Is Therapy Working? How to Tell, and What to Do If It Isn't

In crisis or thinking about suicide? Call or text 988 now (in Colorado it reaches the 988 Colorado Mental Health Line). If you are in immediate danger, call 911.

If you are not sure therapy is helping

Maybe you have been going for a couple of months and you cannot tell if anything has changed. Maybe sessions feel pleasant but aimless. Or maybe you feel worse than when you started and wonder if that is normal. These are common worries, and they are worth taking seriously.

This guide walks through how to check progress against your goals, what normal ups and downs look like, how to bring it up with your therapist, and when switching or ending makes sense. It cannot judge your therapy for you, but it can help you have a clearer conversation about it.

The American Psychological Association (APA) gives clear advice for anyone in treatment: work with your therapist to set clear treatment goals and monitor progress toward them. APA adds that even treatments with scientific support will not work for everyone, and careful tracking helps you and your therapist decide if a different approach should be tried.

Start with your goals

You cannot tell if therapy is working without knowing what 'working' means for you. NIMH suggests asking a therapist early on: What are the goals of therapy? How will progress be assessed? What happens if you are not starting to improve?

Goals work better when you can see them. 'Feel less anxious' is a start. 'Drive on the highway again' or 'sleep through the night four nights a week' is easier to track. If you are not sure what your goals are, ask your therapist to write them down with you. It also helps to note where you are starting from: how many nights you sleep well, how often panic hits, how many days you get out of the house. A simple baseline makes change easier to see later, when memory tends to blur the early weeks. What a therapy treatment plan is explains how goals become a written plan, and the treatment approach page describes how the practice builds individualized plans.

How progress is measured

Some therapists use short questionnaires every week or every few weeks. Researchers call this measurement-based care: the regular, systematic check of symptoms before or during a session to guide treatment. A review in JAMA Psychiatry describes it as underused, even though it can help detect people whose health would otherwise get worse. A separate research review describes progress tracking as a way to help therapists notice a poor response early and work with the client to address it.

Scores are only one signal. The site's CBT timeline guide lists signs that CBT is working, so they are not repeated here. Across approaches, it can help to look at:

• Whether the goals you wrote down are moving, even slowly.
• Whether you use skills outside the session without being reminded.
• Whether hard moments are shorter, less frequent or easier to recover from.
• Whether things you avoided have become possible.
• Whether you feel able to be honest in session, including about what is not helping.

Normal ups and downs

Progress is rarely a straight line. A stressful month at work, a breakup or a holiday can make a good stretch look like a setback. APA notes that treatment length is often tentative and revisited along the way, and advises having enough treatment and reasonable expectations before deciding it is not working.

Some kinds of therapy feel harder before they feel easier. APA notes that exposure work for PTSD is very anxiety-provoking for most people, which is why therapists work to keep sessions feeling safe. Feeling stirred up after a session can be part of the process. Getting steadily worse is different. If you notice new or stronger thoughts of suicide or self-harm, tell your therapist right away, and call or text 988 if you need help before your next session.

How to raise it with your therapist

Therapists generally want to hear this. Feedback helps them adjust, and the conversation itself can be useful. A careful therapist will usually respond by reviewing your goals, checking any measures, and suggesting a change in focus, pace or method, or a referral if another approach fits better. You do not need to be polished. Try something like:

• 'I'm not sure we're making progress on my sleep. Can we look at that together?'
• 'Can we review my goals and my questionnaire scores from the last few months?'
• 'Is there a different approach that might fit this problem better?'
• 'What would you expect to see change, and by when?'
• 'Some sessions feel aimless to me. Can we set an agenda at the start?'

When to switch, and how to end well

If you believe progress has been too slow after a reasonable period, APA says it is always appropriate to talk with another therapist or to ask for a re-evaluation of your plan. NIMH says rapport and trust are essential and, if you are not getting better, suggests exploring other professionals or approaches. A change can mean a new therapist, a different method, adding a skills group or more support. How long therapy takes helps you judge what 'reasonable' means for your approach, and the site's FAQ covers switching clinicians.

Reasons people commonly consider a change include: the same problems keep coming up with no new tools to handle them; sessions drift without a plan even after you have raised it; your therapist does not offer the specific treatment that fits your problem, such as a trauma-focused therapy or a DBT skills group; or you simply do not feel safe being honest in the room.

Ending is a step of its own. The APA ethics code says psychologists end therapy when it is reasonably clear the client no longer needs it, is not likely to benefit or is being harmed, and that before ending they provide pretermination counseling and suggest other providers when appropriate. In plain terms: a good ending is talked about ahead of time and includes a plan for staying well and for coming back.

If you are looking for a new fit, Mountainside offers a free 15-minute consultation; the free consultation guide explains what to cover, and you can reach the team through the contact page.

Frequently asked questions