How Do I Know if Therapy Is Working? And Other Questions About Therapy Answered

When someone outside of therapy learns that Panthea Saidipour is a psychoanalytic psychotherapist, their first question is usually: “Are you analyzing me right now?” Saidipour jokingly responds they shouldn’t worry because she’s off the clock.

But this question actually reveals a common concern clients have, whether they mention it aloud or not: “Are you judging me right now?”

Judgment has no place in therapy, said Saidipour, who works with young professionals in their 20s and 30s who want to gain a deeper understanding of themselves. It kills curiosity. And curiosity is critical in therapy.

“A few of the main goals of psychotherapy, as I see them, are to deepen your understanding of yourself, to help you get more in touch with your inner thoughts and feelings, and to make what’s unconscious more conscious,” Saidipour said. “This requires shifting from a place of judgment to curiosity about yourself.” And it’s from this place of curiosity that clinicians also operate.

The issue of judgment is just one of many questions that comes up. Below, you’ll find other questions clinicians get asked regularly, along with their responses.

Can you help me?

This is probably the number one question psychotherapist Katrina Taylor, LMFT, gets asked by potential clients, who are wondering about her knowledge and experience, and if they’d be a good fit. Taylor stressed the importance of attending an initial session to see what it feels like to talk with a therapist—and to trust your gut feeling about whether they can help you or not.

Of course, this is hard to do if you’re in crisis or in the depths of a difficult illness, which is why Taylor shared these suggestions: Pause to check in with your body and yourself in the session. Ask yourself: How do I feel? What are my emotions telling me?

It’s totally normal to feel anxious, because you’re meeting this therapist for the first time and sharing some vulnerable parts of yourself, Taylor said. “But if this therapist is a good fit for you, you should also feel like you’re listened to and treated with respect.”

There also should be some understanding of your problem, she said. And while your issues won’t be resolved in one session, you and the therapist should have an understanding of how to move forward.

Sometimes, this might look like: “Let’s figure out what the problem is.” “Other times, it can be more specific, such as ‘you’ve been struggling with lifelong depression and you don’t know why. Our task is to work together to understand why you feel that way.’

According to psychologist Matt Varnell, Ph.D, “Therapy is about building a relationship that helps you endure the pain of change.” So if your therapist feels cold or distant, you probably won’t trust them enough to fully engage in therapy, he said. “Having the experience that your therapist understands you and can relate well to you is the best indication that therapy will be successful,” said Varnell, who practices at The Center for Psychological and Family Services in the Chapel Hill, North Carolina area.

And, lastly, you’ll know that a therapist is a good fit if you leave the session with some hope, Taylor said.

Isn’t therapy like talking to a friend?

In a way, it is, said Ryan Howes, Ph.D, a psychologist in Pasadena, Calif. “When you talk to a friend you can feel supported, understood, and maybe even hear some helpful advice.”

However, therapy also is very different. According to Howes, that’s because: clinicians are bound by confidentiality, which means they can’t share anything you say in session (unless you’re a danger to yourself or someone else); the focus is exclusively on you (not your therapist’s issues); and you’re working with a professional who specializes in helping people with your particular concerns.

As Howes said, “Your friend may be great in her line of work and sharp where relationships are concerned, but a graduate degree and thousands of hours of experience providing therapy aren’t even in the same league.” Even if your friend is a therapist, they’re limited in the help they can provide in that role, he added.

What do therapists think about during session?

As Saidipour noted, some clients worry that their therapists are judging them. Or they’re simply curious about what goes through their therapist’s mind as they’re talking.

Varnell typically thinks about what it’s like for his clients to live their lives, and how it feels to be them. “In an odd way, it is almost like a movie of their life is playing in my brain as they talk to me. Often times I am trying to imagine what it would be like for my clients to experience different events given their unique histories.”

For instance, Varnell worked with a client whose parents punished them by taking the door off their room. In one session, the client shared they were anxious about their boss asking questions about their personal life. “As the client was describing that anxiety, a vision of the client sitting in their room with their door off flashed into my mind. I was able to say, ‘Yeah, it’s almost like the door is off your room again and you aren’t entitled to any privacy.’ The client stated, ‘Yes, that is exactly what it is like.’”

How do I know if therapy is working?

According to Howes, the most obvious sign is that your symptoms are decreasing, and you’re accomplishing your goals. For instance, you came to therapy to become more assertive at work. You’ve already asked for a raise and spoke up when a coworker took all the credit for a joint project.

Other signs, however, are less concrete. For instance, for you, improvement might look like trusting another person with your story and emotions, Howes said. “Maybe just being willing to focus on yourself and ask why you do what you do is a sign of progress, as you would normally numb out through busyness, screen time, or self-medication.”

It also might look like noticing patterns in your life, and getting more curious about your automatic reactions, Saidipour said.

But improvement isn’t linear, and things can get worse before they get better. Howes used the analogy of cleaning out a closet: “When you open the closet and start emptying it out, it can feel a bit overwhelming and messy at first. But when you start organizing things and determining what you need and don’t, it becomes more manageable and really feels like progress.”

It also might seem worse because you’re feeling more painful emotions due to greater self-awareness, Taylor said. “Clients can get scared when they feel more. They’re afraid of their anger, hurt and sadness.” Which is understandable. However, this kind of work is the path to long-term healing, she said.

If you’re wondering whether therapy is working, Howes suggested raising the question with your therapist, such as asking: “I sometimes wonder if we’re making any headway here. Are we making any progress toward my goals?”

“Certainly, I can understand feeling a little skeptical about asking your therapist if therapy is working—as they have some stake in the response—but their answer should make some logical sense to you and help you feel more clear about the answer,” Howes said. And if it doesn’t and you feel your therapy isn’t helping, it might be time to find another therapist.

People often want to know how therapy works and exactly what it’ll feel like before they start, Saidipour said. But the relationship between each client and each clinician is unique. “The best way to learn about therapy is to experience it for yourself, and the most rigorous psychotherapy training programs require trainees to experience it for themselves,” too.

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