How do you know if your therapy is working?


I had a recent request in my feminist community for a blog on how to know when therapy is actually working and of benefit. I am a qualified person-centred counsellor and have also had therapy myself in the past at different points in my life. When I use the word ‘therapy’ in this piece I am specifically referring to talking therapies, of which there are many modalities. It may well be though that some of the points I raise are relevant to other kinds of therapy (hypnotherapy, dance therapy, art therapy etc.).

The truth is that no-one can give us a fail-safe way of assessing whether therapy is beneficial or not. Evaluating the effectiveness of the therapy is notoriously difficult in the counselling world. Ultimately in many respects this is left to our own personal judgment. The aim of this blog is to provide a few points to think about when evaluating if the therapy you are receiving is right and helpful for you. The points come mainly from my own experience both as a counsellor and a client. They are also informed by my general reading in this area which does correspond with my own personal experience. Please note this is not a tick box exercise. Assessing the effectiveness of therapy can be massively complex and we are all individuals, so our experiences in therapy will reflect that. You’ll notice some of the points I mention look positive and desirable and some of them don’t. That’s because therapy, when we commit to it, can be really hard work and actually very painful and disruptive at times. It’s my aim to present a realistic picture of what therapy can be like.

The following are some signs that your therapy may be effective:

You are making changes in your life 

One of the obvious signs that therapy is effective is that you find that you are making some conscious and significant changes in your life. Whilst having therapy I have made several big life changes which were for the better including; moving home, ending abusive friendships, rebuilding my relationship with my father, stopping smoking and so on. If you are able to see that therapy helps you to feel empowered to take action in your life and make improvements this is clearly a strong indication that some good things are coming out of your therapy.

You feel like you are looking at things differently 

Part of therapeutic work is often examining how we see the world and ourselves. If you feel you are becoming more open-minded and flexible in your attitudes this is often a sign of learning, trust and development. It’s worth bearing in mind though that attitudes change all the time and if we feel closed and rigid about things this isn’t necessarily ‘bad’ or even a sign of regression. We may have excellent reasons for being defended at certain points in our lives. Development is not one long straight line between two binaries. It’s complicated and it looks like what it looks like.

You may feel like leaving therapy  

This might seem like an odd one but it’s actually very common and logical when you think about it. When clients reach the most painful parts of their therapy it can be terrifying for them and I’ve seen clients walk away just as they seemed to be on the verge of a big breakthrough. Many clients can reach this ‘crisis’ point in therapy. I’ve also left therapy myself when it became too emotional and distressing for me and then later returned to it. When someone I am working with leaves therapy I always believe they have done the right thing for themselves. People do things when they are ready to and not before. There is no shame in leaving therapy as it can be an important act of self-care. Sometimes people have too much going on in their day to day lives to continue unpacking their issues with a therapist and that’s absolutely fine.

If you feel like you are on the verge of leaving therapy ask yourself some questions. Are you leaving because the therapeutic work is done? Is it because you have a problem with your counsellor and if so is it possible this issue can be resolved? Is it because you feel uncomfortable and challenged? Being uncomfortable and feeling challenged can be a good thing. It’s important to assess whether this will have long-term benefits or if something inappropriate is happening that is making you feel this way. Keeping the lines of communication open within the counselling relationship in terms of what feels useful and what doesn’t will be important here.

Things may get worse before they get better 

Again this may seem like an odd one. Therapy should make you feel better right? Not necessarily. At least not in the short-term. Therapy makes you face old conflicts in your life which are unresolved. There is absolutely no way of doing this without some level of discomfort. Many clients report that their lives become more chaotic during the therapeutic process before they get any better. I’ve seen this happen with my own clients and the year I first had therapy was quite possibly the hardest of my life. That is not an exaggeration. I was having to deal with numerous unprocessed issues which I had been blocking out for years and when we start to look at repressed emotions things can get messy. Our behaviour and our lives can become unpredictable and that can be frightening. I don’t want to scare anyone or put anyone off therapy! The journey is well worth it, but you need to be prepared for the fact that therapy won’t instantly make you feel great and that self-care is vital. Therapy is a process and it can be a tough one.

You may feel stuck 

Yes, incredibly being stuck and going over the same ground again and again can actually be productive. Sometimes we need to do this in order to make sense of things that have happened to us. Being stuck does not mean nothing is happening! Quite the contrary. I’ve had clients come back week after week turning over the same problem and sometimes it does look like things aren’t going anywhere, however repeating a narrative can be crucial for a client in order to make a breakthrough. Don’t be afraid of getting stuck!

It’s also worth bearing in mind that while you are having therapy your thoughts about it may differ widely from when you reflect back on it in the future. When I first had therapy I was unconvinced at the time that it was useful. Now when I look back I can see very clearly how it helped me to transform my life. It’s important to give yourself over to the therapeutic process and trust in it because you won’t always be able to tell what is happening when you are in the middle of it. This is why it is really important to find the right counsellor to support you. Finding the right counsellor is truly half of the battle. A counselling relationship is just like any other relationship in your life. Some counselling relationships are better than others and you deserve the best, so make sure you get it because the person you choose is going to be working with some of your most vulnerable aspects of self. This may include parts of yourself that you haven’t even shared before. Counselling relationships can be incredibly intimate and may well have more depth than other close relationships in your life in some cases.

Some signs that you are not working with the right counsellor:

You don’t feel heard

Is your counsellor interrupting you? Constantly forgetting or ignoring what you said? Making everything about them? If your counsellor isn’t listening to you then quite simply they aren’t doing their job properly because listening is what counsellors are supposed to do above all else.

Your counsellor can’t seem to empathize with certain issues 

I had a white counsellor who really struggled to empathize with my experiences of racism. At one point she actually tried to get me to empathize with the behaviour of a racist and dismissed my justified anger at him by asking me ‘well do you think he meant it?’ If your counsellor is struggling to empathize with you ask them about their experience in the area you need help with. Ideally it’s better to check out a counsellor’s experience before getting into a counselling relationship, but sometimes we bring up issues in counselling that we didn’t even know we were going to need to do, so it isn’t always possible to plan ahead. If your counsellor has limited experience in the area you need help with you may either wish to draw their attention to this and see if you can learn a way forward together, or you may wish to move on and find more suitable support. The important thing is to put your own needs first and not feel bad about leaving if your counsellor can’t meet your needs.

Your counsellor doesn’t respect your boundaries and autonomy 

The counselling relationship will have boundaries which the counsellor should outline to you in the first session. These are expectations and rules such as arriving at a certain time on a certain day, agreeing appropriate forms of communication outside of sessions and so on. Clients also get to have their own boundaries however. If you feel your boundaries are being crossed in a counselling relationship and you point this out to your counsellor, then they need to respect your limits. If they can’t work with you boundaries and respect your personal needs (as long as these are obviously not unreasonable demands) then your counsellor has a problem.

Your counsellor is not responsive to feedback 

If you’ve told your counsellor something upsets you/ doesn’t work for you/ needs to change and they haven’t responded to this in a way you find acceptable or haven’t responded at all, this is likely to leave you feeling unvalued. You may wish to explore this with your counsellor further or decide you need to work with someone else.

The counselling relationship feels abusive and oppressive

Arguably all of the above issues could be experienced as abusive and oppressive and may well merit a complaint. You can find out which professional body you counsellor is linked with and make a complaint via that organization. In the UK this will commonly be the BACP. If your counsellor demonstrates explicit or implicit prejudice in the counselling relationship this can be a cause for concern. I would raise the matter with the counsellor in the first instance and then if it cannot be resolved satisfactorily with them consider making a formal complaint.

You are having recurring thoughts that you and your counsellor may not be a good match

It may be that you’d prefer a counsellor of a different age, sexual orientation, gender, race, culture etc. In some cases it may actually be detrimental to work with a counsellor from a certain group. As an example it is advised that a woman who has been raped by a man does not work with a male counsellor the first time she has counselling. It’s perfectly ok to request a counsellor who has an identity that would make you feel more at ease.

You may also prefer to have a different type of therapy so it’s definitely worth doing some research on the different types of therapy that are available. If you are paying for your therapy this offers much more flexibility in terms of choice, however there is some great and varied therapy available for free.

I hope this article is useful for those who are in therapy or considering having it. Therapy has changed my life and can be a fantastic resource. I would not be a counsellor myself if I did not believe in the power of therapy. I do believe however that being informed to some degree about therapy and being aware of your rights, especially if you are from an oppressed minority group, can enhance the experience. Let me know what you think in the comments.

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