How to know if therapy is working

I recently asked folks in our community to offer their advice for those starting therapy for the first time. As always, the feedback was honest and helpful and I was reminded of what a stellar community we have.

An interesting theme emerged as the feedback rolled in. Several people noted how important it was to recognize if a therapist wasn’t the right fit and to move on quickly if they weren’t. “There are lots of therapists in the sea!,” one person noted.

Meanwhile, many others recommended giving therapy enough time and being patient in building a relationship with a therapist. “It takes a while to feel really comfortable. Don’t assume it’s not helping.”

So which is it?! Are first impressions valid when it comes to your therapist? What do you do it your gut says something’s off? How long does it take to know if this is the right therapy for you? And what should it feel like if you are making progress?

Just like therapy, let’s take a breath and approach this one step at a time.

What should I do if I don’t feel connected right away? 

Therapy is a really interesting type of relationship and not one we have much of a model for outside of therapy. This means that sometimes the inner feelings that we use to assess our day to day relationships can — to a degree — be less useful here.

And in some cases, feeling like the dynamic in our therapeutic relationship is different than what we are used to can actually be a really useful aspect of the experience. For example, if we tend to gravitate to people who are louder or more domineering because it lets us to retreat into the safety of being in the background, sitting with someone who is quieter or gentler may actually feel really uncomfortable because it pulls for something different in us.

What this means is that it can indeed take time to understand our reactions to our therapist and even to discover if they are actually just what we need. What can help is talking openly about our reactions to our therapist.

Look, I know that feels strange. It’s not something that we often do in our regular social interactions. But that’s the thing — this isn’t social. The therapeutic relationship is founded on being different than others and being able to share your genuine feelings and reactions with your therapist, even — and especially — about the relationship itself.

On the other hand, if it’s less that that it feels different and more that you feel misunderstood, invalidated, or that the therapist doesn’t have the requisite skills or experience, it’s likely time to move on.

How long does it usually take to benefit from therapy? 

I’m going to start with the infamously frustrating therapy response of, “It depends.”

The main factors that determine how long therapy should take include what type of problem you’re seeking help for, what the treatment approach is, and whether there are other challenges that are impacting how much progress can be made.

For most people, they tend to feel some progress right away, regardless of the problem. This is because just starting therapy and feeling that you are making an active effort to take control and that you have someone on your support team can have tremendous benefit.

Briefer therapy interventions tend to take 12 to 20 sessions, particularly when you are seeking help for  something like sleep problems, a single-incident trauma, panic symptoms, or a first-time depressive episode. Therapy is generally a longer process when addressing long-standing relational patterns, eating disorders, or more ongoing mental health challenges.

How do I know if therapy is working? 

Breakthroughs are totally possible in therapy, but the reality is that most of therapy is not about having a life-altering insight. It’s nice when it happens, but it’s not necessary for real, sustainable change. For most of us, the change that happens in therapy comes in fits and starts. It feels much less glamorous then what’s portrayed on HBO. And, honestly, it sometimes sucks.

If you’ve gone to therapy to stop skin-picking or stop yelling so much or to binge eat less often, you will probably have a good gauge of whether your symptoms are improving based on how things are going behaviorally. With mood or anxiety issues or improving stress management, it’s helpful to come up with some behavioral and mental markers to track so that you can determine how things are moving.

What is often more nuanced is progress toward goals like better self-esteem, dealing with complex trauma, improving relationship patterns, and feeling more secure in your abilities. In these circumstances, therapeutic changes often do take more time and may be harder to see — at first.

Awareness of progress often comes after the fact — realizing that you handled that situation that would have normally driven you to meltdown with less intensity; noticing that you and your partner aren’t avoiding each other at home as much; finding that you were able to set a boundary about working after hours. It’s often not an “aha!” Rather, it’s, “Huh, well look at that…”

Since these goals are met incrementally, it’s not usually to feel frustrated with the pace of progress. When you’ve been doing the hard work of healing, it can feel demoralizing when a situation makes you feel like you’re back at square one. But the reality is that we are never back at square one. We’re constantly moving forward with the experience and wisdom we gain from each new fumble — even when it hurts.

Sometimes, just noticing that we did fumble is a sign of progress. Whereas before we might have plowed ahead, avoiding our feelings about the hard stuff, noticing that we didn’t act in alignment with the work we are doing is a sign that we’re getting there.

And if it’s truly not working, what do I do? 

If you’ve been participating in therapy for a while and you’re not seeing or feeling changes, it might be time to try a different approach. Sometimes that means working with your therapist to identify a different intervention. You might have some ideas about what that could look like, and you shouldn’t be afraid to say so. For example, you might realize that while you’ve been focusing on certain situational stressors in your work together, you realize that there are roots of the problem that go back much farther. Or, you might realize that while you’ve made lots of progress in understanding the issue, you need to be putting into practice some tangible skills.

Keep in mind that you don’t have to understand what’s not working or how to address it to make a change. Letting your therapist know that you feel stuck is the key. Often, just that conversation alone can be enough to prompt new insights or spark change.

In having that conversation, you and your therapist might also agree that you need to change course by seeing a different practitioner. That could be someone that practices from a different style of therapy or has other qualities that might help move you forward. A good therapist will help connect you with someone who can better suit your needs. serve to feel free.

Dr. Ashley Solomon is the founder of Galia Collaborative, an organization dedicated to helping women heal, thrive, and lead. She works with individuals, teams, and companies to empower women with modern mental healthcare and the tools they need to amplify their impact in a messy world.

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