Progress in therapy - how do you measure it?

Hi all,

As I've been marinating in my concern over going virtual during the summer, I've also been thinking about the concept of progress in therapy.

For me, working virtually means that my emotions bolt for the door before I have a chance to process them. R describes this as authentic, but for me it's excruciating.

Granted, it's easier to measure progress if you have concrete goals that you're working towards.

I sometimes feel as though I struggle to see the progress from session to session, and yet R has said previously that part of her job is to 'hold up a mirror' so that I can see the progress I'm making.

If you think about your progress in your therapy, how do you measure it?

Per session, or in terms of the bigger picture?

Whilst I'm being beaten with the Grief Stick again it's especially hard to see mine.

I wanted to know whether I'm the only one.

Thanks,

Lost

For me, I think progress is definitely hard to see/measure especially if there's no goals. I have no concrete goals with L. Just yesterday I was telling her how I felt I wasn't doing any better. She listed and explained like 5 ways I have progressed since I started with her. I don't remember 4, but the 5th was self-mentalization. Everything she said, I could agree with. Still, it was hard to take in, probably why I can't remember. L would say that the therapy is still working and growing even if it's not at the forefront. I also think it was harder to grasp because it was a compliment and I still struggle with those. I guess there might be little victories like when I told her I was angry at her the first time. But for the most part, we measure my progress in the long-term, not session by session.

I can't measure it on a session by session basis. At least for my issues, I don't think those resolve within one session, so looking at that scale doesn't make sense.

I am lucky in that I have written down a lot of my thoughts prior to starting therapy. Which contain lots of my struggles at the time. What helps me is compare then vs. now. There are very clear differences, for example being fine with my T being gone for about 5 weeks now, vs. not being able to handle a friend cancelling a thing.

It does help that I know of some very clear things that are "goals" to work on. Like fear of abandonment, self harm, mood swings. If I think of any of those things and compare them to how it was a few years ago, I definitely see lots of change. I'm also lucky because I've written down most of my sessions, so I can compare about what we talked, how, what I struggled with... there's clear differences there.

I definitely don't measure it on a session-by-session basis, but over the longer term. Similar to what CNS said, like thinking of how I handled something now vs. how I would have handled it 3 years or even, sometimes, 6 months ago. And Dr. T will comment on my growth in certain areas, too.

One of the things that led me to leave ex-T is that she made this comment that I still had so much anxiety, where it seemed that she didn't thing I'd improved much. Even though I felt I had. I think it was more that she felt she hadn't helped me enough, but it made me feel really bad. On the other hand, Dr. T has said a few times, including in a recent discussion, that I'll always have some level of anxiety; it's about how I handle it, and I'm handling it better than I had been before overall (though I still have my moments).

He's also said how progress isn't linear. How a client can think, for example, that they handled a particular situation poorly and that means they haven't made any progress, that they're right back to where they started from. But that's not the case. How it's just one event/reaction, and it doesn't erase the progress they've made. (He said it better than that.) It's helped to think of it that way.

I have some sort of vague goals, but nothing easily measurable, or at least not objectively. Like being better able to trust in my own feelings about a situation instead of being so swayed by what others think (I have made progress there).

Benchmarks. Mostly based on interactions with others, including t. Where before, i couldnt stop myself from talking to strangers in my apartment elevator, i gradually became calmer and quiet, eventually without much effort.

Conversely, i became bolder with friends and t, not so afraid of rejection if i spoke my mind. It helps that i was pretty pathetic to begin with - at the start of my therapy, i couldnt even accept a glass of
water from t. Around the middle, i had given him a set of coasters. By the end, i was complaining that the glass looked unwashed!

So, nothing to do really with the content of our meetings, but the result was i was able to respond as a healthier person. The past was no longer dogging my every step.

I look at progress in terms of the bigger picture. I do have goals but one of them is so huge that it gets overwhelming and can be discouraging at times. But A (my T) will remind me that progress is not linear. Just me being able to trust her is progress (it took well over a year for me to even entertain the idea of trust). Me not shutting down every time I get upset is progress. Me being able to even look at her (instead of at my walls) is progress. I think if I tried to look at it session to session I would get so discouraged that I would run away!

Trust is a huge thing for me as I’ve never had it before and didn’t know it was important. I can measure progress like that, I started therapy thinking I didn’t need to trust, then I started to understand it was a thing, then I started to build it. That’s how I know I’ve made progress.
I would never have been able to make that a ‘goal’ in the beginning because it didn’t exist to me. So I prefer to think I will make more ‘discoveries’ as I go instead of focusing on ‘goals’

I love that, Ana.

The idea of discoveries really resonates with me.

In all the years I had therapy ( decades) it wasn’t until I stopped that I saw progress. Going on a weekly schedule didn’t really give me any time to grow. But I stopped because physically it got hard to get there and this was before video became a thing during covid. I slowly realized I was doing fine and after my surgery I had no intention of returning.

Progress isn't linear and it's also very subjective, so difficult to measure (unless a client is doing more goal-oriented therapy such as CBT). I get the 'hold up a mirror' concept, my T does that too. Often I struggle to see what progress I am making, but she is able to reassure that I have made progress and give examples where that has been the case. It helps to have another person keep track and provide encouragement at times when I feel discouraged.

As for the going virtual over the summer, I'm assuming you will be returning to in person at some point and it's not going to be a permanent thing. I started off with current-T doing all virtual, then moved to seeing her twice a month in person. We now alternate between online and f2f sessions each week. However this is out of necessity rather than choice. I would rather see her in person every week but it's not possible, so every other week is a good compromise. The online weeks are more for maintainence, for issues that are safe to deal with when not working from a safe environment. They help maintain the connection.

Depending on how long the working virtual is going to last for, you could maybe treat these as 'lighter' sessions, not going to deep into difficult stuff, but using the time to do more supplemental work which will underpin and reinforce things when you return to in person.

Thanks, East.

The virtual sessions will be from the 15th August to the 5th of September.
I'd love to use the sessions for lighter stuff but I'm really feeling the weight of what I'm dealing with just now.

Luckily I'm able to access additional support, but the spaces where I can be honest are few and far between.

One thing I know is that keeping this in doesn't do me any good.

Appreciate you taking the time to chip in.

Take care,

Lost

I don't see my therapy in terms of progress. For me, it is about the endeavour and how I respond within the relationship. Development and expansion happens as a natural part of understanding my patterns, parts, conflicts, and so on but a focus on progress isn't really interesting to me. Although tracking the progression of the relationship is interesting to me - when do I feel closer to her, more distant, at what point do we reach an intimacy and so on - so maybe this is all progress by a different name.

I also think the areas of the work can contribute to a feeling of progress or stuckness. For example, I move across multiple areas and issues and this can feel like I am staying surface sometimes or at least for a while. I can also imagine that stuckness might come around if you are focussing on one issue and repeatedly revisiting it. I know this happens for me when the issue of my ex-therapist's abandonment comes back again and again - am I ever going to move beyond the distrust?

In terms of the virtual sessions, is there any room for taking work to those sessions which fit better in a virtual environment, for whatever reason. So not taking lighter work, but exploring the painful in a way which suits online. For example, it might be easier to watch/listen to something online, or you might be able to explore space between you in a different way, or edit imagery together, I don't know, whatever really. I have things I do in person which suit in person and things which suit online - it opens up different mediums and this in itself can expand the work. I realise you aren't looking for suggestions about this so feel free to ignore if this is derailing!

Thanks Comrade,

Your description of how you respond within the relationship resonates with me.
It's taken me a long time to feel comfortable with R, and I will still find ways to avoid saying certain words.

The biggest issue for me in terms of the virtual sessions is the lack of safety in the shared physical space...but that's a whole different thread that I started a couple of weeks ago.

Virtual therapy is not the container for deep emotional work in my world, and deep emotional work is where I am at present.

The emphasis will therefore be on staying in touch/keeping the connection rather than discussing what I need to discuss.

The timing is exquisite.

Feeling memories..

Thank you, TR.

Would you be able to elaborate on that?
I'm curious because I've not come across that concept before.

Take care,

Lost

I don’t want to de-rail the thread, but, I LOVE talking to strangers. I’d like it if I happened to be in an elevator with you and you talked to me. However I usually take the stairs (for the exercise).

For me, it was simple - was the reason I hired one fixed? It was not - in fact therapy made some things much worse.
Time passed and things changed like they do from a passage of time, but nothing I could attribute to a therapist or therapy. To me it seems like people twist themselves into knots trying to give those people benefit of the doubt of having been useful.

Honestly, it was more like i was assaulting them. Ive had former coworkers back away from me in public before i barely nod hello, obviously afraid i was going to start up with them. That was painful, esp since it was AFTER i stopped doing the chatterbox thing.

But thanks!

I understand about measuring progress, some days for me are really dark and hard and other days. I feel so relieved and so free and I realize that the cost of freedom has the up-and-down part of healing and I don’t know if there is a timeline for that, as I think everybody is so different based on their childhood and other past traumas and losses, I think it all blends in as part of the Healing sometimes a lot of deep sorrow seems to take longer sometimes than we think. I had a therapist who told me that there’s a certain amount of tears that need to be shed and that when it’s done it’s done and you can’t always have a crystal ball to know exactly when that starts to lessen, and where the line in the sand brings you to the other side of your life , where things start to really feel like they’re moving forward. I’m in the middle of my second divorce after being married the first time for 25 years this time for 11 years and my situation was very difficult because my husband lost his wife prior to meeting me and had an adopted Child with autism very severe and it pretty much took over the whole marriage and as much as we both tried to really really make it work it just was not a sustainable design. I look forward to meeting people on this site and hearing about their stories.