is important, because if you don’t think highly of them, talking to them won’t be helpful,” says Jennie Steinberg, LMFT, LPCC, in a Los Angeles-based psychotherapy practice called Through the Woods Therapy Center.

In fact, research shows that the main thing that impacts whether you change through therapy is the quality of the therapeutic alliance. Can you be blunt with your therapist? Can you tell them everything? If you’re afraid to tell your therapist things, especially things you think they might disagree with, then therapy won’t be effective. “It only works when you can be your whole self,” says Steinberg.

Setting Your Expectations For Therapy

“Progress in therapy isn’t supposed to be shrouded in mystery,” says Hailey Shafir, LCMHCS, LPCS, a therapist at Choosing Therapy, in Brooklyn, N.Y.

Early in treatment, the client and therapist should set SMART goals (specific, measurable, attainable, relevant and time-bound) that structure your work together.

Goals should be periodically revisited to check on progress and revised to reflect the treatment plan.

“I emphasize that the real progress doesn’t occur in the one hour they spend with me each week, but in all of the other hours where they have the opportunity to take what they have learned and do things differently,” says Shafir.

One way to look at your therapy goals is to imagine it’s your last session, six weeks, six months or six years from now. What’s different? “Once you know what you’d like to see change, you can take a look at those goals as a metric for whether anything is actually moving in that direction,” says Steinberg.

How To Tell If It’s Working

Whether or not therapy works can also depend on the kind of therapy you’re doing, how often you see your therapist, whether you’re digging deep into issues or staying surface-level, and your benchmark of awareness, insight and understanding.

“Therapy—good, change-inducing therapy—take longer than people think,” says Wolcott. Although sometimes a few sessions can make a big impact, lasting change takes something like a year to 18 months for most.

Sometimes it’s boring, sometimes tedious, sometimes it may seem like not much is happening but working through these “meh” times can allow you to dig deeper to the work that really matters.

What’s more, therapy sometimes makes you feel worse before you feel better.

Steinberg says, therapy isn’t about advice; it’s about helping you figure out what feels most authentic. “If you find yourself at a crossroads thinking, “I’ll ask Susie what to do next week in our session, and she’ll tell me,” that’s not effective therapy. If you find yourself thinking, “Susie has been teaching me to trust my own intuition, and my gut tells me that choice number one is better,” that’s a sign of effective therapy.”

How To Track Your Progress in Therapy

Overall, ask yourself some questions to make sure you’re experiencing the kind of change—and progress you’re looking for, and if you answer yes, here’s what it may mean:

  1. Do I feel more hopeful? (Bleakness is lifting.)
  2. Do I hear my therapist’s “voice” between sessions? Do I find myself asking, “What would my therapist do or say here” and know the answer? (Sessions are memorable and helpful.)
  3. Am I thinking new thoughts/thinking of things in new ways? (You’re learning tools and coping mechanisms.)
  4. Am I taking some new risks? (You’re incorporating new ways of being.)
  5. Are my relationships getting better? (Your life’s improving.)
  6. Do I feel my therapist is doing more than just “yessing” me or providing a compassionate ear (There’s a good match between you.)
  7. Is my therapist giving me relevant resources and techniques to use outside of therapy, and am I using them? (Shows trust, investment and progress.)
  8. Do I have increased resilience and the ability to bounce back when facing challenging situations? (There’s an effective environment for change.)

One thing to note, therapy doesn’t necessarily make you feel better after each session. Sometimes deep emotional work is the very thing that makes you feel exhausted, teary and spent afterward, but it’s also what brings about lasting results.

“Progress occurs when a depressed client calls a friend instead of isolating, when anxious clients face their fears, and when self-medicating clients are strong enough to face their feelings sober,” says Shafir.

Last Updated: May 14, 2021