How do I know therapy is working?

Congratulations on starting therapy! Making this choice is a big step. You invest time, energy, and sometimes money into your well-being, and just like if you had a physical illness, you want to know if the treatment is making a difference. I completely understand.

It’s important to remember that therapy takes time. There are no magic pills or quick fixes that can create change overnight. Some sessions might even leave you feeling worse because you’ve confronted difficult emotions or uncovered challenging truths. That’s all part of the process.

Still, over time, you should start to notice positive changes that align with the goals you’ve set with your therapist. To help you assess whether therapy is working for you, here’s my advice.

Setting Realistic Expectations

One of the most important things you can do early in therapy is to talk with your therapist about setting realistic expectations for your goals and timeline. This can be tricky—after all, if you don’t know what “better” looks like, how can you tell if you’re improving?

Adding to the complexity, it can take time to figure out what’s really going on when you start therapy. Some people come in with a clear understanding of their concerns, like seeking help for obsessive-compulsive disorder, anxiety, or depression. Others may feel unsure about what’s wrong or why they’re struggling. If that’s you, it’s perfectly OK to tell your therapist that you’re not sure what you need. That’s exactly what the intake session (your initial consultation) is for: to explore your concerns and clarify what brings you to therapy.

Once you’ve identified your starting point, I recommend working with your therapist to set a clear goal for therapy. Your goal is personal—it’s about what you hope to achieve—and it will guide your treatment plan. A good therapist will tailor their approach to your specific needs using evidence-based techniques. For example, if you’re dealing with depression, they might use cognitive behavioral therapy (CBT) or interpersonal therapy.

You can also discuss a general timeline. This doesn’t mean setting a hard deadline for “finishing” therapy (healing isn’t that straightforward), but it does mean identifying markers or milestones to track your progress. Don’t hesitate to ask your therapist directly: How will I know if therapy is working for me?

Is Therapy Working? 3 Steps to Find Out

Once you’ve set goals with your therapist, it’s important to periodically evaluate your progress. Here are three ways to assess whether therapy is working for you:

1. Check in with yourself.

Take a moment to reflect on your own progress. Are you noticing any changes in the areas you’re working on? For example, if you’re using eye movement desensitization and reprocessing (EMDR) to address trauma, is your trauma response becoming easier to manage? Or, if you’re in couples therapy with the goal of handling conflict differently, are you applying those new skills in your daily interactions? Pay attention to the small wins—they matter.

2. Check in with others.

Sometimes, change can be so gradual that it’s hard to notice in yourself. That’s where feedback from trusted people in your life can be invaluable. Ask a partner, close friend, or family member if they’ve observed any changes in you. Be specific: What do they see that’s different? Their perspective can offer insights you might not have recognized on your own.

3. Check in with your therapist.

Your therapist can also help you gauge progress by asking pointed questions. For instance, they might say: “When you first came to me, you had a hard time getting out of bed. How is that now?” You might respond: “I don’t even think about it anymore—I just get up.”

Or they might ask if weekly sessions still feel necessary. You could find yourself saying: “Actually, I think I’d feel comfortable moving to twice a month.”

These conversations are a great opportunity to reflect on where you started and how far you’ve come—or to identify areas where adjustments might be needed.

What if Therapy Doesn’t Seem to Be Working?

It can be tough to face the possibility that therapy might not be working for you. However, recognizing the signs is an important step toward finding the care you need. Here’s what to watch for:

1. You feel worse after every session.

While it’s normal to have hard days in therapy, you shouldn’t feel like you’re backpedaling after every session. Occasional discomfort is part of growth, but consistent feelings of regression may signal a problem.

2. You’re not making expected progress.

If therapy doesn’t seem to be moving the needle for you, it’s worth revisiting your goals with your therapist. Together, you can assess where you are now and whether adjustments are needed. Lack of progress over time is a red flag that something isn’t working as intended.

3. Your symptoms are worsening.

Therapy isn’t meant to make you feel cheerful all the time, but it should help improve measures like your mood, coping skills, and day-to-day functioning. If your symptoms are becoming more frequent or severe—or if they’re impairing your ability to live your life—it’s time to reevaluate.

What Can You Do?

Start by talking to your therapist. Many people find this intimidating, but it’s an essential part of ensuring you get the care you need. Therapists are trained to receive and integrate feedback from clients, even when it’s hard to hear.

Your therapist may suggest recalibrating your treatment plan or exploring a different approach. In some cases, they might refer you to another therapist who could be a better fit for your needs. Remember: Therapy is about you, and finding the right support is key to your healing journey.

When Therapy May Not Be Enough

Sometimes therapy alone isn’t sufficient to address mental health challenges—and that’s perfectly OK. Many additional tools can complement therapy and enhance its effectiveness.

Considering Psychiatric Medication

Psychiatric medication is one option worth considering, as it can significantly enhance the effectiveness of therapy. For example, medications like selective serotonin reuptake inhibitors (SSRIs), commonly used to treat depression, can help stabilize symptoms. This stability often makes it easier for people to actively participate in therapy and implement positive changes in their daily lives.

Plus, research shows that combining talk therapy with psychiatric medication often yields better results than either treatment alone.

If you’re curious about whether medication might be right for you, bring it up with your therapist, primary care provider, or a psychiatrist. They can guide you through the decision-making process by asking the right questions and assessing your specific needs.

Ruling Out Medical Causes

It’s also essential to consult your primary care provider to rule out underlying medical conditions that may contribute to mood problems. Physical health issues, such as thyroid disorders, are known to cause symptoms of depression or anxiety. Addressing these conditions can significantly improve mental health outcomes and make therapy more effective.

Therapist’s Final Note

To make therapy as effective as possible, I recommend three key things:

1. Find a clinician who fits your needs. Look for someone who specializes in the specific issue you’re dealing with.
2. Ensure your treatment plan is personalized. Your clinician should tailor the approach to address your specific concerns.
3. Be open to adjustments along the way. Therapy isn’t one-size-fits-all, so your plan may evolve as you progress.

Think of therapy like going to the gym: It’s all about consistency and gradual change. At first, you might feel sore or not notice much improvement day-to-day or week-to-week. But months later, you realize you’re fitting into jeans that didn’t fit last year, your arms look stronger, or you’ve gone from barely running to signing up for a half-marathon. The progress may seem subtle at first, but when you look back, you’ll see just how far you’ve come.