How Can I Tell If Therapy is Working?

When starting therapy, many of us are eager to know when we can expect to see results. While a therapist can’t give you an exact estimate, it’s not unreasonable to expect that your sessions will have an impact, given enough time.

But how much time should we wait, exactly, before deciding that something isn’t working? And how do we know when it’s time to switch things up?

This isn’t an uncommon question. As Alma therapist Nira Shah, LMHC, explains, it can be hard to notice progress at first.

“Sometimes progress can feel slow,” she says. “Oftentimes, clients think that big revelations, behavior change, or feeling better happens quickly, when in reality, therapy is working with a complex system of our internal makeup [and] it takes time and active work to [sort] through.”

That “internal makeup” can include years of maladaptive thought patterns, emotional wounds, personal narratives, and trauma, so expecting noticeable progress within a few sessions or even a few months may not be realistic.

It’s still a good instinct, of course, to reflect on how therapy is going for you. This can help you better understand what type of therapy is right for you, if the therapist you’re working with is a good fit, and if another modality or professional might be a better option for you.

If you’re not sure if therapy is benefitting you, explore the following questions — ideally with your therapist! — to see what comes up for you.

1. What are my goals? And are they actually achievable?

It can be hard to tell if therapy is working if you don’t have any concrete, achievable goals you’re working toward. But how do we know what a good goal for therapy is?

According to Shah, goals can be behavioral — for example, improving your communication skills with your partner — or emotional, like experiencing less anxiety.

Emotional goals can be tricky, as many of us tend to set emotional goals that aren’t actually realistic. It can be tempting to set an emotional goal that is actually a “dead person’s goals,” Shah says, meaning it’s more achievable for a corpse than an actual person.

“For example, the goal of ‘I don’t want to be sad’ or ‘I want to get rid of my anxiety’ is a dead person’s goals because sadness and anxiety are human normal emotions, so it’s impossible to get rid of them entirely,” Shah explains.

“It is possible though, to respond to those difficult emotions differently—in a way that is healthier, more resilient, and makes those moments feel less intense,” Shah continues. “Any emotional goals should be paired with behavioral goals so they are not left vague; the behavioral goal can indicate the ‘how’ of achieving an emotional goal.”

Shah also notes that it’s important that our behavioral goals focus on what’s within our control. So, instead of setting a goal of finding a partner or getting a job, you might reframe these into behavioral goals that hone in on the skills you can develop to increase your odds of success.

You don’t have to be an expert at forming goals, however. “It’s OK if you do not know exactly what you want to get out of therapy, past ‘feeling better,’” Shah says. “Your therapist is your guide and can help form these goals.”

2. How do I feel about my therapist?

When considering whether or not therapy is working for you, it can be helpful to explore how you feel about the relationship between you and your therapist.

Research has shown that the efficacy of therapy is impacted by the strength of the “therapeutic alliance” between client and provider. How well you collaborate together is a reliable indicator of how effective therapy will be for you, making this an important question to reflect on.

“Signs a therapeutic relationship is strong can include rapport, feeling safe and supported (even when challenged), a sense of trust, feeling able to safely bring up discomfort related to the therapist or what is happening in sessions, and a sense of collaboration,” Shah explains.

For clients with marginalized social identities, Shah notes, it’s also important to be able to openly acknowledge differences between you and your therapist. “For clients of color or those belonging to minority or marginalized groups, it may also not feel like a fit if the therapist is ignoring, oblivious, or not responsive to the diverse needs of the client,” she says.

You might also consider your therapist’s style of collaboration, and whether or not it resonates with you.

Some therapists are very active and solution-oriented, while others might remain more passive. Some may bring humor and directness into the room, and others may be more reserved.

It’s important to remember, too, that talking about the therapeutic relationship in therapy is fair game. In fact, this can help bridge gaps between you and your therapist, and shape future goals you may have for your work together.

3. What are some things, if anything, that aren’t working for me?

In addition to exploring how you feel about your therapist, it can be helpful to reflect on what aspects of therapy don’t seem to be working for you.

Some questions you might reflect on privately:

• When do I not feel heard and understood? What happens when I raise this concern with my therapist?
• Where am I feeling misaligned? Is it something about the therapist’s demeanor (their perceived warmth and attentiveness, for example), or is it the content (their responses, questions, and feedback)?
• Do I feel safe to discuss the topics that are important to me, or am I holding back?
• Am I experiencing more frustration than I am benefits?

While it can be nerve-racking to share feedback with your therapist, this can actually strengthen the therapeutic relationship. If you’ve reflected on these questions and made some relevant observations, it may be worthwhile to share them with your therapist.

“It’s also important to know that your therapist should not feel like a friend. While they are supportive, caring, and have your best interest in mind, there is a clear relationship dynamic in therapy which also consists of boundaries,” Shah says. If you feel your therapist is disclosing too much about their personal life, or is giving you advice, these might be red flags.

4. What internal shifts have I noticed in myself?

Therapy’s impact on us is not always obvious. Sometimes, the shifts within us are subtle. Some of these shifts will be internal, Shah says, and others will be more external.

Internal shifts may include how you’re thinking or feeling — and it can be as simple as becoming more observant of your internal state.

For example, recognizing unhelpful thought patterns and bringing mindful awareness to your emotions (so, being able to observe what emotions are coming up for you, label them, and notice where they’re happening in your body) are both indicators of progress.

“These indicate that the client is becoming [a] better observer of their own internal state. That’s a major and important starting point,” Shah explains.

“While it may feel like nothing has changed, this noticing indicates introspection, and that you are thinking about your thinking, or thinking about your emotional experiences,” she continues. “That mindful awareness is incredibly useful and why ‘tiny shifts’ should not be discounted.”

Changes in self-talk can also be an internal indicator that therapy is effective. Being less self-critical, for example, can show that therapy is shifting how you relate to yourself. You may also come to understand new parts of yourself that were unclear before, and find yourself more fluent in naming and talking about them.

5. Am I behaving or coping differently? How so?

Externally, you may notice shifts in behavior, patterns, and coping tools.

“For clients who have challenges with vulnerability and difficult emotions, a sign therapy is working is them being able to speak about these emotions in session and sit with them for a little longer outside of session,” she explains.

Reaching for coping tools in difficult moments — like taking a few deep breaths in the heat of an argument — is also an important example of behavior change, even when those tools aren’t as effective as we’d like them to be.

“That turning towards yourself with care is not for nothing; it helps embody more of the compassionate spirit a client needs for healing, growth, and patience for themself in the process,” she says.

While feeling more stable or grounded is a positive sign, Shah points out that feeling worse can be an indicator of progress, too.

“Especially for folks who tend to avoid uncomfortable emotions or distract themselves, being able to sit with the discomfort is a huge step forward . . . So while it may seem ironic, [it] can actually mean that you’re connecting with yourself more through therapy, and that’s a great sign.”

Of course, if we could easily observe the shifts in ourselves, we probably wouldn’t be asking if therapy is working for us! If you’re having trouble noticing progress, it’s a good idea to ask your therapist what they’ve observed, too. Their answer may surprise you!

6. Am I doing the work outside of session?

If you’re hoping to see results with therapy, what you do outside of session is just as important as what you’re doing in your sessions.

“With most therapy models, only attending therapy sessions is not enough for meaningful change,” Shah explains. “It needs to be matched with active efforts outside of sessions to integrate what is discovered in sessions and put tools into use in real life, consistently.”

If you aren’t sure how to integrate what you’re learning, ask your therapist to identify some opportunities for you. If you’re the sort of person who benefits from structure, you might even ask your therapist to give you “homework” to practice outside of session.

While progress may be slow, therapy can still be worthwhile.

It’s totally normal to feel impatient with your progress. If you arrived at therapy feeling particularly down, it makes sense that you’d want to see results! While it may take time, therapy can be an incredibly worthwhile endeavor in the long run.

If you’re still struggling and find that your needs are unmet, don’t hesitate to open up a dialogue with your therapist.

“If you feel that therapy is not working, it’s best to discuss this with your therapist,” Shah says.

An open conversation about how therapy is going can be empowering, particularly if you’re someone that tends to avoid difficult conversations, Shah adds. “By having an honest conversation, it can not only provide clarity for the client, but is also an incredible point of processing—being able to speak about the therapeutic relationship is, in itself, therapeutic. It allows clients to be honest, direct and communicate their needs in a safe environment.”

Best case scenario, you can revisit your goals and shift gears! And worst case scenario, you now have the information you need to make a decision about whether or not to continue on with your specific therapist.