Is my therapy working?
You’ve been going to therapy for a while, and you’re not sure whether anything is changing, or whether you’ve reached a plateau. It’s a reasonable thing to wonder, and a reasonable thing to ask your therapist. This page covers what progress usually looks like, what to compare it against, how to track it together, and what to do if therapy feels stuck or unhelpful.
What progress tends to look like
Progress isn’t a straight line. In therapy, it often isn’t gradual either. A review of 50 studies, with about 6,400 people, found that a sudden, large improvement between one session and the next was common across many kinds of therapy (Shalom and Aderka, 2020). People who had one of those jumps tended to be doing better by the end of therapy, and later. Across 26 studies of everyday therapy, improvement tended to come faster in the earlier sessions and slow down later on (Robinson and colleagues, 2020).
Early sessions are awkward for nearly everyone, and it usually takes three or four before you can tell whether this is someone you can work with. Early on, the first thing to judge is the working relationship rather than results. Why who you see matters more than what they do explains how much the relationship matters.
What to compare against
The most useful thing to compare against is what you wanted to be different when you started. It helps to keep track of how you’re progressing towards whatever goals or changes you first brought to therapy. Moving towards them, even slowly or unevenly, suggests therapy is working for you. Speak to your therapist if you’ve lost track of what your goals are, or if you think they may have shifted.
Tracking it with your therapist
Some therapists track progress with a short questionnaire every session or so, and look at the results with you (de Jong and colleagues, 2021). A review of 58 studies, with about 21,700 people, found therapy went a little better when progress was tracked and fed back this way, including for people who weren’t improving as expected. Fewer people dropped out, too. It’s reasonable to speak to your therapist about how you might be able to track your progress.
Here are two questions you could use to start that conversation:
- “How will we know if this is working?”
- “Can we look back at how things have changed since I started?”
When it doesn’t feel like it’s working
What to do next depends on what’s happening.
- It feels stuck, or it helped and then stopped. Why therapy stalls, and what each reason points to goes through the common reasons one at a time.
- You haven’t said anything yet. How to tell your therapist something isn’t working covers how to raise it, and what your therapist will probably do.
- You’re getting worse. Across the research, a small number of people get worse during therapy. Tell your therapist, and if things feel much worse between sessions, don’t wait for the next one to let them know.
- Something about it feels wrong. All the ways therapy can go wrong covers what to do when it’s more than a poor fit, including if you’re feeling worse.
If it is working
If things have changed, it’s also fair to ask what comes next, and whether you’re close to done. When is therapy finished? covers how to tell when you might be ready to stop. How long does therapy take? covers what the research shows about how much therapy people tend to need.
If things are getting harder rather than easier, the numbers below are there any time.
If things are difficult right now, Lifeline is on 13 11 14, the Suicide Call Back Service is on 1300 659 467, and Kids Helpline is on 1800 55 1800 for anyone aged 5 to 25. In an emergency, call 000. Crisis and emergency support has the full list.