How To Know When Therapy Is Working (A Checklist)

I found this list as part of an article with 50 signs of good therapy (50 Signs of Good Therapy) but I thought the last section was the most important, with concrete examples (which are so hard to come by in therapy) of how you can know when your therapy is working.

Personally, I don't think I've been getting the results below much, I wonder if others have?

33. You feel better! You notice that you are happier, calmer, at ease more often, and more hopeful about the future.

34. You are resolving your own issues and not looking to your therapist or anyone else to fix things for you. A good therapist guides you to your own best solutions. They are not “rescuers” who are there to save you from the issues you are facing. Instead they help you achieve insight into your own thoughts, feelings, and experiences so that you can make the right choices for yourself and move toward a healthier emotional state.

35. You handle life’s ups and downs more easily and with more control over your emotions. You see the difficult times as part of life and are less likely to become overwhelmed by them.

36. You are more forgiving and accepting. You are seeing those around you, including those who may have hurt you, as humans who may have simply made mistakes just as you have.

37. You are more connected to yourself and your own emotions, to those around you, and to life in general. You look forward to living your life and not just moving through it.

38. You are beginning to see things differently. Your perspective on life and everything around you is changing, and you see solutions where you may have seen problems in the past.

39. You are making different choices and looking at your own needs more often. You recognize that you have choices you didn’t used to think you had.

40. You smile or laugh more; your whole demeanor is more positive and future-focused.

41. Other people are noticing differences in you, and they are beginning to react to you in different and more positive ways.

42. You are getting along better with the other people in your life—from your friends and family members, to your coworkers, to strangers you come across on a day-to-day basis.

43. You have more hope for a brighter future for yourself and for your loved ones.

44. You have some sort of plan or goal for what you want your life to be, and you’re working towards that goal.

45. You are setting healthy boundaries with the people in your life and actually building stronger relationships because of it.

46. You notice that you’re feeling better outside of the therapeutic setting and not just while you’re talking to your therapist.

47. You feel safe both emotionally and physically.

48. You feel important, competent, and significant in the lives of those around you. You know you have value to them and to yourself.

49. You feel stronger and better able to express your own needs and desires. You don’t feel victimized by the actions of others.

50. You are making your own healthier choices for your behavior, for your thoughts, and for your feelings.

33. No
34. I never looked to the therapist in the first place
35. No
36. I never thought they were out to get me in first place
37. I am the same as I have always been. Don't see this as a problem
38 no - but I did not see tons of problems everywhere before I went
39. No - but I have always thought almost everything was a choice of some sort
40. No
41 No
42 No
43. no
44. I always did - nothing to do with therapy
45 Always have had good boundaries - nothing to do with therapy
46 No I never feel better when at the appointment with the therapist
47. Not more than before I started
48. I never think of this one way or the other
49 Never did
50. Always have - so no different due to therapy

These questions don't really seem to apply to why I started seeing a therapist in the first place. Some of the nos are no, but I wasn't looking or wanting to have any difference in these areas.

Yes I have. I can relate to a great part of these results. That's why I'm ending therapy.

For me the answers would be:

33. No
34. Yes (But I always have.)
35. No
36. No
37.No
38.No
39.No
40.No
41.No
42.No
43.No
44.No
45.Never had boundary issues.
46.No
47.No
48. Meh. Maybe.
49.No. Never did feel victimized, and never had a problem expressing myself.
50.No. My decisions and choices weren't really a problem anyway.

This checklist is thought provoking, but I wonder if it is simplistic? Maybe it is more relevant for CBT than psychodynamic therapy? i think that therapy can stir up a huge amount of emotion, perhaps emotion that has been buried for years, and so at times will not feel good. I've been wondering if, for this reason, that for some people long term therapy may not be good as it makes them continue to feel all this emotion? Maybe it depends on the therapist?

I could answer Yes to all of those statements. Some of them I already did before therapy anyway, but most resulted from what I learned and changes I made through therapy. Therapy most definitely was helpful to me and I was able to essentially discontinue therapy because I don't really need it any longer.

My answers are either "I'm still working on it", or "sometimes". Either I'm hopeless, or too stubborn to change..

Then again, maybe I just wasn't open enough in therapy to make a difference?

Hello SykscraperMeow,

Thank you for this thread. I have been thinking of starting a similar thread, wondering how other people view their own therapy-past and present-and whether they feel it is helping them or had helped them. Can they see areas of positive healing or growth and do they attribute those things to the therapy process.

When I look at the list you provided I feel an intense sadness for my own experiences in therapy, which were not only unhelpful, they were extremely damaging. I am glad for all those who have found a therapist who has been helpful to them-I have read that people have said they have had positive experiences in therapy. As for me, I wasn't so fortunate. Not due to lack of trying. I don't give myself a lot of credit for things but on this subject I can say that I have never tried harder at anything than I have to heal-when I was in therapy and now on my own. I have tons to say on this subject. Tons. In fact, I have recently decided to write a book about my experiences in therapy. I don't know how that will go but I think that I need to have something, something worthwhile come for what I went through.

I remember talking to someone, while I was in the therapy process that I mentioned above. This person had been in therapy and she was describing her experience, using many of the comments on the list you provided. She told me that she felt better, stronger and more positive about life. She felt she had tools to use to help her in the difficult moments, that she didn't have before. She felt a trust in her abilities to get through the dark times, that she didn't have before. I remember hearing her talk, feeling stunned by what she described. I had been telling myself, for years, that the fact that I wasn't getting better in therapy (I was getting worse) was because there was something drastically wrong with me, that it must have been because I was inadequate. Or, maybe I was too troubled to ever get better, I always told myself. And, even though there was a part of me that knew that the therapist was being harmful, I had become so attached to him that I feared I would not survive without him-being without him seemed even worse than what he was doing. I couldn't see straight. I no longer had any trust in my own instincts, to know what was really going on around me, whether I had a legitimate reason to be concerned about the therapy or whether I was simply loosing my mind. Long story short, I did not achieve any of the items on the list in your post through the therapy process.

I think the list you provided would be an excellent guideline for people choosing to opt for therapy. Understanding, of course, that this won't all happen instantly and that it requires a lot of hard and usually painful work on the client's part. But, I think it's a great idea to have a plan-an end game or goal-for what you are looking to achieve in therapy. And, to feel that you can talk with your therapist when things seem to be going off track.

I've seen progress on many of these things, but a lot of them took time, and I have had some distinct phases in my therapy. I've been in therapy for about 2.5 years now, much of it (and still currently) twice a week. Psychodynamic, wonderful T. Background of childhood trauma that is not so bad as some of what I see here at PC, similarly for CSA. Came into therapy as a result of major life stressors and decisions needing to be made, stayed to work on all the rest... ("Come for the major life stressors, stay for the trauma..." )

Not trying to convince you to stay in therapy or not, Skyscraper, but I often wanted some reassurance--still do in the harder times--that this stuff would work eventually. So for anybody else who is looking for that, I thought I'd try to estimate how long it took to make progress on some of these things.

Up and down on this. Once I made some major decisions and changes, about 5 months in, definitely. I find that as old traumas and memories begin to bubble up, this sense goes away, then comes back once I've worked on things for a while.

This has pretty much always been the case from the beginning, though it sometimes takes a while to find my solutions.

I'd say minor to moderate progress on this. Took at least a year.

Really, my problem was always the opposite-- people pleasing, doormat issues, an abundance of compassion that didn't flow toward myself. My real work was in finding my anger (which took a *long* time), and *then* working on forgiving and accepting.

Definitely more connected to myself and my emotions, more connected in terms of having deepened some friendships. Incremental progress over time. Still up and down in terms of looking forward to living my life. My dark moments are generally less dark than they used to be.

I'd say this is all still evolving.

Definitely. When I began therapy, I felt trapped in so many ways. I could sort of see the choices available, but I tended to rule them all out. Looking at my own needs rather than those of others was pretty much alien to me. I started to see real results after about 5 months, and I am still making progress.

Up and down. I came into therapy in absolute anguish. After several months people began to tell me that I seemed like my old self again. I go through phases now where I am less positive, but not in the anguish I was before.

My few friends who were aware that I was in therapy began to comment after a few months; these changes were subtle at the time. People have generally always interacted with me positively (I'm a people pleaser, after all), so for me the bigger issue was in feeling more comfortable inwardly and also in not stuffing my own needs in order to have people interact positively with me. Made huge progress here, incrementally over time.

Never really had an issue with this. I do find my mother somewhat less difficult to bear, and I feel less obligated (at my own expense) toward her, so that has improved, I suppose. That took quite a bit of time, almost two years.

Up and down. It's no longer the absolute blackness that I came into therapy with.

Yes in some areas (took about a year or more), still working in other areas. I'm at some major transition points in my life, so while I would like in theory to hurry things up, I recognize that this is reasonable considering where I am.

Majorly. Took several months to start, continues now.

For the first several months, when I was working more on surface issues of life circumstances, I would feel better after session, then gradually lose that sense as the days went by. When I started working on deeper stuff, for a little while, I felt worse both inside and outside of therapy. It took a long time to establish that sense of containing things inside the room, but miracle of miracles, after maybe a year and a half, I found that whether I felt better or worse immediately during/after session, I quickly went back to baseline and was able to process things calmly and live life normally in the outside world.

Still trying to make progress here. This has been very difficult for me. As far back as I can remember, I have always felt fearful and unsafe. I'm starting to deal with CSA in session now and really focusing on establishing a sense of safety. It's hard work.

Yes, big time. I entered therapy assuming that even my closest friends spent time with me more or less out of pity. Major sea change in this, starting after a few months.

Feeling victimized hasn't been much of an issue for me, but I entered therapy with an absolute inability to express my needs and desires-- almost an inability to discern them at all. The very idea that I could have needs was a new one. This was one of the first things I started working on, and I have seen slow progress over time. Things are very different for me now than they were then.

Yes, although I saw some backsliding into old unhealthy coping methods during certain periods of therapy. Overall things are better, but it has been an up-and-down motion with a gradual upward trend.

I'm doooooomed... lol

#34 is the only one that would have a positive answer.... I don't, and have not ever, looked to my therapist (or anyone else) to fix things for me. If I don't fix them, they don't get fixed.

34. You are resolving your own issues and not looking to your therapist or anyone else to fix things for you. A good therapist guides you to your own best solutions. They are not “rescuers” who are there to save you from the issues you are facing. Instead they help you achieve insight into your own thoughts, feelings, and experiences so that you can make the right choices for yourself and move toward a healthier emotional state.

Middlemarcher - thanks for your time estimates. I dont want to tell people ive been at this my entire adult life, im retired now, feeling good for a month or so, and waiting for the evil one to contact me and bomb me back to ground zero again. Maybe this time a few seedlings will survive, not all hope will be pulverized. T thinks we will make it this time. The rebuilding has gotten further than it ever has before. OP - thanks to you too! I will try to hold on to this list of successes, by the skin of my teeth!

musinglizzy, I don't think you should take a list of general points, written by somebody who does not know you, as any kind of signal that therapy is not going well for you. If people look at the points and see signs of improvement in their lives, that's great, but for me, several of the goals are quite simply inapplicable, and that's fine, too. I have improved in ways that are not covered in the list, and a few of the points are things that would mean a worse life for me. (I could rephrase some of the points to be better fits for me, but I won't subject the rest of you to that. )

Pick the points that fit you and that represent goals that you think are worthwhile. If the rest don't fit, that doesn't mean that there is anything wrong with you, or with the list - it's just that no model of reality can ever be both general enough and specific enough to fit all individuals.

Hmm... I have a lot of yes but a few ... uh, nopes, because of recent events in my life. I don't blame 'bad therapy' for that though. But this is a good thing for me I have a need to take stock. When I take it item by item, and think about it, I'm actually better off overall than I feel at the moment. If that makes sense.

33. Yes, but I'm still not sure about my future.
34. Yes, I've dealt with a lot of issues on my own, even though I still like having someone to validate my feeling and decisions about those actions.
35. Yes. I've definitley have some new coping skills. I don't internalize stuff as much as I used to and I don't spiral down the drain in self-defeat like I used to. I have methods for picking myself up and moving again. I'm also better at letting somethings go.
36. I'm not sure. I want to be more forgiving but I feel mixed on this one because I'm dealing with a lot of hurts that I've never expressed before. But I would consider 'forgiveness' an ideal goal of mine. On the other hand,
I am getting there with strangers, coworkers, etc. And ... learning.
37. Yes. I've had a set back recently but overall, yes.
38. See things differently um yes. Solutions... um. I don't know. Getting there.
39. Yes for sure.
40. I'm trying. I can't say if I smile more. I can say that I've realized the importance of joy and am trying to reconnect with people more.
41. Uh ... I don't know.
42. Uh ... I don't know.
43. Uh ... I don't know. Talk to me in a couple of months.
44. Nope.
45. Yes, or I'm getting better at it.
46. Sometimes. yes. Overall.
47. Emotionally, I feel raw and vulnerable. Physically, I'm feeling better.
48. Sometimes. Not today but overall, perhaps. I don't know.
49. Yes and no. I am speaking back to abuse and speaking up when I feel dismissed but in other ways, I've lost my energy.
50. YES. Definitely Yes.

The author of that 50 Signs of Good Therapy piece, previously tried to hold court on the 50 Warning Signs of Questionable Therapy and Counseling thread.

The following is only my opinion, but I responded to her posts very poorly. The 50 Warning Signs drew posts from clients who were often freshly harmed in therapy. I thought this author jumped into the conversation like an enlightened priestess, essentially "blaming" harm on the clients' defects, selling more treatment and talking to everyone else there as if they were her patients.

She clearly missed that the last thing some harmed in therapy want to do is receive patronizing advice from another therapist.

She smugly announced that counselors were "experts... in relationships, grieving and other areas." I thought she cattily put words in my mouth and diagnosed me when I questioned her posturing. She seemed lordly while everyone else was vulnerable, and she was ostensibly trolling that thread for new patients.

When her pearls of wisdom were less than appreciated, she abandoned her throne to write the 50-Signs-of-Good Therapy thread. This author might feel all therapized and fit-as-a-fiddle, but there's something this "relationship expert" misses on relating, in my opinion.

PS. S-M-Not to take away from this list or discussion. Just had to vent about my brush with this author.

PPS. Kudos to the therapists and therapists-in-training on PC. I've seen many opinions given with grace and modesty.

There are a LOT of really, really harmful therapists out there. Of course most people just blame the clients for the "failure" of therapy, but it is really the fault of the horrible therapists.

I'm more concerned about the "setting goals" items in the previous list. i don't recall my therapist ever sitting down with me and telling me what her methods were, how they worked, and my making a list of goals.

It was more a general "I'm depressed and anxious" kind of thing and "okay - let's talk about that..."

I agree that it's always a good to know that no single person's 'expertise' or experience is The Authority on any subject. This applies to published 'experts' as well.

Yes to all.

I think it is good to have some way of judging whether therapy is working or not. The problem with the list here for me is that almost none of those things were any thing I had an issue with nor were related to why I decided to try therapy again.

I "checked" a yes by 49/50 boxes. Guess we can't be perfect, but she is pretty awesome.

same for me.

I honestly had no idea why I tried therapy generally. I just knew things were not well for me and hoped for some help, so kudos to those who actually know what they are wanting out of therapy when they first walk through the door.

For me, what I needed, what I needed to work on, what I needed to find stability, etc. didn't come clear until I was somewhat into the process. But that process of finding that clarity was hugely helpful and I'm fortunate to say I came out of therapy in MUCH better shape, with MUCH more stability, and MUCH for content in my life and my "self" than I ever was before therapy.

I tried for a very specific reason. My life works for me for the most part and the parts that work and the parts I like - which are most of them - are not anything I want the therapist messing with at all.
I do get that some people go because of a more general situation.