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In therapy? Here's how to assess effectiveness

March 26, 2007|Jonathan Alpert | Special to The Times

So, you've been in therapy for several months and aren't sure if you're improving.

You seem to feel better, getting things off your mind each week, but how do you know if you're actually gaining from seeing your therapist? There's a difference between feeling better and getting better. The former usually brings immediate relief. The latter results in lasting life change that will lead to healthy behaviors and new ways of coping with stress and problems. This comes only when you acquire tools and skills you can apply beyond the immediate crisis or concern that brought you to the therapist in the first place.

In psychotherapy, regardless of the school of thought, a collaborative effort should exist in which the client and therapist both work hard to achieve the desired outcome.

One of the first things that you should do is make a list of realistic goals and what you're hoping to gain from therapy. Share it with your therapist so that a specific treatment plan can be established. Reviewing the goals every few sessions will give you and the therapist an opportunity to monitor progress.

Ideally, as insight, support, and direction are provided, you should move closer to reaching the goals with each session.

Homework should be given, as this bridges what's learned in the session with what happens in real life. It gives the patient an opportunity to develop thoughts or concepts arrived at during sessions, to try out newly acquired skills and to implement exercises.

For example, if social anxiety is the problem, then homework may be practicing relaxation techniques and an exercise in which the patient approaches others casually, asking for the time or directions. The patient should keep a written record of his or her reactions to the exercise and bring it back to a session and review it with the therapist.

As treatment continues, information learned in sessions will be more accessible when a patient is away from therapy, and come more naturally. The patient will develop a set of skills that can be applied with confidence to situations that once proved to be problematic.

Over time, the patient will find the answers and rely less on the therapist's guidance, and the need for sessions will be less frequent, allowing the patient to develop a sense of independence.

Be a good consumer of this personalized service and assess your progress. One way this is accomplished is to review the notes and goals that were established at the first session. This will reveal what progress has been made -- or not. It's quite possible that goals aren't being reached but you're simply feeling better having someone to talk to. This isn't the healthiest set-up, as it could lead to becoming dependent on your therapist. An honest and skilled therapist should recognize this -- and either set a new course of treatment or suggest a different therapist.

What are some signs that you should shop for a new therapist? Beyond a lack of progress toward your goals, there are some other things you should check.

Therapy is your time and your opportunity to address issues. Therefore, you should be the one to choose what's most important to work on.

You should feel respected in session and not as though your therapist's values are being placed on you or you're being judged -- otherwise, you'll surely feel uncomfortable and limit or withhold valuable information.

A feeling of safety should also be abundantly available, as therapy addresses sensitive and fragile issues.

Don't just accept the therapist's methods. In fact, the talk therapy model where patient talks and therapist listens, offering an occasional, "I see" or "tell me how that makes you feel," isn't necessarily the gold standard or helpful.

Rather than being a passive participant, take an active role and question the course of treatment and outcome. After all, with a physical disorder, if the doctor prescribed medication or physical therapy and you saw no improvement, you'd probably speak up.

If, say, after a month of treatment for anxiety you still worry excessively, feel restless or edgy and have difficulty concentrating, then bring it to the therapist's attention. Share how you feel and don't assume it's known. A disorder such as anxiety is treatable and results are measurable. Frequency, duration and intensity of symptoms can be monitored -- and there should be noticeable, if not marked, improvements after several weeks as you learn new skills and develop insight.

If you try therapy and don't feel comfortable, chances are it's just not a good fit -- and not necessarily a reflection on you. It's a very personal service, and comfort has to exist. If it doesn't, keep trying until you find a therapist you click with: You'll likely know within the first few minutes. Don't give up.

Although it may be a sensitive matter, word of mouth is probably the best way to find a good therapist. If someone you know has gained from seeing one, then he or she will probably be proud to share those improvements with you and tell you about the person who helped.


In On the Mind, Jonathan Alpert, a psychotherapist in New York, answers questions about healthy mental living. Send questions and comments to

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