Does therapy work? 4 ways to track your progress
You’re sifting through the websites and directories, looking for the right person and wondering if therapy is really going to pay off. You may have had therapy before and didn’t find it helpful. Or this may be your first time exploring the idea. Either way, you’re on the fence. It’s quite an investment, and what if you don’t make the progress you want to see? What if you go with the wrong person? I mean, how can you even be sure therapy will work for you?
Many factors impact progress in therapy, so it’s true there are no guarantees. There are, however, several ways you can tell if therapy is working for you. In fact, you can measure your progress using both objective and subjective methods.
What does this mean? Read further to learn about 4 ways you can tell if therapy is working.
Use short, quick screeners to help measure your progress in therapy.
Well hopefully at the start of therapy, your therapist will ask you to complete some questionnaires about the difficulties you’re experiencing. The GAD-7, for instance, is a short, 7-question assessment therapists often use when clients experience anxiety. It asks things like how often, over the last two weeks, you have felt on edge, had difficulty controlling worry, or have been really irritable. Similarly, the PHQ-9 is a brief survey that asks how often in the last two weeks you’ve experienced symptoms of depression, like feeling down or having little energy. Your scores on these measures are something that can be easily recorded and tracked over time. Numerous other questionnaires are used to quantify substance use, reactions to severe stress, and pretty much any other symptoms you may be experiencing.
Used at the start of therapy, these brief assessment tools can provide your therapist with a sense of what is most difficult for you and a baseline from which to track progress during therapy. During the course of your work together, retaking these measures periodically is a great way to get a sense of how your symptoms are improving.
Now, we all have good days and bad days, so of course you have to put these in context. There are times, particularly in trauma treatment, when outcomes will look worse mid-treatment than when you first started. Sometimes this happens when certain memories come to the fore while you’re working through them, for example. Your results might also look worse if something stressful, like an argument with your partner, just happened. Other times you might see that your anxiety has improved significantly, but now the depression scores are up. These are common scenarios and are great topics to explore with your therapist.
Because progress is rarely linear and will not always fit into neat checkboxes, I wouldn’t rely on these tools as the sole way of gauging progress. Still I find these measures helpful for looking at overall trends and identifying particular problem areas. Clients, too, seem to really appreciate being able to look back at their scores and see how things have gotten better over time. Recently, during a 6-month review of goals, a client’s anxiety and depression dropped from initial scores considered severe and moderate, respectively, to mild for both. We were delighted, of course, but also surprised. Sometimes, you don’t realize how far you’ve come unless you have something concrete to compare it to.
2. Define your goals for therapy from the start.
What is it that brings you to therapy and what would you like out of it? How will you know you are done? When you start therapy, you’ll be asked these questions in order to define your treatment goals. Do you want to have more fun, pick better partners, feel more confident, worry less? Great outcomes have a lot to do with clarity about your goals. In my experience, both clinicians and clients sometimes forget the initial reasons for therapy as they veer from topic to topic. For some clients, a fluid approach like this works fine. If you’re not sure you’re making progress, though, reviewing the initial goals of therapy is a good way to clarify how things are going.
You might ask yourself: Are the reasons I got into therapy the same difficulties I have now? Have things gotten better, at least the parts I have some control over? If you feel your sessions have strayed from your most important reason for starting therapy in the first place, and that goal is still primary, don’t be shy about talking to your therapist about it. They’re your sessions, and your therapist wants you to get the most out of your time together! Plus, there may be a reason you and your therapist have been addressing other topics first, or moving more slowly, and these can be rich conversations to have. Looking back might also help you see that you have actually met your initial goals or made enough progress that you have organically shifted focus to other important areas. Therapists tend to review goals with clients every 3-6 months, but you can do this anytime, with your therapist or on your own. Reflecting on your initial why for starting therapy and the goals most important to you now is a great way to monitor your progress.
3. Tune in to your own experience.
Once you start therapy, I encourage you to reflect on your feelings about how it’s going. Give yourself and your therapist a little time, of course, and then consider how you’re experiencing yourself and moving through the world. Can you observe a positive shift inside in how you react to things or relate to others, even if it’s not consistent yet? Do you notice you are doing things a bit differently and feel proud of this change? Do the places of stuckness feel less solid and more workable? Are you finding that, little by little, you like yourself more, understand yourself more, have more compassion and less shame, even if there are setbacks along the way?
You might check in too on your feelings about your therapist, as this relationship plays an important role in therapeutic progress. Do you feel seen and heard, like this therapist gets you and cares how things are going for you? Do they remember the important things and seem responsive and genuine? If there is misattunement – because no one is perfect – and they say or do something that does not sit well with you, can you let them know and it’s ok? I actually get very excited when clients tell me I did something that bugged them. Why? It reflects a certain amount of trust and an opportunity for meaningful conversation. For many, it is hard to speak up and ask for what is really needed or wanted, and this interaction itself may be a sign of progress!
Your sense of how things are going in therapy are really important and, when used as a yardstick for progress, often best combined with #1 above, the scored assessments. Wanting to make big change fast is understandable but can sometimes obscure the less obvious but significant steps forward that you’ve taken. Objective assessment tools can help balance your evaluation of progress by felt-sense alone.
4. Notice what others are noticing about you.
A fourth way to get a sense of progress is to observe what people say about you and how they relate to you as you invest effort into your therapy goals. You may hear comments that point to positive change. Sometimes this comes from coworkers or bosses, other times from friends or family. They may observe that you seem calmer, more present, or more social again. Clients have described others taking notice of them keeping plans rather than canceling, expressing more optimism and less criticism, and using fewer substances, for instance. Keep your eye, too, on the rippling of positive interactions as the changes you make elicit desirable responses from others. Perhaps they respect your boundaries more or are in a better mood themselves. One caveat, of course, is if you are making changes that run counter to another person’s agenda for you. Then they may not like it! At the same time, depending on your goals, sometimes this is progress.
If you are on the fence about starting therapy and worried about whether it’ll work, I hope the above tips give you more confidence in your ability to evaluate progress as you give it a go. Within two to three months, you should be able to – objectively and/or subjectively – experience change in a positive direction, though it will likely have some ups and downs along the way. If you’d like to give it a whirl, I’d love to hear from you.
Licensed Therapist
Linda Shing
Linda Shing is a Los Angeles-based therapist. She helps high-achieving artists and professionals overcome perfectionism, imposter syndrome, and low self-esteem.