How do you know if/when therapy is working?

I still don't feel like I'm getting anything out of therapy.

How do you know if it's working? Was there a moment when you felt like something changed, or where it was clear to you that something was happening?

What makes you feel like it's worth continuing?

For me it was when sometime during year 1 I went back to visit my family in the Midwest and we spent some time at a relative's house. My mom and sister both later told me what a change they saw in me, that I was mingling around the house looking people in the eye and actually conversing instead of staring at the floor and mumbling one-syllable answers like I always had in the past.

Then along the way in different increments I got a new job, got promoted, moved to a nicer house, got another new position, did a training I'd wanted to do, went back to school.... of course this is all over a 6 years period.

For me there was never a big "a-ha" moment but there have been lots of little things. In the moment, I have questioned why I keep going but looking back I can see that I am miles from where I started.

I guess that doesn't really answer your question though. For me, I guess I just trusted my T and trusted the process but I also realize that does not work for everyone and every situation.

For me, it did not work for why I started it. I started using it to vent about my sick/dying/dead person and all the stuff around that - which was useful to me in some ways - although again not necessarily in the way a therapist would describe. I never subscribed to the theory that any change is good or even that if there is something I change it is due to the fact I paid a therapist to sit there. But the other sorts of things I see those guys describe is quite nebulous and designed to make them and therapy look good - I think therapists try and take credit for stuff that is not theirs. Often like weather reporters - we have weather whoohoo - it is working.

For me I went into therapy expecting something, and ended up with something different to my expectations. Fir me is always been internal changes that happened whilst I was looking a different way.

For me it was just the feeling that the man just opposite can help me somehow. But this was my conclusion on his approach.
Do you trust your T?
Has he/she shown you that he cares?

There's nothing magical about therapy and I believe that any therapist who acts like there is something magic is being unethical. For that reason, I think that any progress other than maybe some symptom relief of having someone listen to you, is slow and incremental. I also think that if there is progress the client deserves most of the credit, and the lot of change actually happens between sessions. The therapist thinks about the client for one hour a week maybe? But the client is thinking and processing and dealing with stuff all the time.

I think I was like others have said, there were lots of little things...like being able to deal with someone being angry at me without thinking about suicide, or telling someone else that I was angry at them. But although I appreciate the therapists' advice and attention, I don't really think they did anything to me. I decided to change stuff because I didn't like how I was feeling.

There have been many times that I did not feel like therapy was working at all and some periods when I think it even made it worse, but I still keep plugging away because overall I am not as miserable as I was 10 years ago.

To me it's mostly small things. I'm less impulsive. I can see different sides to things and not only see good or bad. I can regulate my emotions better.

I'm still a long way from where I want to be, but I notice that things I discuss in therapy stick with me and I can apply concepts I learned to new situations that we have not talked about. Which will in the end lead me to my goal, although right now it's still a struggle, and I probably miss a lot of things.

The moment I first noticed was when someone said something, which I'd normally interpret as them abandoning me, and I realized that a) I was probably overthinking this and that was not the intention of the comment at all and b) that even if abandonment would happen, I am confident that I could deal with it in a healthy way.

To me it's worth continuing because I see those changes, even if sometimes I have to wait a while until something new happens.

No big dramatic moment. My life outside therapy just slowly got better. Little thing by little thing, until it was worth living again.

Have you asked your current T what she thinks? What is that you are hoping to get out of therapy, is there anything specific that you can describe? Does your T understand and agree that it is possible? Has she helped others in this process? Can she describe some milestones that you might go through along the way?

All these are questions I never asked. I just kept plodding along, believing in the process, being a good client, as best I knew to. People pleasing the one "in charge" even if I had selected her and was, therefore, in charge. But it was a pattern that I selected and was conditioned to. I tried different things from time to time but it all eventually went back to me people-pleasing, "working hard" (well, I did get to know myself some through all of that), and eventually reaching some impassable impasse.

18 months after the last therapy ended, I am suspecting that the rejection I got from my last therapist, and the feelings I had about that, connected with intense, horrible feelings of rejection that I had as a child, and which I had numbed out and could not "recover" on my own. Therapy off and on my whole adult life couldn't get past that, despite my best conscious efforts.

If someone had told me that the root of my problem was intense fear of rejection, and avoiding it at almost any cost, I would not have believed them. None of that was conscious. So, I had to experience it.

However, it was an unbelievably intolerable experience, over many months, still ongoing. Without PC and some support groups IRL I doubt that I could have "made" it. I may well have caved and gone back to try to find another therapist who could "be there" for me -- as bad and expensive and as useless/hurtful as therapy has been for me at times, the desperation from the loneliness and feelings of worthlessness might well have won out. Ahh. . .So I guess I've got some things to be thankful for, although it's still a struggle.

My therapy ended badly because my last T reacted out of her own stuff. I wonder if somebody else might have been able to elicit or even trigger the rejection feelings without actually rejecting me. I would hope that there are some T's out there who can do that kind of thing, but my last T could not.

I think it depends on what you're in therapy for. I know that therapy is working for me because I am able to better identify and express my emotions. Especially negative emotions. (That doesn't always feel good, but it generally always feels healthy) I am starting to recognize that I am worthy of self care and that I don't need to over function for the other people in my life.

Could I have done that without therapy? Maybe, it's possible. It's a lot easier with therapy I think because I have a lot of deconditioning that needs to be done.

I’ve been finally noticing some change after 7 months of weekly sessions. For me, it’s a lightening, I’m sharing the burden of bad memories I had never really shared with anyone. I’ve noticed just recently parts of my life going back to normal, I’m no longer in such a bad place of hurting. I’ve also found the shift in my perspective of the past to be helpful, I can now look back on bad things that have happened and be less bothered by it. I’ve still got a lot of work I want to do, but therapy is working for me. I’m learning my own resources so I can bounce back more easily when I do get depressed.

The evidence pops up unexpectedly for me. For example, when I encounter a situation in my life, and my T's 'voice' pops up in my head reminding me of something relevant, and that ends up influencing my choice in response.

Very interesting question. I have 200+ hours in different types of counselling, both in therapy but also more "non professional" counselling within church. As you I often feel I don´t gain much from engaging in therapy. To me there is a practical reason for joining and it´s because I have to participate to get sick leave.

But I´ve attented therapy also when I haven´t had sick leave and after so many sessions I see therapy or counselling more as just having someone to talk to, not to reach any goals or gain anything from it. What I can get from it is perhaps the feeling that someone listens to me, I have someone to meet from week to week. But to me personally therapy has no therapeutic value whatsoever.

So in some way I can say "it´s working" when it comes to socialize with another person but no more than that.

I think setting therapy goals could be really helpful so you know what to look for. I think it depends, sometimes you don't see quick progresses but have to wait a bit more to see some results, it depends on your issues. With my first therapist, I noticed that it was positive after a while, because I saw improvements in my life outside (relationships, I was less isolated, etc). With my second therapist I noticed that it wasn't really good because I became too isolated, obsessed only over him, forgot to study because I was thinking about him! I think it's about taking small steps and seeing small improvements in your life.

Deconditioning, yes. That's what much of my therapy has been doing.

Thanks, everyone.

It's really interesting to see what things you all have noticed, that helped you realize that therapy was helping.

I think, to those of you who talked about goals, that you're right. I struggle a lot with goals... I'm not very "goal-driven" and I think that being depressed makes that harder (i.e. I tend to feel like, "what's the point, nothing matters").

I'm finding it harder as I get older... because I feel like I've tried a lot of things, and nothing has really helped or worked out. For example, T talked about me looking for a new job, and I think, "Yeah, I know. But I've worked at a lot of different companies - in a couple different professions - and it's always the same. It's ALWAYS the same, this isn't an exaggeration. So why exert the energy, when I'm already exhausted, trying to find a new job, interview, actually start a new job... when I have no reason to really believe it's going to be any better than where I'm at now?"

There's got to be some truth in there, right? It's not like I'm at my first job, or first T, and just managed to step into a bad fit.

And, yes, I asked about this (success with therapy) because I don't know that therapy is doing anything for me. I've seen LOTS of therapists previously and spent a LOT of time in therapy (last therapist was probably a good year, but the one before was about 3 years). And it just... doesn't seem to actually help with anything. This latest therapist is a lovely person, she seems competent, she has experience with the stuff that I need. I have no actual complaints - nothing we need to fix. Except, something isn't connecting for me I don't not like her, but I don't really feel a connection either.

It's just so hard.

---

ArtieSwimsOn - thanks for sharing that. It sounds like your family actually noticed the change in you before you did? Neat that it was something visible. And, I'm really happy to hear about all the positives that came after, awesome!

BesideMySelvez - That's an interesting take on it though... I *do* have trouble with "trusting the process". It's not that I don't want to trust it, it's that... it seems like there should be something, somewhere along the way, to validate that you're making some kind of progress (I think?). At least, I'd find it helpful... it's nice that you can look back and see progress though! That has to be helpful, right?!

StopDog - It seems like you were very clear from the beginning what you wanted to get from therapy (i.e. what you wanted the therapist to do, and not do). I wish I had that kind of clarity, because it seems easier, in a way, to evaluate whether they're doing what you want/need?

Mouse_62 - The internal changes are sort of what I want, I think! But, it's really hard to see (from where I'm at now) whether this T will be helpful in creating them. (Or, if not this T, which T? I don't know how to tell... so it feels like a very random process of trying Ts, sometimes for years, before deciding that they're not helping.)

RiseNRoll - Oh! I really liked your response! Even though I'm not sure how to use it for myself. My last T, I felt very connected to, and felt like he projected *stability* (which I wanted/needed). But, he kind of let me down (didn't understand a lot of what I said - eventually I had to give up). This new T, I don't get that feeling from. But, it's so weird/hard/confusing because I don't dislike her or have any real complaints... in the past, with Ts, I had specific issues with them. This one is great, no issues. But, for some reason, I'm not feeling a lot of connection either and it kind of feels awful. I don't think it's her fault, per se, but I don't know how to wrap my head around it. Like... to the point that I was upset this weekend, and wanted to call old T... or go sit in his parking lot (after hours, he wouldn't be there). Which I didn't do... but that's weird, right?

Maybeblue - I don't disagree that the client has to do the work, it's not like the therapist is shaping us out of clay or anything. But, still... I think a lot of us don't make the changes on our own. The therapist is doing *something* (or why go back?) - right? Whether it's helping us identify we can and want to change, helping us understand how to change, or something else... I don't know. I'm just trying to figure out what things people see as positive changes that let them know that therapy is working, and make it worth continuing. (Your examples were great, thanks!)

ChickenNoodleSoup - That makes sense, and great examples, thank you! It's interesting, because I've seen similar changes in myself - but they don't seem related to therapy. They seem to come more from my interactions with a few people who have really been there for me (but they're not therapists). I don't think I've actually experienced therapists as being that good at really *being there* for me, if that makes sense.

Argonautmobile - Fair enough, and if I could get to that point (feeling like my life was moving towards "worth living") I'd be really happy with that!

Here Today - Thanks for the reply. No, we haven't discussed it that in-depth. I think... it's hard. I don't really know what I want, and that's part of the problem. I'm very undefined (and not very goal-driven). I think I'm a little burned out on therapy goals... last T asked me for goals, and I put a lot of effort into thinking about them and communicating them. He wrote them down, put them in a notebook of stuff for my sessions... and then seemingly lost them. I wish I were joking! He asked me, several months later, about my goals... and I told him that I didn't remember, he had them written down, pull out the paper... but when he went to look for it, it was't there. (He says it's not lost, it's just in another notebook... but the fact is, when we needed to refer to it, it was not there!). Ugh... really didn't help.

Your stuff seems hard too. I mean, an intense fear of rejection seems like exactly the type of thing that a good T should have been able to help with, so the fact that your T screwed it up so badly, is hard to wrap my head around. Not confidence-inspiring, is it?

Healingprogress - ooh, that's a good one (identifying and expressing emotions). My T thinks I need to work on that one too.

MrsDuckL - oh wow, that sounds wonderful! I'm glad that you're feeling better, and that your T experience is helping!

TooManyCats - That's neat that you carry your T's words, voice, and advice with you. I think... I maybe did that with old T. But new T, so far, doesn't really stick with me.

SarahSweden - I can relate. I'm fairly isolated, so just having a human to talk to each week is probably good for me too, on some level. But, it's disappointing that it doesn't feel more "therapeutic"! Do you feel like a different type of therapy might be more helpful? It's something I'm thinking about... all the therapists that I've seen have been very similar in their approach, I'm wondering if I need to find somebody who does things differently.

Alpacalicious - Good points, thanks. I struggle with goals, so I'm not sure if that would help. I wish that I could see things changing in my life, for the better. That's great that you were able to see those changes (with one of the therapists, anyway!)

Thanks, everyone. I appreciate the thoughts. I'm going to have to think a bit more on this. I don't know if my lack of feelings about the current therapists are actually about her/the relationship, or if I've just shut down a bit since the last one (I left, he didn't abandon me, but it made me cry a bit and still feels - sad.)

For me, therapy with first t was not working, and i kept getting worse and worse.
This T, things started working as soon as I started seeing her. I began to change my thoughts, my habits. Six years later I am a different person. I used to be depressed, severly anorexic, self injured frequently, was miserable a lot, my DID and trauma stuff was out of control.
Now- I am a very positive and happy person, I am healthy and have good habits, I encourage others, I am strong, and my trauma and DID stuff is under control 98% of the time. I have friends and good relatonships.

I know I'm making progress because I am getting closer to attaining the goals I set. I want very specific thing out of therapy. I know what I need to do to get there and I constantly work towards those things. The T is just there for me to tell the things to.
I know what I need to do and I am doing it.

It was a full 9 months before I felt a bit better. It took 20+ years to reach absolute rock bottom, so I think I would need a minimum of three years therapy.

My moods are less extreme and I rage less.

For me, it was when I was able to get my fat but off the couch and go live a life that I get to direct. I am pretty okay with being alive and enjoying my time participating in my own life. I am able to take responsibility for what I’m feeling when others affect me. I no longer give others that power; they’re my feelings. This mind frame has certainly led to better physical health. In the past,I used to manifested all emotional pain physically. Therapy changed my life in so many ways. In the beginning my therapist had to remind me, time and again of the little steps that were happening till I could see them, HOLD on to them and give MYSELF permission to have a good life that I got to define.